Transcript Sample Talk
Association of Academic
Dermatologic Surgeons
Content Review date: August 27, 2012
Originally Submitted: September 15, 2007
How to Write a Paper
Timothy M. Johnson MD
Lewis and Lillian Becker Professor
University of Michigan
I have No COI-no relevant relationships with industry
How to Write a Paper ?
Disclaimer: My Perspective. Everyone is
different. These are just guidelines and pearls
that I have found useful.
How to Write a Paper
Why Write?
“Duty vs. Passion”
To advance knowledge
Improvement
in management of disease
To advance your institution
Academic
accomplishment, prestige, funding
To advance yourself
Enhances
clear thinking & scholarship ability
Promotion, career development, reputation
Benefits often greater to author than reader
The Evidence Pyramid
Systematic Review
& Meta-Analysis
Randomized Controlled
Trial (RCT) Double Blind
RCT
Cohort studies
Case Control studies
Case Series
Case Reports
Ideas, Editorials, Expert Opinion
Animal research, Test tube
Stages 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
“The only way to learn to write is to write”
--Peggy Teeters
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
Writing a Paper: Getting Started
IRB
Find statistician BEFORE study
Sample
size
Power analysis
Appropiate 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
Parts
of a in
Manuscript--Structure
Write
What Order?
Title
Abstract
Introduction
Methods
Results
Discussion
References
“Writing is a lot easier if you have something to say”
--Sholem Asch
1
Methods I
WHAT DID YOU DO?
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
1
Methods II
WHAT DID YOU DO?
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
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 IRB
Exemption
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.
2
Results I
WHAT DID YOU FIND?
Just the facts, in a logical sequence
Past tense
Importance of accuracy cannot be overstatedcheck, 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
2
Results II
WHAT DID YOU FIND?
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
Statistical vs. Clinical Significance
Is it real? vs. Is it important?
There are three
kinds of lies:
lies, damned lies, and
statistics.
In God we trust
All others must bring
data.
Mark Twain
3
Discussion I
WHAT DOES IT MEAN?
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)
3
Discussion II
WHAT DOES IT MEAN?
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
3
Discussion III
WHAT DOES IT MEAN?
Strengths and weaknesses in relation to
other studies, particularly any differences
in results
Usually avoid ending with a conclusionssummary section if redundant
“further studies are required”- usually not
necessary and implies to some you need
to do before submitting
4
Introduction
WHAT IS THE QUESTION/OBJECTIVE?
Short (3 paragraphs)-1 typewritten page
First
paragraph
What we know?
Brief background-establish context, relevance,
nature of the problem/question/purpose
Second
paragraph What we don’t know?
Importance of the problem and unresolved issues
Last
paragraph Why we did the study?
Rationale: state hypothesis/main objective/purpose
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 Draft
What works for me?
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
Style 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
Style
Accuracy, 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
Style
Accuracy, Clarity, Brevity
Use active voice whenever possible
Active voice: the subject is performing the verb
Passive voice: the subject receives the action
expressed in the verb
Avoid overusing there is, there are, it is, it was, etc.
Active: Scientists have conducted experiments to test the hypothesis
There are treatment guidelines for Merkel cell
Passive:
Experimentsthat
have were
been conducted
by scientists
to test the hypothesis
carcinoma
reported
by Bichakjian,
et al.
Passive
(more wordy) Active (more concise)
Correction: Treatment guidelines for Merkel cell
carcinoma were reported by Bichakjian, et al.
Style
Accuracy, Clarity, Brevity
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
“Those who
referred to as = called
have the most
has the capacity to = can
to say usually
it is clear that = clearly
say it with the
at the present time = now
fewest words”
give rise to = cause
is defined as = is
subsequent to = after
Style
Accuracy, Clarity, Brevity
Abbreviations and Acronyms
Liked by authors, disliked by readers
Reading should not require a glossary
Unwieldy word occurring > 10 times
Avoid using colloquial language
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
“Deadly Sins”
Publish and Perish
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?
Happens more commonly than expected
Data in conference abstract? No
Same data, different journal? Yes
Data on website? Maybe
Data included in review article? OK if later
Expansion of published data set? Probably
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?
The Review Process
Acceptance
Revision
Rejection
If at first
you don’t
succeed,
you’re about
average!
The Post Review Phase-Revision
Listen to your reviewers
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
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
-disappointing at best
A journey of a thousand miles sometimes
ends very, very badly
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 wrong
More
confirmatory than original
Insufficient priority, backlog inventory
Wrong journal
Why Papers are Rejected II
Poorly written
Sweeping
conclusions-unjustified
data
Your manuscript
is both by
good
and original,
butnot
the
part that
Ethics
(IRB) approval
obtained
is good
is not
original,
and the
Flawed
or poor
study
design-methods
part
that issample(s)
original is not good.
Unrepresentative
--Samuel
Johnson
Uncontrolled, poor
controls,
nonrandomized interventions
Sample size too small
Incorrect statistical analysis
Hypothesis not adequately tested
The Post Review Phase-Rejection
Honest criticism is hard to take, particularly from a
relative, a friend, an acquaintance, or a stranger.
--Franklin Jones
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
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
Become a Better Writer
Approach the editors and editorial staff
The best reviewers are often the best
writers and vice versa
Apply principles from today
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 2005
http://www.health.library.mcgill.ca/ebm/greenhalgh.htm
Professor Trisha Greenhalgh (University College London)
"How to Read a Paper" Series
Getting 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.