Crafting a Message for Publication Graham McMahon MD MMSc Editor for Medical Education, NEJM

1. Crafting a Message for Publication Graham McMahon MD MMSc Editor for Medical Education, NEJM

3. Specific Goals To familiarize you with the “publishing biz” and how it works To help you think about how to convert your scholarship into publishable papers Research Innovative curricula New teaching/learning methods Other projects Help you strategize your work with editors

4. Overall Objective To help you become a Better Smarter More successful writer for publication as an educator

5. From the Author’s Perspective

6. Why Experiment? Evidence based education! Rigor in educational approaches Improved quality for learners Personal and professional value Elevate the field 6

7. Challenges in Educational Research Participants are actively learning over time Interventions must demonstrate additional increments of performance improvement Comparison groups difficult to identify Placebo groups challenging in education Small sample sizes and short studies Open-label Students may be vulnerable to experimental coercion and to change behavior as a result of being in an experiment Contamination between research groups is common Time between learning and behavior can be long Dependence on intermediary endpoints Frequent changes in regulatory expectations Learners increasingly have survey fatigue 7

8. Challenges for Educational Researchers Conflicting demands Isolation Lack of programmatic support Constrained budget Activities not valued

9. Why Write? To share your ideas, programs, research To get feedback from others To incrementally advance the knowledge base To get appropriate recognition

10. Top Issues in MedEd Research Todres M, Rogers R. BMJ. 2007 Aug 18;335(7615):333-5 10

11. Write about what you believe in Ability to convince others Get it done Withstand the slings and arrows of publishing and its highly variable, unpredictable and intermittent reinforcement

12. How are papers organized? Logical structure with a basic formula Five sections Abstract: summary Introduction: set the stage, why important, state hypothesis Methods: what you did, IRB Results: data only Discussion: what you found, what it means, what’s next, what you found

13. Introduction Start building the case why the reader should be interested in your study Describe the area being studied Review the pertinent literature in that area that leads ups to your study Conclude with a description of how your study is the logical next step, fills a gap, or in other ways adds to the existing literature Write hypothesis

14. Methods Describe what you did, so the reader can understand and someone else potentially could repeat your study Setting Sample Timeframe Outcomes Measures Data analysis plan

15. Results Describe what you found (not what you believe it means) Present the positive and negative data of your findings in Text – little space, most important findings Tables and figures – present more of the data

16. Discussion Summarize what you found Describe what you believe the findings displayed in your Results section mean in the context of other research Describe the strengths and limitations of your study and findings, without over-generalizing To conclude, describe where your findings lead and possible logical next steps

17. Aim High Who is your audience? What do they ready? Review what the Journal is currently publishing Consult with colleagues Time to first decision Review process Duration Look at Journal’s impact factors

18. Education Papers don’t only get published in education journalsWrite About Education and the Other Things You Do/Study

19. Mission of a Journal • Find the best work • Report it dispassionately

20. How does the process work?

21. Manuscripts Received

22. Types of Research 2012

23. Origin of Research US International

24. Initial Submission Editor-in-chief Associate/ Deputy Editor Peer Review Editorial Meeting Statistical Review Initial Decision

25. Initial Submission Editor-in-chief Associate/ Deputy Editor Peer Review Editorial Meeting Statistical Review Initial Decision

26. Initial Submission Editor-in-chief Associate/ Deputy Editor Peer Review Editorial Meeting Statistical Review Initial Decision

27. Peer Review • Peer review is a mechanism by which the research community asserts quality control. • It has become an essential feature of the decision-making processes used by most funding agencies and all major medical journals. • A feature common to all peer reviews is that they are performed by one or more individuals active in a field of study that is central to the item being reviewed.

28. Types of Peer Review • Double blind • Article is de-identified, and identity of reviewer remains confidential. • Single blind • Reviewer knows identity of authors. Authors don’t find out identity of reviewers. • Open • Identity of authors, reviewers known to all • Often reviews are published with the article.

29. Editors use the Reviews • Once reviews are in the editor reads the paper and the reviews • The editor, not the reviewer, makes the decision about the paper • Reviewers’ comments are valuable, but reviewers are only consultants to the thinking process

30. Reviewers’ Grades of Papers Accepted Rejected

31. Editors are looking for work that is…. • Important • Informative • Novel • Ethical Important informative novel ethical

32. What is Important? • Research results that will • change or affect practice, • teach us about biology, or • serve as a launching platform to define new directions in medicine Important informative novel ethical

33. What is Informative? • Study adds appreciably to available data • Conclusions provide clear direction • Conclusions follow from the data • Free from commercial or intellectual bias Important informative novel ethical

34. What is Novel ? • A study that • breaks new ground, • defines new treatments or • resolves major controversies Important informative novel ethical

35. What is Ethical? • Adequate informed consent obtained • Minimum number of subjects put at risk to gain needed information • Honest reporting Important informative novel ethical

36. Associate Editor makes a decision • Full consideration? • Manuscript is presented to all the editors • Minimal consideration? • Manuscript is on the agenda but discussion is minimal

37. Initial Submission Editor-in-chief Associate/ Deputy Editor Peer Review Editorial Meeting Statistical Review Initial Decision

38. The Editors Meet

39. Initial Submission Editor-in-chief Associate/ Deputy Editor Peer Review Editorial Meeting About 20% of papers fail at this step Statistical Review Initial Decision

40. Possible Decisions Needs additional Experiments-1% We’re very interested 0.8% We’re interested 3.5% Reject After Peer Review 33.8% Initial Reject 60.5%

41. Three Major Reasons for Rejection • Quality – the science is flawed • Novelty – the science is good, but has previously been published or does not advance the field • Specialty – it’s good, but not of general interest and belongs in a specialty journal

42. Reasons for Rejection Bordages G. Acad. Med. 2001;76:889–896.

43. Initial Submission Revision Submitted Associate Editor Peer Review Editorial Meeting Final Decision Editor-in-chief Associate/ Deputy Editor Peer Review Editorial Meeting Statistical Review Initial Decision

44. Expanded Mission of Medical Journals • Find the best work • Solicit submissions • Meet authors needs for expeditious review • Best reviewers • Thoughtful debate • Report it dispassionately • Careful manuscript editing • Content • Language • Remove ‘spin’ • Clear graphics • Supplementary commentary • Disseminate the findings • Attract readers to the site • Email and print • Support teachers • Support the reader • Easy search and retrieval • Portfolio • Provide an educational program • Support the scientific mission • Meet the needs of readers • Enhance the experience

45. Journal’s Role evaluate work do determine if it is important, informative, novel and ethical ensure the data has been analyzed appropriately and that conclusions follow from the data relationships that could lead to perceptions of bias are disclosed Differing Perspectives • Authors role • Do the right study • Write about it clearly • Report it dispassionately • Submit to the right Journal • Respond clearly

47. Submissions in 2012 (n=14,441) Perspectives

48. NEJM.org Audience PCPs = FMs + IMs + GP 46%

49. Assigning the Manuscripts About 10% of papers are rejected at this stage Assigned manuscripts are sent to the Associate Editors

50. Local experts in major areas of medicine Being local facilitates in-person meetings 10 AEs: Cardiology, Infectious Disease, Cancer, Endocrinology, Gastroenterology, Associate Editors • Maternal-Fetal • Neurology • Office Practice, • Health Policy & • Vascular Disease