Changing the Publication Game: The C4 Article

Written by Lucie Robathan on October 22, 2018

Author’s Note: The American Journal of Transplantation (AJT) recently embarked on an experiment in crowdsourcing called The C4 Article. This was a new, collaborative way of creating a manuscript for publication, and aimed to spark dialogue between contributors and editors to produce a representative and dynamic piece of research. To understand the story behind this project, I interviewed Dr. John Gill, Deputy Editor of the AJT, and Ashley Morgan, Assistant Managing Editor.

The relationship between a community and the policies put in place to structure and serve it is a difficult one to navigate. For those responsible for discussing, suggesting, or advocating for policy change and creation, mediating the needs of the community means having a comprehensive grasp of the diverse population at hand. How can an organization best engage with and represent the voices of their community?

The American Journal of Transplantation is the official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, and serves a diverse, multi-disciplinary community of transplant professionals. Surveying their standard review articles, the AJT Editorial Board noticed that the topics that most mattered were often covered by the same thought leaders, or systematically reviewed by a limited number of people. Despite practice variation both clinically and at the central level, along with deviations amongst local drivers of practice, there is the potential for inherent biases to make their way into the journal publications. An experiment was therefore concocted, conceived of by Editor in Chief Dr. Allan Kirk, to engage a broader group of contributors, and to create a platform to expose gaps in knowledge and allow new ideas to percolate.

The C4 article offers a collaborative and experimental way to write a manuscript through crowdsourcing. With contributors ranging from academics, to people in leadership roles, to patient representatives, the philosophy behind C4 is to provide a platform for meaningful and respectful dialogue within and beyond the transplant community. As people get busier, and the patient population expands and diversifies, this article experiment represents an innovative way both to connect the professional and patient communities, and to continue to be relevant and proactive in the face of new issues.

How it Works:

The project was officially launched during the American Transplant Congress, alongside a marketing campaign that highlighted the significance of expanding the bandwidth of the transplant field, and encouraged people to log into the C4 collaboration platform and share their contributions.

Through a Dropbox login, collaborators could access an online manuscript, divided into sections headed by questions posed by the editorial group. They could contribute their own answers, as well as commenting on others’ contributions – all overseen by an editorial subcommittee. Weekly editorial reviews were made transparent, and the revisions were all explained before being re-submitted for new comments and conversations. The live process continued for a month, with each weekly version archived and available to visit. The editors’ job was then to summarize and condense the discussion, in line with supporting evidence, to produce a final draft manuscript for abbreviated review.

This writing, commenting, and editing system was designed with openness and interaction in mind. As opposed to the regular blind peer review concept, the collaborative nature of this editorial process was intended to expand the discussion in an iterative and positive way.

What it Means:

The AJT is committed to leading innovation, and has a responsibility to produce the most representative and relevant content. As such, the content of this crowdsourced piece has the potential to be deeper, richer, and more forward-thinking than one created by an individual voice or single working group (the total number of contributors and editors of the C4 Article was 107).

The breadth of contributions is also unique: the project was open to anybody, beyond the confines of academia, and the editorial team even sent personal reach-outs to people across the sector. It was their hope that the inclusivity of the writing approach would make the article itself more accessible. This inclusive aspect also helped to reveal how people understood certain topics, the concepts being rallied around that are not current practice, and the areas in which additional policy research would be useful. As John Gill remarked, it will be interesting to see the extent to which community support for certain new and contemporary ideas will actually lead to policy change – but it presents a less reactionary way of including community insight in policy considerations.

Although it is too early to analyse the impact of the article, the feedback on the project so far has been incredibly positive. It seems to have been successful in expanding – and to some extent levelling – the playing field, capturing a range of ages, experience, expertise and perspective, and it embodies the kind of dialogue that is essential for innovation. The story of C4 is ultimately one of engagement: to engage the wide and diverse membership of the professional transplant community, and beyond that to engage the patients they serve.