Our impact: 2024

BMJ Group impact report. Improving health outcomes worldwide - these are our success stories.

Improving health outcomes worldwide

Impact report 2024

Better evidence Better decisions

Better systems

Impact report 2022

Helping to create a healthier world As a leading global healthcare knowledge provider, we share knowledge and expertise to improve health outcomes.

A rich history Since 1840, BMJ Group has been at the forefront of providing research, knowledge, and education to health professionals A top 10 health policy influencer With 7K new or updated health and social care policy documents and clinical guidelines citing research published by BMJ Group in 2023, we are among the top ten publishers influencing health policy and practice*

A strong international presence Five offices located in the UK, North America, India, and China A reliable source Nearly 11M visitors frequent our websites every month

A global reach Over 10K institutions across the world currently have an active subscription to BMJ Group tools and resources

A world leader The BMJ is the 3rd most cited journal across the Medicine, General & Internal category**

A privileged network Working with 3.5M authors and peer reviewers across the world

Sources: *BMJ Impact Analytics, Open Alex, and Dimensions 2024 **Clarivate’s Journal Citation Reports (JCR) database

Our vision of creating a healthier world is evident in our collaborative efforts to design and implement projects that enhance community wellbeing. We strive to make a difference across all the communities we serve worldwide. A key focus for us is empowering future generations by providing new opportunities. This year, we took action to address social mobility disparities. A conversation with a school career counsellor highlighted the widening gap in the UK between middle-class students with access to enriching work experiences and those from disadvantaged backgrounds who miss out. To bridge this gap, we partnered with local schools to offer work experience placements exclusively for 55 students on free school meals. This initiative is a cornerstone of our social mobility agenda, reflecting our commitment to fostering social equity and career development. As you read this report, you will find real-world stories that illustrate our tangible differences. These stories embody our vision of a healthier world and demonstrate how our work is driving positive change and transforming communities globally. This report provides an opportunity to reflect each year on our commitment to delivering impact, recognition, and value within the global healthcare community. As a 500-strong organisation, we are consistently proud of what we achieve. We have always said that we are small enough to care but big enough to deliver, and this report proves this statement to be true. Welcome to our 2024 annual impact report

Chris Jones Chief Executive Officer, BMJ Group

Showing real-world impact through policy documents and clinical guidelines citations At BMJ Group, we prioritise making a tangible impact through our publications. While scholarly influence is important, its true value lies in its implications for policy and clinical guidelines, and in driving meaningful change in health and social care. In 2023, BMJ Group’s articles were cited in over 7000 policy documents and clinical guidelines, directly improving clinical practice and how health and social care is provided. This places us among the top ten most influential publishers on health and social care policy, outperforming many larger publishers in terms of the real-world impact we deliver. It also illustrates our ability to provide the best available research that resonates deeply with the clinical community. Global, rapid reach with open access I n 2019, Artificial Intelligence, Bias and Clinical Safety, 1 published in BMJ Quality and Safety , swiftly impacted global policy and practice regarding artificial intelligence (AI) in healthcare. The open access article has been cited in 24 policy documents and by 15 sources across nine countries. It has influenced reports by the European Union, the Australian Council of Learned Academies (ACOLA), and the World Health Organization (WHO). Providing open access options to the authors we work with ensures timely access to crucial research, driving the development of effective policies in fast evolving fields like AI.

Inspiring real change through global reach and recognition Typically, research takes five to 15 years to impact clinical guidelines. Various factors influence this timeline, from the quality and strength of evidence to peer review, publication, design development processes, consensus, and clinical adoption. BMJ Group’s brand recognition and global reach can accelerate this process by improving clinical practice worldwide. In less than four years, an observational study published in the Journal of Neurology, Neurosurgery & Psychiatry received 27 academic citations. It was also cited in clinical guidelines in Canada, Germany, and the Netherlands, with references from four different sources. The study, which compared outcomes after treatment with autologous haematopoietic stem cell transplantation (AHSCT) and alemtuzumab (ALZ) in patients with relapsing-remitting multiple sclerosis, was incorporated into clinical guidelines across Canada, Germany, and the Netherlands. Its influence extended beyond these countries, with references from four sources highlighting its global reach. This swift translation from research to real-world application impacted care practices in higher income countries and helped lower income regions provide more affordable care for people with multiple sclerosis.

Without open access, you miss the opportunity to expose your ideas to new communities with fresh perspectives.” Rob Challen, UK Research and Innovation AI Hub for Collective Intelligence, Engineering Mathematics, University of Bristol

85% of funded research articles published by BMJ Group in 2023 were open access

BMJ Medicine : making significant contributions to research In just two years since its launch, BMJ Medicine has already made a big impact, helping to shape clinical practices and health policies. BMJ Medicine has published 90 research and review articles, with nearly 20% of these works being cited in health policy or clinical guidance. This level of influence is particularly notable given the average time research typically takes to be cited in policy. 2 Since its inception, BMJ Medicine’s article citations have appeared in 33 documents across 15 different countries from 23 sources, including the governments of Switzerland and the WHO, the Analysis and Policy Observatory, and the American Cancer Society.

