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ORIGINAL ARTICLES Improving Faculty Publication Output: The Role of a Writing Coach CLAIRE BALDWIN, MS,* AND GENEVIEVE E. CHANDLER, PHD, RN†

Publishing academic papers is recognized by faculty as vital not only to their careers, but also to the standing of their school within the university and the discipline. Although writing is perceived as a critical, highpriority task, it often has low follow-through behavior. To facilitate the publication output of our faculty, a part-time writing coach was hired. Blanchard’s situational leadership II® model (1985), which tailors leadership style to the needs of the group, indicated a framework of coaching and support would best meet faculty writing needs. The literature further suggested that an ongoing coaching relationship in the form of a committed partnership would empower faculty to achieve beyond prior performance. We present a model to show how coaching and support facilitate perseverance in writing for publication. Sixteen of 26 faculty sought the coach’s help in the first 2.5 years, generating 21 submissions to peer-reviewed journals. Fifteen of these were published or accepted (71 per cent), and one was still under review when this article was written. Five rejected papers had not yet been resubmitted. Faculty with recent doctorates appeared to benefit most from coaching. (Index words: Faculty development, Scholarship, Writing, Coaching, Publishing, Mentoring) J Prof Nurs 18:8-15, 2002. Copyright © 2002 by W.B. Saunders Company


UBLISHING ACADEMIC PAPERS is an activity recognized by faculty as vital not only to their careers, but also to the standing of their school within

*Writing Coach, University of Massachusetts at Amherst, School of Nursing, Amherst, MA. †Associate Professor, University of Massachusetts at Amherst, School of Nursing, Amherst, MA. Address correspondence and reprint requests to Dr. Genevieve E. Chandler: University of Massachusetts, School of Nursing, Arnold House, Box 30420, Amherst, MA 01003. E-mail: gec@ Copyright © 2002 by W.B. Saunders Company 8755-7223/02/1801-0006$35.00/0 doi:10.1053/jpnu.2002.30896 8

the university and the discipline. Promotions and grants are awarded based on the frequency and quality of faculty publications. Despite these widely recognized facts, many faculty members are not satisfied with their publication output and feel they could and should publish more. An important factor that is neither well acknowledged nor addressed in programs to improve faculty publication output is that writing is a time-consuming and emotionally complex process (Boice, 1994). Creative writing can be described as bearing one’s soul, telling the truth by writing from the heart. Academic writing, usually considered a very different genre, nonetheless has similarities to the work of the creative artist. A scholarly paper reveals its author’s level of thinking, stage of skill sophistication, and knowledge of the topic. When a paper is peer-reviewed and published, the author’s ideas are open to critique, debate, and judgment. In-depth knowledge and expertise in a subject area and skill in clearly communicating that expertise are the initial requirements for a publishable paper. Then the time commitment, perseverance, motivation, confidence, and courage must be developed. Writing, however, demands less immediate attention than typical faculty role requirements, such as class preparation and teaching, administrative responsibilities, committee work, student advising, and added personal and social obligations. These time conflicts and the necessities for successful writing can lead to what Boice (1989) has described as a high-priority activity with low behavioral follow-through. In addition, an academic’s professional survival may be felt to depend on publishing scholarly papers. Such pressure can lead to avoidance. An issue relevant to a field dominated by women is

Journal of Professional Nursing, Vol 18, No 1 (January–February), 2002: pp 8-15




that along with minorities, women are overrepresented among nonprolific faculty (Creamer, 1998). Among the factors cited by 18 productive, senior-level, women faculty as helpful to their productivity (Creamer & Engstrom, 1996) were a “culture of scholarship” and “a specific person who taught them how to be strategic about publishing” (p.14). One of the goals of our school of nursing (SON) was to enhance the culture of scholarship. This paper describes an innovative program to encourage faculty publications by hiring a writing coach. We introduce the framework used to conceptualize the coaching and writing processes, review coaching and support strategies, present the coach’s qualifications, and describe the structure and process of coaching.


Various researchers have studied the factors that influence scholarly productivity of academic nurses (Andreoli & Musser, 1986; Barhyte & Redman, 1993; Collins, 1993; Norbeck, 1998; Roberts, 1997; Stevenson, 1991). In an extensive literature review, Collins summarized the explanations for faculty productivity under four categories: individual and psychologic (e.g., innate qualities); discipline related (e.g., state of paradigm development); reinforcement or recognition and feedback (e.g., collegial relationships, mentoring, coaching); and accumulation of advantages (e.g., time, more resources, career advances). Factors cited as positively influencing academic output included doctoral preparation (Andreoli & Musser; Stevenson), collegial relationships and mentoring (Collins; Norbeck; Roberts), institutional support for research and scholarship (Andreoli & Musser; Barhyte & Redman; Collins; Norbeck), and sabbaticals and leaves (Norbeck, Roberts). Of the earlier-mentioned dimensions and factors related to nurse faculty productivity, the SON has made support for scholarship a priority, which comes under the category of reinforcement and feedback. To determine the best approach to enhancing faculty publication rate, we used a leadership model (situational leadership II®; Blanchard, Zigarmi, & Zigarmi, 1985). This model, adapted from Hersey and Blanchard’s earlier situational leadership theory (1977), asserts that leadership style should match the needs of the group being led or guided. The model offers variations on the two leadership approaches of directive and relational. Specifically, if the group lacks knowledge or is inexperienced with a situation, a structured, directive ap-

