Access to science for junior doctors and neurologists in French-speaking countries: challenges and future perspectives

doi:10.21203/rs.3.rs-1991468/v1

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Access to science for junior doctors and neurologists in French-speaking countries: challenges and future perspectives

https://doi.org/10.21203/rs.3.rs-1991468/v1

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Background and objectives: Science education developed historically from experimentation science to model theories of cognition. Digitization in medical science brought about new challenges of access to science for education and publishing. The aims of our study are to describe the differences in access to science and scientific publications for junior doctors and neurologists in French-speaking countries, and to identify difficulties and their association with demographic, workplace, social and personal factors.

Methods: We performed a thirty-nine-question-survey to define access to science from two major perspectives, scientific education, and scientific publishing. We explored scientific education through demographic data and scientific resources (institutional, online, personal), and evaluated scientific publishing of thesis and articles according to demographic data, number of publications, and difficulties with publishing.

Results: Our study identified personal and environmental factors interfering with scientific access, some of which are attributed to junior doctors and neurologists in French-speaking countries as age, gender, ethnicity, income and work and life-balance. A heavier load was observed for African scientists. The main scientific resources used for medical education were Journals 82,9%, Congresses 79,4%, and Sci-Hub 74,5%. Junior scientists are facing major difficulties in writing in science due to linguistic (56,5%), financial (64,7%), scientific (55,3%), and logistic (65,3%) factors.

Conclusions: This paper suggests that ethnicity, age, gender, and work-life balance can all impact access to science at different levels. The challenge now is to create digital platforms that modernize medical education and help build bridges for research within diverse scientific communities.

Access to science

Junior doctors

neurologists

diversity

open access

scientific publishing

The landscape of medical journals has been continuously developing since the 16th century. The first journals focused on philosophy, then science journals were established. General medicine and more specialized journals, increased in number since then to reach 30,000 in 2021^{1 2 3 4}. In parallel, medical education went through many reforms and has developed from experimentation science to new modeling theories of cognition ^3,5. In the era of digital science, big data and globalization, new challenges are arising. This is bringing about the necessity for easier access to science and selective research while respecting the values of diversity ⁶. Furthermore, some quantitative criteria of value set by journals, like impact factor and metrics, are hindering a misconception of the value of scientific research. While specialty, originality, reviewing quality, continuous medical education (CME) activities and authorship policies are focusing on delivering quality science.

Nowadays, access to science for education and publishing is still challenging for junior doctors and neurologists. The rising numbers of open access journals and platforms like Sci-Hub brought about the huge inequality gap of access to science and financial obstacles. More recently, some journals proposed financial discounts on publishing costs to peer reviewers for the time they spend on working for publishers⁷. In this article we will analyze the different challenges of scientific access of junior doctors and neurologists in French-speaking countries. And we will suggest the potential solutions to provide access to scientific platforms.

The survey consisted of thirty-nine questions and could be answered online. It was made available in French and English and sent via email to junior doctors in French-speaking countries through the International Federation of Junior French Speaking Neurologists (FIJNF). Data was collected from June 22nd, 2021 to January 31st, 2022.

The first part of the survey gathered demographic information of participants, including the date of birth, gender, nationality and country of exercise. The second part of the survey collected information about professional experience; this included the academic degree, number of years of medical education, financial income, number of senior doctors in the workplace, academic degree of doctors in the workplace as well as their gender and geographic distribution. We looked at the impact of diversity on scientific access according to academic degree, gender and nationality. In the fourth section, we identified work, life and workplace environment characteristics, including the type of hospital, healthcare sector, the number of working hours per day and the number of on-call shifts per month. Finally, in the last section, we measured access to science according to the resources used as educational material, thesis and articles publications and the difficulties encountered in publishing. The difficulties were divided into logistic, scientific, financial and linguistic.