Remarkable citation impact of elite athlete recovery and performance research

Clare Ardern, Assistant Professor at the University of British Columbia, has made significant contributions to sports medicine through her research on anterior cruciate ligament (ACL) reconstruction. Her 2017 publication 3 in the British Journal of Sports Medicine (BJSM) has achieved exceptional influence with 340 citations—91 times the field average. This landmark study highlighted that 83% of elite athletes return to their preinjury sport level and underscored the effectiveness of ACL reconstruction, setting new standards for recovery expectations and clinical practices. Together with the success of her previous paper, this has further solidified her impact. With 992 citations across 11 categories and a citation rate approximately 216 times the average for similar studies, Ardern’s review 4 of return to sport rates following anterior cruciate ligament (ACL) reconstruction surgery continues to guide postoperative rehabilitation strategies.

The ongoing impact of our research, which is still being cited today, underscores BJSM’s reputation for publishing significant and valuable work, highlighting the broad readership that benefits from BJSM’s research.” Clare Ardern, PhD , Assistant Professor, Department of Physical Therapy, University of British Columbia

Supporting open science through increased preprint publications

Contributing to rising research output in low and middle income countries Since 2002, BMJ Group has contributed to improving global health by participating in the WHO’s Research4Life Organization’s Access to Research Initiative (HINARI) . This programme grants free access to nearly 20,000 journals and e-books to health workers and researchers in more than 100 developing countries. A recent study 5 by the World Intellectual Property Organization (WIPO) reveals that the Research4Life initiative has directly contributed to a significant increase in scientific output. In low and middle income countries, research production in health sciences has increased by up to 75%, and clinical trial activity has risen by up to 35%.

We want to continue reshaping the way medical research is conducted and disseminated, and our co-founding of medRxiv in 2019 with Cold Spring Harbour Laboratory and Yale University is helping us to do that. The best decisions rely on the best evidence. Therefore, we make it our responsibility to help authors and researchers reach and share the most robust evidence available. Collaboration and preprints are crucial in achieving this goal. Throughout 2023, medRxiv contributed significantly to open science by publishing 12,200 preprints, representing a 30% increase from the previous year. Our preprint server allows authors in the clinical field to share their findings quickly with the scientific community, fostering faster collaboration and advancement. Our partnership with medRxiv also enables us to directly transfer manuscripts from medRxiv to all journals within our 60+ collection.

Enabling faster access to evidence

Over 585K open access articles published, with 12.4M citations 6

5.9M mentions of open access articles across social media, international news, policy documents and academic sources 7

Content published open access in our journals received nearly 33M article views by 16M users in more than 190 countries 8

BMJ Journals Staying at the forefront of research

86% of our indexed journals are within the top half of their specialty category, with 26% ranking in the top 10*

100K international news mentions of articles published by BMJ Group in 2023****

10th most cited in Clinical Medicine, 12th in Public Health, and 8 th in Health Services Research**

7K clinical guidance and health policy documents from 74 countries published in 2023, cited BMJ Group***

Sources: *Journal Citation Reports, ** Analysis of most cited publishers ranked by total citations in 2021, 2022, 2023, Broad Research Areas, Dimensions 2024, *** BMJ Impact Analytics I Only impact tool dedicated to health care [Online] https://impactanalytics.bmj.com/, ****Cision, 2024

Retaining impressive rankings BMJ Group publishes over 60 journals, many of which are the most influential titles in their field

GUT Number 5 out of 143 in Gastroenterology & Hepatology 23 JIF | 45.7 CiteScore Thorax Number 7 out of 100 in Respiratory System 9 JIF | 16.1 CiteScore Family Medicine and Community Health Number 7 out of 30 in Primary Health Care 2.6 JIF | 9.7 CiteScore

British Journal of Sports Medicine Number 1 out of 127 in Sports Sciences 11.6 JIF | 27.1 CiteScore Journal of Medical Ethics Number 2 out of 23 in Medical Ethics 3.3 JIF | 7.8 CiteScore Journal of NeuroInterventional Surgery Number 2 out of 15 in Neuroimaging 4.5 JIF | 9.5 CiteScore

The BMJ Number 3 out of 325 in Medicine, General & Internal 93.6 JIF | 19.9 CiteScore

Journal of Neurology, Neurosurgery and Psychiatry Number 5 out of 290 in Surgery 8.7 JIF | 15.7 CiteScore BMJ Sexual & Reproductive Health Number 4 out of 66 in Family Studies 3.4 JIF | 5.1 CiteScore

Family Medicine and Community Health

fmch.bmj.com

Unlocking further insights with BMJ Impact Analytics’ newly launched badges BMJ Impact Analytics makes it easy to find, track, and share the real- world impact of research on health and medical care. The Association of Learned and Professional Society Publishers (ALPSP) declared BMJ Impact Analytics the winner of its 2023 Award for Innovation in Publishing, and it was an OpenAthens 2024 UX Award finalist. Since its launch in 2023, we have been actively collaborating with funders, universities, and researchers globally to comprehend their real-world impact-related challenges and to guarantee that BMJ Impact Analytics keeps progressing and adapting to meet their requirements.

