The case for the South Australian Journal of Medicine

Why in the world would we want to start a medical journal in South Australia? Many journals exist primarily to generate revenue for publishers, relying on volunteer reviewers and authors who pay to see their work in print. Other journals exist to share polished research with as wide an audience as possible. In contrast, the South Australian Journal of Medicine (SAJM) is being established purely to strengthen and disseminate medical scholarship in South Australia. It is a place to share sound clinical work, certainly, but also a way of gathering a community around the practice of medicine as a calling: thinking carefully, observing closely, teaching one another and working out how to do better. A local journal can remind clinicians that they are more than interchangeable cogs in a service machine, and that scholarship, reflection and teaching are intrinsic to professional identity, not optional extras squeezed in on the run. In South Australia, such a journal can give that calling a visible form by creating a shared space in which clinicians at all levels learn to think, write and improve together.

An entry-level journal in the zone of growth

For that shared space to work, it has to feel accessible. The SAJM is deliberately entry level. It was designed for medical students, nursing students, basic and advanced trainee doctors, allied health students, junior consultant physicians and senior clinicians of any kind who want to dip a toe in the water. It is for physiotherapists, nurses, speech pathologists, pharmacists and others whose work shapes patient care but rarely finds its way into print. For seasoned researchers with established publication pipelines in high-impact journals, this will not displace existing plans, but it is not intended to be another rung on the prestige ladder. Instead, it is more akin to a couch-to-5k run for scholarly work: a structured, humane on-ramp into clinical research and reflective practice.

Educational theory offers a helpful analogy in the ‘zone of proximal development’, which describes the space in which a learner is guided to perform a task that would be too difficult alone. A local journal can serve as scaffolding for novice authors in this zone: challenging enough to foster growth but not so daunting that it invites frustration, avoidance or shame. In that sense, the SAJM is less a distant gatekeeper and more a supportive structure that helps clinicians take the next step in their scholarly development, with mentors and peers alongside them.

Why South Australia needs its own platform

There is ample material in South Australia that is clinically relevant, locally meaningful and currently lying fallow. Across the state, trainees and Master’s degree candidates complete accreditation projects that are related to health care, as well as quality improvement initiatives and audits, that meet training requirements but often go no further. At the end of training, many simply want to move on, and time-poor supervisors lack the bandwidth to shepherd these projects into publication. The result is a quiet erosion of potential: lessons learned but not shared, innovations tested but not spread, and trainees who never quite see themselves as scholars.

A local journal can change that trajectory by providing a baby chair for writing and publishing: a visible structure and a community that says, ‘This is for you, and we will help you get your work across the line’. For a student, the SAJM can be a first, confidence-building publication that opens the door to more ambitious work later. For a public health clinician, it can be a sounding board to a readership that understands the local context. For the state, it can help convert individual learning into a collective research culture that will take decades and generations to mature—so building one must start now.

Learning by doing, together

Much of what makes clinicians excellent is not strictly required by policy or standards. One can practise fairly average medicine knowing fairly little, teach minimally, skip autopsy and radiology conferences, and rely on reports rather than reading films or formulating proper differentials. One can learn from podcasts and videos ‘when there is time’, and remain a competent, efficient cog in the machine. But this is a low bar to set for us and for our health system.

A journal such as the SAJM is an undercurrent that pulls in a different direction. It asks, How many structured opportunities do trainees and juniors need to become their best, and what responsibility do we have to create those opportunities locally? It pairs inexperienced but ambitious clinicians with a smaller group of academic mentors so that learning to design, conduct and publish clinical research becomes a shared endeavour. Reading and reviewing other people’s work will become a part of this apprenticeship; reviewers who might never volunteer for a major international journal can learn the craft of critique in a supportive, local setting. Writing remains hard work, but as the saying goes, ‘writing is thinking’, and clearer writing enables clearer thinking and better care.

In any medical journal, the greatest beneficiaries are the patients and communities whose care is improved by clearer thinking and better evidence. The second-greatest beneficiaries are the authors themselves, who, through drafting, critiquing and revising, become stronger versions of their former professional selves. Each completed article is both a contribution to the literature and a small act of personal transformation, reinforcing habits of curiosity, rigour and reflection that will persist long after the relevance of specific results have faded.

Starting small, accepting imperfection

They say that Warren Buffett is as wealthy as he is simply because he has lived to be 95 and is still working; had he retired at 65, he might have been worth only a fraction of his current fortune. Similarly, the New England Journal of Medicine (NEJM), founded in Boston in 1812 and renamed in 1928, is extraordinary in part because it has had over two centuries to grow, adapt and compound its influence. When those early Boston clinicians began what became the NEJM, they were simply trying to help one another by sharing observations, ideas and critiques, building an exchange that improved the skills of both authors and readers. The greatest beneficiaries then, and arguably now, were the people of Boston and the surrounding region, whose care has been shaped for generations by a culture of rigorous local scholarship. A journal in South Australia could, over time, have a similar effect on the health of our own communities.

The SAJM will almost certainly start in a modest, even average, state. Early issues may contain work that, by the standards of established journals, looks like a demo track rather than a finished album. Yet, judging any creative or scholarly endeavour solely by its earliest outputs risks discarding what might, with time and persistence, become something of enduring value. The key is to accept that the first steps will be imperfect, that the outcomes will improve as the community learns, and that ‘we gather strength as we go’.

‘Even though’ and the case for better, not just good enough

Objections are easy to list: there are already tens of thousands of medical journals; concerns about quality are legitimate; South Australians can publish in national and international outlets; and we will get by without a local journal. By the same reasoning, one might argue that a small-town newspaper is unnecessary when global media exist, that a local bank is redundant when larger banks offer slicker services or that a community garden is superfluous because supermarkets sell vegetables at a lower cost. Yet, people continue to invest in local newspapers, banks, gardens, book clubs, neighbourhood watches and quilting circles—not because they are strictly necessary, but because they create belonging, trust and shared purpose.

The SAJM sits in that ‘even though’ space. Even though clinicians can publish elsewhere, there is value in a local venue that reflects the healing work quietly undertaken in South Australian hospitals and communities. Even though the health system will function without it, South Australian medicine will be richer with it: more reflective, more ambitious and more connected.

A higher aspiration than ‘average’

It is possible to run a hospital that meets national standards, works hard yet remains, in truth, only average. Talented clinicians can provide solid care, go home and treat research and publication as a niche hobby. For the individuals involved, this may feel sufficient; for the community, it leaves unrealised the possibility of something better. The question for South Australia is not whether we can get by without a journal, but whether it is acceptable to aim only for ‘good enough’ when we could, with effort, create a culture that consistently reaches higher.

Starting a local medical journal is not akin to launching a hedge fund or a defence contractor; it is closer to founding a small-town newspaper or a community garden. It will require time, patience and a willingness to risk mediocrity at the beginning. It may fail. But to avoid it because it might fail, or because it is not strictly necessary, is to accept a lower aim than we are capable of. The alternative—committing to build something that better serves our patients, better develops our trainees and reflects the quiet excellence in our hospitals—is demanding, but anything less is ultimately much less satisfying.