We divided respondents into groups according to three major elements. Their geographic location (African, non-African), the first language they use in science (French versus non-French speaking), and their specialty (Neurology versus, other). We also evaluated access to science in these groups based on age, gender, scientific degree, work life balance, and the challenges to scientific writing and publishing. We analyzed the interaction between these different factors and examined their impact on access to science.

To compare the relationship between participants’ answers to demographic, personal, professional data, we condensed qualitative responses into binary variables (No = 1, Yes = 2) in an SPSS format. We analyzed the dataset of 200 participants using SPSS V26, after coding the different variables. We extracted descriptive demographic statistics of each group and defined the numeric data by their confidence interval and by percentage for qualitative data. Normality of the population’s distribution was verified by the test of Kolmogorov-Smirnov. The comparison of percentages was performed by the Chi² test and the comparison of means by the analysis of variance. Significance level was fixed at P < 0,05 for all analyzes.

A. Descriptive statistics:

Demographics:

The survey collected data from 200 junior doctors divided into 181 doctors from 23 French-speaking countries and 19 from non-French-speaking countries.

The mean of age was 32,55 [min:23-max:56; STD=4,63]. Male/female ratio was 0,97. Distribution of participants by nationality showed a predominance of French 48 (24%), and Tunisian 48 (24%). The dominant country of work was France 28,5%.

Distribution according to academic degree for men was 18 (9%) interns, 18 (9%) residents, 4 (2%) Master students, 57 (28,5%) PHD and higher. For women, 39 (19,5%) interns, 53 (26,5%) residents, 10 (5%) master students, and 98 (49%) PHD and above. 111 (55,5%) participants had over 10 years of medical studies, while 84 (42%) studied from 5 to 10 years and only 5 (2,5%) less than 5 years.

Distribution of participants according to specialty and gender showed 133 (66,5%) neurologists with close male/female distribution respectively 63 (47,4%) and 70 (52,6%). Other specialties were represented by 67 (33,5%) participants with an equal male/female distribution 33 (49,2%).

2. Work and workplace characteristics:

Financial income: 156 (78%) doctors had financial income. Distribution of income differed largely between countries of exercise. 44 (22%) participants were not paid and 71% among them worked in African countries.
Human resources: The number of doctors with a university degree in departments was zero in 11% of cases, between 1 and 3 in 29% of cases, between 3 and 6 in 37% of cases, between 6 and 9 in 12% of cases, and above 9 in 11% of cases. Departments in which junior doctors worked had 70,6% professors, 66% specialists, 56,7% assistants and 44,3% associate professors. Teams were male predominant in 32,8%, female predominant in 32,3%, and an equal representation was observed in 28,3% of cases. Only 3(3,5%) of teams had a single gender. Teams with a single ethnic origin were most frequent (60%), compared to teams with two (17%) and three ethnicities (23%). Continental origins were African 66,5%, European 39,5%, Asian 11% and rarely American 4,5% and Australian 0,5%. 123 (61,5%) participants reported that they have equal scientific access regardless of their ethnicity. Meanwhile academic degree limited access to science for 129 (64,5%) junior doctors compared to their senior peers.