proach is recommended. If the group has some knowledge of a situation and past experience, then a relational supportive style would meet the group’s needs. The amount of direction and relational support a leader provides should fit the group’s interest in engaging in the problem (is this a problem the group would be willing to address?) and skill level (has the group previously dealt with this type of problem?). According to situational leadership theory, a leader’s behavior is directive or task-oriented when one-way communication is used to provide detailed information and specific directives. Directive behavior is offered through structure, control, and supervision. A writing workshop that focuses on the technical aspects of publication is an example of a directive or taskoriented approach to enhancing academic writing productivity. Primarily one-way communication would be used to give faculty detailed publishing information and advice on specific skills. Although some writing skills can be fine tuned, such as organization and grammar, the outcomes of a one-time workshop are limited. Relational leadership behavior, on the other hand, encompasses the extent to which a leader engages in interactive communication by providing socioemotional support to facilitate desired behaviors. Most academic writers have technical writing skills or access to them, so a directive approach would have limited benefit. Even the most accomplished writers, however, may lack confidence in their abilities (or not recognize the ability they have). “Anxious, negative thinking includes anticipation of failures lying ahead, repetitive messages from internal critics about likely occasions for embarrassment, and impatience about not achieving success and appreciation soon enough” (Boice, 1994, p. 138). Because many writers periodically experience crises of self-esteem, becoming immobilized by “reemerging doubts about abilities to imagine and write” (Boice, p. 131), support and encouragement can be helpful. According to situational leadership theory, an ongoing leadership style characterized by relational behaviors of listening, encouraging, and praising (coaching) would be appropriate for writer’s needs. Thus, the most fitting approach for a group of nurse scholars interested in improving their publication output would be coaching and support. COACHING

Coaching, a concept associated with sports, first appeared in the management literature in the 1950s as a master-apprentice relationship. Most coaches taught some skills and enforced the rules. This type of coach




was in charge, commanding others, prescribing behaviors, and controlling results. Hierarchy was enforced, rules were followed, and control was maintained. Obedience to authority was required, with initiative emanating from the coach. Evered and Selman (1989) recognized, however, that the prevailing characteristics of the coach role in management (control, order, and prescribing behaviors) were outdated. Coaching is currently perceived as a mentoring technique for developing rather than managing employees (Goleman, 2000; Whitworth, Kimsey-House, & Sandahl, 1998). Within an organization, coach and client have more of a power parity than in sports, an equal partnership rather than a superior-subordinate relationship. Evered and Selman (1989) suggested that within a paradigm of “acknowledge-create-empower,” the modern coach is “someone who has an ongoing, committed partnership with a player/performer and who empowers that person to exceed prior levels of performance” (p. 21). Within this framework, the coach empowers through validation and encouragement (acknowledge), as well as dialogue, feedback, and guidance (create). Although coaching may not “scream ‘bottom-line results,’ it delivers them” (Goleman, 2000, p. 87). Because developing new approaches to old problems involves changing assumptions and ingrained patterns of behavior, coaching takes time. Coaching is not oriented toward completing a task, but to supporting and encouraging a client to find his or her own way toward a desired goal. Motivation to reach the goal, however, has to come from the client. Although it is not the coach’s role to motivate, he or she works with clients to develop strategies that enhance intrinsic motivation. Because a coaching partnership involves helping clients to identify their unique strengths and weaknesses, clients must not only be aware of their problem areas, but also willing to improve them. Coaching makes little sense when clients, for whatever reason, resist learning or changing their ways (Goleman). The client and coach negotiate agreements and short-range goals to develop ways to circumvent unproductive habits, with check-ins to applaud progress or renegotiate strategies (Whitworth et al., 1998).

strumental support (money, time, labor, aid in kind, modifying environment), informational support (advice, direction, suggestions), appraisal support (affirmation, feedback, social comparison), and emotional support (esteem, trust, listening, affect, concern). House’s analysis focused on informal and nonprofessional sources of support, which he felt were more effective than formal support structures in preventing work-related stress. Emotional Support

When most people describe a person as “supportive,” they are thinking of the emotional support that person offers. Characteristic behaviors include listening, reflecting respect and understanding, reassuring, reflecting concern, encouraging, and reflecting trust (assuring the confidentiality of shared information). Instrumental Support

This aspect of social support is most readily distinguished from emotional support by behaviors that directly help persons in need, such as helping them do their work. House (1981) noted that a purely instrumental act also has psychologic consequences, which can be either positive or negative. For example, a faculty member could view a coach’s help as a boon to her or his publishing capacity or as a sign that he or she is not up to the task. Informational Support

Informational and appraisal support are the most difficult to distinguish from the other two forms of support. Informational support is defined as facts or knowledge that can be used to cope with personal and environmental problems. Unlike instrumental support, this information is not inherently useful, but helps people to help themselves. In the case of coaching writers, providing information about the writing process involves instrumental support because the writer’s major need is the best way to write. Appraisal Support


Social support as a specific patient intervention is a concept well studied in nursing practice (Norbeck, 1982, 1985), but is less evident among colleagues in organizations of higher education. House (1981) identified four components of socially supportive acts: in-

Like informational support, appraisal support transmits information (feedback) rather than the affect of emotional support or the specific help of instrumental support. The information about performance offered in appraisal support, however, allows the person being appraised to make a self-evaluation (House, 1981).