Understanding the impact of our research on global healthcare policymaking would be impossible without BMJ Impact Analytics. The scale and depth of information we can access, and the ease with which we can navigate it, is hugely impressive.” Tim Watson, Director of Marketing and Communications, Office of Health Economics

BMJ Impact Analytics

Our most recent development, BMJ Impact Analytics badges, provide researchers with an instant summary of the real-world impact of the research they’ve either authored or are reading. Subscribed customers can use BMJ Impact Analytics to delve into results and context on sources and citations. The badges use different colours to categorise source types, and the numbers on the badges indicate the actual number of citations for each source.

Clinical guidance citations: 133 Health policy citations: 42 Countries cited in: 14

With a growing number of customers now trialling and subscribing to BMJ Impact Analytics, we are seeing its value in how it is supporting academic institutions and funders. This year, BMJ Group corporate news releases announced that BMJ Impact Analytics is now available to users at Baylor College of Medicine, Bibliosan, the Office of Health Economics, and The George Institute for Global Health.

The BMJ Our flagship journal: supporting doctors to make better decisions

With a 93.6 Journal Impact Factor , The BMJ is currently ranked 3rd in the Medicine, General & Internal category *

bmj.com attracts 1.8M visitors every month **

First published in 1840 , The BMJ is one of the world’s oldest, most influential medical journals

The BMJ received front-page national coverage 6 times in the past year

Sources: *Clarivate’s Journal Citation Reports (JCR) database, ** Google Analytics, July 2024

The BMJ Commission on the Future of the NHS Convening healthcare leaders to reset national priorities In January 2024, we launched The BMJ Commission on the Future of the NHS to identify key areas for analysis and combine them in a series of papers to be published in The BMJ . It has been instrumental in shaping discussions and policies around the future of healthcare in the UK.

By highlighting critical issues such as funding, workforce shortages, and sustainability, the commission has encouraged a broader public discourse, involving patients, health professionals, and stakeholders in meaningful discussions about the future of the UK’s National Health Service (NHS). The BMJ Commission on the Future of the NHS was launched at the House of Commons to a full room of over 70 engaged attendees, including commissioners, journalists, and Presidents of Royal Colleges. Key figures at the event included Steve Brine, Chair of the

One specific proposal is the creation of a new Office of NHS Budgetary Responsibility to hold governments to account for their strategy and plans for the NHS. 9 An Office of NHS Budgetary Responsibility would ensure a more rigorous and independent oversight of NHS budgets. It would help enhance transparency in how funds are allocated and used, promote accountability in financial management, and support better financial planning based on comprehensive and accurate data. Financial decisions would then be well-informed and aligned with the broader goals of sustaining and improving the NHS. In its 75th year, the NHS has never been in deeper crisis, and although the problems may seem insoluble, we believe that the central premise of the NHS – a health service free at the point of care for all the population – is worth fighting for. It is possible to create a vision for a society that prioritises outcomes related to health and wellbeing with the NHS at the heart of it.” Dr Kamran Abbasi, Editor in Chief, The BMJ The BMJ Commission brought together a range of people with different backgrounds and deep experience to produce a powerful set of practical reports which could have important implications for the NHS.” Nigel Crisp, (The Lord Crisp KCB), Former CEO of the English NHS and Permanent Secretary of the UK Department of Health

Health Select Committee, Daisy Cooper, Liberal Democrat MP for St Albans, Sheilabye Sobrany, President of the Royal College of Nursing, and Hugh Pym, BBC Health Editor. The initiative gained extensive national television coverage and front-page newspaper media interest. It also garnered strong dedication and drive from the expert panel of commissioners, showcasing how The BMJ’s extensive networks and ability to attract media attention are crucial in driving meaningful change. The BMJ’s connections enable us to facilitate high-level discussions and mobilise influential voices, ultimately shaping the most beneficial actions and strategies for the future of the NHS. We established The BMJ Commission on the Future of the NHS to address the unprecedented crisis in the NHS. The Commission supports the founding principles of the NHS – in other words, a service free at the point of care funded through general taxation – and urges an all party and whole of government consensus on a long term vision for the NHS.

The Cass Review: a landmark report on gender dysphoria The Cass Review, led by Dr Hilary Cass, was an independent evaluation of the services provided by the Tavistock and Portman NHS Foundation Trust’s Gender Identity Development Service (GIDS). Largely informed by research published in the Archives of Disease in Childhood ( ADC )—a journal produced by BMJ Group and the Royal College of Paediatrics and Child Health —the Cass Review’s findings were prominently featured in The BMJ . Our flagship journal’s coverage helped explain the review’s recommendations to health professionals and policymakers. The Cass Review proposed a more regionalised model of holistic care, underscoring the necessity for enhanced mental health support for young people with gender dysphoria. It recommended limiting the use of puberty blockers in research settings and called for new training programmes and clinical guidelines for health professionals. These proposals have been adopted by the NHS. 10 ADC and The BMJ played central roles in the dissemination of research, evidence synthesis, and professional dialogue relating to the Cass Review.