Workplace environment: Distribution of the workplace in the capital city (52%) and other cities (48%) did not differ significantly. 146 (73%) worked in university hospitals, 24 (12%) in specialized university hospitals, 7 (3,5%) in military hospitals, 15 (7,5%) in regional hospitals, 2 (1%) in primary care units and 6 (3%) in the private sector. Work-and-life balance: 70,7% worked between 6 to 10 hours, while 7,6% worked less than 6 hours and 21,7% worked over 10 hours. The number of night-shifts each month was below 4 in 40,2%, between 4 and 8 in 33,2%, and over 8 in 2%. Introspection about the importance of diversity in the scientific access: 33% participants valued diversity, while 15,5% did not consider it important in the workplace. 51,5% participants didn’t know if diversity had a positive impact on scientific access. French participants disagreed 11 (23%) or were not sure 30 (63%), while Tunisian participants agreed 15 (31,2%) or were not sure 29 (60%) about the importance of diversity. Gender introspection on diversity showed that male participants approved (38%) or doubted (42%), while female participants often doubted (60%) the importance of diversity. Scientific access for education and publishing: The main scientific resources used for medical education were Journals 82,9%, Congresses 79,4%, Sci-Hub 74,5% followed by individual learning 63,3%, Books 60,8%, CME 47,7%, non-formal resources 18,1%, and exchange summer/spring schools 14,1%. 119 (59,5%) defended their thesis. Within this group, 81 (68,1%) reported difficulties in publishing their thesis in journals. 103 (51,5%) wrote at least one article, while 23 (11,5%) had one ongoing, and 73 (36,5%) did not write any. The number of articles written was in 23,5% of cases between 2 and 5, and in 13% of cases only one. 9% wrote between 6 to 10 articles, 5,5% wrote between 11 to 20, and 3% wrote over 20 articles. Distribution of published articles according to gender showed that more than a half of women (55%) published between 2-5 articles whereas, most of people who published more than 10 articles were men (88%). Working in France and Tunisia was linked to a higher number of published articles within the range of 1 to 5. 53% of junior doctors in Madagascar reported a number of published articles above 6. Academic grade showed a general predominance in the number of articles published below 5, and a greater number of publications after PhD. These articles were published in a journal with an impact factor below 1 in 32% and between 1 and 4 in 14,5%. The main journal selection criteria were a high-impact factor (67,4%), a journal in the same specialty (57%), free submission (55,4%), similar research theme (42,5%), short reviewing time (32,6%) and reviewing quality (29%). The minimum reviewing time for an article is divided equally between the periods 1 to 4 months (39%) and 5 to 8 months (38%). Difficulties in writing a scientific paper were divided into 4 categories: linguistic (56,5%), financial (64,7%), scientific (55,3%), and logistic (65,3%). Writing in a foreign language 93(70,5%) was the main difficulty reported, followed by scientific writing 75(56, 8%), scientific editing 65(49,2%) and choice of pertinent information 55(41,7%). Financial difficulties included expensive submission fees 106(79, 1%), the absence of university financial support 99(73,9%), expensive articles 92(68,7%) and books 73(54,5%), the absence of financial support modalities of submission for low- and middle-income countries 60(44,8%), and currency exchange restrictions 35(26,1%). Financial difficulties in Madagascar limited scientific publishing (P=0,007, OR 10,04[13 ;77,7]) in opposition to France (P=0,000, OR 0,084[0,35; 0,2]). The percentage of scientific difficulties was over 50% in all categories and was a result of difficulties using softwares like Excel, SPSS, Endnote and Zotero 71,4%, the slow update of national scientific resources 63,7%, and the uncertainty about the validity of scientific information 59,1%. Logistic difficulties included different submission criteria in each journal 61,1%, complicated submission procedures 57,9%, slow reviewing 50,5%, and difficulties in selecting the appropriate journal 45,8%. Motivation and availability to write accounted for 32,1% and 33,7% of cases while use of internet resources, and relational difficulties due to ethnicity gender and academic grade were the least reported.

B. Analytical statistics:

Access to science for medical training:

The association between geographic, academic factors and educational resources used in science is detailed in Table 1.

Access to science for publishing:

Impact of demographics on scientific publications:

Impact of age: The mean of age was close in the different groups and didn’t seem to have an impact on scientific publications (articles and thesis) and difficulties. The impact of age on the scientific publishing and scientific education, is represented in figure 1.

Impact of gender and ethnicity:

We analyzed the differences in scientific publishing for both genders in France and Tunisia. We noticed that frequencies of submitted thesis were close in both countries for both genders (20 to 26% for men and 30 to 33% for women). The percentage of published articles was, however, more important in the man's group in Tunisia 80% compared to the woman's group 48%. This difference was not identified for doctors working in France (31% for men and 33% for women). The number of published articles didn’t surpass 2 to 5 for both genders in Tunisia (50%-69%). Meanwhile, in France, the majority published between 2 to 5 (47%-54%) a group of participants could publish between 6 to 10 articles (15%-20%).