The Coach

With degrees in physics and biophysics, the coach has 25 years of experience in biochemistry and neurochemistry basic research. During that time she coauthored 13 articles in peer-reviewed scientific journals on topics ranging from drug and surgical effects on liver enzymes to immunohistochemical localization of peptide neurotransmitters. In 1991 she left science to write fiction. Of the 20 or so short stories she has written since then, two have been published. The coach was hired on a part-time, as-needed basis. A nonnurse writing coach offers certain advantages. Jargon, procedures, and concepts familiar to nurses will raise questions for the coach as she reviews manuscripts, leading to more precise writing and arguments. In addition, the coach’s training in the physical sciences, in which practice is in the laboratory and data are generally more easily obtained and analyzed than in the social sciences, exposed her to a culture in which writing academic papers was an ongoing activity. Structure

Two vital aspects of the coaching program were that it was voluntary and anonymous. Faculty were not required to work with the writing coach, nor did the coach report to the Dean the names of her clients. To introduce the role of the coach, flyers were posted on bulletin boards and the Dean introduced her in a faculty meeting. After being introduced, the coach directly approached faculty. Over a representative 13month period (September 1999 to July 2000), she spent an average of 21 hr/mo serving the faculty, about 9 ho/mo on-site and about 12 ho/mo off-site. During that same period, 10 faculty were coached an average of 15.1 ho/mo each (range ⫽ 3.7–33.1). The coach submitted invoices and was paid an hourly wage. Process

Coaching and support feed into the process of scholarly writing, which does not proceed linearly to publication (see Figure 1). Many of the steps to publication involve reiteration— editing, revising, and incorporating reviewer feedback—which can seem like backtracking, even to those clients with a history of publication, and may arouse frustration or feelings of inferiority. The coach can offer help, encouragement, and support at each of these steps, depending on the client’s needs.

Figure 1. Model for the process of coaching to write for publication.

All scholarly papers begin with at least one idea and/or some data. Through dialogue and feedback, the coach supported the creative process and acknowledged creativity by validating and encouraging both the creator (author) and the creation (manuscript). Elements of support at this step might be emotional (listening, reflecting respect and understanding), appraisal (comparing the presentation to author’s goals), and instrumental/informational (how to brainstorm and organize the presentation of the ideas and data). Brainstorming was encouraged before creating an outline. Clients inexperienced with brainstorming benefited from telling the details of the research, findings, and conclusions while the coach took notes and asked questions. At the end of the session, the coach helped the author to diagram the flow of the article. These notes and diagrams were used to write the next draft. Most clients, however, did not come to the coach this early in the writing process; the most common pattern has been to bring the coach a complete draft, which was then coached to revision once or twice before being submitted to a journal. Another scenario has been to bring a provisionally accepted or rejected manuscript for help with rewriting and reorganizing. The cycle of writing/editing/revising shown in Figure 1 is where most faculty have sought the coach’s help. The coaching process began with a request for a model article and authors’ guidelines from the journal to which the client planned to submit. The approach to giving feedback was based on separation of the creative and critical phases of writing (Elbow, 1973,



1981; Schneider, 1993). Initially, the coach read themanuscript for an overview, then more thoroughly for understanding, writing questions in the margins and editing for clarity. When reading early drafts, focusing on the positive was important for both the author and coach. The act of ferreting out strong points from a disjointed early draft reinforced the belief that no matter how vague or superficial the initial writing, it would eventually become clearer and more profound with revision. The coach let faculty know that the way to a polished piece is rarely direct or painless (Boice, 1994; Lamott, 1994). Most faculty have not studied writing and, like other writers, both novice and experienced, labor under a commonly held misconception that“writing, when it can be managed with seeming spontaneity and mystery, [is] the ultimate test of brilliance” (Boice, 1994, p. 51). The coach directly addressed the common fear that disjointed, rambling, or incomplete early drafts may show that one is not very bright. Even the most accomplished and motivated faculty either deny or do not realize how long and complex the writing process can be. An inability to produce a polished product in a couple of revisions may evoke feelings of frustration, inadequacy, and shame, too often followed by self-flagellation and/or setting ever more impossible standards and goals, leading to “binge” writing (Boice, 1989). Binge writing occurs when a writer spends whole days and weekends doing nothing but writing. The rush of binge writing is usually followed by exhaustion, depression, and/or little interest in writing for a long time (Boice, 1994). The coach’s knowledge of the writing process comes from the work of Boice (1989, 1994) and others (Elbow, 1973, 1981; Schneider, 1993). A pioneer in the study of the writing process and in interventions for academic writing problems, Boice states, “When we put exaggerated value on writing that is managed quickly, spontaneously, independently, brilliantly, we burden ourselves with unnecessary emotional baggage about writing. Such writing is possible but rare and it is, in fact, no better than most deliberate writing” (1994, p. 51). Teaching the complex subtleties of the writing process (and reassuring each client what is normal) was an important part of the coach’s role. The coach routinely gave tips on American Psychological Association formatting and organization of manuscripts, computer files, and office space. Lesser-known tools of word processing programs were taught, such as how to readily find a specific word or phrase in a 20page or longer manuscript or how to customize a toolbar with commonly used formatting functions.


