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Physiotherapy 94 (2008) 29–34

Expert article

Facilitating writing for publicationRowena Murray ∗, Mary Newton

Educational and Professional Studies Department, University of Strathclyde, Henry Wood Building,76 Southbrae Drive, Glasgow G13 1PP, UK

bstract

In order to develop physiotherapy practice and interventions, it is essential that both service development and research be brought intohe public domain. Writing for publication requires a high level of writing skills, and clinicians facing competing demands for their timeeed strategies for productive writing. These skills and strategies are not always developed in undergraduate or postgraduate courses. Thistudy assessed a writing for publication course for allied health professionals. It explored the writing skills and strategies that participantseveloped during the course. It also assessed whether these skills and strategies were sustained in clinical workplaces after the course. Clinicalrofessionals, including physiotherapists, who had attended the 6-month course were identified. Semi-structured interviews were conductedith 12 of the 14 participants (four males, 10 females), including six physiotherapists. The results show that course participants reported a

ange of benefits, which included improved skills and increased confidence. They also increased their published output. However, participantslso identified the need for ongoing support. This paper identifies the main issues in establishing writing for publication as part of the alliedealth professional role.

2007 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

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eywords: Writing; Publication; Output; Process

ntroduction

Historically, clinical physiotherapists have not experi-nced the same pressure as their academic colleagues tondertake and publish research. However, the culture inhe clinical world is changing rapidly, as more cliniciansndertake higher degrees, and as clinical posts have comeo include an academic remit. Most clinicians will not,t any stage in their career, be taught how to write forublication. In the past, many clinicians never published.owever, as increasing numbers of physiotherapists com-lete research degrees, there is an expectation that they willublish their findings, and that these findings will strengthenhe evidence base of physiotherapy and improve patientare.

However, it is not yet the case that all research and

ractice development projects are converted into publica-ions, suggesting that there is a potential wealth of datand evidence that is not being disseminated [1,2]; an out-

∗ Corresponding author. Tel.: +44 141 950 3066; fax: +44 141 950 3367.E-mail address: r.e.g.murray@strath.ac.uk (R. Murray).

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031-9406/$ – see front matter © 2007 Chartered Society of Physiotherapy. Publisoi:10.1016/j.physio.2007.06.004

ome that has been described as unethical [3]. In addition,here physiotherapy degree programmes have evolved to

nclude a research component, it is less likely that they willnclude writing for publication. Although there is a grow-ng expectation that physiotherapists should publish, theres no consensus that writing for publication should be partf the physiotherapy curriculum. In this respect, physiother-py is like many other disciplines, in not yet positioninghis important skill at either undergraduate or postgraduateevel. In this context, there is unlikely to be consensus abouthat form such skills development might take, and all of

hese issues can make writing for publication problematic forriters.The lack of consensus is perhaps partly attributable to

he sparseness of literature on writing for publication. Whilehere are many general texts on the subject, there is very lit-le on the specific practices that writers develop to enablehem to publish. A systematic review of the literature on aca-

emic writing identified 17 papers evaluating the outcomef programmes designed to support writing for publica-ion [4]. Although its authors did not limit the review tohe health professions, they found that most publications

hed by Elsevier Ltd. All rights reserved.

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ere by and/or about health professionals. The literatureas mainly American and involved academics. Only twoublications cited non-academic nurses [5,6]. The interven-ions used varied in terms of duration and concentration,rom monthly meetings over 3 months to 1-day work-hops. The study of a course run as a series of monthlyorkshops over 3 months reported a 15% publication rate

5].Other research reviewed also reported the rate of pub-

ished output resulting from other forms of intervention. Forxample, a 1-day seminar increased the publication rate by%, whereas the same number of hours spread over 5 monthsncreased the rate by 56% [6]. Both of these studies suggestedhat there were barriers to nurses writing for publication,ut acknowledged that publishing was essential in order tomprove patient care, enhance the profession and add to theody of theory and research. It could be argued that the sameoncepts and aspirations apply generally to the allied healthrofessions, including physiotherapy.