Scientific publishing according to monthly income, academic grade, ethnical origins and gender is represented in figure 2.

Impact of specialty and number of years of education on scientific publishing:

The maximum number of articles published for junior neurologists and doctors of other specialties was between 2 and 5, with respective percentages of 46% and 35%. The number of published articles increased according to the number of years of education. I was more difficult to publish a thesis in the field of neurology 54(66,7%) compared to other specialties 27(33,3%). Difficulties increased in parallel to the number of years of education. In fact, 78 % of participants who studied for more than 10 years reported having difficulties publishing their articles compared to only 2.5% of those with 2 years of education. Income did not seem to influence these difficulties that were present in highly paid and non-paid groups.

Workplace environment impact on publishing; including the number of senior doctors holding and academic degree, gender, ethnic distribution of senior doctors and workplace location: Thesis publication difficulties were more important in teams that had less than 6 medical university hospital teachers and gender did not influence these difficulties. The number of articles published depended on the workplace location and the health structure type. The role of workplace environment in publishing articles is represented in figure 3.

Work-and-life balance affected positively thesis and articles publication in groups working between 6 to 10 hours a day and having less than 4 on-call shifts per month (figure 4).

Influence of journal selection criteria on publications: For participants who published several articles between 2 and 5, choosing a high or low-impact factor journal, a paying journal, or reviewing duration did not change chances of manuscript acceptance. However, choosing a non-paying journal was correlated with 32,7% chances of having published manuscripts. Also, reviewing quality, same specialty, same research theme, known editorial board members and special offers increased chances to publish by 25% to 36,5%. Submitting manuscripts in journals using one’s native language increased chances of publishing to 50%.

Analysis of difficulties associated with scientific publishing by nature, country and academic degree (table 2):

New concepts addressing science education at a global level nowadays include 3 major actors; scientific content, the teacher and the student⁸. Open science rendered major data available for anyone with an internet connection. The multiplicity of scientific resources has raised many problems related to the ethical foundations of medical journalism like monopoly of scientific knowledge, reliability and authenticity⁹. Impact factor, indexing services, and publisher’s prestige were selected by individuals and scientific communities as criteria of reliability of science journals¹⁰.

Access to scientific resources for education for junior doctors and neurologists in French-speaking countries:

The key resources used for scientific access in our survey included journals, congresses and sci-Hub, followed by books and auto-learning. Science education developed historically from experimental research to model theories of cognition⁵. The use of the internet during the 20th century revolutionized science education worldwide¹¹. The digitation of medical journals facilitated scientific access exponentially¹¹. A counter-current open access journals and other illegal platforms like Sci-hub protested against limited access to science. Sci-Hub is nowadays providing scientific access to almost 81,6 million scholarly articles and is one of the principal scientific resources for science education in some countries¹². In our survey, Sci-Hub was the first resource of scientific access to junior doctors in Tunisia 38(88,4%) and even in non-African countries 48(85,7%) including France 48(84,2%). Our survey also showed that junior doctors benefit particularly from Sci-Hub 82,1% compared to their PHD peers 66,3%. While scientific journalism in medical studies was founded by doctors in the beginning of their career³, they are now limited to follow up with their research. We also noticed a general predominance of scientific resources used for junior neurologists, probably because neurology depends on scientific advancement in daily patient care¹³. Sci-hub helped many scientists of all academic levels worldwide in scientific research. The legal issue related to paying-scientific journals and their limitations to access to science is now expanding even to high-income countries and the value of open access and free access to science requires changes within the by-laws.

