How to Write a Paper

How to Write a Paper

Association of Academic Dermatologic Surgeons

Content Review date: August 27, 2012Originally Submitted: September 15, 2007

Timothy M. Johnson MD Lewis and Lillian Becker Professor University of Michigan

I have No COI-no relevant relationships with industry


Disclaimer: My Perspective. Everyone is different. These are just guidelines and pearls

that I have found useful.

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Why Write? “Duty vs. Passion”

To advance knowledge Improvement in management of disease

To advance your institutionAcademic accomplishment, prestige, funding

To advance yourselfEnhances clear thinking & scholarship ability Promotion, career development, reputation

Benefits often greater to author than reader

The Evidence Pyramid

Systematic Review& Meta-AnalysisRandomized Controlled

Trial (RCT) Double Blind

RCT

Cohort studies

Case Control studies

Case Series

Case Reports

Ideas, Editorials, Expert Opinion

Animal research, Test tube

EV

IDE

NC

E L

AD

DE

R

Stages in a Research StudyStages in a Research Study

Planning the study & writing the protocol IRB approval Funding/Infrastructure Executing the study & collecting the data Data analysis Writing Going through the editorial process

Writing a Paper: Getting Started

No single best way Varies from paper to paper Background reading--Literature search! Identify mentors to understand what

constitutes good versus bad papers Decide on authorship

“The only way to learn to write is to write” --Peggy Teeters

Writing a Paper: Getting Started

IRB Find statistician BEFORE study

Sample sizePower analysisAppropiate statistical tests

Select journal-review guidelines

Writing a Paper

Fix realistic schedule (Adherence) Write by a biological clock Need stretch of protected hours or days Ideas come while writing When time is short: prepare, revise Location

Boring area, nothing to distract Maintain momentum

Academicians rated by what they finish, not by what they attempt

Write in What Order?

Title

Abstract

Introduction

Methods

Results

Discussion

References

Parts of a Manuscript--Structure

“Writing is a lot easier if you have something to say” --Sholem Asch

Methods I

For informed readers this is the most important section

Past tense Precision-study design-like a recipe Explicit inclusion/exclusion criteria,

retrospective or prospective, etc. Detailed enough so results can be

repeated by others

WHAT DID YOU DO?

1

Methods II

Ethical approval (IRB) Statistical methods Subheadings only if necessary-duplicate

in results Remember that you can put detailed

methods on the web-i.e., questionnaire

WHAT DID YOU DO?

1

IRB !!

Start by reading your local IRB website http://www.med.umich.edu/irbmed/

PEERRS certification: Program for Education and Evaluation in Responsible Research and Scholarship Fulfills the NIH requirement for human subjects

training for PIs and "key personnel”

Trials MUST be enrolled for publication in the best journals http://clincaltrials.gov http://prsinfo.clinicaltrials.gov

IRB !!

Almost every study worth publishing requires IRB approval

Determination of exempt status is made by the IRBExemption Categories

4. Research, involving the collection or study of existing data, documents, records, pathological specimens, or diagnostic specimens, if these sources are publicly available or if the information is recorded by the investigator in such a manner that subjects cannot be identified, directly or through identifiers linked to the subjects.

Results I

Just the facts, in a logical sequence Past tense Importance of accuracy cannot be overstated-

check, recheck data/numbers-must add up Give numbers and percentages: 1 (10%) of 10…

P values and confidence intervals Avoid discussion of results in this section

WHAT DID YOU FIND?

2

Results II

Tables & figures-straightforward, concise, not duplicative, should stand alone

Table(s) - short specific title at top of page, footnotes

Figure(s) - concise legends, QUALTY, avoid distracters, anonymity

You can put extra results on the web

WHAT DID YOU FIND?

2

Statistical vs. Clinical Significance Is it real? vs. Is it important?

There are three kinds of lies:

lies, damned lies, and statistics.

Mark Twain

In God we trust All others must

bring data.

Discussion I

Always focus on your results Outline 2 or 5 main points that come

from results Build a paragraph or two for each point Finally permitted latitude to elaborate

and speculate (some)

WHAT DOES IT MEAN?

3

Discussion II

First answer the question posed in the Introduction

Summarize previous work-compare your results

Explain what is new without exaggerating, perspectives, implications

What do your results mean? - clinical practice, management, policy

WHAT DOES IT MEAN?