These outputs may be associated with different forms ofntervention. The review showed that writing for publicationan be supported by a range of methods, including writingupport groups [7–9], writing courses [10–12] and writingetreats [13]. Writing support groups consist of short, regu-ar, informal meetings where self-selecting writers spend timeriting and reviewing writing in progress in discussion. Thisode may be most suited to those who benefit from groupork situations and peer discussion. Writing courses areore formal, including instruction in, for example, the skills

f constructing an argument and producing academic style.here may be elements of the writing support group in suchourses, if they allow participants to discuss and progressheir writing in course time. Writing retreats involve remov-ng writers from their workplaces for a period of dedicatedriting time, such as 5 days. Like writing support groups,

etreats develop collegial relationships focused on writing forublication.

This paper describes an example of a writing for pub-ication course, and reports an evaluation of the long-termutcomes of the course for participating allied health profes-ionals. The main purpose of the study was to explore theechanisms involved in scholarly publication. It was partic-

larly important to assess the extent to which participantssed practices they had developed on the course when theyeturned to the workplace. Their publication rate was alsodentified.

ethod

ubjects

The subjects were participants in a writing for publica-ion course. There were 14 clinical allied health professionalsfour males, 10 females): six physiotherapists; two occupa-ional therapists; three speech and language therapists; and

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herapy 94 (2008) 29–34

hree podiatrists. They were all at Senior 1 level or above,nd six had higher degrees. In order to derive the maximumenefit from the course, each participant was required to haveproject to write up for a journal article.

thics

The course was financed by the Clinical Governanceepartment and supported by senior managers of Greaterlasgow National Health Service Primary Care Division.thical approval was given by the Greater Glasgow Researchthics Committee. Each participant was given an informa-

ion sheet and signed an informed consent form. Participantsere assured of anonymity in all reports and publications,

nd were informed that audiotapes would be stored securelynd wiped after completion of the work.

ourse outline

The rationale for the course attended by participants inhis study was that health professionals who had completedpiece of research or practice development, and who there-

ore had a body of data or material to write about, wouldenefit from support and development in preparing the workor publication. The course had three aims: (1) to developarticipants’ skills and strategies for writing for publica-ion; (2) to support the writing and submission of a paperuring the course; and (3) to help participants to developkills, networks and understanding for writing beyond theourse.

The course consisted of six 3-hour meetings, with oneeeting every month for 6 months. Meetings included time

or writing, discussion and planning activities and were facil-tated by an expert on academic writing who gave shortresentations on a range of writing skills and strategies, withuggestions on how they could be combined into a productiveriting practice for the longer term [14]. The course content

s presented in Appendix A. The course was conducted insupportive atmosphere, with open discussion encouraged.

n addition, participants were encouraged to use a ‘buddy’utside the monthly sessions to review and provide feedbackn writing.

This form of writing for publication course drew on a wideange of literature in both the health professional and higherducation disciplines. The course content included a range ofifferent approaches to scholarly writing that had been triednd tested in numerous other workshops and found to beffective [10]. This programme had been implemented andvaluated previously, and findings on its impact had beenublished [12]. In addition, the course involved peer discus-ion at each meeting, as this had been found to be a factorn writers’ development and motivation [8,9]. Although this

ourse was not a writer’s retreat, it did take participants awayrom their workplaces, which has been shown to increaseime and space for writing and to reduce guilt, fear and anxi-ty associated with writing for publication [13]. Finally, this

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ourse had a structured approach, which was recommendedn the only systematic review of writing for publication toate [4].

valuation

One year after the end of the course, participants wereontacted and invited to take part in a semi-structured inter-iew. The tape-recorded interview lasted for approximately5 minutes. The tapes were transcribed verbatim and veri-ed with the participants. The transcriptions were coded, andmergent themes were identified and checked by an indepen-ent researcher.

esults

uantitative outcome measures: publication rates

Twelve (three males, nine females) of the 14 participantsone was on maternity leave and one was unavailable dueo staff shortages) took part in a one-to-one, semi-structurednterview with the researcher.