Reflecting its influence, 75% of primary care clinicians “strongly agree” that The BMJ affects their practice. 11

Content integrity: an embedded approach Integrity goes beyond mere research integrity; it is an embedded approach involving all teams. The BMJ Group Content Integrity team supports journal editors, production, systems, legal, and technical teams through training and specialised advice, ensuring consistent, high-quality research publication. Integrity is a collective responsibility, with publicly accessible policies and author guidance available on the BMJ Author Hub . Investigations into potential issues are thorough, involving pre- and post-publication scrutiny, collaboration with editors, and input from technical experts, ensuring careful and timely corrections or retractions when necessary. The BMJ’s mandatory data and code sharing policy: making improvements in research integrity and quality The case for sharing data from clinical research is strong. 12 Clinical study data includes all information collected during a study, which is then analysed using computer codes to generate results. Unimpeded access to data and code across the research community maximises the value of each research project. Since 2013, The BMJ has required that authors of drug and device trials published in the journal agree to share relevant trial data upon reasonable request. In 2015, this requirement extended to all clinical trials published in the journal. Sadly, not all authors honoured this promise, and trial data sharing remains disappointingly low. That’s why, from May 2024, we implemented a formal policy that enforces authors of all submitted trials to post relevant trial data 13 in an enduring, publicly accessible repository before publication. The new BMJ Group policy on sharing data from drug and device trials mandates that authors must provide access to the underlying data for drug and device trials as a condition for publication. This initiative helps to enhance the credibility of published research, promote independent verification of results, and ultimately improve patient care by ensuring that clinical decisions are based on complete and accessible evidence.

Open data is very important to us, and we anticipate the impact of the open data and code sharing policy will be threefold: Enhanced transparency and reproducibility: The policy requiring the sharing of data and code ensures that other researchers can verify and replicate study results. This transparency helps identify errors, validate findings, and build on previous work, thereby strengthening the reliability of scientific research. Increased collaboration and innovation: Open access to data and code facilitates greater collaboration among researchers across different institutions and disciplines. This openness can lead to innovative approaches, discoveries, and the rapid advancement of knowledge, as researchers can easily build on each other’s work. Improved trust and accountability: The policy promotes accountability by making researchers’ methodologies and data publicly accessible. This openness helps to deter misconduct, such as data fabrication or selective reporting, and increases public trust in scientific research by demonstrating a commitment to rigorous and ethical practices.

Tobacco policy: making a stand BMJ Group’s stringent tobacco policy exemplifies our long- standing dedication to independent publishing. Recognising the harmful impact of the tobacco industry—responsible for killing up to two-thirds of long-term users—we have excluded tobacco-sponsored research from our publications for over a decade. It’s important to note that while our initial policy was a significant step, it did not cover all journals but rather a minority. We strive for comprehensive coverage in our ongoing efforts to maintain integrity in our publishing practices. As a result, in 2024, we extended our policy to cover all content types and to exclude authors with personal financial interests with tobacco companies or tobacco-related subsidiary companies or organisations. These measures strengthen our editorial integrity by supporting the independence of research from commercial interests, and the publication of independent, trusted research, contributing to a healthier world.

The BMJ Investigations Unit: journalism with a global impact The BMJ believes in investigative journalism as a force for change. Over the past decade, our investigative journalism has unearthed research fraud and misconduct, prompted improvements in the transparency of clinical research, led to changes in guidelines and clinical practice, and triggered parliamentary inquiries. As a direct result of this work, medical education provider Medscape bowed to pressure and agreed to permanently remove a series of accredited medical education courses on smoking cessation funded by the tobacco industry giant Philip Morris International (PMI) . The global company acknowledged its “misjudgment” in a letter to complainants and said it will not accept funding from any organisation affiliated with the tobacco industry in the future. The move came after an investigation by The BMJ revealed the PMI deal and the widespread protests among doctors and academics in reaction to the partnership.

Better decisions Supporting health professionals in their clinical decision making

BMJ Best Practice is the only clinical decision support tool with a Comorbidities Manager. This feature prompts the consideration of patient comorbidities and instantly provides a tailored management plan.

Helps 78% of survey respondents to improve the care they give to patients**

Accredited by over 65 institutions across the world*

The Comorbidities Manager has over 50K guideline combinations to support the treatment of comorbidities in the acute setting

Keeps 87% of survey respondents' knowledge current

Rated 4.9 on Google Play and 4.8 on Apple Store, making BMJ Best Practice one of the most highly rated clinical decision support tool apps in the world***

Accessed in over 100 countries worldwide throughout 2023

Sources: * BMJ Best Practice users can now claim continuing professional development (CPD) and continued medical education (CME) points for time spent reading topics: bestpractice.bmj.com/info/us/earn-cme-cpd-points/ ** BMJ Group-led survey of BMJ Best Practice users, H2/FY 2023 *** App ratings, August 2024

