Welcome to the fifth issue of 2019 of the Journal of the Royal Army Medical Corps (JRAMC). I am writing these dispatches during my deployment to the US-led Role 3 Craig Joint Theater Hospital at Bagram Airfield, Afghanistan. Running the journal remotely is challenging, and I continue to be indebted to Major Piers Page as Deputy Editor and Mrs Claire Langford at the BMJ for helping me at times when I cannot access the internet. This current issue of the JRAMC covers a broad range of topical subjects including research from our Australian colleagues on alcohol disorders in service personnel,1 which I have made my highlights, and the worsening of mental health in military spouses when their partners are deployed.2 I would also commend you to read Lieutenant Colonel Andy Johnston’s editorial about deskilling and return to practice on low-tempo contingency operations,3 which I feel is particularly pertinent during my current deployment.

As I was about to get on the plane to Afghanistan in June, the impact factor (IF) of JRAMC for 2018 was announced as 0.99. This is a further increase from 0.88 in 2017 and a massive achievement (Table 1), although I was hoping very much to have breached the big 1.0 this time. I would like to thank the members of the JRAMC Editorial Board and the BMJ for enabling this, as well as a cohort of authors that continue to submit and support the journal, often when it would be easier or more desirable to publish elsewhere. That brand loyalty will be essential to the journal’s success as we hopefully transition to our new guise in 2020. However, how relevant to our readers and potential submitting authors is our IF? It is certainly perceived as being relevant among BMJ Editors in Chief, as IF continues to dominate discussions during the yearly Editors Retreats.

The impact factor (IF) or journal impact factor of an academic journal is a scientometric index which reflects the yearly average number of citations to recent articles published in that journal.4 It is frequently used as a proxy for the relative importance of a journal within its field; journals with higher IFs are often deemed to be more important than those with lower ones. The IF was devised by Eugene Garfield, the founder of the Institute for Scientific Information. IFs are calculated yearly starting from 1975 for journals listed in the Journal Citation Reports (JCR). JCR in turn is an annual publication by Clarivate Analytics (previously the intellectual property of Thomson Reuters). A journal’s IF is based on dividing the numerator by the denominator. The numerator is the number of citations, received in that year, of articles published in that journal during the two preceding years. The denominator is the total number of ‘ citable items ’ published in that journal during the two preceding years.4 Part of the challenge has been a lack of clarity in which articles determine the denominator and are thereby ‘ citable ’ for the IF. Letters in particular are difficult to predict, with short letters containing only a few references unlikely to count (Table 2). IF rankings are also highly misleading and disheartening. For example, JRAMC is ranked within a group of journals classed as ‘ medicine , general and internal ’, meaning that a highly specialised journal such as ours will often rank near the bottom. In my opinion those journals we should be measuring ourselves against are other military medical journals (at last count over 20), of which only JRAMC and Military Medicine are listed in JCR and therefore have an IF (Table 1).

In the never-ending quest to raise IF, many editorial boards have made overt decisions to stop publishing articles or article types which are highly unlikely to be cited, such as case reports (Table 3). Such cynicism can lead to the production of papers in which only those articles published in your own journal are reviewed,5 or editors actively encourage authors to cite articles in their own journal.6 However, this has the potential to increase the journal’s self-citation rate, which can lead to unwanted attention. This year (IF year 2018), Clarivate Analytics suppressed 20 journals, 14 for high levels of self-citation and six for citation stacking.6 Although suppression from the JCR lasts 1 year, it has been shown to drastically reduce levels of self-citation following reintroduction. However, threshold levels are set so high that one particular journal that increased its IF by nearly fivefold (3.089 in 2014 to 8.145 in 2015), and moved to first place among its subject category, still managed to escape suppression.7 Some care must be taken when analysing this self-citation rate though, as when you publish in specialist areas such as Military Medicine, it is likely that a large proportion of your citations will be published in your own journal anyway (Table 4).

Certainly care has to be taken when introducing new article types as to whether they will have a negative effect on IF. For example the JRAMC introduced the ‘ personal view ’ article type to enhance debate and enable the promulgation of ideas that do not fit discretely into more traditional article types. This article type however was excluded from determining the IF, meaning we did lose a small number of highly cited articles (Table 5). There is also currently a desire to invite authors to write commentaries on papers that they have published in other larger journals to signpost readers; however, it is unclear as whether these would be used as denominators should a new article type be chosen as these do not fit neatly into personal views.

So the question remains will we as a journal overtly chase the IF, and to what lengths do we do it? I feel the ethics behind overt self-citation preclude this from a military journal and I will not actively undertake this, despite the obvious temptation. However we will be taking the line of increasing the number of reviews, which will ideally be systematic in nature, and use those previously highest cited articles as guidance (Table 6). We continually increase the number of countries that submit to the journal,8 and this I believe is reflected in the countries of authors citing articles published in JRAMC (Table 7). This increased visibility will increase the potential for article citation. Readers will have noticed that I have heavily pushed the number of special issues in a year, from one of six issues during my predecessors’ tenure, to up to three of six issues in my tenure. I also hope that topical subjects such as emergency preparedness and women in ground close combat will engage the readership and increase downloads and subsequent citations. We are now the most cited and influential military health journal in the world, and I thank you all for supporting us in the journey so far and that to come.