Writing (a paper)
This page advises on how to write a paper, meaning a document for publication in a scientific journal (such as Clinical Rehabilitation). The advice is based on my own experience over about 50 years (I once edited the medical school gazette and even helped with a school newspaper). It is also based on 27 years as an editor of a journal, over which time I have read at least 11200 submitted papers, probably many more. When giving talks on the topic, I usually use the subtitle, “How to avoid immediate rejection of your paper“, because the lack of care or interest that many authors demonstrate suggests they do not want their paper to be accepted. And the two main messages I give are, first, know what you want to say, and say no more than is needed to get your message across and, second, at all points, consider your reader – the editor, the reviewer, and if you are lucky, a reader who wants to read your paper. There is a downloadable document here. Other available sources of help are given.
Table of Contents
I failed the Use of English examination at school (I passed on the second attempt), yet I now edit a journal and write extensively. Writing is a skill that needs learning, and it is not (for most people) a naturally present ability. Like everything in rehabilitation (and in life), with effort and practice, you may improve. But, like most car drivers, who typically assume they have above-average driving abilities, many authors believe they can write well. My experience as an editor (and as a reader of many work-related documents) is that most people write badly.
This section of the website is different from an academic treatise on writing. Instead, it highlights some of the significant weaknesses in writing that strike me when reading. I have the advantage of being taught well when about 21 years old, learning from being given excellent (but quite strong) feedback with advice. My first article, for a newspaper had every word, sentence, and paragraph changed by my teacher! I will outline the common problems in papers submitted to Clinical Rehabilitation and other documents I read.
The most important single piece of advice is to think of your reader. At all times, consider the person who will be reading what you produce. This includes, obviously, the actual content. Still, submitting a paper also covers other matters such as layout, font size, line spacing, clarity of figures and tables, removing tracked changes and comments, etc.
Questions to ask yourself are:
- who will be reading this? Ans. Usually, a wide variety of people.
- what will they be looking for? Ans. Often quite different things.
- will they find what they want quickly? Ans. Only if you structure everything logically so they can.
- does my paper have a clear, unifying main message? Ans. It will only do so if you get to the point; your article is not a nineteenth-century Russian novel.
Put yourself in the position of potential readers. There are several ways to emulate the reader:
- ask a friend or colleague unfamiliar with the research or the article’s content to read it and give feedback. They will represent the reader.
- read the paper out aloud to yourself. You will soon pick up mistakes and poor writing. (I picked up this idea from Twitter.)
- leave the paper completely untouched for one week before submission. Then read it anew; you will notice many areas needing improvement
Four other critical general messages are given below, followed by advice on learning to write and improve your presentation of papers.
Writing - always focus on your message.
You must always:
- have a central message for the document, something you can encapsulate in no more than 50 words
- ensure that everything you write relates to that key, thematic message.
At every point, you must consider your message. What is this sentence, paragraph, section or page, and whole document saying? Is what it is saying relevant to the larger message? An article is like a story, a sequence of ideas you communicate to the reader. Always ask yourself, does this sentence carry the argument I wish to transfer within it?
One advantage of writing on a computer screen is that you can only see a limited part of the document. When you come back to read and edit it, ask yourself if you know what the sentence or paragraph is saying without going back to discover.
When writing any document, the most critical matters to consider are whether you have a single, vital message and whether everything in the piece is crucial to conveying your message. Your central idea is your theme, and everything within the document must relate to the overall message. If something does not relate to your article’s core message, remove it because it will confuse the reader.
If using the standard Introduction, Methods, Results, and Discussion format for a scientific paper, the message for each part is given to you. Stick to it. The introduction is different from the place to discuss or give anything to do with your method or results. At most, as in many stories, you may hint at something to be expanded on later, but it should only be a tantalising hint to maintain the reader’s interest.
To help yourself, imagine that your paper has hit the headlines (none of mine ever have!), and you are on national television. You have probably 60 seconds. The interviewer asks, “What is your paper on XXX about?“. In two sentences, you need to say whatever you think is the paper’s most important message—no more. The audience switches off after two sentences.
Writing - build in a structure.
It would be best if you remembered that:
- The reader needs to know where she is, where she has been, and where she is going at all times.
- Structure gives the reader a mental map, so they feel confident and can find something they need quickly.
Writing has structure. Letters are formed into words, carrying meaning. Groups of words form structured sentences (sometimes!) by grammar rules, grouped into paragraphs, etc. Each level of the structure holds a meta-message: this word means ….; this sentence means ….; and so on.
The greatest weakness of most authors is an inability to use paragraphs to provide a structural framework, coupled with an inability to structure a group of paragraphs. For example, a single paragraph in the methods section of a paper submitted to Clinical Rehabilitation might contain, in this order, sentences about the random allocation of patients; recruitment of patients; collecting baseline data; the treatments given; blinding (masking) of the people collecting data; ending with a sentence about trial registration. (this example is real)
This weakness is exacerbated by a tendency to use subheadings to give structure. Often the subheading contains material that is unrelated to the subheading. Sometimes the heading is followed by one very long paragraph. The subheadings are rarely in a logical order. They force people to put items in an illogical place. Subheadings should be like chapters in a book, indicating a fresh start on something different. As you are not writing a book, you will rarely need subheadings.
Any section covering more than one topic must have a logical framework to assist the author and help the reader. It ensures that the author covers all vital issues, assuming the framework is complete; it ensures the reader can quickly find what she wants.
In the introduction section, the structure usually covers the problem being addressed; a summary of what is known; identifying a gap; how this study will fill that gap. In the method section of most clinical papers, the most apparent framework follows a patient over time: how will or did a patient enter, flow through, and leave the project? In the results section, a different logical structure is needed. In most clinical papers, it will be patient flow in numbers, baseline data, important outcome data, secondary data, and other data or analyses. The discussion section is fluid and requires the author to take an overview and consider their message. One general structure is an overview of results; placing results in a broader context; considering limitations and cautions; what the implications are.