Access to scientific publishing for junior doctors and neurologists in French-speaking countries:

Demographic barriers to scientific publishing:

- Age, gender and geographic location:

Our study included mainly young adults with equal gender representation. Age seemed to have a boosting effect on the number of publications, which is a natural result of experience and commitment to research. Women seemed to have more difficulties to publish according to their academic degree in Tunisia compared to France. They also were more likely to publish during their residency and seem to require higher income to publish articles like their male colleagues. Gender inequality is explained by many factors, including conflicts related to gender roles in the workplace, imposter syndrome altering women’s introspection about their scientific capacities, work and life balance and heavier social roles attributed to women outside work¹⁴.

Access to science in French-speaking and non-French speaking countries.

In groups from France and Tunisia, nationality did not impact scientific publications. However, considering the country of work, scientific publishing was easier in France. Healthcare education and policy makers play an important role in scientific advancement. While France spent 11,26% of Gross Domestic Product (GDP) (4690$ per capita) on healthcare in 2018,¹⁵ Tunisia invested only 7,29% of GDP (252$ per capita) in 2017¹⁶. Scientific publications seemed to increase in a work environment that values diversity. The importance of diversity in neuroscience was introduced recently in the ALBA declaration¹⁷.

Difficulties to publish were numerous yet different between countries; Linguistic difficulties were mostly important for doctors from Madagascar. Reported difficulties are writing in a foreigner language, scientific writing, and editing. Literature review showed that writing in a foreign language was dominated by grammar difficulties and causing articles rejection in 43,5% of cases¹⁸. Researchers are now working on breaking linguistic barriers by developing translation softwares to facilitate science access while respecting linguistic diversity¹⁹. African countries report more financial difficulties. These are high submission fees, absence of university financial support, expensive articles and books, absence of low- and middle-income countries special considerations, and currency exchange restrictions in some. Economic crisis African countries are living²⁰ rendered some countries like Madagascar in our observation particularly affected (P = 0,007, OR 10,04[13; 77,7]) in opposition to France (P = 0,000, OR 0,084[0,35 ;0,2]). Over 50% of the participants complained of having scientific difficulties. These were more important in non-French-speaking countries. Not using English as a primary language in science may give a broader access to multilingual scientific resources²¹. Difficulties using softwares like excel, endnote, Zotero and SPSS were highly reported. Lack of training in research methods is a major obstacle to scientific publishing for junior scientists²². Logistic difficulties were reported by non-French-speaking countries. African countries had more academic relational difficulties and problems using internet resources. Tunisian participants reported difficulties related to slow review time, choosing an appropriate journal, motivational issues, gender related difficulties and academic relational difficulties. Creating strategic work regulations related to publishing in academia should protect junior scientists from personal and professional abuse²³.

Workplace factors interfering with scientific publishing:

We noticed that teams with fewer senior doctors (between 3 and 6) had junior doctors publishing more articles than teams containing over 9 senior doctors. Overload of responsibilities for senior doctors makes them more likely to engage junior doctors in scientific collaboration and leadership positions²⁴. In opposition to conflictual demands that may arise with a high number of senior doctors²⁵. Collaboration in science is vital and should harvest physicians’ skills to provide quality care and research²⁵. Many doctors left the public health sector at a young age because of intellectual and moral restrictions, obligations’ overload and work-and-life imbalance²⁵. Gender distribution was homogenous in our survey and gender diversity in teams was associated with a higher number of scientific publications. Inclusivity in teams increases the collective intelligence factor, promotes cognitive visual performance, brainstorming, collective moral judgments, and negotiating over limited resources²⁶. Most teams in our survey had one-nationality and were principally African. A selection bias can explain this observation. Also, the results observed can be explained by the educational inequality between countries causing a “brain drain” for science towards Europe instead of Africa^27,28. Participants lived both in the capital or other cities equally. Healthcare structure type showed a centralization of scientific publications in university hospitals. The monopoly of university published research has been contested as an obstacle, excluding scientists from other sectors from maximizing scientific progress and translating basic science into innovative practical strategies²⁹. Our survey showed a thrive in scientific publishing for junior doctors having fewer working hours per day (between 6 and 10), and fewer on-call shifts (below 4). The key factors interfering with work and life balance are individual, societal and organizational³⁰. Most studies focused on individual and societal elements and omitted organizational factors. Better experimental models are required to quantify work and life balance more objectively³⁰.

