Reading, Writing and Rejection: How to Get

PublishedJohn H. Burton, MDChairDepartment of Emergency MedicineCarillion Clinic

James R Miner MDResearch DirectorDepartment of Emergency MedicineHennepin County Medical Center

Writing a manuscript and doing clinical research are very different

Writing up good research is much easier than writing up bad research

It all starts with the research

Writing

A good argument is a work of art – every word matters

Acknowledge and compliment the correct aspects from the other discussants

Directly state your opposing viewpoint Leave room for alternative viewpoints Concede when you’re wrong Don’t write angry

Written Arguments

Participating in written arguments on list serves, blogs, and social media can be a great way to have your writing critically appraised and to improve your skills

Remember that its going to exist for ever

Online

Can be a fun way to review a topic Take a lot of time that should be spent

writing up your research and innovations Don’t make you better at writing science If you do a lot of good research, you’ll have

all the opportunities you want to do this later, don’t let it bog you down at the beginning

Chapters, Reviews, etc.

“Yes”To an invitation to write ANYTHING…

Critically read everything you can related to your work

Carefully thought our arguments over clinical questions with colleagues by email are an excellent way to refine your writing skills

Getting started

Getting Started:get SOMETHING on the paper

Abstracts◦ Model your writing on abstracts that were well

received and on the same topic as yours◦ Every word matters◦ Sets up the structure of your subsequent

manuscript Put your focus on publishing abstracts

rather than non-peer reviewed work to get your career on track

Getting Started

Writing an abstract/manuscript:

Structure and convention are important◦ A lot of aspects of a research project are not

written in a manuscript, if you’re manuscript is sloppy, readers will assume your research is as well

◦ Nobody reads scientific manuscripts for entertainment

◦ Always make clear distinctions between what you think and what you know whenever you write Both are important as long as you know the

difference

Writing scientific findings

Starts when you write your protocol Add you results Discuss what your found out between

writing the protocol and analyzing your results

Include all limitations your readers may not have been able to deduce

Writing Manuscripts

Your protocol is the methods section of your paper

The background section of your IRB or IACUC application is your introduction

Having your manuscript half way written before you collect any data leads to getting it finished in the end

The Protocol

What is the question What is known about the question What is left to find Describe your model Describe the theoretical validity of your

model Specifically state your hypothesis and

primary outcome measures

The Introduction

The Manuscript:

AbstractBackgroundProtocol

Cut/Paste into the SectionsRewrite

What is validity?◦ Internal validity

Truth in the study Nobody should read the paper if its not there,

describe it in the introduction◦ External validity

Truth in the universe The goal of your manuscript is to help the reader

judge this for your study, you need to help them get there

Validity

Never conclude that further research needs to be done

Don’t present 2-D data in 3-D Don’t avoid the elephant in the room

◦ Know your limitations and state them clearly◦ State why and which part of your work is

important anyway◦ If you don’t acknowledge a limitation readers

assume you didn’t know about it

Common Errors

Carefully describe how the assignment of patients to treatments accounts for confounders (I/E criteria, randomization)

Describe all of the patients who were screened and entered the trial and account for them

Common Errors in Studies of Therapy

Was there an independent, blind comparison with a reference standard?

Did the patient sample include an appropriate spectrum of the sort of patients to whom the diagnostic test will be applied in clinical practice?

Common Errors in Studies of Diagnosis

Were there clearly identified comparison groups that were similar with respect to important determinants of outcome (other than the one of interest)?

Were outcomes and exposures measured in the same way in the groups being compared?

Common Errors in Comparisons

Were there clearly identified comparison groups that were similar with respect to important determinants of outcome (other than the one of interest)?

Were outcomes and exposures measured in the same way in the groups being compared?

Is the study designed around the primary outcome?

Common Errors in Outcomes

The weaknesses in a study must be balanced with the relevance of the findings◦ This is what the discussion is for◦ If you can’t describe why your data is still

important given the flaws in your study, you should probably repeat the experiment with an improved design

◦ Fixing these flaws may lead to a line of research that keeps you writing for your whole career

If we only write perfect research we’ll have a big pile of internally valid irrelevant data◦ There are journals that specialize in this

Exceptions to the Rule

Read the paper and decide if and what part of the findings can be used to reveal some

piece of truth in the Universe

StatisticsGet a Statistician with

Clinical Experience

Prioritize Let go of your failures Write every day If you don’t know what to write, just write

something

Organizing your efforts

Don’t always go for the low hanging fruit Don’t get bogged down for ever on

something really hard

Prioritize

I work on revisions as soon as I get them If I don’t have anything in press, I finish and

submit the thing closest to being ready to publish

If I have don’t have anything under review anywhere, I finish and submit the thing closest to being ready for submission

If I have data from a finished study that isn’t written up, I start writing that manuscript

If I have an idea without a protocol, I start writing that

My work flow (in order)

Therefore, the goal is to always have at least one:◦ Manuscript in press◦ Manuscript under review◦ Manuscript being written◦ Protocol being written

You always need something that needs writing if you want to write every day

My work flow

Always have something in the mail

Rejections Take the feedback/reviewer comments,

change it, Send it somewhere else

If your manuscript is getting rejected everywhere you send it due to its flaws, you may need to repeat the study with improvements

If your manuscript gets rejected without flaws noted, it may be that only you find it interesting ( I have a lot of these)

If you haven’t written something up after a long time, it might not be that interesting to you (give it away)

Save it somewhere; big pieces on rejected papers usually end up published in subsequent manuscripts

Let go of your failures

Write down your ideas Sometimes writing takes a lot of focus for a

long time Sometimes your best stuff will pop up out of

nowhere◦ Allow yourself to do both

Write Every Day

Make an outline Add to it wherever you can Eventually it will start to form prose Write the whole 1st draft yourself Editing is a lot easier than writing, even

when your editing yourself◦ Don’t be afraid to cut◦ Work with coauthors who are better at writing

than you

Just Write Something

In general, submit to the journals you read Peer review can sometimes be random,

rejection is not the end of the road Read the reviewers comments, revise if you

agree, and resubmit before inertia takes over

Impact Factor has received a lot of attention

Which Journal?

*Education – stop doing those lectures*Research – stop doing surveys

WRITE THE MANUSCRIPT

Stop Doing the Easy Stuff:

If you have nothing, offer

to write for other people!

A good paper starts with good research Learn the rules Follow the rules Its easier to cut than to add Don’t get bogged down by one thing Once you’ve written something, keep

submitting It’s not as hard as you may think…

Conclusions

Thank You CORD!