John H. Burton, MD Chair Department of Emergency Medicine Carillion Clinic James R Miner MD Research Director Department of Emergency Medicine Hennepin County Medical Center

 Writing a manuscript and doing clinical research are very different  Writing up good research is much easier than writing up bad research  It all starts with the research

 A good argument is a work of art – every word matters  Acknowledge and compliment the correct aspects from the other discussants  Directly state your opposing viewpoint  Leave room for alternative viewpoints  Concede when you’re wrong  Don’t write angry

 Participating in written arguments on list serves, blogs, and social media can be a great way to have your writing critically appraised and to improve your skills  Remember that its going to exist for ever

 Can be a fun way to review a topic  Take a lot of time that should be spent writing up your research and innovations  Don’t make you better at writing science  If you do a lot of good research, you’ll have all the opportunities you want to do this later, don’t let it bog you down at the beginning

“Yes” To an invitation to write ANYTHING…

 Critically read everything you can related to your work  Carefully thought our arguments over clinical questions with colleagues by are an excellent way to refine your writing skills

Getting Started: get SOMETHING on the paper

 Abstracts ◦ Model your writing on abstracts that were well received and on the same topic as yours ◦ Every word matters ◦ Sets up the structure of your subsequent manuscript  Put your focus on publishing abstracts rather than non-peer reviewed work to get your career on track

Writing an abstract/manuscript:

 Structure and convention are important ◦ A lot of aspects of a research project are not written in a manuscript, if you’re manuscript is sloppy, readers will assume your research is as well ◦ Nobody reads scientific manuscripts for entertainment ◦ Always make clear distinctions between what you think and what you know whenever you write  Both are important as long as you know the difference

 Starts when you write your protocol  Add you results  Discuss what your found out between writing the protocol and analyzing your results  Include all limitations your readers may not have been able to deduce

 Your protocol is the methods section of your paper  The background section of your IRB or IACUC application is your introduction  Having your manuscript half way written before you collect any data leads to getting it finished in the end

 What is the question  What is known about the question  What is left to find  Describe your model  Describe the theoretical validity of your model  Specifically state your hypothesis and primary outcome measures

The Manuscript: Abstract Background Protocol

Cut/Paste into the Sections Rewrite

 What is validity? ◦ Internal validity  Truth in the study  Nobody should read the paper if its not there, describe it in the introduction ◦ External validity  Truth in the universe  The goal of your manuscript is to help the reader judge this for your study, you need to help them get there

 Never conclude that further research needs to be done  Don’t present 2-D data in 3-D  Don’t avoid the elephant in the room ◦ Know your limitations and state them clearly ◦ State why and which part of your work is important anyway ◦ If you don’t acknowledge a limitation readers assume you didn’t know about it

 Carefully describe how the assignment of patients to treatments accounts for confounders (I/E criteria, randomization)  Describe all of the patients who were screened and entered the trial and account for them

 Was there an independent, blind comparison with a reference standard?  Did the patient sample include an appropriate spectrum of the sort of patients to whom the diagnostic test will be applied in clinical practice?

 Were there clearly identified comparison groups that were similar with respect to important determinants of outcome (other than the one of interest)?  Were outcomes and exposures measured in the same way in the groups being compared?

 Were there clearly identified comparison groups that were similar with respect to important determinants of outcome (other than the one of interest)?  Were outcomes and exposures measured in the same way in the groups being compared?  Is the study designed around the primary outcome?

 The weaknesses in a study must be balanced with the relevance of the findings ◦ This is what the discussion is for ◦ If you can’t describe why your data is still important given the flaws in your study, you should probably repeat the experiment with an improved design ◦ Fixing these flaws may lead to a line of research that keeps you writing for your whole career  If we only write perfect research we’ll have a big pile of internally valid irrelevant data ◦ There are journals that specialize in this

Read the paper and decide if and what part of the findings can be used to reveal some piece of truth in the Universe

Statistics Get a Statistician with Clinical Experience

 Prioritize  Let go of your failures  Write every day  If you don’t know what to write, just write something

 Don’t always go for the low hanging fruit  Don’t get bogged down for ever on something really hard

 I work on revisions as soon as I get them  If I don’t have anything in press, I finish and submit the thing closest to being ready to publish  If I have don’t have anything under review anywhere, I finish and submit the thing closest to being ready for submission  If I have data from a finished study that isn’t written up, I start writing that manuscript  If I have an idea without a protocol, I start writing that

 Therefore, the goal is to always have at least one: ◦ Manuscript in press ◦ Manuscript under review ◦ Manuscript being written ◦ Protocol being written  You always need something that needs writing if you want to write every day

Always have something in the mail

Rejections Take the feedback/reviewer comments, change it, Send it somewhere else

 If your manuscript is getting rejected everywhere you send it due to its flaws, you may need to repeat the study with improvements  If your manuscript gets rejected without flaws noted, it may be that only you find it interesting ( I have a lot of these)  If you haven’t written something up after a long time, it might not be that interesting to you (give it away)  Save it somewhere; big pieces on rejected papers usually end up published in subsequent manuscripts

 Write down your ideas  Sometimes writing takes a lot of focus for a long time  Sometimes your best stuff will pop up out of nowhere ◦ Allow yourself to do both

 Make an outline  Add to it wherever you can  Eventually it will start to form prose  Write the whole 1 st draft yourself  Editing is a lot easier than writing, even when your editing yourself ◦ Don’t be afraid to cut ◦ Work with coauthors who are better at writing than you

 In general, submit to the journals you read  Peer review can sometimes be random, rejection is not the end of the road  Read the reviewers comments, revise if you agree, and resubmit before inertia takes over  Impact Factor has received a lot of attention

Stop Doing the Easy Stuff:

If you have nothing, offer to write for other people!

 A good paper starts with good research  Learn the rules  Follow the rules  Its easier to cut than to add  Don’t get bogged down by one thing  Once you’ve written something, keep submitting  It’s not as hard as you may think…

Thank You CORD!