Mobilising knowledge for quality improvement and learning health systems BMJ Best Practice is a valuable tool for frontline health professionals, helping to improve patient care and reduce costs. Health professionals frequently use this clinical decision support CDS resource to streamline patient management, often resulting in shorter hospital stays and more efficient use of resources. Multiple examples exist where users or organisations have used BMJ Best Practice to drive behaviour change, and there is now evidence from over 40 publications 14 that BMJ Best Practice drives clinical and educational quality improvement. These publications showcase direct improvements from using BMJ Best Practice in primary, secondary, and tertiary care, including doctors, nurses, pharmacists, physiotherapists, radiologists, lab staff, and allied health professionals. Junior and senior staff have used BMJ Best Practice to drive improvement in various specialties, including general practice, infectious disease, 15 orthopaedics, cardiology, rheumatology, radiology, 16 neurology, and public health. Alongside improving knowledge, awareness, and confidence, BMJ Best Practice helps to verify the standard of care, 17 review and analyse patient safety events, 18 and build the evidence for intervention. 19 The purpose of CDS is to provide evidence based and timely information to clinicians to inform decisions about health care and patient needs. However, it also has the potential to lower costs, improve efficiency of care transitions and promote effectiveness of health care services. 20 This year, as part of the intervention in Georgia that builds on five years of success in helping to enhance case detection and reporting efficiency, we launched our BMJ Group CDS Training Initiative in collaboration with the Asian Development Bank (ADB) . 21

BMJ Best Practice and BMJ Learning cover almost all conditions I see regularly in my clinic. There are a lot of resources out there, but BMJ Best Practice gives you exactly what you need when you need it.” Dr Tea Sakhokia , Family Doctor, Meore Nosiri village, Senaki district, Georgia

BMJ Best Practice calculators: essential tool to transform clinical efficiency In clinical practice, time and accuracy are paramount. Health professionals often juggle multiple responsibilities, from patient care to administrative tasks, making efficient decision support tools essential. BMJ Best Practice has a comprehensive collection of over 250 calculators. These help health professionals make data driven decisions more quickly by giving them access to reliable, evidence- based interpretations, thereby enhancing the quality of patient care. By integrating such invaluable resources, BMJ Best Practice empowers clinicians to make informed decisions swiftly and confidently.

One of the greatest time savers in the BMJ Best Practice app is its extensive collection of calculators. With nearly every type of ratio and score calculator readily available, it ensures trustworthy, efficient clinical decision making.” Dr Mohammod Kamrul Islam , Clinical research fellow, University of Oxford

Empowering nursing training and education in Canada With the growing number of nursing students and the increasing demand for improved educational resources, BMJ Best Practice has become an essential tool for Amanda Ross-White, a health sciences librarian at Queen’s University in Kingston, Ontario.

Since the pandemic, Ross-White has observed a significant expansion in the university’s nursing programme. The tool not only enhances her teaching of systematic reviews and evidence based practice but also aids her in helping students navigate the complexities of evaluating and applying information in both academic and clinical settings. “Students need to understand the entire information landscape, even if they’re never going to be publishing their own research. They also need to know how point of care tools take that research and use it to develop tools they can use at the bedside. I have them develop a patient handout by

using point of care tools, like BMJ Best Practice, and translating topics into lay language.” BMJ Best Practice provides quick access, so teaching with it ensures that nursing students at Queen’s University are always well equipped to meet the challenges of their profession and improve patient care. Ross-White’s clever integration of BMJ Best Practice into her educational programmes exemplifies how its use can enhance the learning experience and support the evolving landscape of nursing education.

Bridging knowledge gaps: the impact of BMJ Best Practice Comorbidities Manager on healthcare In the UK, one in four adults has two or more medical conditions, and one in three adults in hospital has five or more conditions. 22 In the US, 42% of people are dealing with two or more multiple chronic conditions , and 12% have at least five. 23 These conditions lead to poorer functional status, reduced quality of life, and increased use of healthcare resources.

A 2024 study 25 evaluating the usefulness of BMJ Best Practice Comorbidities Manager by using a semistructured online questionnaire in a cohort of recently qualified junior hospital doctors revealed that: 85% of participants obtained useful information from the resource 95% of participants considered that they could apply this information to provide evidence based treatment This evaluation suggests that the BMJ Best Practice Comorbidities Manager has the potential to enhance the preparedness of junior doctors by providing useful information at the point of care. Such findings emphasise the tangible difference that innovative digital point of care information systems can make in enhancing clinical preparedness and decision making, fostering a healthcare environment where both patients and providers benefit from timely, reliable information.

To tackle the complexities of multimorbidity, BMJ Best Practice launched its integrated Comorbidities Manager in 2022. The tool prompts health professionals to consider the patient’s comorbidities when accessing treatment information and produces an initial management plan tailored to the patient’s unique needs. Credible evidence demonstrates both the importance of taking comorbidities into account when managing patients and the role that the BMJ Comorbidities Manager can play in this regard. 24 Treating patients’ acute presentation alongside existing conditions enables hospitals to increase the quality and efficiency of care. It leads to better clinical outcomes, shorter hospital stays, and fewer readmissions.