Seven of the twelve participants had submitted articles toournals, and six of these had been accepted. One of the sevenarticipants had also submitted a book chapter. A further fivearticipants sent off outline submissions, but although theyeceived encouraging responses from journal editors, they didot proceed to submission. Two participants were invited toesubmit but, to date, neither have done so. Reasons given forot resubmitting were varied, including taking up a new post,tarting an MSc, completing an MPhil, not being convincedhat the subject was good enough, and dissatisfaction withhe outcome of the work.

ualitative outcome measures: changing writingractices and attitudes to writing

Participants reported that the course offered a variety ofechniques to enable them to write, including ‘snack writing’writing for short periods of time, such as 15 or 20 minutes),sing ‘warm-up’ activities for writing, freewriting (writingor 5 minutes without stopping), generative writing (writ-ng for 5 minutes to generate ideas on a specific subject)nd strategies for structuring a paper. This was the strongestheme to emerge from the scripts; it was mentioned by allarticipants as the most useful technique learned on theourse.

The use of ‘snacking’ constitutes a significant change inriting behaviour. Before the course, participants reported

hat they saw writing as a massive undertaking that had toe allocated several hours or, in some cases, days before it

ould be undertaken. For example, one participant revealed,Beforehand I would have been very much . . . I’ve only got0 minutes I will never get anything done’; similarly, anotheraid, ‘It was either I can do this in the next 3 hours or I can-

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erapy 94 (2008) 29–34 31

ot do any of it’; and a similar comment was, ‘I used toegularly be saying to myself, that is massive when I have

days I will look at it’. In contrast, after the course, par-icipants reported that they were regularly able to use smalleriods of time to write: ‘I’m snacking if I am 20 minutesn the bus’; ‘you can do little bits at a time and then putt all together’. One participant was relieved to be allowedo manage scholarly writing in this way: ‘I think it is theermission to be okay to do wee bits, I think it is know-ng it is a technique and valid and you are allowed to uset, whereas before you thought I must sit here until this isnished’.

Another important outcome, given the limited time avail-ble for scholarly writing, was learning to start writing moreuickly. Participants were surprised at the outcome of theriting ‘warm up’. They learned how to ‘just start writing’

nd found it was ‘surprising how quickly you can get into it’.here was evidence that this also led them to procrastinate

ess in their writing.Other areas of participants’ work were affected by what

hey learned on the course. One participant reported ‘gettings in my essays for my MSc’, another reported using ‘snack-

ng’ to prepare for an interview, and one felt that the strategiesere good preparation for a move to a position in higher

ducation: ‘I’m far more prepared for this environment’.Most of the group had initially been intimidated by the

riting process. All but two of the interviewees revealed aack of confidence in their ability to write: ‘writing is notor me’; ‘writing is a very highfaluting [high status] kind ofctivity’. However, as a result of the techniques learned onhe course, they gained confidence about writing: ‘it’s lessverwhelming’; ‘less scary’; ‘now I believe I can write’. Onearticipant summed up this change as follows: ‘before it wasike a brick wall with no way round it, now I have stepso go over it’. Only one participant qualified a statement ofncreased confidence with the comment, ‘emotionally I stilleel it is a bit daunting’. Some participants reported increasedonfidence to continue with scholarly writing: ‘already I amhinking of my next project’.