3

Discussion III

Strengths and weaknesses in relation to other studies, particularly any differences in results

Usually avoid ending with a conclusions-summary section if redundant

“further studies are required”- usually not necessary and implies to some you need to do before submitting

WHAT DOES IT MEAN?

3

Introduction

Short (3 paragraphs)-1 typewritten pageFirst paragraph Brief background-establish context, relevance,

nature of the problem/question/purposeSecond paragraph Importance of the problem and unresolved issuesLast paragraph Rationale: state hypothesis/main

objective/purpose

WHAT IS THE QUESTION/OBJECTIVE?

What we know?

What we don’t know?

Why we did the study?

4

Abstract

Critical part of paper Determines if paper will be read Is distributed freely in databases Structured per format Avoid acronyms and abbreviations Write and rewrite until flawless Clear and concise - stand alone

References

Errors reflect scholarship-check & recheck Be selective-cite only those vital Relevant and recent (or seminal) Balance Read the references Do not misquote Use correct style for journal

Title

Determines how paper gets indexed Often determines whether paper gets read Should describe and identify subject matter Avoid long title-impossible to comprehend

at a glance Avoid abbreviations Question: may be easier to understand,

more impact?

First DraftFirst Draft

Write as quickly as possible Get everything down Ignore spelling, grammar, style Skip troublesome words Correct and rewrite only when the whole

text is on paper Do not split the manuscript among the co-

authors

What works for me?

Style and AuthorshipStyle and Authorship Follow ICMJE* criteria:

Uniform Requirements for Manuscripts

Submitted to Biomedical Journals

http://www.icmje.org/index.html#top Order:

First author-primarily responsible for collecting & analyzing data, and writing

Last author-usually an established investigator, assumes overall responsibility

Middle authors-list in order of contribution

* International Committee of Medical Journal Editors

StyleAccuracy, Clarity, Brevity

Proper words in proper places make the true definition of style. --Jonathan Swift

Have something to say and say it as clearly as you can… the essence of style. --Matthew Arnold

If writing is unclear, meaning unintelligible readers and reviewers won’t understand

Use concrete over vague language Multiple mistakes in spelling and syntax,

suggests similar sloppiness in the project Check and double check data


Use active voice whenever possible Active voice: the subject is performing the verb

Passive voice: the subject receives the action expressed in the verb

Passive (more wordy) Active (more concise)

Active: Scientists have conducted experiments to test the hypothesis

Passive: Experiments have been conducted by scientists to test the hypothesis

Avoid overusing there is, there are, it is, it was, etc.

There are treatment guidelines for Merkel cell carcinoma that were reported by Bichakjian, et al.

Correction: Treatment guidelines for Merkel cell carcinoma were reported by Bichakjian, et al.

Better: Bichakjian, et al. reported treatment guidelines for Merkel cell carcinoma. (Active voice)


All first drafts have too many words Next drafts: prune vigorously, avoid repetition,

wordiness, long sentences, excessive adverbs/adjectives

Strip every sentence Writing improves in proportion to deletion of

unnecessary words When you have the choice of two words, use

the simpler one The most valuable of all talents is that of never

using two words when one will do. --Thomas

Jefferson

Simplify a majority of = most a considerable amount of = much a number of = several/some on account of = because referred to as = called has the capacity to = can it is clear that = clearly at the present time = now give rise to = cause is defined as = is subsequent to = after

“Those who have the most to say usually say it with the fewest words”


Liked by authors, disliked by readers Reading should not require a glossary Unwieldy word occurring > 10 times Avoid using colloquial language

Abbreviations and Acronyms

Troublesome Terms

And/or: and or or alone usually suffices Diabetic as a noun may be condescending

to some, patient with diabetes Significant means statistically significant “Firstness”-provide details if true, rarely

needed

Getting Help

Get co-author and mentor help Experts are good Non-experts may also be good “I got lost here” is more important than

“oncololy is misspelled” Learn from editing changes

Revise, Revise and Revise

You may not be a very good writer, but be an excellent rewriter

Always look from a distance--see your paper as the reviewer will see it

Polish the writing style Double check spelling, look for typos Double check references Every fat paper has a thin one trying to

get out

Publish and Perish“Deadly Sins”

Data manipulation, falsification Duplicate manuscripts Redundant publication Plagiarism Humans use concerns Animal use concerns Author conflicts of interest Failure to discose conflict of interest

What is Redundant Publication?

Data in conference abstract?

Same data, different journal?

Data on website?

Data included in review article?

Expansion of published data set?