BMJ Learning: sharing knowledge and problem solving skills BMJ Learning is a beacon in healthcare education, empowering doctors and health professionals with cutting edge knowledge and skills across various medical specialties. Through rigorous academic studies , its effectiveness is asserted by users and educators, and demonstrated by success statistics. Results from a recent survey assessing the use of internet resources for continuing professional development 26 revealed that general practitioners in Scotland preferentially and frequently use BMJ Learning for their continuing professional development (CPD), focusing on patient information, clinical questions, and evidence based, peer reviewed materials. Evidence of effectiveness A study on the performance of the BMJ Learning training modules for electrocardiogram (ECG) interpretation in athletes showcases the effectiveness of the online modules in significantly improving ECG interpretation skills among primary and secondary care health professionals, with an overall improvement of 15.3% post-course. 27 Our modules can significantly enhance health professionals’ knowledge and problem solving abilities in managing infectious diseases, with a substantial mean improvement in test scores from 47.8% to 82%. This significant test score improvement trend was noted in an analysis of the infectious disease modules on BMJ Learning to determine if the e-learning modules enable users to improve their applied knowledge and problem solving skills in this field. The study indicates the potential of digital education to improve infectious disease management practices globally. 28

Translating learning into practice Beyond knowledge acquisition, BMJ Learning encourages doctors to put their learning into practice. A study found that 88.6% of participants reported better implementation of NICE guidelines in practice after completing BMJ Learning modules. 29 Research also reveals that after engaging with BMJ Learning, health professionals exhibit better adherence to guidelines and increased implementation of best practices in patient care, thus bridging the gap between theory and practice. 30 Having an environmental impact A study assessing the potential environmental impact of e-learning in medical education 31 modelled various environmental outcomes that might emerge from the use of an e-learning resource (BMJ Learning) in CPD, from the perspective of a General Practitioner (GP) who completes 50 hours or credits of CPD per year. It revealed that a high user of e-learning can reduce the carbon footprint that relates to their CPD by 18.5 kg.

PACES: a revolution in reshaping doctor exam preparation

With AI technology at its core, BMJ OnExam PACES is set to transform the way doctors prepare for their PACES exam. In April 2024, we unveiled BMJ OnExam PACES, the first AI-driven revision product for a postgraduate medical qualification’s objective structured clinical examination (OSCE) element. This marks a pioneering moment in exam revision, offering candidates the unique opportunity to engage in real time interactions with a range of simulated patients simply by speaking into their computers. Similar tools for other specialities are on the way.

I think this is a groundbreaking product to help one become proficient in PACES revision. With different schedules, it is really tough to find a partner to practice with. Not only does this solve that problem, but it also provides excellent point based feedback, which is an excellent tool for improvement.” PACES candidate

Better systems Today’s health systems rely on robust policies and guidelines to deliver the best care for patients

Over 10 years of successfully incorporating community engagement in our operations, from local programme advisory committees to bursaries and support for local patients attending major health forums

31K applications to jobs within various clinical fields were facilitated by BMJ Health Careers

In 2023, nearly 10% of articles published in BMJ Group journals featured corresponding authors from low and middle income countries

97% of BMJ Leader Live delegates subsequently made changes to their practice or organisation

90% of BMJ Best Practice patient leaflets produced in 2023 were reviewed by our patient panel

BMJ TAG: making meaningful contributions to patient care In the last year, the BMJ Technology Assessment Group (BMJ-TAG) has played a key role in evaluating the safety and effectiveness of drugs for public use through the NHS, contributing to the development of high profile NICE guidance.

In July 2023, rimegepant was recommended for use in the UK’s NHS by the National Institute for Health and Care Excellence (NICE) as a preventive option for adults with episodic migraine and in October 2023, it was recommended as a treatment option for acute migraine in adults. Rimegepant is an oral treatment in the form of a wafer that dissolves on or under the tongue. It was the first oral preventive option to be recommended as the fourth line by NICE, offering an alternative to existing treatments that require injections for up to 145,000 people in England. In the acute setting, rimegepant is the first treatment to be recommended by NICE and may be available to up to 13,000 patients in England, offering an alternative to treatments that were originally designed for use in other conditions. Later, in May 2024, atogepant was the latest preventive migraine treatment to be recommended by NICE. In the form of an oral tablet, atogepant is the second oral treatment to be recommended in the fourth-line setting for the prevention of episodic migraines (following rimegepant), but the first oral treatment at this line of therapy for the prevention of chronic migraines, providing more choice for those with episodic migraine and an oral alternative to existing preventive treatments for chronic migraine which require injections. The new guidance may provide an additional treatment option for up to 170,000 people in England.

