Academic Psychiatry is committed to advancing the scholarship and methods of psychiatric education and to building a diverse and rigorous education literature in psychiatry (¹, ²). We strive to publish the best educational research and scholarship, both nationally and internationally, which we hope will, in turn, enrich our readership, improve our educational systems, and foster leadership in academic psychiatry and academic medicine. A number of specific challenges have been described previously in meeting these goals (¹). An additional challenge, which is our focus here, is to increase international contributions to the Journal.

There are four principal ways for journals to evaluate their importance and relevance as international journals. The first, and perhaps most important, concerns the number of international submissions and publications. The second concerns the number of citations to research published in other countries, and the third concerns the number and proportion of international members of the editorial board. International readership, the fourth, is also important but is less easy to determine accurately. Our goals for this editorial are to examine how Academic Psychiatry fares as an international journal in each of these areas and to describe how we intend to improve the international standing of the Journal.

International submissions to general medical journals published in the United States should increase, given an increasing globalization of research (³). Yet many countries with a lower proficiency in the English language and with less research funding are underrepresented in highly ranked journals (⁴). One survey (⁵) of six leading psychiatry journals suggested that only 6% of the literature was published from the regions of the world that account for over 90% of the world’s population. The reasons for this regional underrepresentation are many. Submission rates or quality might be lower from countries poorly represented in the psychiatric literature. Alternatively, editorial biases and a preference for journals to publish materials of particular interest to their primary readers (⁵) or from their own countries (⁶) might contribute to this finding. Nevertheless, international authors will likely judge the receptivity to their work or their likelihood of success of publication in part by the number of international publications within a journal.

One education journal that has examined its own international standing is Medical Education (⁶). In 2002, more than half of the published papers in Medical Education came from countries outside of the country of publication (the United Kingdom) (⁶). For Academic Psychiatry, from January 1, 2002, to December 31, 2006, 459 original submissions were received. Of these, 77% came from the United States, 6% came from Canada, and the remainder derived from other countries throughout the world (9% unspecified). During the same time period, 258 papers were accepted for publication. The acceptance rate for papers from the United States was 60%, whereas the rate of acceptance for submissions from other countries was 0% to 50%. This suggests that international authors may face greater challenges in getting their work published if we do not specifically seek to facilitate this goal.

We have experienced a recent surge in submissions to Academic Psychiatry. Three important milestones for the journal have likely contributed to this surge. In 2001, Academic Psychiatry was incorporated into the National Library of Medicine’s electronic database, MEDLINE. In 2003, electronic submissions were established, expediting the amount of time from initial submission to a decision concerning publication. Finally, in 2005, the Journal became a bimonthly publication, which allowed for a reduced delay between submission and publication and for a greater volume of publications. We hope and anticipate that these initiatives together will lead to a concomitant surge in submissions from other countries.

A second method for judging the international status of a journal is by assessing the number of citations to research published in other countries. We constructed a limited measure of this number. We calculated how often original articles or brief reports published in Academic Psychiatry cited two major medical education journals published in the United Kingdom (Medical Education and Medical Teacher) or two major medical education journals published in the United States (Academic Medicine and Teaching and Learning in Medicine). We also calculated how often our articles cited prominent medical journals published in the United Kingdom (Lancet and British Medical Journal) or in the United States (Journal of the American Medical Association [JAMA] and The New England Journal of Medicine [NEJM]). The time period for these calculations was 2 years, from 2005 to 2007. Finally, we counted the number of citations to The British Journal of Psychiatry, The American Journal of Psychiatry, and Archives of General Psychiatry over the same time period.

The majority of articles cited were from journals published in the United States (N=299; 80%); the remainder (N=75; 20%) were from journals published in the United Kingdom. Academic Medicine and Teaching and Learning in Medicine were together cited more frequently (N=150) than Medical Education and Medical Teacher combined (N=51). The two American general medical journals (JAMA and NEJM) were also cited more frequently (N=56) than the two United Kingdom general medical journals (Lancet and BMJ) (N=8). Finally, both The American Journal of Psychiatry and Archives of General Psychiatry were cited more frequently (N=72; N=21) than The British Journal of Psychiatry (N=15).