Writing: no abbreviations or jargon. NONE!
Please realise that:
- all abbreviations and all jargon reduce readability and risk profound misunderstanding
- articles are judged on the standard of writing, and clarity, not on word count
One day, at a hospital executive board meeting, the conversation about a paper had been progressing for about five minutes when I asked what an abbreviation (acronym), which was reasonably central to the report, stood for. No-one knew! But this was the first time anyone else had been prepared to ask. And the document’s authors must have presumed that everyone would know, as there was no explanation.
Abbreviations hinder understanding and readability. See here, here, and here. Please do not use them. The only exceptions I allow in clinical research papers are for standard statistical measures and processes. The excuses given by the authors include the following:
- abbreviations save space (probably untrue, and anyway, clear writing will save more space)
- everyone knows what it means (rarely true)
- it makes reading quicker (undoubtedly false)
- other journals use them (when was following the crowd ever proof of being correct?)
- a paper you published in 2018 had them (probably true; some authors just do not read my requests, and I give up!).
Jargon is more insidious. Jargon is a form of exclusive, in-house language that serves as much to exclude others as it does to improve communication. Whoever talks about their ‘upper limb’ except when acting like a professional? Or who says, “my lower limb hurts”? In rehabilitation, many professionals will read articles and sometimes by people outside healthcare. Hence, using plain words and explaining any unusual terms is imperative.
Instead, write clear prose. Avoid over-complicated sentences. Keep it short, and never use three words when one suffices. If you are still determining whether something is necessary, remove it. Remember, “If anything at all, perfection is finally attained not when there is no longer anything to add, but when there is no longer anything to take away”. Antoine de Saint-Exupery. (Thank you, Dr James Cauraugh.)
Writing: respect your readers.
To show your respect for the reader,
- present your paper carefully to avoid a reputation for a slapdash approach
- read journal guidance and articles to learn how submissions are expected to look in the chosen journal.
When submitting a scientific article for publication, you should respect the editor and reviewers. Start by addressing any letter to the journal editor you are offering the article to (many authors write to another journal). Continue by ensuring that your submitted article is well written, well presented, follows journal guidance on layout, etc., and is free of obvious errors.
Some journals employ (I assume) someone to check all this before the editor sees an article. Most do not. It shows a lack of respect to present an article that does not adhere to the journal’s guidance, and, as an editor, I am very wary of authors who submit papers full of apparent errors. If the author cannot be bothered to check the quality and accuracy of the submitted article, why should I trust the validity of their reported methods and results? At the end of the submission process, there is always a chance to review and check the whole paper. Use it.
Even more importantly, the review process does not and cannot check for errors, mistakes (or fraud), and all the named authors have complete responsibility for everything written and presented. It behoves anyone designated as an author to satisfy him- or herself that the paper is high quality and accurate. If any malfeasance is detected, all authors are liable. Beware.
Learning to write.
In seven words, you should:
- Practice, practice, practice, and
- Read, read, read.
Writing well is essential. The pen, or now the word processor, is indeed mightier than the sword. People will die willingly to defend or promulgate an idea, and ideas ultimately come from someone’s writing. Moreover, whoever writes the history of events determines the future perception of what happened and decisions and actions. ‘Fake News’ is more convincing if accompanied by an image of a printed newspaper or document.
More prosaically, whoever writes the minutes of a meeting often determines what people believe was said and decided. I discovered this as a junior psychiatrist, where junior doctors were responsible for giving electroconvulsive therapy (ECT). As chair of the junior committee, I wrote meeting minutes that suggested we needed a policy to ensure patient safety. We had only discussed the need for an approach in general, but it was sufficient for a procedure to be devised because “it had been agreed at a committee meeting“.
It distresses me that most people seem unable to write. Learning to write well appears to be outside of learning about research. Yet, researchers depend upon writing applications to obtain grants. A researcher’s status and progression both, ultimately, depend upon publications, and these have to be written. Only a tiny proportion of grant applications succeed, and only a small proportion of papers submitted to higher-impact journals are accepted. Writing well will significantly improve the chances of success in both spheres. As a reviewer, I judge that someone who can write clearly can also think clearly, and that poor writing may indicate poor research skills.
Learning requires hard work. As in every other matter, practice improves ability, and education is much more effective when the person receives feedback on performance. Failure to gain a grant or have a paper accepted is not effective feedback. There is a long delay, and the connection between the quality of writing and feedback could be more robust because there are many other reasons for failure. Poor writing will rarely be given as a reason, even though it may be the primary reason. Effective feedback needs to be timely, to point out where improvements are needed and why, and then to suggest ways to improve, with explanations.
There are other ways to learn, some quite enjoyable. When reading a book, article, or other document, consider how easy it is to read and understand and how much it attracts and maintains your attention. Then analyse what it is that helps. There are also websites. For example, the Equator Network (an excellent general resource) has a specific section on writing for publication. Another site is Good Reports.
Further advice can be seen in this graphic also shown below, in a document I have written, based on 20 years of editing and reading terrible submissions, and in another article.
Writing is a crucial skill for any professional. Writing well, and communicating effectively, is rarely an inborn skill, and even the best commercial authors benefit from critical editors to give feedback and improve their written work. So it would be best if you devoted time and effort to learning. Active reading, which means reflecting on how the piece you are reading is constructed, how the words are used, and how it attracts you and maintains your interest, will help you. Asking for constructive feedback from friends and colleagues – and even family members – is a powerful method for improving your skill,