One of the aims of this study was to assess the extento which participants used practices they had learned on theourse when they returned to their workplaces. Some par-icipants said that they worked in busy clinical environmentshat ‘did not facilitate writing’, and some worked in busy openlan offices that were also found to be unsuitable for schol-rly writing. This study shows that the practice of scholarlyriting was not firmly located in the workplace.However, in addition to the physical environment and lay-

ut of workplaces, there were more complex reasons whyriting did not occur in the workplace. One was related toarticipants’ perception that writing was not valued by theiranagers, expressed by three participants as follows: ‘they

ay lip service to it’; ‘they think it is skiving [avoiding work]’.his led participants to feel that they had to ‘sneak writing

n’ and ‘not advertise the fact [they were] writing’. The othertated reason for not writing in the workplace was the low pri-

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rity given to writing by participants themselves. Even thoseho felt supported by their managers and tried to ‘pencilriting time in [their] diaries’ did not manage to do scholarlyriting at work. They did not feel they could prioritise writ-

ng over clinical work: ‘the priority will still be the patient’;the huge pressure is to provide a service to the patient’. Par-icipants who did produce scholarly writing in the workplacesed the ‘snacking’ technique, underlining the importancef the strongest theme from the interviews: ‘snacking ischievable here’; ‘I can take 20 minutes if a patient failso attend’; ‘when I am doing the snacking, I can write atork’.Three other themes emerged from the analysis: the struc-

ure of the course; the role of the facilitator; and the buddyystem. Firstly, the structure of the course was consideredo be excellent by all participants. Specifically, the 6-monthourse gave participants time to complete writing projects:I did the course. I wrote something. It was published.reat’; ‘I would never have published so quickly’; ‘I was

ble to take on board comments from peer review withore understanding’. Secondly, the facilitator was seen to

ave played an important part: the facilitator ‘set tasks’,kept the group focused and motivated’, was ‘very chal-enging’ and ‘really made you think’. Finally, participants’omments revealed that the buddy system did not workor everyone, mainly for practical reasons such as find-ng a time and location to meet. The few who did use auddy found that it helped to have their work reviewed by aolleague.

iscussion

This study was the first to examine the writing behaviourf clinical allied health professionals. Previous studies wereoncerned with the publication rates of academics. Theesults of this study show that writing for publication cane seen as an activity that is daunting and mysterious tollied health professionals. However, it can be supported andlarified: ‘It wasn’t even complicated, it was just simple andogical’. Course participants viewed the course as a posi-ive experience that not only developed their writing skillsut also increased their self-confidence as writers: ‘It washe single most useful course I have done’. They learnedtrategies to enable them to write and gained confidence inheir ability to write. Their improved attitude towards writing

ay be a factor in their increased output [6]. The publica-ion rate of 50% was similar to that reported in other studies5,6]. In addition, the techniques that participants learnedelped them with other professional writing tasks, includ-ng report writing, and improved their ability to supporteers in their writing. Since only 50% of the participants

ad Masters degrees or doctorates, these outputs confirm thendings of another study which showed that publication cane achieved by those who have not completed higher degrees4].

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herapy 94 (2008) 29–34

However, this study also found that writing in professionalettings, when participants returned to their workplaces afterhe course, was problematic. The majority reported difficul-ies in finding time, space and motivation to write in theirorkplaces. This study shows that even those who learned

ppropriate skills, developed confidence and published stillaced difficulties in achieving publication or in continuing toublish.

A limitation of this study was the small number of par-icipants, although this did facilitate in-depth explorationf writers’ views and experiences. Similarly, the partici-ants were self-selecting, and may have been more likelyo write for publication than those who did not choose tottend the course. However, this self-selection allowed for aocus on those who felt that they had material to write about,hich has been shown to be a factor in achieving publication

5].The ‘snacking’ technique, an adaptation of freewriting

15], was mentioned by all the participants. It appearedo revolutionise the way they viewed and managed theirriting. This study has provided a specific example of a

actor involved in writing for publication, ‘positive pub-ishing behaviours’ [6]. However, since these benefits hadimited impact in participants’ workplaces, perhaps futureourses should address the problems associated with tran-ition from the writing course to the clinical workplaceore explicitly [16]. This type of course can support writ-

ng for publication, but ongoing support, including provisionf time and space for writing in the workplace, should alsoe considered. These are the main issues in establishing writ-ng for publication as part of the allied health professionalole.

