Study skills and medical
writing
Professor B. J. Bain
Department of Haematology
Declaration
• The lecturer has no conflict of interest to
declare
Study Skills and Medical Writing
• Some of your teaching is didactic
• Some of it requires you to seek out information
for yourself or generate data by research and
synthesize it into your own work
• This lecture deals mainly with the latter
• It also deals with medical writing
• Essays
• Practicals
• Scientific articles
Study Skills
• Science and the Patient starts your
preparation for the BSc course
• The BSc is different from the rest of the
undergraduate medical course
• It is more scientific
• It is less clinical
• Learning is more self-directed
• Science and the Patient introduces you to
self-directed learning skills
Study Skills
• These skills are relevant to writing up your 2nd
year practical (and to essay writing in year 4)
• Some study skills are crucial for you whole
medical career
• Independent learning
• Critical ability
• This includes the ability to find information for yourself
and assess its validity
• You need to think for yourself and question
what you are told
Wall of British Library
Photography K. Bain
Study Skills
• You need to be able to find information in
the scientific literature; you should be using
original scientific articles
• Not just text books and lecturers’ handouts or
Power Point Presentations
• To a lesser extent, you need to be able to
find and assess the validity of information
in alternative electronic sources
Study Skills
• The ability to write clear concise and
accurate English is essential for your whole
medical career
• It is time to start practicing
• So how do you do all this?
How to find relevant sources of
information
• Start with recommended text books and
lecture handouts to make sure you have the
necessary basic knowledge
• When you have done that, search by topic
on PubMed or using a search engine to find
further up-to date information
• Google, Yahoo etc give you a shortcut to
relevant articles
• PubMed gives you are more exhaustive list
Beware!
• Beware of websites for patients (sometimes
they are very good but their quality is
variable)
• Be cautious with Wikipedia
• Wikipedia often gives high quality information
• An article in Nature in 2005 found 162 errors in
Wikipedia and 123 in Encyclopaedia Britannica
(quoted in Wilkinson N, ‘Tis all in pieces, The Author, Spring 2010, p15)
• Original articles are the most reliable source
How to find relevant sources of
information
• Textbooks are a secondary source
• The primary source is the original scientific
article
• Primary sources can be right up-to-date;
textbooks are always out of date
• You need to learn how to read and assess an
original article
How to find relevant sources of
information
• When you have found an article that looks
relevant, read the abstract
• If the abstract suggests it is relevant, read the
article
• It is sometimes useful to read the abstract, the
introduction and the discussion first since
that tells you what the authors think they
have discovered
How to find relevant sources of
information
• Once you have done that, read the methods
and the results
• Sometimes authors misinterpret their own
results so read what they actually did and see
if you agree with their conclusions
• For example, have they claimed to have
established something when the results are
not statistically significant?
How to find relevant sources of
information
• You may need to go back to earlier articles
that are referred to if the authors have
assumed knowledge that you do not have
• When you find a relevant article in PubMed
you will notice that there is also a link to
related articles
• You may also want to check for published
corrections or later letters relating to the
article
How to find relevant sources of
information
• You may also want to look at other articles
that have cited the article you have found
• For essays, don’t bother looking at articles in
languages other than English (unless you
happen to speak them)
• However, for serious research you should try
to read anything relevant, despite language
problems—read the English abstract and if it
seems relevant get some help
How to find relevant sources of
information
• You may be able to make sense of something by
using an automatic translation
• It will not be good English but it might be
intelligible
How to find relevant sources of
information
• In critically reviewing an article there are two
important questions to ask yourself
• What have the authors discovered?
• Is it important – scientifically or clinically?
• Statistical significance does not necessarily
equate to scientific or clinical significance
• Ask yourself if it matters and if so why
Other skills
• You need to understand and be able to use
standard statistical tests
• You need to be able to use a word processing
package
• You need to learn to write accurately, clearly
and concisely, using appropriate scientific
language
Writing an essay
• Read the title carefully
• Answer the question
• Draw up an outline based on what you know and
then seek relevant extra information
• Start with a BRIEF introduction
• Set out your essay in paragraphs so that there is a
logical flow
• Start by outlining briefly what you are going to do
Writing an essay
•
•
•
•
•
•
Then do what you said you were going to do
Finally end with a conclusion or synopsis
Count the words
Shorten if necessary
Always give a list of cited references
If you have drawn heavily on a single source
or a few sources, put it or them in a
bibliography
Writing an essay
• If you think your essay needs illustrations, it
is better to draw them yourself rather than use
anyone else’s—you can scan them in or
compose them electronically
• If you think a table is needed, compose your
own
• If you do use someone else’s tables or figures
this MUST be acknowledged—otherwise it is
plagiarism
Writing an essay
• Don’t plagiarise
• Do cite anyone when you are quoting their
ideas or using precise information they have
given—if you say ‘53% of British adult
males drink more than the advised number of
units of alcohol per week’ they reader wants
to know your source—cite it
• Don’t cite anyone you haven’t read
Writing an essay
What is plagiarism?
