Dr (Col) Awadhesh Kumar Mishra
MS(ENT), DNB(ENT) , MNAMS
Professor & Sr Adviser (ENT)
Army Hospital (R&R)
Delhi Cantt -110010
AIM
 Sensitize younger colleagues to scientific paper writing
 Eliminate myths and apprehensions about paper writing
 Provide a template for reporting a well conducted study
with high chances of acceptance for publication
Not covered:
 Research methodology for conducting a scientific study. It
is presumed that a good study has been conducted which
needs to be published as a scientific paper
Why publish at all ?
•Scientific papers help in advancement of
knowledge
•Papers improve clinical practice
•Unpublished research = No research
•Career progression
•Legal binding to report the results of
drug trials / research involving human/ animals
Writing a paper - Making a dish based
on recipe book ?
 Arrange all ingredients  Hypothesis
 Methods
 Results
 Stats
 Conclusions
 Check all ingredients
validity –
- for Correctness /
internal / external
Writing a paper - Making a dish based
on recipe book ?
 Execute preparation as per following recipes o Format of a paper - IMRD & TAKAR
o Instructions to authors from the journal
o Applicable reporting guidelines for the type of
study from ICMJE
o Guidelines from EQUATOR (Enhancing
the QUAlity and Transparency Of health Research)
on reporting research and Scientific writing from
www.equator.org
o Elements of style by Strunk W & White EB for
English language
Writing a paper - Making a dish based
on recipe book ?
 Taste the finished product
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Read the manuscript
yourself aloud
Make adjustments if needed
Revise
Get the dish tasted by family
Make colleagues read the
paper
Make the adjustments if needed Revise
Serve to the guest
Submit to the journal
Survive the comments
Survive peer review
Appreciated –enjoy
Accepted – actions after
acceptance
Published – actions after
publication
What are the editors and reviewers
looking for ?
•Brevity & clarity
•Validity – internal and external
(credible results, appropriate design
and methodology)
•Fits the standards and scope of the journal
• Innovative or original
•Adds to existing knowledge
•Develops novel concepts
What are the editors and reviewers
looking for ?
•Relevant to clinical practice
•Methods described clearly and in enough detail
for others to replicate?
•Statistical analysis and level of significance is
appropriate?
•The results answer the research question
•Ethics approval was obtained and the
study was ethical
•Are the conclusions appropriate
How do we proceed?
(Graphic art- courtesy http://korimillerkidlit.com/tell-me-a-story/)
Selecting the journal…
 Journal relevance - Study must match the
scope of the journal
 Should be Indexed, Peer reviewed
 Target audience, geographical location of
journal
 Timing, flexibility and access options –
Subscription / open / hybrid
 Reputation : Impact factor, Scopus Journal
Analyzer , SCImago Journal Rank (SJR),
Source Normalized Impact per Paper
Selecting the journal…
 Average time for decision making Vs your
need for early publication
 Rate of rejection
 Beware of predatory journal (Refer Website
by Jeffrey Beall, https://scholarlyoa.com/)
 Open access – charges authors for
publication. Free to readers. Leads to more
circulation but not necessarily more citation
Read and keep these handy…
 Journal’s Instructions to authors
 “Recommendations for the Conduct, Reporting,
Editing, and Publication of Scholarly Work in
Medical Journals”
(ICMJE Recommendations, http://www.icmje.org/) Up
dated Dec 2014. Its comprehensive guide for scholarly work
 Reporting guidelines for research, at the EQUATOR
network resource centre http://www.equatornetwork.org/. This gives guidelines for various types
of studies.
The birth of a manuscript
Graphic art – courtesy
http://www.e-custompapers.com/blog/guidance-on-research-paper-outline.html
The research question
 Clearly defined
 Attempts to add to existing knowledge
 Meets FINER criteria:
 Feasible (answerable with a robust method)
 Interesting
 Novel
 Ethical
 Relevant
Title page
 “Not all who look at a journal are going to
read even one article in it; Writers must
know therefore what turns a looker in to a
reader”
-- J. W. Howie
(J.W.Howie. Writing and Speaking in Medicine BMJ,1976,3,1113-25)
The Title page
 Title is the only sentence or phrase in the paper which is
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always read
Have a working title initially; final afterwards
Be concise : fewest possible words but adequately indicate
the paper’s content
Express only one subject ie paper’s main issue
Simple, unambiguous and complete
Enticing and interesting - make people want to read further
Differentiate the paper from other papers in the field
Avoid abbreviations and jargon
Trendy /stylish/ so called cute titles soon become outdated
and even embarrassing later on
Write the Materials and Methods first
 Most critical part of the manuscript.
