How international is Medical Education?
AIMS: To consider Medical Education's claim to international status in terms of the extent of international authorship within published articles, the degree to which authors draw on the international literature to support their work, and its self-citation rates and publication decisions. METHOD: We examined 6 journals' citation rates for the period 1997-2001 to see if there was evidence of national publication bias; we calculated their self-citation rates to see if this had any influence on impact factor, and we examined Medical Education's management files for trends which might indicate publication bias due to country of origin of authors. RESULTS: All 6 journals exhibited a bias in favour of citing journals from their own countries. The US journals were more likely to cite journals from their own country. Medical Education was most likely to cite journals from non-UK countries. Self-citation rates did not appear to affect impact factors. The ratio of UK to non-UK papers published in Medical Education has not changed significantly over the period studied although non-UK submissions increased sharply in 2002 and the number of North American submissions has doubled since 1998. CONCLUSION: Medical Education is justified in calling itself an international journal to the extent that the majority of papers it publishes are from countries other than the UK, and it is more likely than other journals in the field to publish papers which cite work in journals published outside the UK. Nevertheless, there is some evidence of publication bias in the journal and more work is needed to discover why this is the case. Various strategies to address the issue of national bias in Medical Education are discussed.