Plagiarise, plagiarise
Let no-one’s work evade your eyes
That’s why the Good Lord made your eyes
So don’t shade your eyes
But plagiarise, plagiarise, plagiarise…...
Remember always to call it research
Nikolai Ivanovich Lobachevsky, a song by Tom
Lehrer
Writing an essay
• What is plagiarism?
“The act of presenting another’s
work or ideas as your own”
www.tilt.lib.utsystem.edu
Writing an essay
• What is plagiarism?
www.palgrave.com
Writing an essay
• What is plagiarism?
www.cjpeters.com
Writing an essay
• What is
plagiarism?
www.cmu.edu/teaching/resources/plagiarism.html
Writing an essay
• What is
plagiarism?
www.cartonstock.com/directory/j/john_grisham.asp
Writing an essay
Don’t ‘Cut
and Paste’
Source: Roger Beale,
FT Magazine, April 1/2
2006
Writing an essay
• What is plagiarism?
www.library.appstate.edu
An Example of Plagiarism (from
a previously respected popular
medical writer)
'He took paragraphs from my work, word for word' psychiatrist faces plagiarism charge
· Journal retracts article after US scholar complains
· Raj Persaud says credits 'inadvertently omitted'
Helen Pidd
Monday November 7, 2005
The Guardian
Britain's most ubiquitous psychiatrist was yesterday at the
centre of a plagiarism row after it emerged that substantial
portions of an article he had written for a medical journal
were copied from the work of an American academic.
An Example of Plagiarism
The article written by Raj Persaud in the February edition of
Progress in Neurology and Psychiatry was withdrawn and a
retraction printed, but it went unnoticed outside the mental
health community. One of the youngest doctors to become a
consultant at the highly respected Maudsley teaching
hospital in London, and boasting eight degrees, Dr Persaud
writes on mental health matters in a string of publications
and has presented the Radio 4 psychology programme All in
the Mind.
The alleged plagiarism came to light when Thomas Blass,
professor of psychology at the University of Maryland,
happened upon Dr Persaud's article. He said he was
shocked by the similarity between Dr Persaud's piece and
his work……………..
An Example of Plagiarism
• Why the Media Refuses
• The Man Who Shocked the
to Obey, by Raj Persaud,
World, by Professor
Progress in Neurology
Thomas Blass PhD,
and Psychiatry, Vol 9,
University of Maryland, in
issue 2.
Psychology Today (March
2002)
• "Milgram's study
demonstrated with brutal • "[The study] demonstrated
clarity that ordinary
with jarring clarity that
individuals could be
ordinary individuals could be
induced to act destructively induced to act destructively
even in the absence of
even in the absence of
physical coercion, and
physical coercion, and
humans need not be
humans need not be innately
innately evil or aberrant to
evil or aberrant to
An Example of Plagiarism
• Why the Media Refuses • The Man Who Shocked the
to Obey, by Raj Persaud, World, by Professor
Progress in Neurology
Thomas Blass PhD,
and Psychiatry, Vol 9,
University of Maryland, in
issue 2.
Psychology Today (March
2002)
• act in ways that are
reprehensible and
• act in ways that are
inhumane. While we
reprehensible and inhumane.
would like to believe that
While we would like to
when confronted with a
believe that when confronted
moral dilemma we will act
with a moral dilemma we will
as our conscience
act as our conscience
dictates, Milgram's
dictates, Milgram's
obedience experiments
obedience experiments
An Example of Plagiarism
• The Man Who Shocked
the World, by Professor
Thomas Blass PhD,
to Obey, by Raj Persaud,
University of Maryland, in
Progress in Neurology
Psychology Today
and Psychiatry, Vol 9,
issue 2.
(March 2002)
• teach us that in a concrete • teach us that in a concrete
situation with powerful
situation with powerful
social constraints, our
social constraints, our
moral sense can be all
moral sense can easily be
too easily
trampled."
overwhelmed."