Rimegepant and atogepant represent significant advancements in migraine care. According to patient and healthcare experts involved in the NICE appraisals, migraines can severely impact daily life and current treatments often fall short. These new oral medications offer a much-needed improvement in treatment options for adults with migraines. In November 2023, foslevodopa-foscarpidoba became the first treatment for Parkinson’s disease to be approved by NICE for use in the NHS. It is administered as a continuous subcutaneous infusion (24 hours a day), with release controlled by a small automatic pump with an option for manual boost if needed. Unlike traditional oral treatments, it provides a steady supply of medication, preventing the harmful spikes and drops in dopamine levels that cause movement problems. Limiting movement problems can significantly improve Parkinson’s Disease patients’ quality of life. Foslevodopa- foscarpidoba provided a notable improvement in quality of life over Levodopa-Carbidopa Intestinal Gel (LCIG). LCIG has a similar concept for regulating levodopa administrations/dopamine levels but involves invasive surgery, which was both costly and negatively impacted patients’ quality of life. An NHS England News item from February 2024 outlines how the patient community welcomes the new treatment and estimates that nearly 1000 patients will benefit from it. 32

A migraine attack can be incredibly debilitating. Symptoms can include intense head pain, loss of or changes to the senses and lack of ability to carry out day-to-day life. It is positive to see even more therapies emerging for people with migraine, as many still rely on treatments developed for other conditions. We now need to ensure access to the newer treatments is swift so that migraine patients can benefit from them. Rob Music, Chief Executive, The Migraine Trust

“For someone who has lived with severe migraine for over 40 years and for whom no treatment has ever worked, the innovation of atogepant has brought me hope and life-changing relief.” Deborah, migraine patient

BMJ Careers: connecting job seekers and employers in healthcare Since 2005, BMJ Careers has been essential in bringing job seekers and employers together within the healthcare sector. Today, nearly half of NHS trusts and health boards in the UK subscribe to BMJ Careers, and the platform has long established itself as a trusted resource for recruitment and career development. It supports 55% of consultant vacancies in England and Wales, highlighting its importance in the job market.

In the second half of 2023, BMJ Careers received 67.4K medical job applications, a 12% increase from the year’s first half and a 39% rise from the same period in 2022.

Addressing the NHS staffing crisis: how BMJ Health Careers is transforming mental health recruitment In 2022, we responded to the staffing crisis by launching BMJ Health Careers—the UK’s first dedicated recruitment service for all clinical mental health roles. The online job board provides mental health specialists with thousands of live vacancies for their area of expertise. During the past year, BMJ Health Careers facilitated 31,000 applications, a threefold increase from the first half and a tenfold rise from the previous year. These figures highlight our vital contribution to helping health organisations grow, retain, and upskill their clinical workforces, meeting the industry’s ever evolving needs.

“I advertised for a salaried GP through BMJ Careers. We have managed to recruit successfully and have had some fantastic applicants via the advert.” Claire Banks, Blackburn Road Medical Centre

Celebrating a decade of patient and public partnership: improving healthcare and health systems Patient involvement in healthcare research is changing the healthcare landscape and building better health systems. Patients are becoming key decision makers in various aspects of healthcare, including research, where funders actively support patient and public involvement. In July 2024, The BMJ marked ten years of working in partnership with patients and the public with a special patient led issue. The articles in this issue have been written and curated by patients and the public on topics that matter to them. While we highlight and celebrate the progress made over the last ten years, we also look to what needs to happen next to ensure patients and the public are part of all aspects of healthcare.

PxP Conference: advancing patient engagement in research

perspectives effectively into research and policy. 33 Other work also notes the positive outcomes of patient-led approaches, affirming the conference’s role in promoting best practices in patient engagement. 34 The work of the PxP steering committee laid a strong foundation for ongoing patient engagement initiatives and provided a successful model for incorporating patient perspectives into research and policy.

In 2023, the For Patients, By Patients (PxP) conference made history as the first fully patient led event designed to elevate patient engagement in research. Over three days, the virtual conference delved into topics such as boosting skills development, advancing health research innovation, and raising the benchmarks for best practices in patient engagement. 32 Research published in BMJ Open highlights how patient- led initiatives like PxP integrate patient

BMJ Group’s support in amplifying the 2024 conference and expanding our reach is greatly appreciated.” Dawn Richards , Patient Engagement Specialist, Canadian Institutes of Health Research Institute of Musculoskeletal Health and Arthritis

The impact of patient advocacy on peer review A step-by-step guide to peer review: a template for patients and novice reviewers, 35 co-authored by Liz Salmi and Charlotte Blease, PhD, provides a structured approach to peer review to enhance the involvement of patients and novice researchers in the review process. This guide has been valuable in helping new reviewers understand their roles and the importance of reporting on the impact of research on patients. It has received six formal citations, including one in the monograph Applying Metascientific Principles to Autism Research , which offers practical ideas for academics to improve the quality of their research on the autism spectrum. As an educator at Uppsala University in Sweden, Dr Blease finds the guide particularly useful for PhD students and early career researchers. It is an educational tool that helps familiarise them with the peer review process, enhancing their academic training. Both Salmi and Blease believe that the guide inspired the development of similar resources and increased the involvement of patient advocates in peer review, thereby broadening the scope and diversity of reviewers. BMJ Group’s support through its dedicated patient advisory board also significantly contributed to the guide’s visibility and success.