Detailed, positive cover letters routinely offered support not only for the manuscript under consideration, but also for the sustained effort needed to see a manuscript through to publication. Cover letters always, always began with the article’s strengths. Beginning with positive comments also softened the sting of calling attention to issues of grammar, organization, and style that detracted from strengths. Returning feedback within a week or two was critical to keeping up the momentum, so the writer did not lose the heat of creation. Periodic e-mails, a phone call, or note card offered encouragement and support if the client was working under a deadline or other stress. The most common writing problems were easily remedied. These included overuse of the passive voice, wordiness (“the data are descriptive of” vs. “the data describe”), and use of long or polysyllabic words where a simpler one would do (“utilize” vs. “use”). Use of “this” or “it” when the antecedent was unclear made for imprecise, confusing writing. Also important to the readability of a manuscript were such stylistic matters as varying sentence structure and length, using language that was neither too dry nor overly literary, and minimizing the use of jargon. Pictorial aids such as tables and figures often needed simplification or their data could be clearly summarized in the narrative, without need of a table. Less easy to correct were problems of organization and syntax. Brainstorming as described earlier often helped the author to organize ideas and the flow of the paper. Common problems in organization included commenting on the data in the results section rather than in the discussion section, including material in the literature review that is not directly related to the study, and making conclusions beyond the data. Syntax reflects the arrangement and relationship of words and phrases to make meaning in a sentence. Difficulties in this area may involve not only the ordering of sentence components, but also assumptions of relationships among parts of a sentence, compressing complex relationships into a string of adjectives, or a lack of clarity in the writer’s thinking. The coach has solved such problems by sitting with the client, who explains what is meant or answers specific questions, which the coach then translates to written English, providing a model for future writing. Submitting a completed manuscript is in itself an empowering act, but uncertainty about the paper’s acceptance can arouse some anxiety. The coach has acknowledged and celebrated with each client the submission of manuscripts and routinely offered emo-




tional, informational, and instrumental support between submission and the next step, whether full acceptance (an uncommon outcome after an initial submission), provisional acceptance, or rejection. In addition to offering encouragement via e-mails, phone calls, or visits at the SON, the coach supported faculty who were waiting to hear about a submitted paper by informing them when and how to contact a journal to inquire about the status of the manuscript. Dealing with reviewer comments can be an emotional experience for both seasoned and novice authors. Emotional support at this stage took the form of listening to frustration, encouraging the writer to hang in there, and applauding progress (authors often forgot that a paper not rejected is likely to be accepted after revision). The coach routinely offered advice on how to handle reviewer comments (whether to address them and resubmit to the same journal, or submit elsewhere) or how to argue for reconsideration of a paper. Informational support was given to help organize cover letters detailing revisions according to reviewer comments; appraisal support helped the author to compare the revised draft with reviewer feedback; and instrumental support involved the coach’s attention to making sure all points raised by the reviewers were covered. The success of publishing an article reverberates throughout one’s career, but the moment of receiving the letter of acceptance is perhaps the sweetest, followed closely by the proud occasion of seeing one’s words and ideas in print. These events are the most empowering forces in a writer’s career, and the coach’s acknowledgment, celebration, and show of shared pride on the client’s success reinforces his or her feelings of empowerment.


Given the innovative nature of the program and that the coach was initially known by only one faculty member, it is remarkable that so many faculty were willing to embrace the coaching process. We believe that the coaching program has effectively bridged the gap between informal and formal faculty development and support programs by offering a one-on-one relationship that is paid for by the SON. A critical factor in the success of this program has been the Dean’s patience and philosophy of allowing as much time as needed for individual faculty development. During the coach’s first 2.5 years as coach (April 1997 to October 1999), 16 of 26 faculty sought her services, either individually or through another faculty

member, and submitted 21 manuscripts to peer-reviewed journals, of which 15 (71 per cent) have been published or accepted for publication (Table 1). The majority of these articles (n ⫽ 7) were published in clinical journals, with the rest appearing in research (n ⫽ 4) and educational (n ⫽ 4) journals. One coached paper was lead article in the Western Journal of Nursing Research. Of the nonpublished articles, one was still in the peer review process and five had been rejected and not resubmitted at the time of this writing. Only two faculty members who had been historically productive sought the coach’s help. They and the noncoached faculty members continued to write and submit their work alone or with other help. To this steady scholarly output was added the output of the coached faculty. In an informal, anonymous poll designed to take only 1 minute (Angelo & Cross, 1993), seven respondents (of the 11 clients remaining on the faculty) described the experience of being coached as supportive, encouraging, and helpful. Others factors noted were timeliness of the feedback and the coach’s expertise with academic publishing. The publication rates of the coached faculty in the 4-year periods before and during their relationship with the coach are shown in Table 2. Although the coaching period covered by this article extends from early 1997 to late 1999, a 4-year period beginning in 1998 was chosen to account for the length of time from submission of an article to its acceptance or publication. A comparable period (1994 –1997) was chosen to obtain a precoached publication rate for each faculty client. Most faculty who were coached (13 of 16) published more than or the same as the previous 4 years. Three of the five coached and rejected manuscripts were written by faculty authors who had published in the 4-year period before working with the coach. One of these authors (Client 10) left the SON during the period covered by this article, but both she and another author (Client 2) presented their papers at national nursing conferences. Factors outside the coach’s expertise could also have affected whether or not a manuscript was accepted: study design and relevance, scientific merit, and author perseverance to revise and/or submit to another journal. TABLE

1. Academic Articles by Coached Faculty

Submitted Rejected Under peer review Published/accepted



21 5 1 15

100 24 5 71




2. Comparison of Faculty Publication Rates Before, With, and Without Coaching


Client 1 Client 2 Client 3 Client 4 Client 5 Client 6 Client 7 Client 8 Client 9 Client 10 Client 11 Client 12 Client 13 Client 14 Client 15 Client 16 Total