• Why the Media Refuses
An Example of Plagiarism
• Why the Media Refuses • The Man Who Shocked the
to Obey, by Raj Persaud,
Progress in Neurology
and Psychiatry, Vol 9,
issue 2.
• Milgram's interest in the •
study of obedience partly
emerged out of a deep
concern with the suffering
of fellow Jews at the hands
of the Nazis and an
attempt to fathom how the
Holocaust could have
happened.
World, by Professor Thomas
Blass PhD, University of
Maryland, in Psychology
Today (March 2002)
Milgram's interest in the study
of obedience also emerged
out of a continuing
identification with the
suffering of fellow Jews at the
hands of the Nazis and an
attempt to fathom how the
Holocaust could have
happened.
Writing an essay
• What is plagiarism?
• What would you think if you read the following
in a student essay: “Following the identification of
hepatitis C virus it became apparent that this
infection is widespread and presents a serious risk to
patients with transfusion-dependent thalassaemia.
The prevalence of anti-HCV antibodies varies in
different parts of the world from 11.7% in Turkish
Cypriots to 75% in Italians”
Writing an essay
• You might suspect plagiarism
Writing an essay
• You might suspect plagiarism
• If you want to convey this information how do
you deal with it?
Writing an essay
• You might suspect plagiarism
• If you want to convey this information how do
you deal with it?
• First find the original references
Writing an essay
• You might suspect plagiarism
• If you want to convey this information how do
you deal with it?
• First find the original references
• Next establish the facts
Writing an essay
• You might suspect plagiarism
• If you want to convey this information how do
you deal with it?
• First find the original references
• Next establish the facts
• Then put it in your own words
Writing an essay
• You might suspect plagiarism
• If you want to convey this information how do
•
•
•
•
you deal with it?
First find the original references
Next establish the facts
Then put it in your own words
Then indicate your sources
Writing an essay
• You might end up with something like this
“Since hepatitis C can be transmitted by
blood transfusion it is a serious risk to
patients, such as those with thalassaemia
major, who need regular blood transfusion.
This was particularly so in the past before
there was adequate testing of donor blood.
Wonke et al in 19901 reported that a quarter
of 73 thalassaemia major patients had antiHCV antibodies. The prevalence was…
Writing an essay
• … 12% in those transfused only in the UK
and 44% in those who had been transfused
elsewhere. Lau et al2 found a higher
prevalence of seropositivity in Hong Kong, 34
of 99 patients having anti-HCV. Both these
studies observed a correlation between
seropositivity and impaired liver function”
• However, at this stage you run into a problem
Writing an essay
• You would like to give the information about
the even higher prevalence reported in Italy
(which was mentioned in the textbook from
which the extract was taken) but neither of the
references with Italian names are available
electronically
• What do you do?
Writing an essay
• You would like to give the information about
the even higher prevalence reported in Italy
(which was mentioned in the textbook from
which the extract was taken) but neither of the
references with Italian names are available
electronically
• What do you do?
• You have at least 4 choices
Writing an essay
• Send for both references on interlibrary loan and
hope one of them has the information you are
looking for
• Do a literature search for hepatitis C + transfusion
+ Italy and see if anything useful turns up
• Leave it out
• Cite the person who cited it (in this case
Weatherall DJ and Clegg JB, The Thalassaemia
Syndromes, Blackwell Science, Oxford, p. 309)
Writing an essay
• If you were sure which reference the
information came from it would be best to put it
in the form: Cancado RD, Guerra LGM,
Rosenfeld MOJA, et al. (1993) Prevalence of
hepatitis C virus antibody in beta
thalassaemia patients, Fifth International
Conference on Thalassaemia, p. 176, Nicosia,
Cyprus, cited by Weatherall DJ and Clegg
JB, The Thalassaemia Syndromes, Blackwell
Science, Oxford, p. 309.