onclusions

This study has implications for the physiotherapy cur-iculum, for physiotherapists’ competence and for theirractice. In relation to the curriculum, undergraduate degreesnclude research training and experience, and many phys-otherapists will complete Masters degrees. Perhaps theext step is to include training in writing for publicationn the undergraduate curriculum, although this would putressure on an already packed curriculum and on tutors.lternatively, there are postgraduate modules, such as ‘Therofessional Dimension’ module of the Doctorate in Edu-ation, University of Strathclyde, in which students, whore generally practitioners in education, develop a con-erence paper or journal article as part of an accreditedourse [17]. Perhaps physiotherapy should consider thisodel.In relation to competence, if physiotherapists are to con-

ribute regularly to the body of evidence for practice in theorm of publications, and if they are to benefit from the expe-ience of submitting their work for publication, recognitionust be given to this role in terms of allocation of time for

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riting and support in developing writing skills. Testing theirnowledge through submissions to journals is an importantorm of learning, post qualification, and learning about writ-ng should be part of continuing professional developmentor physiotherapists. This may include acquiring the skillsnd behaviours that are developed in a writing for publica-ion course. More importantly, the impact of this course onarticipants suggests that features of the programme and for-at should be embedded in workplace practices. In terms of

ractice, this study suggests that graduating physiotherapists,oving from university to clinical contexts where there isore emphasis on the patient and less emphasis on academicriting, should see writing for publication as part of their

ole. The type of course described in this paper supports clin-cians as they make that transition, but there is a limit to whathe individual physiotherapist can achieve in terms of estab-ishing writing for publication as part of their professionalractice.

There are, finally, implications for physiotherapy man-gers. Since writing for publication enhances clinicalnowledge and practice, another implication of this studys that managers should acknowledge that writing for publi-ation is as important as other skills and other professionaluties. It is important that managers allow allied healthrofessionals to dedicate time and resources to develop-ng their skills and confidence in writing for publication.n addition, managers must also enable clinical staff to pri-ritise writing for publication over other tasks and duties,nd work with clinical staff to remove the barriers they facen building writing for publication into their professionalole.

thical approval: Greater Glasgow Research Ethics Com-ittee.

unding: Clinical Governance Department, Greater Glas-ow National Health Service Primary Care Division, Nuffieldoundation.

onflicts of interest: None.

ppendix A. Writing for publication course

irst meetingGetting started Using prompts and warm ups for writingStructured discussion Writing plans, subjects for papersTargeting Choosing a journal and contacting editorsDrafting an abstract Using Brown’s eight questions [14]Planning Interim meetings

econd meetingWriting warm up Activity, review and discussion – progress

and new subgoalStrategies Regular writing, ‘snack vs binge’ writing

Reporting Responses from journal editorsWriting time 1 hour (+ discussion)Goal setting Specific writing goals: short, medium and

long term

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erapy 94 (2008) 29–34 33

hird meetingWriting warm up Choosing from range of activities + review

and discussionReview Interim meetings, progress with writing and

problemsAnalysing Abstracts of published papersAnalysing Structure of papers published in target

journalsDiscussion Rehearsing arguments

ourth meetingTaking stock Progress with writing goals set + resetting

writing goalsOutlining Detailed outline, ‘calibrated’ with target

journalAnalysing Introductions to published papersWriting time Using outline

ifth meetingReview of progress Counting words written, topics coveredPeer review How to comment on writing in progressAnalysing Papers published in target journalsWriting time Discussion, planning and goal setting for

writing

ixth meetingReviewers’ feedback Emotional impact, analysing, processing,

respondingPeer review Feedback and revisionWriting time Completing drafts, peer review, revisionPlanning Goal setting

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