Doc.* Date

1994 1986 1991 1983 2001 2000 1997 1967 1992 1993 1995 n/a 1989 n/a n/a n/a

Publications† Before Coach (1994–1997)

Publications† With Coach (1998–2001)

Net Coached Publications

Publications† Without Coach (1998–2001)

1 2 0 0 2 0 2 0 0 2 0 0 4 0 0 0 13

2‡ 2‡ 1‡ 0 1 1 6 0 1 0 1‡ 0 0 1‡ 2‡ 2 (1, 1‡) 20‡

1 1 .5 0 1 1 6 0 1 0 .5 0 0 .5 1 1.5 15

n/a§ 2 0 n/a§ 0 1 0 n/a§ 0 n/a§ n/a§ 0 0 0 0 0 3

*Year doctoral degree awarded. †Peer-reviewed journal (book chapters not included). ‡Joint publication(s) with other faculty member. §Left SON faculty between 1998 and 2001.

Comparison of faculty output before and after working with the coach is confounded by several factors. Not every coached faculty member sustained an ongoing relationship with the coach over the 4-year period from 1998 to 2001. Five of 16 coached faculty left the SON during the coach’s first 2.5 years. As can be seen from the year in which faculty members earned their doctorates (Table 2), seven had recently completed their degrees (1992 or later), which might have contributed to low publication rates in the 1994 to 1997 period. On the other hand, these newer, doctoral-level faculty appeared to benefit most from coaching. Another factor that confounds an assessment of the coach’s impact on faculty productivity was the formation of the Office for Nursing Scholarship at the end of the coach’s first year. In addition to the coach’s oneon-one attention to the writing needs of the faculty, the senior faculty member who headed this office also devoted much effort to encouraging academic writing. The head of this office and the Dean, however, continually encouraged faculty to use the coach’s services. Whether or not coached faculty publish more articles in peer-reviewed journals than noncoached faculty remains to be quantified by rigorous study. Although the process of coaching used in our SON did not specifically advocate peer coaching, faculty may have learned more effective techniques for supporting and encouraging their peers from the coach’s

example, but we did not evaluate this outcome. In addition to changing personal patterns of writing, the coach’s presence has gradually changed the culture of scholarship in our SON. As more faculty have published and learned the intricacies of the writing and publication process, they have become more confident writers. Seeing others write and go through the process of data searches, making copies to submit, or chewing over ideas may have had a ripple effect on other faculty. Rather than think, “Oh, I just published a paper, now I can rest,” one might see a peer sending out another paper and be inspired to do likewise or to raise a personal bar by trying for a more prestigious journal. Such changes would be fruitful to investigate in the future. At this time, the leadership framework of coaching and support meets faculty writing needs. Empowering faculty to move beyond previous performance has been successfully implemented through an ongoing coaching partnership. The coach has provided an environment of trust and safety by welcoming new ideas, being open to receiving manuscripts at any stage, and offering encouragement to progress from idea to publication. Coaching has enabled scholarly writing in this nursing school to advance from a territory of high priority and low follow-through behavior to a realm of inner-directed and institutionally supported activity that earns faculty the recognition and rewards they deserve.




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Evered, R., & Selman, J. (1989). Coaching and the art of management. Organizational Behavior, 18, 16-32. Goleman, D. (March, 2000). Leadership that gets results. Harvard Business Review. Hersey, P., & Blanchard, K. (1977). Management of organizational behavior (2nd ed.). New York: Prentice Hall. House, J. (1989). Work stress and social support. Reading, MA: Addison-Wesley. Lamott, A. (1994). Bird by Bird. New York: Doubleday. Norbeck, J. S. (1982) The use of social support in clinical practice. Journal of Psychosocial Nursing Mental Health Service, 20, 22-29. Norbeck, J. S. (1985). Types and sources of social support for managing job stress in critical care nursing. Nursing Research, 34, 225-230. Norbeck, J. S. (1998). Teaching, research, and service: Striking the balance in doctoral education. Journal of Professional Nursing, 14, 197-205. Roberts, K. (1997). Nurse academics’ scholarly productivity: Framed by the system, facilitated by mentoring. Australian Journal of Advanced Nursing, 14, 5-14. Schneider, P. (1994). The writer as an artist: A new approach to writing alone and with others. Los Angeles: Lowell House. Stevenson, B. K. (1991). The relationship between faculty practice and scholarly productivity of nurse educators in NLN accredited baccalaureate schools of nursing. Unpublished dissertation. Case Western Reserve University (Health Sciences), Cleveland, OH. Whitworth, L., Kimsey-House, & Sandahl, P. (1998). Co-active coaching. Palo Alto, CA: Davies-Black.


Contribuciones cortas Nuevo enfoque en la teoría y práctica del diagnóstico de la habilidad de expresión escrita en idioma inglés entre profesionales y estudiantes universitarios de las ciencias médicas MSc. Rafael Forteza Fernández1

RESUMEN Se estudian las insuficiencias teórico-prácticas en el diagnóstico de la formación y desarrollo de la habilidad de expresión escrita en inglés en la educación médica superior. Se presenta un nuevo modelo didáctico que, a partir de la teoría holísticoconfiguracional de los procesos sociales, expone las nuevas cualidades, dimensiones, eslabones y estructura de relaciones del objeto transformado. Palabras clave: escritura, diagnóstico, género.

ABSTRACT The present study covers the theoretical and practical insufficiencies of diagnostic testing in the formation and development of the writing ability in English in Higher Medical Education. It presents a new didactic model, which based on the Holistic and Configurational Theory of Social Processes, presents the new qualities, dimensions, stages and structure relations of the transformed object. Key words: Writing, diagnostic testing, genre.

