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- Anthony N. DeMaria, MD, Editor-in-Chief, Journal of the American College of Cardiology* ()
- ↵*Address correspondence to:
Dr. Anthony N. DeMaria, Editor-in-Chief, Journal of the American College of Cardiology, 3655 Nobel Drive, Suite 630, San Diego, California 92112
Like many of you, I just returned home from the ACC Annual Scientific Sessions meeting. As in the past, the meeting was outstanding and provided a venue for important new research findings, state-of-the-art education, information on health policy and legislation, and display of new equipment and technology. It also provided the opportunity to communicate with colleagues, catch up with friends, and enjoy a few meals that we perhaps would not have indulged in at home. However, one concerning aspect of the meeting, as has been true for most large national meetings that I have attended recently, was the apparently diminishing role of original research, particularly oral abstract presentations. These presentations seem to be increasingly overshadowed by the structured sessions and named lectures in the eyes of both presenters and audience.
The late-breaking clinical trial (LBCT) sessions again were strongly featured both prior to and during the sessions. As I have commented in the past (1), these LBCT presentations appear to have taken on a life of their own, and the designation “late-breaking” seems to carry an aura of great importance in and of itself. It may be that the material covered during the convention is so extensive that these presentations are a convenient means to formulate the highlights of the meeting. However, recognizing the frequently immense clinical importance of the large randomized clinical trials, I still believe that a disproportionate attention is focused on these sessions.
With regard to original research other than LBCTs, the data produce a bit of unease. The number of abstract submissions reached a maximum of 7,319 in 2001, and has fallen to 5,111 this year. While the number of abstracts accepted increased from 1,622 (28%) in 2006 to 2,086 (41%) in 2010, oral abstract presentations have declined from 20% to 9% during the same period. Moreover, the poster sessions, which constitute the overwhelming majority of accepted submissions, are probably not as well promoted nor centrally located as they might be. I have witnessed a similar trend to greater poster presentation of research with other societies.
Posters certainly have many advantages relative to oral presentations. Many more posters than oral abstracts can be accommodated, they are available for a longer duration of time, and they provide the opportunity for close and detailed interaction of the author with interested observers. However, posters often lack the author's explanation of their thinking. Moreover, they frequently deprive the observers of hearing the thoughts, questions, and responses of others, and lack the excitement and tension of having the investigator present and defend the work before a large audience. While posters are clearly considered equivalent to oral presentations, it has been my experience that the majority of investigators would prefer the latter format.
Why, one may ask, is the vast majority of original research delivered as a poster presentation? There is a general sense, and one that has rung true in my experience, that oral abstract presentations have been increasingly poorly attended. Reported attendance at oral abstract sessions has been falling for 7 years at the ACC meeting. Although some rooms were overflowing this year, this may have been related to the size of the rooms. This certainly contrasts with the experience I had in attending these meetings at the onset of my career. Attendees were eager to learn what was new in their area. Most individuals doing investigation, as well as their mentors, attended the research presentations. The rooms were generally filled, discussions were usually spirited and constructive, and those attending typically gathered together and interacted during the breaks. Most importantly, young investigators benefitted from the excellent experience and exposure.
Assuming that the premise of poor attendance at oral sessions is correct, and data to substantiate this are difficult to acquire, the question is why. It may be that there is a surfeit of new research, but given that JACCreceived over 6,000 submissions last year, that seems unlikely. I do believe that the large international conventions have become increasingly consumed by committee meetings, assemblages of research groups, and other such activities, and that the mentors and supervisors are increasingly absent from the research reports. Young investigators follow their role models, and if they sense that the research presentations are not most important to them, they are likely to adopt the same attitude. Moreover, cardiology programs have become so big that the divisional rehearsals of the abstracts to be presented, which typically engendered interest and enthusiasm, are difficult to organize. The research sessions might be better featured by the meeting itself, including focusing greater attention and providing better venues. However, the behavior of the program committees is probably the result rather than the cause of the poor attendance.
It also appears to me that abstracts may have suffered a loss of value and esteem. A 10-min discourse can provide only limited details, and there is no record of what has been said when the speaker is done. Presentations may never become manuscripts, and if they do, they are frequently found to have flaws upon review which prevent publication. Even the most highly graded abstracts have a surprisingly high rejection rate when reviewed as manuscripts (2). If, however, rather than being taken as definitive end-products, the abstracts are seen as what they are: a snapshot of the direction that investigation is taking by those driving it, a chance to air the work and have it previewed in preparation for final formulation, and an opportunity for young investigators to exhibit their talent, they still have enormous value.
I must admit to having a personal involvement with this issue. During my last year of fellowship, when deciding whether to enter practice or remain in academics, I had the opportunity to present my first abstract at a national meeting. I prepared that presentation more than 1 month prior to the convention, and rehearsed it at least a dozen times. My paper was scheduled to be delivered at the last session (Thursday then). The session was held in a cavernous room with a capacity of 500, and was attended by about 30 individuals, primarily the other presenters and their colleagues and relatives. Nevertheless, my Chairs were luminaries, the audience was knowledgeable, I was very nervous, and the whole experience was exhilarating. The opportunity to make that presentation sealed my decision to pursue a career in academic medicine. I cannot help but feel that we should provide this opportunity to as many young investigators as possible.
The large international meetings serve many interest groups and purposes. As such, a menu of varied content is to be expected. However, it is important that the content not become excessively skewed to specific topics, formats, or activities. I have some concern that we may be in danger of diminishing the role of original research material, especially the oral abstract presentations. The reasons for this seem to be multifactorial, and relate to all the individuals participating in the meeting. I believe the time has come to review the research presentations at the Scientific Sessions and determine what can be done to revitalize them and restore that segment of the meeting to its appropriate state. Not only would such action be important for the research enterprise, but I believe that it would be one of the best tools available to attract the next generation of basic and clinical investigators.
- American College of Cardiology Foundation