This document is a good example of patient collaboration improving research environments. Such advice must be properly articulated and accessible, as it can significantly enhance research practices.” Dr Charlotte Blease , PhD, Associate Professor, Participatory eHealth & Health Data Research Group, Department of Women’s and Children’s Health, Uppsala University; and Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School

Almost 90% of research papers first submitted to The BMJ in 2023 and sent out for peer review were also sent to a patient and public reviewer for their opinion.

Global partnerships for impact: advancing health and innovation From amplifying and advancing research to shaping policy agendas and addressing global challenges that impact the world’s most vulnerable people, we collaborate with many international organisations to deliver results. Our partnerships span corporations, foundations, multilateral organisations, non-governmental organisations, and governments, allowing us to tackle critical global issues beyond healthcare, including sustainability, poverty reduction, gender and health inequalities, and the evolving landscape of academic research. Through our tailored supplements and themed collections, we are successfully boosting our partners’ visibility and influence within the health community. The high-level discussions and policy dialogues we convene also help shape effective policies and strategies to improve health systems. Our accredited learning modules and interactive events also offer valuable training, driving innovation and skill development. By bringing together leaders from multiple sectors and geographies through BMJ Group-organised roundtables, events, and webinars, we provide platforms for sharing knowledge and best practices that benefit both our partners and the health systems they serve.

Helping to shape future global development strategies and policy directions In February 2024, The BMJ and the Center for Global Development (CGD) co-hosted an event on the future of UK global health leadership and policy. Set against the backdrop of the ongoing recovery from the pandemic, and building on a new report from the CGD titled, The Future of UK Global Health Policy: Challenges and Opportunities , that examines past global health financing efforts, this event provided a critical platform for evaluating the UK’s role and strategies in global health in 2024 and beyond. Chaired by The BMJ’s International Editor, Dr Jocalyn Clark, the event brought together esteemed experts for a panel discussion on the UK’s future role in global health. The debate emphasised the importance of collective efforts and international solidarity, featuring insights from Peter Baker, Deputy Director of Global Health Policy and Policy Fellow at CGD; Mishal Khan, Professor of Global Public Health at the London School of Hygiene and Tropical Medicine (LSHTM); Clare Wenham, Associate Professor of

Global Health Policy at the London School of Economics and Political Science (LSE); Anna Wechsberg, Director of the International Directorate at the UK Department of Health and Social Care, and Chris Lewis, Deputy Chief Scientific Adviser at the Research and Evidence Directorate (RED) of the Foreign, Commonwealth & Development Office (FCDO). It resulted in actionable recommendations for UK government strategy, focusing on revitalising foreign aid and clarifying health and development commitments. Their recommendations provide a foundation for shaping future UK government strategies and policies, influencing upcoming political platforms and potentially guiding international development assistance priorities.

Co-hosting this event with The BMJ provided a vital platform for re-evaluating the UK’s role in global health as we recover from the pandemic. Our discussions, shaped by the insights shared, underscore the need for a strategic reimagining of foreign aid and development commitments.” Peter Baker, Deputy Director, CGD Global Health Policy Programme, and Deputy Director, International Decision Support Initiative

BMJ Collections: addressing critical issues in global health and medicine The BMJ Collections are a series of articles drawing attention to key priorities, neglected issues, or needed debates in global health and medicine. They are often created in collaboration between The BMJ and other international organisations to contribute to contemporary conversations in global health, generate visibility for shared priorities and proposed solutions, and influence policy and decision makers in health to create impact.

Examining systemic failures: The BMJ’s US covid-19 series The BMJ’s series on US covid-19 lessons for future health protection and preparedness 36 stands out as a crucial resource amid the American presidential election year and evolving challenges for global health security. It follows the previous series in The BMJ that helped to inform the UK’s covid-19 inquiry 37 and drive accountability for Canada’s covid-19 response. 38 The post-covid-19 era is marked by heightened interdependence and increasing inequality, and this series of articles provides essential insights into the pandemic’s impact domestically and globally, and draws lessons for future US leadership in international health. This series enriches our understanding of covid-19 and underscores the urgent need for systemic change in the public health system by amplifying diverse voices and interdisciplinary perspectives. Guest editors Professors Gavin Yamey and Ana V Diez Roux call for crucial systemic reforms that should also be central to the manifestos of the 2024 US presidential candidates.

Understanding online behaviour and health outcomes: insights and strategies from The BMJ’s 2024 research collection, How are social media influencing vaccination? The BMJ played a pivotal role in exploring and addressing the influence of social media on vaccination by publishing a comprehensive collection of research 39 that examines how social media impact vaccination beliefs and behaviours worldwide. In addition to publishing the research, The BMJ commissioned further analysis and opinion articles to address the emerging challenges in this field. The BMJ’s involvement also includes releasing a dedicated podcast series and forming an editorial advisory group to select topics and enhance the quality of discourse. The findings suggest that while broad social media bans have been ineffective, developing targeted methods to address misinformation could be more promising. 40

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