Copyright: © ECIMED. Contribución de acceso abierto, distribuida bajo los términos de la Licencia Creative Commons Reconocimiento-No Comercial-Compartir Igual 2.0, que permite consultar, reproducir, distribuir, comunicar públicamente y utilizar los resultados del trabajo en la práctica, así como todos sus derivados, sin propósitos comerciales y con licencia idéntica, siempre que se cite adecuadamente el autor o los autores y su fuente original. Cita (Vancouver): Forteza Fernández R. Nuevo enfoque en la teoría y práctica del diagnóstico de la habilidad de expresión escrita en idioma inglés entre profesionales y estudiantes universitarios de las ciencias médicas. Acimed 2007;16(1). Disponible en: [Consultado: día/mes/año].

El diagnóstico de la formación y desarrollo de la habilidad de expresión escrita en idioma inglés, constituye una de las áreas de actuación pedagógica en la enseñanza médica superior (EMS), donde más se percibe la influencia de corrientes lingüísticas,


como el estructuralismo, y psicológicas, como el conductismo, enterradas desde hace mucho tiempo en la didáctica especial para lenguas extranjeras. El resultado de su influencia se observa cuando el profesor sólo se dedica a diagnosticar el producto final de la actividad de expresión escrita, el texto, y lo hace sobre la base de sus formas, las estructuras, elementos éstos que convierten el diagnóstico en una actividad de poca utilidad durante el proceso enseñanza-aprendizaje (PEA) de la habilidad antes mencionada. Puede afirmarse con otras palabras que esta actividad no se encuentra a tono con las concepciones pedagógicas actuales sobre la necesidad de comprender el PEA, como un proceso donde intervienen, también, factores afectivos -necesidades, motivaciones, intereses, ideales- que junto con los cognitivos -conocimientos, habilidades y hábitosregulan y dirigen la actividad cognoscitiva. En trabajos anteriores, se ha expresado la necesidad de una re-conceptuación de la importancia de la habilidad de expresión escrita en el futuro egresado de la EMS, a tenor con los cambios ocurridos a escala global y los planes de colaboración solidaria con todo el mundo, que como política de estado, desarrolla el país.1 Dicha reconceptuación debe partir de un adecuado proceso de diagnóstico, sobre la base del cual se harán las correcciones necesarias al PEA, para explotar las fortalezas y resolver las dificultades de los estudiantes. Por ello, la presente contribución se dedica a aprehender de manera holística y dialéctica el proceso de diagnóstico de la formación y desarrollo de la habilidad de expresión escrita. Para ello, se exponen las nuevas cualidades, dimensiones, eslabones y estructura de relaciones que conforman un nuevo modelo didáctico para dicho proceso.

LAS DIMENSIONES DEL PROCESO DE DIAGNÓSTICO Por dimensiones, se entienden las categorías que expresan el movimiento y transformación del sujeto y como resultados de estos, se desarrollan cualidades, que se expresan mediante la relación entre configuraciones, como rasgos que en su relación dialéctica conceden significación y sentido al proceso.2 En el modelo que se propone, se identifican como la dimensión genérica del proceso de diagnóstico de la formación y desarrollo de la habilidad de expresión escrita en géneros propios de las ciencias médicas, aquellos elementos textuales que son factores sociales externos al sistema de la lengua, pero que tienen sus manifestaciones en esta.3-5 Por otro lado, en la actividad interna, individual, o proceso de interiorización de la cultura producida por la sociedad en su devenir histórico, participan, en una unidad de contrarios, tanto los procesos afectivos-motivacionales como los cognitivos. Por su importancia metodológica para el conocimiento de la actividad de formación y desarrollo de la habilidad de expresión escrita, ambos se unen en el modelo propuesto, y se constituyen en la dimensión afectivo-motivacional. Además, para el diagnóstico de los elementos propios del sistema de la lengua, la competencia en la lengua materna, el seguimiento de los procesos de construcción


textual, de transformación del pensamiento en habla y estrategias de composición se constituyen en la dimensión linguo-procesal. A diferencia del modelo didáctico anterior, la primera de las dimensiones es un aporte de la investigación del autor; la segunda constituye la aplicación al diagnóstico de la formación y desarrollo de la habilidad de expresión escrita, de las concepciones pedagógicas actuales; la tercera, es una ampliación a la práctica actual del diagnóstico en esta área que sólo se circunscribe a la detección de dificultades en el sistema de la lengua, nunca a los procesos y estrategias de producción textual, y muchos menos a la influencia de la lengua materna en el aprendizaje de la lengua extranjera. Estas tres dimensiones forman una tríada, cada una de ellas depende de la otra, en una relación dialéctica de coexistencia, que da cuenta de gran parte de los factores implicados en la formación y desarrollo de la habilidad mencionada. La nueva configuración de las dimensiones del diagnóstico emerge de un análisis sistémico, holístico y dialéctico del mencionado proceso, que adquiere los siguientes rasgos y cualidades: •

