This guide is helpful advice for medical students writing their first papers.
We provide some tips and suggestions to help authors craft a paper that has a reasonable chance of getting accepted for publication. The guide also outlines certain steps of how the process plays out. This article applies to clinical research studies only such as case series.
Coming up with a good question
Whether you are writing about pituitary adenomas or meningiomas, you have to have a novel story to tell. Knowing what you want to write about is only the start. There are probably hundreds, if not thousands of papers on this topic. So how do you ask a question and give it an angle that is different?
It is not realistic for a medical student to be able to identify gaps in the literature so certainly the burden of generating an interesting question lies with the senior author. However, if you are interested in generating a question on your own, this starts with a thorough literature review. By painstakingly reviewing the literature, you will understand gaps in the literature. You will typically need to spend 3-4 hours each day for a few days. reading every paper written on your topic to truly appreciate some of the areas of interest and controversy. This is one of the most important steps of the process because with clinical papers, you are usually taking a clinical series and asking a question that has not been well examined in the literature.
At the end, critically ask yourself, is my contribution worthy of being put in the literature permanently?
You should be actively reading new articles as they come out. You will quickly realize that this up-front investment is worth it because when you write one paper, it usually leads to 3-4 more papers once you understand the gaps in the literature.
Outline of the manuscript
Find another paper in the subject that you really like. Try to follow a similar format. Analyze how they presented their data and what statistics they used. How did they present their tables or figures? Obviously, you are going to say something different but this will serve as a model to make a skeleton of your own manuscript.
You should always work off a well-thought out outline. An outline is critical because it forces you to only include the relevant information in that section without repeating yourself.
Components of the manuscript
The order in which you work on each section is very important. We recommend first writing the methods and critically thinking about your data collection. Once you have collected the data, work on the results. Next come two of the most important aspects, the title and the conclusion of the abstract. Then write the entire abstract and only then move on to the introduction and discussion, which should be written last.
The title may determine whether your paper even gets reviewed. Avoid a long, run-on title. The title should be “active” and informative and should try to convey the main question or conclusion of the article. Avoid overly general titles. The abstract is another critical part of the paper. It must state the main objective, summarize the important results, state major conclusions, and meet the format and word limit.
The methods can often be pre-written before the start of your study. Try to use descriptive subheadings (Data collection, Statistical analysis). Be sure include IRB approval if applicable. If you need and IRB, and it is best to assume that you will, get that submitted as early as possible. You can start writing the paper and collecting data before the IRB is approved but you cannot submit it for publication without IRB approval. Work in parallel. It can stake 6-9 months to get an IRB approved, even for a retrospective chart review.
Results should be presented in a concise manner. The results can also be broken up into subheadings. Tables and figures should be easy on the eye and not confusing. Always include figure captions with the main findings of the figure. Spend your time on figures and tables. Make sure they are crisp and accurate. Some reviewers only read your title, abstract, and look at the tables/figures when deciding whether to review further. Consider hiring an illustrator to create a snazzy cartoon of your main finding.
The introduction should build a case for why the study was performed and why it is important. Provide a brief background, state the central hypothesis or questions, and give a one sentence objective of the study.
In the discussion, it is often helpful to restate your main findings. Address the central hypothesis or questions from the introduction. Then go into each finding in more detail and place it in the context of the existing literature. Relate your conclusion to existing knowledge and explain what is new without exaggerating. Never simply repeat the results. If you are reviewing a significant amount of literature, you may want to put it all in a table or consider performing a systematic review of the literature using PRISMA guidelines. Always include a “Limitations” sections at the end of the discussion.
The conclusion should be a summary with future implications.
There is no excuse for sloppily written manuscripts, incorrect formatting, typos, or incorrect grammar.
If your manuscript gets rejected
All journals have a unique peer-review protocol and papers may be rejected for a plethora of reasons. The most common reasons are lack of novelty or originality, unclear purpose or rationale, poor data presentation or statistics, poor writing, and inappropriate structure. Your paper may also get rejected if you are overstating the results or your conclusions are not supported by the data.
If your paper gets rejected, use it as an opportunity to learn from the editors’ comments, revise your paper, and submit it to another journal. If you can learn from the reasons for rejection, re-analyze, re-write, and resubmit your manuscript, it will eventually get accepted. Most importantly don’t get discouraged. Everyone has had papers they thought were great get rejected. Use the strong emotion as fuel to make your next paper that much better.
For almost every submission, you will be asked to make revisions. This can range from minor edits or major changes. When responding to reviewers, carefully prepare your responses and always be respectful. Each comment should be addressed and each change should be stated. Some journals have a specific format for responding to reviewers. Once again, it is important to always thank the reviewers and provide a response to each comment. Don’t be surprised if you are asked to collect additional data or revise a substantial portion of your manuscript.
The more you write, the better you become at it and you will begin to enjoy the process. Reviewing the literature and reading articles is a great way to learn, read critically, and find weaknesses or gaps in the literature.
Once you write more papers, you will develop a systematic approach and get in the groove of working on a research project at all times. Find a time when you have an un-interrupted 2-4 hours to work on your research. Dr. Schwartz and I prefer uninterrupted time on weekends such as Sunday morning 6-10 AM.
In academic neurosurgery, you should always be writing. Don’t forget to also submit your research to a meeting. This will afford you the opportunity to meet new people in the field, defend your data to questions, allow you to think more critically about your work, and lead to more notable research in the future. Remember to have fun with it and don’t look at it like a chore.
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