Tips and tricks on how to write a quality paper

ZF FMMr Frank McDermott, consultant surgeon in Exeter, UK, Honorary Senior Lecturer at University of Exeter, former associate editor at Colorectal Disease and current Associate Editor at BJS Open, shares tips and tricks with the ESCP audience on how to write a quality paper.

Zoe Garoufalia (ZG): Mr McDermott, thank you very much for agreeing to this interview. Many young surgeons and trainees are trying to improve their academic skills and produce research papers. There is so much information out there and many steps to take. Where should one begin?

Frank McDermott (FMD): The key thing is to find research active colleagues and mentors that have done this before. I was given advice many years ago to find as many mentors as possible throughout your career to help support your growth as a surgeon and in the field of academia. There are many opportunities to ‘dip your toe into the water’ such as joining research collaboratives such as some of the excellent ESCP initiatives, writing a case report or letter to the editor. These help to immerse you in the world of research and learn about academic language, formatting, journal submission guidelines and software.

ZG: How to make your title attractive for your targeted audience and what are the secrets to a successful abstract?

FMD: This will come down to the target audience, which will depend on the piece of work you are writing up and what type of research you are doing such as translational, qualitative, or clinical research. Look at the journal you are submitting to and see what format they use for their titles. Journals often like the first part of the title to describe the outcomes that were measured followed by the type of study it was e.g., Clinical outcomes following oesophagectomy: a prospective cohort study. This has been shown to help with citations and metrics driving impact factor which is still the metric journals are judged on and universities demand. I avoid giving the results of the study in the title or using funny statements or questions. However, part of publishing is expressing the style of the authors and not one size fits all. Editors and peer reviewers will always be quick to tell if you if they don’t like something!

ZG: The importance of statistical planning before data collection – what mistakes should be avoided and how?

FMD: This is a great question and cannot be stressed enough. The first part is to ensure that what you are measuring is relevant to patients which means doing your due diligence with patient and public involvement. Once you have a relevant research question, using clinical trials units, methodologists and statisticians is crucial. The main mistakes that I see, other than not looking at outcomes that are meaningful to patients is lack of statistical power. RCTs can be enormously useful studies, but too often I see studies with 20 patients compared with 20 patients which are underpowered. We owe it to the patients, funders and research teams that support our research, to perform studies that are high quality and powered to answer the question.

ZG: Who should lead the statistical analysis, the surgeon or the biostatistician? Why?

FMD: Research is a team sport. Healthcare professionals having spoken to patients need to define the research question. Once you’ve done this, statisticians and colleagues in trials units work with us to make sure the study is scientifically robust. Research is hard especially surgical research. Over the last few decades surgeons have become smarter with the research they do to maximise the impact and cost effectiveness of research. This is exemplified by collaborative research and using smart methodologies such as multi-arm multi-stage (MAMS) studies, but this requires support of a multi-disciplinary research team.

ZG: What makes an excellent paper?

FMD: The quick answer would be a paper that is succinct, novel, with appropriate methodology and practice changing. However, there are many different papers that can be excellent such as papers that are cutting edge or systematic reviews that meta-analyse high quality papers. Not all research questions can be easily tested with randomized control trials and there are excellent papers using data from cohort studies or using registry data that can change practice or define future research strategies. The ESCP Collaborative studies were excellent as they provided ‘messy’ real world data from multiple centres in many countries rather than tightly defined patient groups in some prospective trial designs. These data identified quality improvement projects and future research which were immensely powerful.

ZG: How to formulate a high impact discussion?

FMD: Discussions do not need to be overly long. The discussion is there for you to summarise your findings and discuss them within the context of the published literature whilst allowing some flexibility to hypothesise future research. It is important to identify other papers that agree or contrast your research findings and contextualise this based on their relative power, methodology and risk of bias. Avoid grand standing such as ‘this is the largest, the greatest case series/ study etc’. It also really important to have a limitations section and to be honest. I’ve said it already, surgical research is hard, and we are often looking at potentially highly morbid medical interventions. Inevitably there will be limitations and surgeons often will not have equipoise. I would rather that authors avoid writing ‘more research is needed’ and to instead define what the next study should look like if this is feasible.

ZG: What characteristics render a paper as unfit to publish?

FMD: Firstly, most papers will find a home unless the methodology is completely flawed or there are concerns about the accuracy of the data. I have been rejected many times from many different journals so I would advise authors not to be disheartened. The Editor in Chief of the journal has an overview of manuscripts coming in and makes the assessment of what is novel, what other manuscripts they have already accepted and whether the manuscript meets the threshold for peer review. They will also ‘bench reject’ a large proportion of papers that are not suitable for the journal or they feel will not meet the bar for publication. Journals use sophisticated software to identify the risk of plagiarism. There is an art to both writing manuscripts and to being an Editor which means there are human factors that come into play. Although it sounds contradictory, academic publishing is not an exact science. If you are rejected do not take it personally, if your paper has gone for peer review take the feedback from your peers in a constructive fashion and use it to improve your manuscript. Although there is always the option to challenge a decision, these are not usually overturned.

ZG: What is your message to all the young researchers out there?

FMD: Get involved! The earlier the better, we have medical students and trainees performing and delivering high quality research look at Eurosurg. Find a mentor and that doesn’t necessarily have to be a Professor, there are many research active healthcare professionals who consistently deliver. Whilst I am encouraging you all to be enthusiastic you also want to make sure that you use your time efficiently. We all have manuscripts on our hard drive that never got published and I’ve learnt over time to pick winners although I still get this wrong.

Join associations and research organisations aligned to your specialist interest such as specialist organisations like ESCP for colorectal surgery, EuroSurg for medical students, and your local collaboratives. The CovidSurg team produced hugely powerful studies by harnessing the energy and enthusiasm of the surgical community.

Get involved with journals, there are opportunities to attend writing courses, editorial assistantships and BJS has initiatives such as ‘Young BJS’ and the newly launched ‘BJS academy’ which has lots of useful resources to nurture academic skills.

Writing a quality paper is tough and requires lots of skills including team work, communication, time management and effort. However, it is such a rewarding feeling to see your work and words published and still gives me a buzz!

ZG: This was extremely helpful, many thanks for your time and insights!

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