Concise Academic Writing
Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS
Professor and Chair
University of California, Irvine
Editor, Western Journal of Emergency Medicine
Choosing a target journal
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35 general and subspecialty journals in EM
11 indexed in Medline (National Library of
Medicine)
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most established and prestigious
most discriminating
Rough order: most discriminating to least are:
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Most: Annals, Academic
Middle tier: Journal of, American Journal of, Canadian
Journal of, European Journal of, Journal of Accident
and EM, EM Journal (formerly Journal of Accident and
EM)
Lower tier: Internal and EM (Italy), EM Australasia
(formerly EM), Journal of Trauma: Injury, Infection
and Critical Care
20 Non-Medline EM Journals
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Author pays for publication:
BMC Emergency Medicine ($1860 if accepted)
World Journal of Emergency Surgery ($1665)
Brand new (2007-08):
Western Journal of EM
International Journal of EM
Electronic only:
Internet Journal of EM
Emergency Medicine Conventions
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Emergency physician (EP)
Emergency department (ED)
Emergency medicine (EM)
Not: emergency room physician, emergency room, emergency medicine
physician, ER physician, EM physician or even ED physician
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First time use: spell them out, and then, in
parentheses, abbreviate
Then use abbreviation throughout paper
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Except for tables and figures
Abstract stands alone
Rules of the Road
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Be brief!
Journal editor wants as much content in as few pages as
possible
Strunk and White, 1918, The Elements of Style:
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“Vigorous writing is concise. A sentence
should contain no unnecessary words, a
paragraph no unnecessary sentences, for
the same reason that a drawing should
have no unnecessary lines and a machine
no unnecessary parts. This requires not
that the writer make all his sentences
short, or that he avoid all detail and treat
his subjects only in outline, but that every
word tell.”
The Structure of DNA
Watson and Crick,
Nature, 1953
How to Get Your Paper Reviewed
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Follow the instructions
Follow the instructions
Follow the instructions
Follow the instructions
Follow the instructions
Get the picture?
to
to
to
to
to
authors
authors
authors
authors
authors
completely.
completely.
completely.
completely.
completely.
Other Tips and Requirements
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Avoid complicated medical terms and jargon
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Not, “juxtaposed,” but “adjacent” or even “next to.”
Use medical terms only when the appropriate lay
term is not precise enough.
Expect active voice almost all the time.
Use the template to include all vital elements
Avoid using the same word twice in a sentence
Other Tips and Requirements
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Avoid redundant hyperbole
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“extremely arachnophobic,
“close proximity”
“summarize briefly”
“very deep”
“overcrowded”
“very precarious”
Vary sentence length
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Avoid run-on sentences
Use no more than one parenthetical phrase per
sentence
Alternate short sentences with long ones.
Rules of the Road
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Paragraphs need to have at least three
sentences:
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a topic
an explanation
some sort of conclusion.
If there are only two, incorporate this thought
into the paragraph before.
Paragraphs should not generally have more than
six sentences.
Rules of the Road
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Someone not in EM, or not even in medicine,
should understand the paper.
A college graduate should be able to understand
much of medical writing
If they would be lost, the paper needs more
work
Goal is to NOT write in a language called
“medicine,” but rather in English
Rules of the Road
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Avoid politics in the paper
Little room for opinion in a scientific paper
Facts speak for themselves
Discussion section: Allow the author to opine a
bit, for maybe 2-3 sentences, if at all
Assure such opinions, are clearly marked, such
as, “we believe.”
If the concept is provocative, it probably doesn’t
belong in a research paper.
Reviewing Papers
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Helps gain experience in academic writing
Flips your perspective from author to consumer
Provides insight into common problems and
mistakes
Time consuming; good review = two hours
Will dramatically improve the quality of the
journal
Ultimate Medline indexing depends on this
The Title
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Answer the question posed by the paper in the
title
Type of study belongs in the title: retrospective,
randomized controlled trial, cohort study, before
and after, case report, case series
120 character limit for WestJEM
Strike balance between brevity and accuracy
Spell out all abbreviations.