Personal: Se centra en el estudiante, en el tratamiento a sus diferencias con respecto a otros estudiantes, a sus estados afectivos y cognitivos, a su disposición para aprender, necesidades y competencias, que sirven de punto de partida y base para todo el proceso de aprendizaje. Profesionalizante: Acerca al estudiante a las formas auténticas de comunicación de la comunidad discursiva, a la cual debe integrarse en un futuro, desde la perspectiva de un comunicador en potencia. Está dirigido a su transformación como individuo, en aras de hacer de este, un constructor de ciencia en la práctica de la profesión. Axiológico: Entraña la diferenciación en el uso del lenguaje científico y el vernáculo, a la vez que le permite comenzar a ejercitar la responsabilidad educativa y laboral del profesional con otros miembros de su comunidad discursiva y en su entorno laboral; al mismo tiempo, ofrece la posibilidad de valorar el esfuerzo del estudiante en la consecución de un objetivo. Abarcador: Incluye variados factores de la producción textual y el propio proceso de aprendizaje por lo que ofrece información en mayor cantidad y calidad. Flexible: Es adaptable a cualquier tipo de PEA de la habilidad de expresión escrita, en contextos del inglés con propósitos específicos (IPE), porque sólo requiere cambios esenciales en la dimensión genérica, para adaptarla al tipo de género que se emplee para el diagnóstico. Dinámico: No está preconcebido el momento o lugar de aplicación del diagnóstico. En ese sentido, los instrumentos pueden aplicarse en el orden y momento que el profesor considere necesarios, de acuerdo con los resultados del PEA y el eslabón del diagnóstico. El concebirlo como una actividad más de este proceso también implica que no se circunscribe al marco estrecho del aula o al tiempo de clase propiamente dicho. Reconoce además la variación procesal y textual en un mismo género, aspecto este de vital importancia en la expresión escrita.



Según Fuentes, Álvarez y Matos, los eslabones del proceso son las categorías que expresan los complejos estadios por los que transita el proceso, que expresan su lógica interna; y se diferencian entre ellos por las características del quehacer de los sujetos entre los diferentes momentos. Constituyen una modelación de la secuencia de estadios por los que transita el proceso en su desarrollo, en los que se revelan las dimensiones del mismo (anexo).2 Los eslabones o estadios del proceso de diagnóstico de la formación y desarrollo de la habilidad de expresión escrita en idioma inglés en las ciencias médicas son tres: 1. Caracterización del estado de la preparación del estudiante para el PEA. 2. Caracterización dinámica del proceso de formación y desarrollo de la habilidad. 3. Caracterización del producto deseado. La adecuada concepción y desarrollo de los tres estadios o eslabones mencionados durante el proceso de diagnóstico mencionado, permite seguir todo el proceso de formación y desarrollo de la expresión escrita, desde la introducción de los géneros en el ciclo de IPE, hasta su nivel de salida, al concluir el cuarto o quinto año, según sea el caso de la carrera que curse el estudiante. El proceso de diagnóstico de la formación y desarrollo la habilidad de expresión escrita en géneros propios de las ciencias médicas se realiza en forma de ciclo, en una espiral ascendente, cuyo fin principal es conocer en qué medida, por aproximaciones sucesivas, ocurren movimientos y transformaciones en el estudiante, el cual alcanza el nivel de competencia comunicativa en idioma inglés necesario para expresarse de forma escrita en su profesión. Estos movimientos y transformaciones, producto de las correcciones hechas al PEA por medio del proceso de diagnóstico de la formación y desarrollo de la habilidad de expresión escrita, generan como resultado, el desarrollo de la competencia comunicativa profesional, como forma particular de la expresión del concepto competencia comunicativa, en la habilidad mencionada, para el profesional de las ciencias médicas. En cuanto a la lógica interna de desarrollo de los distintos eslabones debe distinguirse que, el proceso de diagnóstico de la formación y desarrollo de la habilidad de expresión escrita, es sistemático, continuo y abarcador. Sistemático, porque se concibe como parte integral del sistema de acciones que se realizan en el PEA; continuo, porque siempre se diagnostica; y abarcador, porque en su propia génesis trata de comprender la mayoría de los factores que, de un modo u otro, inciden en el aprendizaje de la habilidad mencionada, lo que lo convierte en un proceso integral. Al plantearse su concepción en forma de espiral ascendente, que caracteriza la forma externa del proceso, se busca reproducir en el plano externo por medio de lo visible, los movimientos internos, la formación y desarrollo de la habilidad que ocurre internamente en el estudiante. Esto se logra mediante la aplicación de instrumentos diagnósticos, que dirigidos al conocimiento de lo alcanzado en las diferentes dimensiones procesales, permite explotar las fortalezas de los estudiantes al máximo, a la vez que superan sus dificultades.


En el modelo que se propone, la relación dimensiones diagnósticas y eslabones del proceso se expresa del siguiente modo: a cada eslabón del proceso corresponde el diagnóstico de la formación y desarrollo de la expresión escrita en una o diferentes dimensiones, o aspectos particulares de diferentes dimensiones, que revelan el estado de la formación y desarrollo de la habilidad de expresión escrita en un preciso momento. Esta relación se ejemplifica de manera esquematizada en el anexo. Se ha partido del principio que la formación y desarrollo de la habilidad de expresión escrita es un proceso complejo y dinámico, que se realiza para la elaboración de productos (textos) que son el resultado de un también complejo y dinámico proceso.

