Modern academic competition measures recognition often based on publications. The number of publications is used widely as an academic measure for career progress, academic advancement, quality of research, capital allocation, and ultimately funding and/or hiring. This academic dogma has created a “curriculitis” early in the medical career of the young aspiring surgeons.1 The threat of ‘publish or perish’ has unfortunately led some surgeons to produce papers without the will, gift, or conviction to do it “right”. In addition, there looms the false attraction of the predatory nature of pseudo-journals, which take advantage of this situation, often bowing to quantity over quality.

In this ever more prevalent chaos, there remain the well-intentioned scholars who continue to strive to produce good, high quality research that can be disseminated through good quality, legitimate medical and scientific journals. These ardent, committed researchers surely have difficulty publishing in this extremely competitive arena, frequently due to the struggle to find formal guidance and/or true mentoring in the area. Our team of three surgeons joined minds to help those in need. We are experienced editors, peer-reviewers, and fundamentally authors, with a collective experience of over 1250 PubMed manuscripts and many books. Our group found a form of “divine” help with this task as provided by the Bishop of San Sebastián in Spain, Monseñor Jose Ignacio Munilla. The learned bishop lectured on “Fourteen Crutches for Mediocrity” (https://www.enticonfio.org/2018/03/20/14-muletillas-de-la-mediocridad/). He consciously addressed the spirituality of the audience; however, his comments were not only addressed to religious people, but they can also be extended to many areas unrelated to theology. Indeed, we maintain that the Bishop's lessons may guide the practice of good research and serious scholarship. Here are the 14 crutches and their adaptation to medical writing.

We frequently review low-quality manuscripts submitted to high-quality journals. Clearly, this is based on the idea that “if it is free and there is no problem, why not submit to the best journal available? It almost undoubtedly will never be published in that journal, but if not, I get a peer-review for free”. But this disingenuous approach creates unwarranted problems. First, journals receive many unworthy manuscripts; second, bad research cannot be fixed by an excellent peer review; third, this conscious abuse of the time-honored peer review process and serious dedication by a journal toward excellence will, if such conscious abuse is repeated, bode poorly (and appropriately) for the reputation of the authors. Journals differ considerably in focus and quality, and each manuscript should be submitted to the proper journal.

Do not justify your incomplete manuscript by comparing it to others that are equally bad or even worse. “Why should I make the manuscript better? I have seen worse papers in the same journal”. We all acknowledge that the process of peer-review is not a perfect science; reviewers may be biased by their own beliefs, and they may not be free of prejudice, bias, jealousy, and xenophobia.2 But we maintain that in good journals with an insightful editor, this possibility is extremely rare (and hopefully screened out by the editor). Submitting a poorly thought-out manuscript with the false justification that “there are worse” decreases the chances of acceptance and reflects the laziness of the Authors.

Do not hide behind the majority. As an example, unethical conduct occurs frequently (on average 2% of scientists admit having falsified their research findings at least once, and up to 34% admit other questionable research practices3).

This means “why would I exaggerate in how careful I do this? Any which way is fine”; This is a false prudence, trying not to be perfect because perfection is unreachable. Saint Vincent de Paul said that “to be good one needs to be very good”. A research protocol is never perfect, as there are always some limitations; however, the work must be carefully planned to limit as best as possible such imperfections. Do not assume that flaws are inherent and that exaggerated carefulness is permissible. Writing a manuscript is not only science but also a type of art as well. It may not be scientifically perfect, but it can always be literarily perfect.

“Oh well, I guess I will do it tomorrow if I get around to it”. Remember that tomorrow usually or often never comes. Procrastination is one of the common problems of modern life. Work every day on your research even if it is something as trivial as aligning a table. This habit will keep the torch burning and prevent having to start the task again tomorrow.

Do not excuse yourself with the premise that things would be different in another situation, at a different institution, or another time. Good research may come from less known authors or less well entitled “academic” centers, as long as a good idea is well presented with data to support it.

It is not used anymore should not be an excuse to abandon a good defensible idea. Brand new “HIGH TECH” methodology/instrumentation/operative devices may be extremely exciting and appealing, and one may think that journals only publish new technology or new trends. This is not true. There are several old questions still to be answered.

The old ways may be appropriate in many situations because of lack of technology, training, expertise, or availability of this latest “innovation” at least at the current time.

This Spanish quote inverting “cousin” and “brother” means that when one is hurt the tendency is to try to avoid close relationships to avoid being hurt again. Every researcher has had papers, grants, etc. rejected. Keep your devotion to good science and do not give up the science easily, do not be afraid or disappointed by a rejection. Enjoy the joy of having a paper published.

“Without recognition and acknowledgment of my contribution, I am not interested in pursuing this work”. Not all research is immediately accepted. Do not investigate a topic or write a paper based solely on the desire to acquire recognition; good work will be eventually recognized by those who care. Indeed, much of the recognition/satisfaction is by yourself for the hard work, the feeling of a job well done, and the determination and dedication you have put into it.

This Spanish quote means “let the emotion take over”. This phrase is intended to show that frivolity but not serious, fact-based reflection on the true meaning and impact of your work and contentions are the consequence of a disingenuous lack of true, indepth reflection.

John F. Kennedy once said that “we choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard”. These were not only words to incentivize, but the phrase “and do the other things” shows that professional and personal life must be included in the overall plans and approach to the challenge; they cannot be neglected out of laziness or indolence during a new endeavor.4 Challenge yourself,4 search out mentors, possibly start with more modest projects to check if you really want to pursue this pathway and whether you can do it appropriately, otherwise choose another pathway in which you can succeed without logismoi.

The impetus and drive to succeed ultimately comes from within you and your beliefs.

You can only really claim that you do not feel like doing it unless you have tried- really tried! However, a successful path often requires some help not only from within yourself but also from others; attempts without proper guidance, without well-thought preparation, and of course without motivation will fail and lead to disappointment.

Whatever you do, work at it with forethought, devotion, help from others, and all your heart.

Resilience was the theme of 3 presidential addresses from 3 different academic surgical societies (Society of Surgery of the Alimentary Track, the Eastern Association for Surgery of Trauma, and the Society of University Surgeons).5–7 In all 3, resilience was claimed as a necessary characteristic to excel in surgery.

As stated and emphasized above, all good authors have faced rejection of their manuscripts. Strive to improve your manuscript and keep trying but remaining cognizant of these 14 Crutches. C.S. Lewis said that “Humility is not thinking less of yourself, it is thinking of yourself less”.

Logismoi is a Greek term that describes thoughts that are tempting or assaultive to the concept of always trying to do your very best. The 14 crutches presented are logismoi that may jeopardize good research and publication as well as self-reliance and self-dignity. Clean your mind from these false crutches that will only serve to lessen your work.

The authors declare that they have no conflict of interest.