For the healthcare professional looking to publish the fruits of their research, the task of writing up the findings and getting them published can seem almost as daunting as the research project itself! There are a number of steps you should take to ensure you are successful, and here we look at the most important aspects in detail, from the initial preparation to dealing with rejection.
1. Present your findings at a conference
Before starting on a draft of your manuscript, it can be extremely helpful to present your research at conferences. This will give you valuable feedback on your suggested approach from your peers in the research community, whether as questions at the end of your presentation or discussions with colleagues. Presenting at a conference also gives you handy, interim deadlines and helps you to focus on the most important aspects of your findings.
2. Choose the right journal
The next question is: Where should you submit your manuscript? The most historic and most prestigious are not always the most appropriate, and the most widely read and highest quality journals are not the easiest to quantify.
One measure for assessing the importance of journals is its clinical relevance, or impact. Termed the ‘impact factor’, the concept was suggested by Eugene Garfield in 1955,1 and a version is now used as part of the Journal Citation Report.2 This is calculated by dividing the number of citations in the current year to any items published in the journal in the previous 2 years by the number of substantive articles published in the same 2 years.
While the impact factor is widely used by libraries and researchers, there are some drawbacks that have led to other methods of assessing a journal’s clinical relevance, such as the Eigenfactor and SCImago, which are similar to Google’s search engine algorithms.
3. Meet the requirements of the journal
Now you have chosen your preferred journal, it important to remember that each journal has its own formats, styles, traditions and special interests. Before you write your manuscript, read the Instructions for Authors in detail, noting down any instructions that, if not followed, could lead to automatic rejection. This may include file formats, text spacing and font size, citation rules, and limits for word counts, reference lists, and the number of tables and figures.
Furthermore, journals publish several different types of articles, corresponding to different types of investigation and analysis. So make sure you chose the type that best fits your research. There are several broad categories that most manuscripts fall into:
- Original articles: Most original research, such as clinical trials, case-control studies, and cohort studies. Clinical trials must conform to the CONSORT guidelines,3 and may include Phase I, II, III, and IV studies, depending on their relevance.
- Reviews: May include meta-analyses alongside the more traditional systematic reviews and narrative reviews
- Short reports: Clinical studies that are preliminary investigations, and smaller case–control studies or case reports
- Research letters: Original clinical research is brief in nature and does not fall into any of the above categories
4. Make sure your research is up-to-date and fully referenced
Next, you need to ensure that the literature you cite in your manuscript is up-to-date. Since you started your research, the field may have moved on considerably. Papers that confirm, refute or change the context of your findings will need to be acknowledged.
There is a wide-range of online resources and databases to help you with your literature search. The most commonly used include powerful search engines, allowing you to quickly assemble a relevant collection from the literature:
- PubMed – https://www.ncbi.nlm.nih.gov/pubmed/
- Embase – http://www.embase.com/
- PsycINFO – http://www.apa.org/pubs/databases/psycinfo/
- The Cochrane Library – http://www.thecochranelibrary.com/
- Best Evidence Encyclopedia – http://www.bestevidence.org/
- Clinical Evidence – http://clinicalevidence.bmj.com/
There are also a huge number of health websites that often claim to be accountable and peer-reviewed, but are not always reliable and should be used with caution. Google Scholar (http://scholar.google.co.uk/), for example, can be seen as a back-up source of information, while Wikipedia (http://www.wikipedia.org/) may be a useful, if unreliable, way of getting up to speed with unfamiliar topics.
To make it easier to identify papers that are relevant for your topic, as well as to prevent information overload, it is recommended that you develop an efficient search strategy. One way is to use the PICO Search Terms.4 Without a well-focused PICO question, it can be very time consuming and difficult to search and find relevant evidence for your paper. PICO stands for:
- Population: Describe the population relevant to your article, which may include the general (geriatric) population, specific age groups, certain risk groups, etc.
- Intervention: The therapy (or exposure) that you would like to investigate
- Comparator: The control or reference group against which your results should be compared
- Outcome: Which outcome is relevant to your population or of interest in your research? What is the relevant time frame?
PICO can also be used to critically appraise the references included in your manuscript. An appraisal tool – like the one highlighted in the video below – can be found on the Centre for Evidence Based Medicine website.
5. Write the main body of the manuscript
As mentioned above, each journal has its preferred formats, styles and article types. Now that you have refined your arguments by presenting your findings at conferences, chosen the right journal, and read the Instructions for Authors, and you have brought your literature search up-to-date, it is time to write the main part of the manuscript.