Writing an essay
• If you use someone else’s words use quotation
marks
• However it is very irritating to the reader if
there are a lot of direct quotes—use your own
words
• Use direct quotes only if the actual words
matter: “I have a dream”
www.writespirit.net/.../martin_luther_king_talks
How to write an essay—spelling,
grammar and punctuation
• Your essay should be spelt and punctuated
correctly and grammar should be correct
• Errors in spelling and grammar irritate the
reader and distract him or her from what you
are saying
• They make the reader think you might also be
careless with scientific data
• Use an electronic ‘Spellcheck’ but don’t rely
on it entirely
A test
Find the error, its impossible:
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
A test–there is a missing
apostrophe
Find the error, its impossible:
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
How to write an essay—spelling,
grammar and punctuation
Beware of erroneous apostrophes
The Guardian
How to write an essay—spelling,
grammar and punctuation
• Beware of erroneous apostrophes—here are
four direct quotes from student essays:
• Two third’s of children
• Coomb’s test
• A group of hereditary haemolytic anaemia’s
• An agent acts on the red cell leading to it’s
destruction
How to write an essay—spelling,
grammar and punctuation
“The confusion of the possessive “its” (no
apostrophe with the contractive “it’s”
(apostrophe) is an unequivocal sign of
illiteracy.”
Truss L, Eats, Shoots and Leaves, Profile
Books, London, 2003, p 43.
The Apostrophe Protection
Society
www.apostrophe.fsnet.co.uk
How to write an essay—spelling,
grammar and punctuation
• Does punctuation matter?
• Here is a story that suggests that it does
A panda walks into a cafe. He orders a sandwich,
eats it, then draws a gun and fires two shots into
the air. “Why?” asks the confused waiter. The
panda produces a badly punctuated wildlife
manual and tosses it over his shoulder. “I’m a
panda,” he says, at the door “Look it up”.
How to write an essay—spelling,
grammar and punctuation
The waiter turns to the relevant entry and, sure
enough, finds an explanation.
“Panda. Large black-and-white bear-like
mammal, native to China. Eats, shoots and
leaves.”
Truss L, Eats, Shoots and Leaves, Profile Books,
London, 2003.
How to Write an Essay—Does
Punctuation Matter?
How to Write an Essay—Does
Punctuation Matter?
Apparently Yes
How to Write an Essay—Does
Punctuation Matter?
How to write an essay—setting
out references
• Follow a standard format from a journal
• If you invent your own format then at least
make sure it conforms to common practices
• For journal articles you need, at a minimum
• the surnames and initials of at least the first 3
authors
• the journal name
• the volume
• the first page
How to write an essay—setting
out references
• Usually you need the title of the article
• Depending on the journal, you might need
the last page as well as the first
For journal articles you usually do not need
• The issue number or month
• The first names of the authors
• The qualifications or titles of the authors
How to write an essay—setting
out references
Here are examples of acceptable formats
• Marcelin A-G, Aaron C, Mateus E, et al.
Rituximab therapy for HIV-associated
Castleman disease, Blood 2003;102:2786-2788.
• Marcelin, A.-G., Aaron, C., Mateus, E., Gyan,
G., Gorin, I., Viard, J.-P., Calvez, B. & Dupin,
N. (2003) Rituximab therapy for HIV-associated
Castleman disease. British Journal of
Haematology, 102, 2786-2788.
How to write an essay—setting
out references
Here are examples of how not to set out
references (copied exactly from student essays)
• -Hematologically Important Mutations: Spectrin
and Ankyrin Variants in Hereditary
Spherocytosis – P.G. Gallagher and B.G. Forget
– Blood cells, Molecules and diseases (1998)
24(23) Dec 15: 529-543.
How to write an essay—setting
out references
Here are examples of how not to set out
references (copied exactly from student essays)
• Bolton-Maggs PHB, (2000) The Diagnosis and
Management of Hereditary Sperocytosis.
Balliere’s Clinical Haematology, Vol. 13, No. 3,
327-342.
• A. Iolascon, S. Perotta, G.W.stewart, Red blood
cell membrane defects, Vol 7.1. 2003.
How to write an essay—setting
out references
• For books, all authors or editors are usually
given and you must give the publisher, city
and year. This is an acceptable format:
Hughes Jones NC and Wickramasinghe SN,
Lecture Notes in Haematology, 6th Edn,
Blackwell Science, Oxford, 1996, pp 102-4.
How to write an essay—setting
out references
• These are some genuine examples from
student essays of unacceptable formats for
citing books
• Clinical Medicine - Kumar and Clark
• Howard, Martin R; Hamilton, Peter J (1997)
Haematology An Illustrated Colour Text, 1st
Edition, Churchill Livingston, NY, 1997 pp
28-35
How to write an essay—setting
out references
In quoting a chapter from a multiauthor book it is
even more complex; here is an acceptable
example
• Lewis SM and Roper D, Laboratory methods
used in the investigation of the haemolytic
anaemias, In Lewis SM, Bain BJ and Bates I
(Eds) Dacie and Lewis Practical Haematology,
Churchill Livingstone, Edinburgh, 2001, pp
149-166.