 Describe what you did in the study and why in that
particular fashion
 Describe in a logical sequence how the study was designed,
carried out, and analysed: Setting, location
 Participants (or objects)
 Sample size calculation
 Interventions (or exposures)
 Outcomes (variables)
 All statistical methods
 Information should be clear, accurate, and complete
(provide enough details to repeat, assess, and compare
with other studies)
Write the Materials and Methods first
 Readily available from protocol document
 Ideally less than 1000 words, but sufficiently elaborate
to allow replication by other researchers
 New methods may need detailed explanation, old
methods may be just given previous publication
reference.
 All material and equipment used in the study to be
identified correctly
 Mention Institutional Ethics Committee clearance,
informed consent, trial registration details
Results
 Describe what you found ! - Second most important part in
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the manuscript – should answer the research question on
its own
Presented in a coherent and organized way. Chronology
not important , logic in the story is important
Description parallels methodology - Start with your
population: size, demography etc
Give the outcome of primary variable first, then secondary
variable.
Do not interpret the results in this section – that is done in
the discussion.
Tables and graphs - visual presentation of the results –
should be self explanatory with legend – column for p
value
Important elements of tables may be included in text
Report on benefits, unexpected results and harms if any.
Discussion
 Start with overview of the most important results
 An assessment why the chosen design or model is
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appropriate.
Strengths and limitations of the study
Place your findings in the broader scientific or
clinical context.
What the study adds to previous knowledge
Describe briefly how the results are consistent or
not consistent with other similar studies
Discuss any confounding factors and their impact
Discussion
 Avoid lengthy discussion – up to 1000 words
 Utilize this space to justify your dosages, protocol,
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inclusion and exclusion criteria, and why you chose a
specific data analysis approach
Discuss the impact of your results on clinical practice or
patient outcome
Do not review literature unnecessarily – limit to studies
essential to place your results into context
But don’t forget to acknowledge previous research
which is of key importance
Mention the questions remaining unanswered and
future research
Conclusions
 Realistic – in one or two sentences
 Do not over sell conclusions – rather understate
 Hint further research on the same line if required
 Must relate to stated hypothesis
 Avoid excessive generalizations of the applicability of
the study findings beyond the study population
Introduction
 Easier to write if done towards the end
 Explain why you did the study, and why the reader be
bothered about it ?
 Scientific background for the study
 Be brief and relevant
 Start with what is known, then what is specific
unknown problem, and what is specific objective of
study
Introduction
 Final paragraph –
 Clear statement of primary hypothesis, followed
by secondary hypotheses (if any).
 Approach taken to test the hypothesis
 Population in which the question studied
 Key measurements taken
 How the answer to study question will contribute to the
over all knowledge in the field of study
References
 Demonstrate how your findings relate to earlier
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reports.
Do not cite papers if you have only read the abstract –
its not only risky due to possibility of misquoting but
also unethical
Format your references as required by the journal –
mostly Vancouver style
Sloppy references = sloppy study
Reference list – reasonable ie neither unnecessary
reference nor ignore crucial previous study.
Respect the limit imposed by the journal in the
instructions to authors
Abstract & Key words
 Appear right at the beginning of the paper but written
the last after streamlining everything else . It is a short
restatement of all essential points of a research paper
 Consult guide to authors for correct format and word
limit allowed by the journal – usually : background,
methods, results, and conclusions
 Write clearly the background (one sentence), the key
components of the methodology, and the key results
(numeric results given with mean and variance)
Abstract & Key words
 Abstract is a test of your capability of writing with
precision and efficiency
 They permit a quick assessment of the applicability,
importance and validity of a research paper
 Abstract may be the only part of your paper read by
many viewers – hence must stand alone and be
complete
 Key Words List:
 Used by abstracting and indexing services
 Crucial for chances of your article being found
by other researchers.
