Some Hints On How To Write And Publish A Good Medical Paper

One of the most noticeable shortcomings of the research career is the general lack of specific training on how to write and publish articles in scientific journals. More often than not, young, inexperienced researchers and clinicians feel overwhelmed when their turn comes to try and publish their results for the first time. However, over the years of writing medical scientific papers, I have come to the conclusion that one can follow certain guidelines that make it easier to put the results of a clinical study on paper, as well as increasing the chances to publish it. I will try to describe this methodology that has been working well for me for quite some time.

Getting Started: Choose A Target Journal

The first step would be to choose a journal. Yes, in my opinion, it is best to pick the journal in advance of writing the manuscript. The more time you spend trying to find the right journal for your article, the easier will be to publish it. First and foremost, one has to be honest with the quality of the study, only this way we will be able to identify a range of suitable journals, which eventually will save us many rejections (our egos will be thankful for that). Second, if the quality of the study allows it, we must aim for journals that are in the first quartile of our knowledge area, that is within the best 25% according to the ranking published by the Journal of Citation Reports (JCR). With the current criteria of the different agencies to evaluate the curriculum, having publications in this range is vital. If this first quartile consists of journals that we consider out of reach, one can always look for related areas of knowledge where the frontier of the first quartile is more affordable.

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For instance, the impact factor of the last journal in the first quartile of the area of Hematology is 4.70, while in the area of Medicine, General & Internal is only 2.36. With this in mind, we can make a list of several potential journals that may be right for our work according to their ranking. Once we know the journals, we will search Pubmed and also the different journal websites to find out which of them accept articles that describe studies similar to ours. In addition, it is always a good idea to read the Aims and Scope section of the journal, which will give us a clue of what the editor is likely to at least consider. Remember, our first goal is to go past the editor and make it to the peer review. The paper may still be rejected but at least the reviewers’ comments will be helpful in improving the paper for the next try.

With all this process we should be able to identify the right journal for our work, as well as other two or three that can be used in case the article is not accepted in our first try; which actually may very well be the case.

Another advantage of choosing the journal in advance is that it helps us give the right focus to the text. For instance, if we have a study that describes the effect of some mutations on the response to chemotherapy in leukemia patients, we basically have two choices. We can highlight the role of the genes involved, describing the mutations in detail, if we plan to submit to a Genetics journal; or rather we can focus on the pathology and the treatment if we have picked an eminently clinical Journal in the Hematology area.

Know The Guidelines For Authors

Once we have our target we need to check the Instructions for Authors to find out the kind of article format that the journal requests. Next, we go to our computer and type a title (no matter how provisional it may be), the name of the authors with their affiliations and all the sections headings that are required in the format guidelines. Normally these will not differ much from abstract, introduction, methods, results, discussion and references. It might seem useless to write all this before the text of the article itself, but I found that at the time of beginning to write it really helps not to find ourselves looking at a blank screen.

Now, about the contents of the paper itself, there are also some simple rules we may follow. The Abstract is the first thing you see in a scientific article but it is much easier to write it at the end when all the ideas are already structured, the tables and figures are in order, and the main discussion and conclusions were written. It will then be just a matter of cutting and pasting one or two sentences from the objectives, methods, results, and conclusions, in that order, and then do some small editing so that the summary, usually 150-300 words, acquires consistency.

How To Write A Good Medical Paper: From Introduction To Conclusion

The first thing I like to write for the main body of the manuscript is the Introduction. It helps to put our ideas in order and collect information we can use later in the discussion. What I do is to separate the section into 2-3 different paragraphs to present each part of the study. For instance, if we go back to the example of mutations in leukemia, we could start with a general paragraph about leukemia (general incidence, types, treatment options, etc.), a second part about the chemotherapy drug in question and the third about the gene or genes whose mutations we are writing about. The order will depend, as I said before, on what aspect we want to put the focus on, which in turn depends on the orientation of the chosen journal. After these paragraphs, we will close the introduction by describing the objective of the work. You have to be extremely concise and clear, just one or two sentences that tell the reader what we wanted to find out with our study. As a general rule, the introduction should not occupy more than one or one and a half pages at double space.

Methods should be an easy section to write. If there are patients involved, as it is usually the case in medical papers, the first thing to do is to describe the study population, its ethnic origin, demographics, diagnosis, and treatment. Then we can move on to explain the laboratory methods utilized, but making sure these are presented in the same order in which we will describe the results later. If you do not have much experience in writing, the best the thing to do is to read previous publications with the same methodology and use that text as a template. Do not forget to include, if the nature of the study so requires, a reference to the authorization granted by the corresponding Ethics Committee and state that the study has been carried out in accordance with the “Declaration of Helsinki and subsequent revisions” if that has been the case, that is. The last paragraph of the Methods usually deals with the statistical methods used in the study.

For the Results section, my advice is to first create the figures and the tables and decide the order they will appear. It is customary that in the case of a clinical study with human subjects, the first table should be a demographic and/or clinical description of the study group, usually with baseline characteristics only. Once this is done, we can start describing our findings, and also add other results that could not be included in the tables or figures. If possible, try to group the findings with subheadings (according to the list of methods described). In addition, it is very important, and this is a common critic by reviewers, not to repeat in the text what is already shown in the tables or figures. The objective should just be to emphasize what we consider to be the most relevant results. Finally, as a general rule, the results should not include bibliographical references.

The Discussion is, by far, the most difficult section to write. After years of dealing with many different journals to publish my work, I have realized that it is almost as important to know how to sell the idea as the idea itself. We can start by writing an initial short introductory paragraph (make sure is something different from what is shown in the Introduction). Then we should comment on the different sets of results in the same order in which we described them in the previous section, although no subheadings are used here. In each part, we must state why our data is important, what is new in relation to what has already been published and what studies exist in the literature that are in favor or against our findings. As far as possible we should avoid the “telegram style” with unconnected phrases. The text should be easy to follow, even entertaining, with one rationale leading to the next one. For this, it is useful to join paragraphs with similar contents as well as to use phrases to face some arguments with others. For example: “Our results suggest that […], which is in line with that published by […]. However, other studies go in the opposite direction when affirming that […]. The explanation for these discrepancies could be that […]”.

After discussing the most important results, there are two last things to do. First, to acknowledge the limitations of the study, which should be done honestly but without an excessive self-punishment. If a limitation is recognized in advance, it is more difficult for a reviewer to be urged by that specific deficiency to reject the article outright. Lastly, the conclusions of the study are presented and, as in the case of the study aims, they must be short and very clear. Be very careful with the triumphalist and categorical tone, however good our results may be this tends to generate rejection in the reviewers.

As for the Reference section, those of us of a certain age perfectly remember what it was like to write articles, or even worse, a doctoral thesis, without a reference management software. These days, with tools such as Reference Manager, Mendeley or EndNote, to give some examples of widely used applications, the preparation of the bibliography according to the requirements of the journal has ceased to be a headache. On the other hand, we must avoid the temptation to include too many references, which is commonplace in our first articles, one or two representative quotes for each idea we want to remark is enough. Finally, it is best to limit the use of references in the introduction, where reviews are usually helpful, and use them more often in the discussion, where the weight of the paper really lies.

It is the fact that scientific writing is not normally taught to young researchers, let alone clinicians, what prompted me to share these simple rules. Of course, the methodology I have described stems from my personal experience and is just one of many valid strategies. The objective should be that, with time, each researcher develops, consciously or unconsciously, their own technique that allows their work to be rapidly published.

This work was written by Professor Guillermo Gervasini from the Universidad de Extremadura.

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