Most physicians have had little or no exposure to systematic teaching or training during the medical school and residency with respect to writing and publishing an original research article. The framework of every article should include the study objective(s), study design, results, and conclusion(s). The current “Clinical Opinion” article proposes a set of guidelines, based on the authors’ experience, which can be useful to junior physicians who plan to publish their work. These guidelines should assist not only in the writing process of the initial manuscript but also in responding to reviews and in modifying the original manuscript.
One of the most frequent, and often overlooked, issues today is the apprehension or fear of young physicians, residents, or fellows to write a peer-reviewed article. Many of these young physicians, despite their desire to pursue academic writing, become very reluctant because of perceived lack of time and/or mentorship. The current article provides writing guidelines to assist young authors in beginning this process. The skill to write and publish a paper is not necessarily “inherited”; it is often acquired but it requires strict adherence to certain principles. Because most young physicians are rarely exposed systematically to such training principles of “how to write and publish a paper” during their medical school or residency, it comes as little surprise that most hesitate to write and submit a paper for publication. One of the natural by-products of knowing “how to write and publish a paper” is the ability to also critically read or even “review” a paper for the journals. In our view, physicians who know how to write and publish a paper, also know how to critically read or review a paper (the converse is not true). Therefore, it is of paramount importance in academic medicine to teach and encourage young physicians on how to write and publish a paper. The purpose of this article is to outline a set of general guidelines (tips ) that the authors have found to be useful, which young physicians may use as a guide to writing and eventually publishing a peer-reviewed article.
Tips to consider while writing a paper
First, the author(s) should be aware of the specific reporting guidelines that many journals have adopted, such as the CONSORT for randomized controlled trials, QUORUM for metaanalyses and systematic reviews of randomized controlled trials, MOOSE for metaanalyses and systematic reviews of observational studies, STARD for studies of diagnostic accuracy, STROBE for observational studies, STREGA for genetic association studies, and other guidelines for reporting economic evaluation studies. In addition, authors should consult the “Guidelines for Authors” and the specific requirements of the journal in which they intend to submit their manuscript.
A peer-reviewed article should be considered as a means of communication. As such, it should be simple with clear organization of the thought process. A presentation framework should be first established ( Figure ). This framework can be used for any peer-reviewed article and it should reflect the ideal flow of the paper after its completion with its connecting 4 main parts, including the study objective(s), study design, results, and conclusion(s). The conclusion(s) should be directly related or connected to the study objective(s). Critical readers or reviewers subconsciously form a “mental” image of the paper that they just reviewed by using a framework similar to the one described here. In general, a peer-reviewed article consists of the title, condensation (or précis or synopsis), abstract, introduction, material and methods (or patients and methods), results, comment (or discussion), and list of references.
Title
The title should be relatively short and succinct. It should be easy to understand and at the same time intriguing enough to stimulate the interest of the reader. Long or confusing titles should be avoided because such titles may act as deterrents to further reading. Some journals may prefer to give the conclusion(s) in the title, whereas other journals require not to use concluding statements in the title. Some journals may not favor titles containing questions but we do because the question, as a title, usually describes the study objective and at the same time stimulates an interest to read further.
Condensation or précis or synopsis
The condensation (or précis or synopsis) should summarize the main conclusion or conclusions in 1 sentence containing no more than 25 words. The rule of thumb should be that this sentence should make sense and be understood by someone who has not read the article. Many busy journal readers frequently read the condensation first even before deciding whether to read the abstract or the paper.
Abstract
The abstract is the “mirror” of the full manuscript. There is no doubt that the abstract is the most widely read part of the article by both those who peruse through the journal, as well as those who perform electronic literature searches. The abstract should be structured with specifically designed headings focusing the writer (and the reader) to the 4 main elements, namely, objective(s), study design, results, and conclusion(s). The author has the opportunity to use succinct language to summarize the paper by following 2 principles: (1) the abstract should be clear enough to be understood by a reader who may not read the rest of the article, and (2) the abstract should not be too long (word limitation varies from journal to journal).
Introduction
The introduction is 1 of the most critical parts of the article because it sets the tone for the reader and the reviewer. Ideally, the introduction should contain 2 components, preferably expressed in 2 paragraphs. The first paragraph should summarize the background information leading to a rationale for performing the study, justifying the need for the study, and clarifying the new information that the study aims to offer. The first paragraph should convince the reader that the study is not a “fishing expedition” but it is based on a solid background with respect to plausibility. The second paragraph should clearly state the study objective (or the hypothesis).
Materials and Methods (or Patients and Methods)
The Materials and Methods (or Patients and Methods) section should include descriptions of (1) study design; (2) documentation of institutional review board (IRB) approval and type of consent obtained, if applicable; (3) demographics of the study cohort, if applicable; (4) inclusion and/or exclusion criteria; (5) clear description of any procedures or tests; (6) clear definitions of exposures, and primary and secondary outcomes; (7) sample size calculation based on primary outcome; (8) types of measurements used; and (9) methods of statistical analysis and level of significance.
In our computerized age, there is widespread use of statistical software among young academic physicians and scientists. Some of the commonly used statistical software programs are SAS ( http://www.sas.com/ ), SPSS ( http://www.spss.com/ ), STATA ( http://www.stata.com/ ), R ( http://www.r-project.org/ ), SPlus ( http://www.splus.com/ ), and MINITAB ( http://www.minitab.com/ ). Tables 1 and 2 can serve as a quick reference to the choice of the appropriate statistical test(s) according to the type of the data to be analyzed and compared.
| Comparison | Continuous data | Ordinal data | Categorical data |
|---|---|---|---|
| 2 groups of different subjects | Unpaired t test a or Z-test a | Mann-Whitney rank sum test b | χ 2 or Fisher’s exact test b |
| ≥3 groups of different subjects | ANOVA a | Kruskal-Wallis test b | χ 2 or Fisher’s exact test b |
| Same subjects (before/after treatment) | Paired (matched) t test a | Wilcoxon-signed rank test b | McNemar’s χ 2 test b |
| Same subjects (≥3 treatments) | Repeated measures ANOVA a | Friedman test b | Cochrane Q test b |
| Association between 2 variables | Linear regression/correlation a | Spearman correlation a | Contingency coefficient b |
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