Academic factors interfering with scientific publishing:

Academic degree was PhD or higher in 50% of our respondents. The number or articles published didn’t surpass 5 articles for interns and residents and was more important for PhDs assistants, associate professors and professors. Studies showed that exposing medical students to research at an early stage of their career increases their chances of publishing³¹. The interference of academia with research creates unequal access to educational material for science and limits the potential for research for junior doctors. Personality traits of team leaders also seem to play an important role in defining scholars’ careers²³. While the opposite occurs for several articles published above 10. Burnout and career dissatisfaction in neurology compared to other specialties may play an important role in these observations³². Work and life-balance heterogeneity in the different specialties may interfere with the availability to publish in science ³³.

Social and personal factors interfering with scientific access:

Social and personal factors include introspection about the importance of diversity in scientific access, personal resources used for education, the criteria of selection of a journal, and the difficulties encountered to publish. All countries had a high percentage of people not sensibilized to the importance of diversity for science. Openness to diversity was narrow for French participants compared to their Tunisian colleagues. Even though France accounts for the highest percentage of physicians of African origin ³⁴. While wages are the principal factor causing brain drain in developing countries³⁵, income gap based on ethnicity and gender is still reported in France and other developed countries^36,3738. Overall work satisfaction and productivity in a multicultural environment increases when leaders ingrain an inclusive culture towards diversity within their working agenda³⁹.

A self-centered approach promoting high-impact-factor-journals as a quality research resource was visible in the journals’ selection criteria among our participants. This misconception between quantitative advancement of a journal and the quality of peer reviewing and research articles available is controversial⁴⁰⁴¹.

Our study highlights the role of personal and environmental factors in shaping the landscape of medical science. Our main striking data include:

Huge disparities of access to science between French and non-French-speaking countries with a heavier ethnicity, financial and logistic load on African scientists.
Financial income disparities between African and non-African countries had little impact on scientific education, but affected publishing.
Gender disparities seem to be variable according to the country of work. Gender-equal environments boost scientific publications; Still, women are less visible in publishing at advanced academic levels. Challenges women scientists face in academia should be considered, including gender representation in the workplace, work and life balance, and financial income.
Access to science for neurologists is vital and is closely linked to scientific advancement. They are more threatened by work overload and burnout and this can have negative repercussions on their motivation to pursue a career in research. Better strategies that organize and balance clinical and research activities should be implemented to maintain professional overall satisfaction.
Early involvement in research solves academic disparities of access to science weighing on junior doctors.

Restrictions of access to science affect scientists and scientific progress at different levels. Junior scientists have logistic, linguistic, financial and scientific challenges to write in science. Open access platforms facilitate scientific exchange, yet bring to surface new challenges related to multiplicity of journals, different instructions for authors and reviewers, time-consuming submission procedures and big data analysis. Our results highlight the importance of considering demographic and personal factors like age, gender, ethnicity, work-and-life balance and academic grade, in science access and publishing. The new challenges for future generations comprise facilitating scientific digitization and breaking off the age, gender and ethnic barriers to scientific access. A fundamental change in science education should be the new priority of the 21st century.

Acknowledgments: we would like to thank all the members of the international federation of junior neurologists in French-speaking countries (FIJNF) who worked diligently to share the survey with junior doctors in their different countries.

Conflicts of interest: none

We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.

Declaration of Conflicting Interests: The Author(s) declare(s) that there is no conflict of interest.

Funding acknowledgement: The author(s) received no financial support for the research, authorship, and/or publication of this article.