 Should conform to medical subject heading
(MeSH) vocabulary in Index Medicus
Cover letter
 The cover letter gives a chance to present the first
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summary of the study that will be read by an editor
Describe, very briefly, what you found and why this is
relevant to readers
Briefly explain the key message and implications of
your findings but don’t oversell your work
State that paper is not submitted elsewhere
Follow journal’s instructions to authors for other
details to be mentioned in cover letter
Before submission
 Revise many times yourself and after feedback of
colleagues and coworkers
 Run various Check Lists – again revise if flaw found
 Preserve raw data for future
 Preserve final version for future reference
Dealing with rejection
Four things can happen to your submission:
• Outright rejection
• Rejection with an invitation to make major changes
and resubmit
• Acceptance conditional on responding to
reviewers’ comments
• Unconditional acceptance.
Dealing with rejection
• Outright rejection:
- Don’t get discouraged
- Probably wrong journal / author instructions
not followed / serious flaw in study
- Read editor’s and reviewer’s comments and try
to improve if possible before sending to
another journal
- Do not send to same journal
Dealing with rejection
• Rejection with an invitation to make major changes
and resubmit:
Try to incorporate reviewer’s suggestion where
ever possible
Reasonable explanation for points not rectified
Indicate changes in manuscript
Many papers get accepted after resubmission
Even if rejected, your paper improves
After acceptance
 Choose appropriate end user license
 Proof reading – extremely important – last chance to
remove anomalies
 Proof reading marks : see Whittaker’s Almanac for
print proofs
 Eletronic proofs – direct correction and highlight
 Copy editing stage :
 Do not get puzzled with copy editors version and let
him have upper hand , except when you strongly feel
that an important error has crept in
After publication
 Personal thanks to coworkers
 Copies to coworkers and institute
 Disseminate
 Search Engine Optimization – for better visibility
 Institutional repository
 Digital repository / Non commercial repositories
 Press release
 Personal blog / Social media
 DO NOT VIOLATE LICENCE PROVISIONS
Authorship
 International Committee of Medical Journal Editors (ICMJE) 4 criteria:
 1. Substantial contributions to the conception or design
of the work; or the acquisition, analysis, or interpretation
of data for the work; AND
 2. Drafting the work or revising it critically for important
intellectual content; AND
 3. Final approval of the version to be published; AND
 4. Agreement to be accountable for all aspects of the
work in ensuring that questions related to the accuracy or
integrity of any part of the work are appropriately investigated
and resolved.
Authorship
 All authors meeting criteria to be included
 Any author not meeting all 4 criteria to be
acknowledged
 The corresponding author is the one individual who
takes primary responsibility for communication with
the journal during the manuscript submission, peer
review, and publication process
 Ghost authors - unethical
Ethical issues
 Authorship disputes
 Conflict of interest
 Plagiarism – check on line – i-Thenticate
 Simultaneous submission
 Salami slicing
 Data falsification
 Data fabrication
 Trial registration
 Ethics committee clearance
Ethical issues
 Informed consent
 Patient identity protection
 Patient harm prevention and compensation
 Influence of industry
Language & Grammar
 Only standard abbreviations
 Active voice wherever possible
 Use first person in limited doses
 Avoid unnecessary words and phrases
 Consult books on elements of style
Papers that get published
 Good scientific content
 Clear to understand message
 Right journal
 Followed instructions to authors
 Perseverance through peer review
 Fills the gap in knowledge
 Provides new insight to the problem
 Leads to further research
 Tells a good research story
Papers that get rejected
 Failure to state a hypothesis
 Not answering the hypothesis
 Contradictions within the manuscript, superficial
discussion, inconsistent use of terms, and a
conclusion that is not supported by the data
 Not following journal instructions
 Not followed reporting guidelines
To conclude
 Scientific writing essential for growth of medical knowledge
and career of doctors
 Challenging job but there are ways out
 Introduction of various guidelines, instructions, monograms,
check lists have provided ready made templates to build the
paper on
 Little sincerity and will power will result in good manuscript
 Patience and perseverance during peer review is always
rewarding