How to write an essay—setting
out references
• If citing a website, give the date you accessed
the site as well as the URL
• Test the URL to make sure that it is correct
• Here are some satisfactory examples
www.chime.ucl.ac.uk/APoGI/ (accessed 21/11/04)
http://www.sicklecelldisease.org/ (accessed 21/11/04)
What makes a good essay?
• Written on a word processor or very clear
•
•
•
•
handwriting
Sticks to the topic
Has a clear, logical sequence (headings are OK)
Shows evidence of both study of the literature and
independent thought
Preferably has some reasonably original ideas or
has discovered something the marker did not know
Writing a Scientific Article
• There is an organised structure
•
•
•
•
•
•
•
Title
Abstract or summary
Introduction – why?
Methods – how?
Results – what was found?
Discussion – what does it mean?
References – what have other people said that
has contributed to your introduction, methods
and discussion?
Writing up a Practical
• You can use the same structure as for an article
•
•
•
•
•
•
•
Title
Abstract or summary
Introduction
Methods
Results
Discussion
References
Writing up a Practical
• Use your full word allocation but no more
• Those setting the practical will have considered
the number of words you are likely to need to
explain what you did and discuss your
conclusions
• It does not matter if you use fewer words
EXCEPT you may leave out something that
could usefully have been included
• It does matter if you go over your word allocation
How Does a Scientific Article
Differ From a Practical Write-Up?
• An article must be succinct
• The article has to be worth writing
• You need to consider which journal might
publish it and how to reach your target
audience
• You need to consider ethical aspects
• Don’t irritate the editor or reviewers by
carelessness
Ethics of Writing a Scientific
Article (i)
• An article must be honest
• Prior work of others must be acknowledged
• Differing results published by others must
not be ignored
• Conflicts of interest must be declared
• The article must not be ghost written
• It may be important to publish negative
results
Ethics of Writing a Scientific
Article (ii)
• People on whose work the article is based
must be authors
• People who have not contributed should not
be authors (‘guest authors’)
• Ethical Committee approval may be needed
• Patient consent may be needed
A final bit of advice….
• Use an practical write-up or an essay as a
learning experience
• Make sure you understand the subject
thoroughly and then it will be easier to write
about it
• Use the essay to clarify your own ideas on
the subject
• Write it so well that it will be useful to you
for revision
Further reading
• Barbour V (2010) How ghost-writing
threatens the credibility of medical
knowledge and medical journals.
Haematologica, 95, 1.
• Hall PA (2010) Getting your paper
published: an editor’s perspective. Ann
Saudi Med, 31, 72. (www.saudiannals.net)
Anything else we
should discuss?
Some exercises
• There was no difference between either
method.
• There were 28 male children and 23 female
children in the study.
• The patients complained of breathlessness
and ankle swelling. She was noted to be pale.
The full blood count revealed anaemia.
• A 67 year old gentleman was admitted with
…………..
• With regard to weight, the women were heavier.
• The fetus was found, on ultrasound, to be
hydropic. Foetal blood sampling led to a diagnosis
of haemoglobin Bart’s’ hydrops fetalis.
• The treatment group showed improved survival
but, because of the small numbers, the difference
was not statistically significant.
• The platelets were 323.
• There were 15 patients in the study, who
were assigned randomly to treatment A (n =
7) or to treatment B (n = 8). The majority of
patients responded to treatment A whereas
only one patient responded to treatment B.
• If liver failure was to develop, a low protein
diet should be given.
• The data is potentially misleading.
• Neither an elevated bilirubin or and increased
alkaline phosphatase provides certain
evidence of liver disease.
• At this point in time……
• Those who inherit the S gene from one
parent only enjoy a degree of protection from
falciparum malaria.
• There is a superior therapeutic outcome with
anti-viral treatment.
• Graft-versus-host disease which may be fatal
is a serious complication of transfusion from
close relatives.
• Graft-versus-host disease which results from
transfusion of blood from close relatives can
be prevented by irradiation of the blood.
• The white cell count did not fall because
folinic acid was given.
• The liver was firmer than normal. It’s edge
was felt two finger-breadths below the costal
margin.
• We performed the biopsy utilizing a
disposable Yamshidi needle.
• With respect to chelating therapy, it is
within the realm of possibility that oral ironchelating agents will be developed in the
foreseeable future
• Beware of erroneous apostrophe’s.
This lecture is sponsored by the
Apostrophe Protection Society
Not really