Originality certification: we certify to the originality of the work.

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Table 1 Geographic and academic factors and their association with educational resources used in science.

	Journals	Congresses	Schools	CME	Books	Sci-Hub	Self-education	Non-formal resources
Role of geographical distribution in access to educational resources
Non-African	80,4%	78,6%	5,4%	28,6%	46,4%	85,7%	64,2%	19,6%
African	82,3%	79%	12,9%	53,2%	64,5%	60,5%	72,6%	20,2%
France	78,9%	82,5%	7%	33,3%	49,1%	84,2%	70,2%	22,8%
Tunisia	83,7%	81,4%	11,6%	48,8%	55,8%	88,4%	67,4%	25,6%
Impact of specialty in the use of educational resources
Neurology	86,4%	81,8%	18,2%	52,3%	61,4%	79,5%	60,6%	15,9%
Other	76,1%	74,6%	6%	38,8%	59,7%	65,7%	68,1%	22,4%
Impact of academic degree on access to science educational resources
Intern	69,2%	71,8%	2,6%	25,6%	56,4%	82,1%	64,1%	17,9%
Resident	88,7%	83%	18,9%	56,6%	60,4%	86,8%	66%	24,5%
Master’s	77,8%	88,9%	11,1%	88,9%	55,6%	66,7%	66,7%	22,2%
PhD and more	85,7%	79,6%	16,3%	48%	63,3%	66,3%	61,2%	14,3%

Table 2 - Analysis of difficulties with scientific access

	Linguistic	Financial	Scientific	Logistic
Difficulties by gender
Male	40(49,4%)	55(67,9%)	43(53,1%)	44(54,3%)
Female	56(62,9%)	55(61,8%)	51(57,3%)	67(75,3%)
Difficulties by nationality
France	19(51,4%)	8(21,6%)	20(54,1%)	24(64,9%)
Madagascar	14(82,4%)	16(94,1%)	9(52,9%)	6(35,3%)
Tunisia	23(54,8%)	30(71,4%)	25(59,5%)	37(88,1%)
African	64(57,1%)	86(76,8%)	59(52,7%)	68(60,7%)
Non-African countries	19(47,5%)	11(27,5%)	20(50%)	26(65%)
French speaking countries	83(54,6%)	97(63,8%)	79(52%)	94(61,8%)
Non-French speaking countries	13(72,2%)	13(72,2%)	15(83,3%)	17(94,4%)
Difficulties by specialty
Neurology	63(55,8%)	68(60,2%)	62(54,9%)	72(63,7%)
Other	33(57,9%)	42(73,7%)	32(56,1%)	39(68,4%)
Difficulties by years of medical education
< 5 years	4(80%)	3(60%)	4(80%)	3(60%)
[5-10] years	34(54%)	37(58,7%)	38(60,3%)	47(74,6%)
>10 years	58(56,9%)	70(68,6%)	52(51%)	61(59,8%)
Difficulties by educational level
Intern	15(57,7%)	10(38,5%)	17(65,4%)	18(69,2%)
Resident	26(56,5%)	33(71,7%)	22(47,8%)	34(73,9%)
Master’s degree	6(75%)	8(100%)	6(75%)	5(62,5%)
PHD/Assistant/Professor	49(55,7%)	57(64,8%)	49(55,7%)	54(61,4%)

No competing interests reported.

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Access to science for junior doctors and neurologists in French-speaking countries: challenges and future perspectives

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Introduction:

Methods:

Results:

Discussion:

Access to scientific resources for education for junior doctors and neurologists in French-speaking countries:

Access to scientific publishing for junior doctors and neurologists in French-speaking countries:

- Age, gender and geographic location:

Workplace factors interfering with scientific publishing:

Academic factors interfering with scientific publishing:

Social and personal factors interfering with scientific access:

Conclusions:

Declarations:

References:

Tables:

Additional Declarations

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