These results suggest that Original and Brief Report articles in Academic Psychiatry are more likely to cite articles in nationally published journals for each of the categories of journals surveyed. This result is consistent with Medical Education’s own survey of article citations (⁷). A better indication of international standing by this measure is to compare journals (⁷) and include citations to journals published in countries beyond the United States and United Kingdom alone.

We emphasize that these results do not necessarily demonstrate that the opportunity to cite important and relevant research from other countries is being missed. Nevertheless, our authors and reviewers should appreciate that journals are judged by citations to the international literature, and authors in particular should assiduously search for all relevant articles to cite. Citing relevant work from other countries is important in assisting readers’ appreciation of the appropriate or full context of educational research.

A third method for judging the international status of a journal is to count the number and proportion of international members of the editorial board. Our editorial board members all live within the United States or Canada. Around 50% of the editorial boards of Medical Education, Medical Teacher, and Academic Medicine, however, live outside of the United Kingdom and the United States (⁸).

International readership is less easy to determine. International subscriptions to Academic Psychiatry, whether individual or institutional, number 20. Like all APPI (American Psychiatric Publishing, Incorporated) journals, Academic Psychiatry grants free or low-cost online access to developing economies through two programs. The first is a HighWire Press Program based on the World Bank list of low income economies (⁹). The second is through HINARI (Health InterNetwork Access to Research Initiative), which provides free or very low-cost online access to the major biomedical and social sciences journals to local and not-for-profit institutions in developing countries (¹⁰). Although data on readers by country are available from weekly access logs, APPI does not have a Web statistics analysis program to allow the creation of a report of electronic readership by country over longer time periods.

We are now ready to position Academic Psychiatry more prominently as an international journal. As summarized in Appendix 1, we will work toward this goal in a number of ways. First and foremost, we invite all international authors or prospective international authors to communicate with us. All ideas are welcome. We would also be delighted to mentor authors in developing contributions that meet standards for publication. Linguistic or stylistic standards, for example, when not met, can be remedied. We are determined to demonstrate that we are receptive to reviewing and publishing educational research conducted in other countries.

We will also seek to enhance the impact of the Journal as a method to attract submissions. The impact factor is one way by which authors will judge the suitability of attempting to publish in our journal and essentially constitutes a fifth method for judging the international status of a journal. This is a measure of the frequency with which a typical article has been cited in a particular year and is determined by both citations to recent articles and the number of articles published in a particular year. It provides a measure of a journal’s importance relative to other journals, especially compared to those in the same field. Although Academic Psychiatry occupies a special niche as the only international journal dedicated to educational research and scholarship in psychiatry, we must, nevertheless, look to enhance our attractiveness to authors by increasing the impact of the Journal. Strategies to this end will be the subject of a later editorial.

We also intend to work closely with APPI to market the journal overseas. One goal is to increase the overseas subscriptions, especially by libraries. Another goal is to grow the number of international reviewers. International reviewers who are familiar with the medical education system of the contributing country can add a helpful perspective to editorial decision making. We also exhort authors to cite all relevant work from other countries.

We have followed the lead of many prominent journals by establishing an International Advisory Board, to be chaired by Richard Balon, M.D. We are truly grateful to the inaugural members of this board for their commitment and collegiality. The International Advisory Board will develop a strategic plan for increasing the international standing of Academic Psychiatry and will work with us in liaising with prominent international educators and researchers, educational organizations, and medical education journals to this end. We hope to enhance the international representation of the Advisory Board over time; the 12 inaugural members reside in North America. Board members can serve in part as a conduit for submissions of articles and can recommend and solicit manuscripts. On occasion, they could assist international authors in reaching a standard that is acceptable for publication. Our commitment as editors is to work closely with the board and with our parent organizations in developing thoughtful, incremental strategies for enhancing the international status of the Journal.

Our goal as editors is to consistently publish important and rigorous research and scholarship relevant to the missions of Academic Psychiatry. In striving to improve the Journal, we also wish to constructively and professionally support authors in optimizing the quality of their work. Encouraging contributions from international settings is absolutely consistent with goals for expansion and development (¹, ²). We seek a diverse, exciting, and innovative product and look forward to learning more from our International Advisory Board and our readers as to how we might achieve this goal. We also look forward with enthusiasm to learning more about educational developments and research from our international colleagues.

We wish to thank Linda LaCour for providing information regarding APPI’s programs to grant free or low-cost online journal access to developing economies.