Barriers to Publishing Scholarship: A Study on Neurology Physician Residents and Fellows.

Background Scholarly activity by trainees is required for US-accredited graduate medical education (GME) programs. Several factors, including financial barriers to open access (OA) journals, may impact trainees' successful completion of scholarly activity, but little is known to what extent, particularly for neurology trainees. Method The authors implemented a cross-sectional, web-based 17-item survey of US-accredited neurology residency and fellowship programs during the 2022-2023 academic year. Participant responses for producing scholarly activity during GME were analyzed by mixed methods and examined by trainee motivation and perceived barriers, available institutional research support, and OA awareness and compared against socio-demographics (i.e., disadvantaged status history, underrepresented in medicine (URiM) status, international medical school graduate (IMG)) and prior research experience. Results Seventy-two respondents from 63 neurology programs completed the survey. Participants represented all US census regions and mostly from academic health centers and in advanced years of training. Overall, 17 (23.6%) self-reported as URiM and 20 (27.8%) as an IMG. Sixty-two (86.1%) were familiar with OA. Prior publications were associated with OA awareness (X = 5.3, p<0.05), and 27 (37.5%) reported financial barriers to publishing. IMGs reported less motivation to publish based on a journal's impact factor (odds ratio [OR] = 0.15, 95% confidence interval [CI], 0.03-0.65, p<0.01) but were nearly 5 times more likely to report financial barriers to OA publishing (OR = 4.62, 95% CI 1.31-16.80, p<0.01). Trainees successfully publishing while training reported prior research experience (OR = 7.27, 95% CI 1.71-42.64, p<0.05) and access to mentors (OR = 4.67, 95% CI 1.52-14.64, p<0.001). Dedicated time for scholarly activity and publishing were reported as significant barriers in open-ended responses. Conclusions One-third of the study participants reported financial barriers to publishing scholarship, with these barriers disproportionately affecting IMGs. Prior research experience and access to mentors were associated with a higher likelihood of publishing.