President's Message: Exploring SCCM: A Society and Its Manuscripts

Over the years, as I became increasingly involved with the Society of Critical Care Medicine (SCCM) as my primary medical society, I realized that manuscript development within a society is more complicated than I initially thought.

As an independent academician, preparing a manuscript appeared relatively simple: start with an idea, search the literature, frame a hypothesis, assemble existing published data, summarize recurrent findings, create best practice recommendations, assemble them into a manuscript, and submit the manuscript to a journal. If it is rejected, submit it to a different journal and repeat until someone publishes it, regardless of reviewer concerns on the strength of the proposed recommendations. 

From a medical society’s perspective, manuscript development may not follow the same reasoning. A society needs to be cognizant that any work it publishes carries the society’s imprimatur, which qualifies the work as meeting a certain standard and upholding the society’s reputation with its members, journals, other societies, the clinical and research world, and the scientific community at large.

At best, a society brand on a published work indicates a trustworthy, high-quality product, crafted meticulously and reflecting carefully conducted research and compelling evidence. Any recommendations therein are expected to be objectively created, trusted by the bedside clinician or seasoned researcher, and potentially able to change practice or inspire new investigation. At worst, a society’s brand is not recognized at all or is seen as an unreliable or low-quality source of information, such as articles that are poorly written or verbose, published because a lot of work went into them even if little or no new data are presented, have weak recommendations, or are based on low-quality evidence.

Over time, a society’s brand becomes recognized as reliable by editors and sought after by readers because it is known as an authoritative standard. Unfortunately, academicians under pressure to publish and a society’s goal of maintaining a trustworthy brand are sometimes in opposition. 

SCCM has many enthusiastic members and groups, including 16 specialty sections, more than 100 committees, 25 task forces, and Discovery, the Critical Care Research Network, that constantly generate ideas for manuscripts. In the past, a few members in a specialty section subcommittee would get together, discuss an exciting new idea, and decide to create a manuscript. The manuscript would eventually reach Council for approval as the first outside eyes on the project. Council might notice that the idea was not as novel as the authors thought and had already been published or that the evidence was weak or nonexistent and yielded low-quality recommendations.

Council would then decide what to do with the project. On one hand, the members had dedicated a lot of work to it. On the other hand, Council was concerned that the project was not of sufficient value to carry the Society brand. While such low-quality evidence might still be publishable, it offered little practical value to clinicians making real-time decisions at the bedside. Council would ultimately accept some manuscripts and reject others, often for incongruous reasons, which would result in authors’ frustration. As an SCCM member, I remember feeling that frustration. Later, as a Council member, I came to understand the importance of protecting Society-branded work products.

The SCCM Council, aware of this tension over the years, developed some strategies to optimize manuscript preparation within SCCM groups and relieve member frustration. Before any SCCM group starts a work product, they must submit a plan to Council for approval, usually by the president on a president call. Once approved, project work can begin. The final product will then be submitted to Council for review. Council members (usually two) are then assigned to review the manuscript for consistency with existing SCCM products, scientific rigor, and study quality. 

For guidelines produced by SCCM’s American College of Critical Care Medicine (ACCM), two or more additional reviewers are assigned from the Board of Regents (BOR). Council and BOR reviewers then present their critiques, and the entire Council votes on whether to submit the manuscript to one of SCCM’s journals for publication bearing the Society brand. Alternatively, Council may vote to return the manuscript to the authors for further study and/or revision. Per Society policy, a manuscript can return for Council review three times, after which it cannot be published with any SCCM affiliation. Should Council allow, the authors can submit their work to an outside journal but without SCCM's endorsement or affiliation.

With increasing pressure from SCCM journal editors wanting high-quality articles from members and pressure from SCCM members wanting to avoid rejection after months of work, Council is now developing a new systematic manuscript review process. The new process would expand beyond the current presidential review to include review by a panel of SCCM members who are diverse in expertise and knowledge. The panel would objectively and agnostically review all manuscript ideas in the context of competing manuscript proposals, prioritizing each manuscript based on three key criteria: response to emerging clinical issues, potential impact on patient care, and broad appeal to ICU researchers and clinicians, as well as alignment with SCCM's mission, strategic plan, and resource feasibility.

This approach would ensure that proposals compete fairly for resources and align with the Society's publishing priorities. While this initiative has been unanimously accepted by Congress as a concept, specific details of operation and integration with SCCM’s other groups have yet to be finalized but would likely include staff to perform an initial preview of the literature to determine the idea’s novelty and the available level of evidence for recommendations. Key considerations would include the clarity of the clinical question, comprehensiveness of available evidence, and potential to generate actionable clinical practice recommendations.

I would like to invite all SCCM members interested in manuscript generation within the Society to connect with me or SCCM staff with your thoughts and suggestions. We want to hear how you propose optimizing manuscript preparation by SCCM members to support our wonderful Society. Please reach out to me at president@sccm.org.