No matter what initially drew you to medicine, you most likely failed to picture yourself spending a hefty portion of your time writing. But, if you entered academic medicine, writing ends up occupying a significant amount of your time. Universities require us to bring in a stream of funding, which requires us to write grant proposals. In the US, only one of every seven proposals researchers write receive funding—and this statistic excludes the highly competitive and prestigious R01 awards offered by the National Institutes of Health (NIH). In addition, to first obtain funding, researchers usually need at least one publication as evidence of expertise in the area their proposal targets. Once you obtain funding, you face still greater pressure to produce a stream of publications that demonstrate you’re making progress in achieving your grant’s specific aims. Moreover, most universities tie job offers and promotions to your publications and papers you present at meetings. In short, in academic medicine, writing is inescapable—and integral to your success.
However, few researchers or clinicians understand the advantages of writing well in a now-competitive environment. A well-written proposal or manuscript increases your odds in receiving funding or getting published. Why? Three of the top seven reasons why journal reviewers and editors reject manuscripts include poor focus, organization, and writing (1). In addition, poor writing ranks fourth in the ten most common reasons why Respiratory Care rejects papers (2). Writing also figured in the top reasons why reviewers rejected manuscripts for a conference, slated for subsequent publication in Academic Medicine (3).
In addition, academic medicine often requires writers to generate reader-friendly lay summaries or recommendations for practice that the general public understands. UK-based journals, including The Lancet-, BMJ-, and Nature-affiliated journals, place particular emphasis on writing articles comprehensible to a general audience, not just subject-matter experts. In the US, the NIH favors research proposals that contain some outreach to the general public. In NIH-funded Clinical and Translational Science Institutes, including the one in which I teach at the University of Florida, we include in our courses for fellows and faculty instruction on reaching lay readers and writing reader-friendly prose.
All these demands bring us to the nub of a rather vexing problem. The handful of publications on writing in medicine contain advice on tackling the rhetorical and content challenges of each section of a proposal or manuscript. A few others have bravely struck out into territory normally claimed by English studies faculty—the components of readable sentences. However, neither approach tells, say, a gastroenterologist how she can identify a problematic sentence or avoid burying important data. The how-to-get-published advice helps you dodge common errors in study design, data analysis and reporting, and the handling of introductions and discussions (1, 4, 5). Other resources included now-dead URLs featuring writing advice on avoiding passive voice and wordiness. But, while most researchers might grasp why passive voice is something to be avoided along with verbosity, few of us know how to recognize when we use either—let alone how to avoid using them.
The first brave foray into giving researchers advice on writing well in academic medicine appeared in Gopen and Swan’s 1990 article on scientific writing (6). Their work tackled examples of academic prose, used linguistics to examine the challenges poor writing throws at its readers, and offered guidance on handling sentence-level challenges. That article represented a quiet milestone on the science of writing, which should have begun a decades-long series of studies on psycholinguistics and its valuable insights into how writers need to write to accommodate the challenges words and sentences pose to our readers’ brains. Instead, however, to use Hamlet’s dying words, the rest is silence.
This silence is particularly ironic, given our growing knowledge of how the reading brain processes written language. Gopen and Swan’s work focused on how words, sentence structure, and connections between sentences impact writing. Their 1990 article used dramatic “before” and “after” versions of scientific writing to demonstrate how to make easily readable even the most complex information. In addition, they established a valuable precedent in recognizing that, as researchers, we are data-driven. Provide a researcher or clinician with data-driven methods for improving their writing, and you’re speaking to us via a conduit we understand.
I spent nearly two decades using research on reading drawn from psycholinguistics and neuroscience to understand reading in multimedia documents before I realized its value to creating a methodology in creating principles for writing. In English studies, every book on writing seeks to be the last word on the subject. In science, you realize that your research can only begin or add to conversations on your subject. My book, The reader’s brain: How neuroscience can make you a better writer uses empirical data to begin a much-needed conversation and research on the connection between writing and the reading brain. One student claimed these methods enabled her to become a full professor and dean within a decade of taking my course via her hefty list of grants and peer-reviewed publications. I hope others in medicine find it as useful—and that considerable conversation and debate ensue.
- D.W., Byrne. (1998). Publishing your medical research paper. What they don’t
teach in medical school. Baltimore: Lippincott Williams & Wilkins.
- Pierson, David J. (2004). The top 10 reasons why manuscripts are not accepted for publication. Respiratory care, 49(10), 1246-1252. PMid:15447812
- Bordage, Georges. (2001). Reasons reviewers reject and accept manuscripts: the strengths and weaknesses in medical education reports. Academic Medicine, 76(9), 889-896. PMid:11553504
- Provenzale, James M. (2007). Ten principles to improve the likelihood of publication of a scientific manuscript. American Journal of Roentgenology, 188(5), 1179-1182. PMid:17449755
- Browner, Warren S. (1998). Publishing and presenting clinical research. Baltimore: Lippincott Williams & Wilkins.
- Gopen, George D, & Swan, Judith A. (1990). The science of scientific writing. American Scientist, 550-558.