No

Yes

Maybe

OK if later

Probably

Happens more commonly than expected

Redundant Publication

Problem is not the publication but the lack of disclosure--disclosure is key

Always send copies of overlapping papers and reference them

Negative studies are often not published; positive studies are more likely be published more than once-creates BIAS

Distorts what the evidence says

Submission

Read “Instructions for Authors” thoroughly Conform to “Instructions” precisely Write cover letter (suggest reviewers) Know the journal, its editors, and why you

submitted the paper there Avoid careless mistakes

What Editors Like About Papers

Originality Interesting to readers, important,

messages that matter Clear questions, correct methods Brevity, clear presentation (style) Good grammar and spelling

Editors and reviewers spend hours reading manuscripts, and greatly appreciate receiving

papers that are easy to read and edit!

What Editors Dislike

Very long papers (> 3,000 words) Second-rate Style Conclusions not justified by data,

sweeping conclusions Inability to follow “Instructions to Authors” Splitting versus lumping

What Happens Next?

Acceptance

Revision

Rejection

The Review Process

If at first you don’t succeed, you’re about

average!

The Post Review Phase-Revision

Study reviews objectively and dispassionately Read every criticism as something you could

explain more clearly Resist temptation to respond “you brainless

person, I meant X”. Fix the paper so that X is apparent even to the most brainless reader.

Be open to criticism - do not get defensive -This is really, really hard, but it is really, really, really, really important

Listen to your reviewers

Responding to Reviewers-Revision

Carefully prepare your responses point-by-point: Each comment should be addressed Each change should be stated Make your changes obvious

Reviewer may be wrong Be tactful-next reviewer may be the same Do not respond to reviewers while upset Get help from co-authors

Rejection

A journey of a thousand miles sometimes ends very, very badly

-disappointing at best

Why Papers are Rejected I

The best scientists get rejected and have to make major revisions

Number of journal pages available has not kept pace with number of articles and authors

May be nothing basically wrongMore confirmatory than originalInsufficient priority, backlog inventory

Wrong journal

Why Papers are Rejected II

Poorly written Sweeping conclusions-unjustified by data Ethics (IRB) approval not obtained Flawed or poor study design-methods

Unrepresentative sample(s) Uncontrolled, poor controls, nonrandomized interventions Sample size too small Incorrect statistical analysis Hypothesis not adequately tested

Your manuscript is both good and original, but the part

that is good is not original, and the part that is original

is not good. --Samuel Johnson

The Post Review Phase-Rejection

Get over it Do not get defensive Study reviews as objectively & unemotionally as

possible-for resubmission to another journal Address all of the reviewers’ concerns Next reviewer may be the same

Honest criticism is hard to take, particularly from a relative, a friend, an acquaintance, or a stranger.

--Franklin Jones

At least 50% of initially rejected articles are eventually published somewhere else!

The Post Review Phase-Rejection

Appeal Option Do not call the editor---usually Willing to consider first appeals--but

must revise the paper, refute criticisms, not just say the subject is important

Few accepted on appeal No second appeals; ends in hostility or

tears; plenty of other journals

Become a Reviewer

Approach the editors and editorial staff The best reviewers are often the best

writers and vice versa Apply principles from today

Become a Better Writer

Professor Trisha Greenhalgh:

"How to Read a Paper" Series--BMJ

Introduction to Evidence Based Medicine: Critical Appraisal and Informed Medical practice

Introduction to Clinical Medicine - Professional Skills January 2005http://www.health.library.mcgill.ca/ebm/greenhalgh.htm

Professor Trisha Greenhalgh (University College London)

"How to Read a Paper" SeriesGetting your bearings (deciding what the paper is about). BMJ 1997;315:243-6.Assessing the methodological quality of published papers. BMJ 1997;315:305-8.Statistics for the non-statistician. II: "Significant" relations and their pitfalls. BMJ

1997; 315: 422-425.Statistics for the non-statistician. I: Different types of data need different statistical

tests. BMJ 1997;315:364-6.Papers that go beyond numbers (qualitative research). BMJ 1997;315:740-3.Papers that summarise other papers (systematic reviews and meta-analyses). BMJ

1997;315:672-5.Papers that tell you what things cost (economic analyses). BMJ. 1997;315:596-9.Papers that report diagnostic or screening tests. BMJ 1997;315:540-3. Papers that report drug trials. BMJ 1997;315:480-3.

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How to Write a Paper