For original research, the majority of manuscripts will need to follow the IMRAD format of:5
- Introduction – why the authors decided to do this research
- Method – how they did it, and how their analyzed their results
- Results – what they found
- Discussion – what the results mean
Both the Introduction and Discussion should refer to previously published research in order to place the aims and findings of your study in context. The Methods should be clear and concise, with any procedures followed and tools used thoroughly described, and the Results should follow the patients studied over time, from their baseline status to the outcomes at final follow-up. Any patients lost to follow-up or excluded from the final analysis should be noted, and the reasons explained.
6. Take the time to write a compelling abstract
The next challenge is writing the abstract. Although the shortest part of the paper, it receives a disproportionate amount of attention, and is used to make important decisions about the value of a piece of medical research.
Written last, the abstract is meant to summarise the paper, and it is a good idea to pull out key sentences as you go along. To help you, here are a few useful dos and don’ts:
- Do count your words – the majority of journals specify that the abstract should be between 150 and 300 words
- Do write in the past tense, and be clear and to be point – abstracts should be precise, concise and incisive
- Do structure your abstract – the majority of journals specify a variation on the IMRAD format of Introduction, Method, Results and Discussion
- Don’t include references to other papers – an abstract should not contain citations
- Don’t leave abbreviations undefined – even an abbreviation that is commonplace to you should always be defined the first time that it is used
- Don’t put information into the abstract that is not contained somewhere within the main body of the text
Once you have come up with a descriptive title for your manuscript and completed the title page in line with the journal requirements, you are finally ready to submit.
7. Take rejection on the chin
Unfortunately, you cannot guarantee that your manuscript will be accepted for publication, and may initially be rejected. One study suggested that up to 62% of published papers have been rejected at least once.6 It is therefore worth looking at the potential reasons why a journal may accept or reject your work. Primarily, journals select manuscripts on the basis three questions:
- Is it true: Does it have internal and external validity; and does the evidence support the conclusions?
- Is it new: How does it advance the field?
- How will it affect patient care?
A paper may be rejected even if it receives a positive response during the peer-review process. A study of submissions to the The Journal of Bone and Joint Surgery, American Volume, found that that, at an overall acceptance rate of 21.3%, the only factor significantly associated with acceptance for publication was level of evidence.7 Another study of submissions to the same journal indicated that commercially funded and US-based studies were more likely to be published, even though they were not associated with higher quality, larger sample sizes, or lower levels of evidence.8 Nevertheless, the most likely reason for rejection is lack of new or useful information.9
If a paper is rejected, it may be possible to submit it to another journal. Or you could ask for it to be reconsidered. Alternatively, a manuscript may be provisionally accepted, with comments. Comments can range from a few paragraphs to detailed feedback running for several pages. Answering each comment specifically and in detail can lead to drastic improvements in the quality of the manuscript, and greatly improve the chances of it being accepted. After all, it is estimated that at least 50% of rejected manuscripts are published within 2 years.10
It may also be that you have to re-run your analyses using a different methodology, or re-think the arguments you have used. Most of all, concise articles that get straight to the point and use the clearest language possible always have a much better reception, regardless of the audience.
- Garfield E. The Agony and the Ecstasy – The History and Meaning of the Journal Impact Factor. International Congress on Peer Review and Biomedical Publication. September 16 2005, Chicago, IL.
- Thomson Reuters. Journal Citation Reports. New York: Thomson Reuters; 2013. http://go.thomsonreuters.com/jcr [Accessed: 22 Apr 2013].
- The CONSORT Group. The CONSORT Statement. CONSORT; 2012. http://www.consort-statement.org/consort-statement/ [Accessed: 22 Apr 2013].
- Centre for Evidence Based Medicine. Asking Focused Questions. Oxford: University of Oxford; 2009. http://www.cebm.net/index.aspx?o=1036 [Accessed: 22 Apr 2013].
- Greenhalgh T. How to read a paper. Getting your bearings (deciding what the paper is about). BMJ 1997;315:243-6.
- Hall SA, Wilcox AJ. The fate of epidemiologic manuscripts: a study of papers submitted to epidemiology. Epidemiology 2007;18:262-5.
- Okike K, Kocher MS, Mehlman CT, Heckman JD, Bhandari M. Publication bias in orthopaedic research: an analysis of scientific factors associated with publication in the Journal of Bone and Joint Surgery (American Volume). J Bone Joint Surg Am 2008;90:595-601.
- Lynch JR, Cunningham MR, Warme WJ, et al. Commercially funded and United States-based research is more likely to be published; good-quality studies with negative outcomes are not. J Bone Joint Surg Am 2007;89:1010-8.
- Ehara S, Takahashi K. Reasons for rejection of manuscripts submitted to AJR by international authors. AJR Am J Roentgenol 2007;188:W113-6.
- Woolley KL, Barron JP. Handling manuscript rejection: insights from evidence and experience. Chest 2009;135:573-7.