Scientific Writing for MCH Epidemiologists Jody W. Zylke, MD Senior Editor JAMA

What an editor looks for in a submission Tips on writing a scientific paper How to get started

What does an editor look for in a paper? Content Ideal paper Addresses a novel question Addresses important clinical question that will be of general interest Answers a controversial question Real paper “Next steps” Not just confirmatory

What does an editor look for in a paper? Study design Strong design—RCT, observational cohort, case-control Design fits the hypothesis Data source provides information on confounding variables Sufficient power Generalizable or clear about what population results apply to

What does an editor look for in a paper? Presentation Indicates what is known and not known about topic and how this study fills gap Clearly analyze and present data Interpret data appropriately Well written

Editor Reading Papers

Fatal Flaws Usually related to study design Negative underpowered study Predictive model that isn’t validated Survey with inadequate response rate

One strike you may be out Topic of article doesn’t suit journal Case report, animal study, specialized Failure to provide enough information on methods to judge validity Failure to address sources of bias and study limitations Conflicts of interest Sloppiness Failure to follow journal format, instructions

What an Editor Wants in a Paper Study with original, clinically important idea Rigorously performed and analyzed Objectively interpreted Paper well organized and written

“Writing is easy. All you have to do is sit and stare at the blank sheet of paper until the drops of blood form on your forehead.” ---Gene Fowler

Tips for Scientific Writing Just the Facts Follow the formula Three qualities of scientific prose (Huth) Accuracy Clarity Brevity

Accuracy Spelling errors Defective choice of verb tense Past tense in describing your results; present tense describing literature Commonly misused words Incidence vs prevalence That vs which Effect vs affect Case vs patient

Clarity Ambiguous antecedents (“He is a person with many convictions.”) Poor choice of verb tense Modifiers (“Hospital nurse physician staff interaction”)

Brevity “After careful consideration of all the foregoing lines of evidence, it is apparent to us that among all the antibiotics discussed penicillin is the one that should be chosen for the treatment of infections caused by the streptococcus.” “We conclude that penicillin is the best antibiotic for treatment of streptococcal infections.” “Streptococcal infections? Penicillin!”

Empty Words and Phrases A majority of (Use “Most”) Accounted for by the fact that (Use “Because”) Despite the fact that (Use “Despite”) Fewer in number (Use “Fewer”) In order to (Use “To”) It is often the case that (Use “Often”) Very, Extremely (Delete)

Abbreviations Well known—MI, LBW Made up—VM (vitamin and mineral) Unnecessary—NORM (normal) Confusing—PA (pulmonary artery, physician’s assistant) Silly—SALD (severe advanced lung disease)

Grace Dehumanizing words Pomposity Slang, jargon, cliches A diabetic vs a woman with diabetes Male and female Pomposity “It is an inescapable conclusion that utilization of this method in order to make the diagnosis . . .” Try “I conclude that use of this method . . .” Slang, jargon, cliches prepped, lab, flat line, exam, status post

Other Prose Features Vary Sentence Structure and Length “It is easy to craft a story about the FDA based on just a couple of actions, out of hundreds taken each year. So competing narratives abound. Some claim the FDA is captive to manufacturers and too quick to approve new therapies; others assert the agency is safety obsessed and too slow to make treatments available.” –Joshua Sharfstein Logical flow of paragraphs, Avoid passive voice (active verbs instead of forms of “to be”) Use key terms consistently

Structure of a Scientific “Story” Introduction Methods Results Discussion

How do you start? Pick the section that seems easiest Schedule times to write Find your most creative time Eliminate distractions Find your most productive environment

Outline or phrases Rough draft Rewrite—again and again Cut excess: “I have made this letter longer than usual, because I lack the time to make it short.” --Pascal Get colleague input