Structured Abstract
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Introduction: two sentences max
Objective: one sentence
Methods: 2-3 sentences
Results: as many as you have, but major only
Conclusion: one sentence
Parallel the rest of the paper in content and
order
Limit for WestJEM: 300 words
Normally, abstract written first, then paper
Must assure consistency with body of the paper
Internal Consistency
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Sample size, numbers, results
Make sure these are the same in Abstract,
Methods and Results
Nothing brands a paper as amateurish than
inconsistencies
Casts doubt in the reviewer’s mind
What else is wrong if they can’t even get this
right?
Introduction
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Typically four paragraphs
Not a literature review
Cite references in the introduction that set stage
for the problem or hypothesis
All other citations belong in the discussion
(except methods description from previous
work)
Last sentence:
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We hypothesized….
Our objective was….
We sought to….
Methods
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Describe setting
How inclusive was the sample
Specific inclusion/exclusion criteria
What was the intervention?
How were subjects identified?
How was data gathered and recorded?
How was it analyzed?
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What tests?
Have statistician or senior mentor write or review
What computer program, version, manufacturer,
corporate headquarters….
Make and model of all equipment
Goal of methods is to enable replication
Methods: Retrospective Chart Review
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Adhere to seven elements of methods described
in Gilbert and Lowenstein, Annals Emerg Med,
1996, or
Worster and Bledsoe, Ann Emerg Med.
2005;45:448-451 with 12 criteria for a proper
methods section:
Worster
and Bledsoe
Results
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Present primary outcome measure first, followed
by secondary
Graphs easily visible in black and white, with
different patterns, not colors
For more than 4-5 related results, use table
Tables are easier to digest
Don’t repeat results from a table in text
Instead refer to general synopsis of the tabular
results
Results: Statistical and Reporting
Conventions
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All results in absolute not relative terms
“The absolute risk reduction from a mortality of
4% to 2% was 2%,” rather than, “The relative
risk reduction was 50%.”
Relative changes inflate the magnitude of the
effect artificially.
To compare two groups, use p values with 95%
confidence intervals AND calculate NNT/NNH
from the absolute difference in outcomes
Gives information to gauge clinical import
Results: Diagnostic Tests
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Use likelihood ratios in addition to sensitivity,
specificity, and positive/negative predictive
values
Allows reader to change probability of a given
condition after the diagnostic test
Pre-test probability modified by likelihood ratio =
post-test probability by the Fagan nomogram
Pulmonary Embolism and d-Dimer
PE +
PE -
Total
d-D +
30
42
72
d-D -
3
30
33
Total
33
72
105
Sensitivity = 91%
Specificity = 42%
LR Pos = (30/33) / (42/72) = 1.5
LR Neg = (3/33) / (30/72) = 0.22
Heit JA, et al. Arch Path Lab Med. 1999;123:235-240
Plain Language
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A negative d-dimer is 0.22 times as likely to
occur in patients with PE than in patients
without PE
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A negative d-Dimer is 4 ½ times less likely to
occur in patients with PE than in patients
without PE
Fagan
Nomogram
Figures
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Even if it seems obvious, annotate figures and
pictures with arrows (point to the brain
hemorrhage or appendicitis)
High resolution, at least 300 dpi
Low resolution images “pixel out.”
Legends for Tables and Figures
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Tables and Figures with their legends are
separate pages, not imbedded in text of paper
Must stand alone and be very descriptive
Must spell out all abbreviations used each time
Must be large and clear (little white space)
Make sure they are numbered in proper order
Discussion
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Most important findings first
Same order as results section
Then secondary outcome measures
This is the place for opinion, though quite limited
How could or should this change clinical care?
Discussions should be limited to 5-6 items, each
with one to two paragraphs
Conclusions
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Don’t allow overstatement
Definitive study is almost impossible
Insist on words such as, “it appears,” or “from
these data.”
Always call for further investigation
Retrospective studies cannot show causation,
only association
Make conclusion specific enough to stand alone.
Include, “in adults,” or “in emergency
department patients with a chief complaint of
chest pain.”
Limitations
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Limit to 1-2 paragraphs
Should acknowledge:
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Small sample size/underpowered study
Incomplete patient enrollment
Lost to follow up
Retrospective design
Lack of blinding
Lack of generalizability
Author should be honest about shortcomings
and biases, or appears naïve
References
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Consistent format, adherent to journal
requirements
Citations go at end of sentence, unless sentence
compound and citation applies only to first part
Need to be up to date: look at most recent
reference
Lit review from two years ago is out of date
Suggest new references as your expertise
dictates
Questions?