CARACTERIZACIÓN DEL ESTADO DE LA PREPARACIÓN DEL ESTUDIANTE PARA EL PEA Corresponde a este eslabón, el objetivo de ofrecer a los sujetos implicados (profesores y estudiantes) la información necesaria para realizar una preparación adecuada del PEA, en el caso de los primeros, y conocer el nivel de disposición y preparación para el mencionado proceso, por parte de los segundos. Como puede observarse, dos de las dimensiones, la afectivo-motivacional y la linguoprocesal, presentan una incidencia directa en este estadio del proceso de diagnóstico de la formación y desarrollo de la habilidad de expresión escrita. Se conoce la influencia de la lengua materna y la posible transferencia, tanto positiva como negativa, que puede tener en el aprendizaje de la extranjera. Por otro lado, la capacidad del estudiante para elaborar un texto coherente en la lengua materna, puede transferirse a la extranjera; de ahí la importancia de este aspecto. El criterio anterior se apoya en el hecho de que el uso que hace un especialista del lenguaje, su coherencia textual, como la encontramos en los informes de investigaciones científicas, textos de diferentes ciencias, los reportes de casos y planes de cuidado, no deben asociarse con variedades formales en una lengua particular, sino con ciertos modos universales de comunicación comunes a lenguas individuales. En este sentido, el inglés de las ciencias médicas debe verse como la realización de un tipo de discurso, que se define en términos funcionales y posibles de distinguir de otros usos de esta lengua, también en términos de los conceptos y procedimientos que se comunican, que son comunes al español, al francés y a cualquier otra lengua. El conocimiento de las experiencias anteriores del estudiante en el aprendizaje de la lengua extranjera incide de manera significativa en su motivación y las actitudes que asume. Un aspecto fundamental que debe también valorar es que, en muchas ocasiones, el estudiante desconoce cuán importante función presenta la formación y desarrollo de la habilidad de expresión escrita en su futura vida profesional y no le dedica, por ende, suficiente atención. Por otro lado, tener una idea de cómo son en español los géneros que va a estudiar, sus propósitos y funciones, formas de expresar los contenidos y patrones de comunicación; en sentido general, sus características lingüísticas y comunicativas, puede ayudar mucho


a aprender esa forma textual en inglés; al tiempo, que les permitiría valorar con mayor exactitud el objeto de aprendizaje y motivarlos para esta actividad. Vistos como un todo, el diagnóstico de los elementos pertenecientes a las dimensiones afectivo-motivacional y linguo-procesal, en la caracterización del estado de la preparación del estudiante para el PEA, permite obtener la información de partida para pasar al segundo de los eslabones.

CARACTERIZACIÓN DINÁMICA DEL PROCESO DE FORMACIÓN Y DESARROLLO DE LA HABILIDAD La caracterización dinámica del proceso de formación y desarrollo de la habilidad de expresión escrita tiene como objetivo seguir la apropiación en aproximaciones sucesivas del género objeto de estudio, que realiza el estudiante por medio de su actividad interna. Al plantear que la caracterización es dinámica, se asume el hecho que el diagnóstico se realiza a partir de los procesos y productos de y para la formación de desarrollo de la habilidad de expresión escrita, los que, en la misma medida en que se trabajan diferentes géneros en el PEA; en la misma medida, en que el estudiante se apropia de las formas de expresión escrita de la comunidad discursiva, en aproximaciones sucesivas, en busca de un nivel alto de generalización de la habilidad; en la medida que se acerca a la competencia comunicativa profesional; en esa misma medida, se perfeccionan y se precisa entonces de un diagnóstico más fino, dirigido a las exquisiteces de la lengua escrita. Como puede observarse, en este estadio o eslabón del proceso, se implican las tres dimensiones propuestas en el modelo. Los cinco elementos, que a consideración del autor, son imprescindibles para realizar una caracterización dinámica del proceso de formación y desarrollo de la habilidad de expresión escrita se relacionan del siguiente modo. En primer lugar, el dominio del sistema de la lengua, la léxico-gramática del idioma inglés y las características discursivas del género se relacionan estrechamente. Por un lado, por medio de las instituciones sociales, se imponen restricciones en las formas de expresión de la lengua, las cuales se realizan a nivel léxico-gramatical. Por otro, por debajo del nivel de la cláusula, existe todo un sistema de opciones léxicogramaticales que es necesario conocer para indicar la cohesión entre ellas y la coherencia textual que puede lograrse por medio de mecanismos lingüísticos o por medios contextuales. Seguir los procesos necesarios para la producción textual es de vital importancia para la planificación y organización del proceso compositivo que le sigue, así como todo el control de la actividad verbal, especialmente para textos largos que requieren procesamiento de información. Estos procesos, unidos a la selección de una estrategia adecuada, garantizan cumplir las exigencias de calidad del contenido, coherencia y cohesión en la entrega de la información y un alto nivel de corrección de los elementos del sistema de la lengua.


Por último, el grado de compromiso con la tarea puede indicar cuánta atención, cuánta energía motivacional se le dedicó a la actividad. Aunque es realmente complejo determinar a ciencia cierta, necesidades, motivos, intereses e ideales, es necesario precisar, al menos, aquellos elementos de índole afectivo-motivacional, que pueden tener una incidencia visible en la actividad de aprendizaje. El autor considera necesario enfatizar que en la misma medida en que se profundice en los aspectos relacionados para una caracterización dinámica del proceso de formación y desarrollo de la habilidad de expresión escrita, en las causas de los problemas, en esa misma medida, las intervenciones pedagógicas tendrán el resultado esperado.

CARACTERIZACIÓN DEL PRODUCTO DESEADO La caracterización del producto deseado, como su nombre los indica, tiene como objetivo caracterizar el nivel de acercamiento logrado por el estudiante a la competencia comunicativa profesional, mediante el estudio de un género de las ciencias médicas escrito por el estudiante. Los primeros cuatro elementos para la caracterización del producto deseado, pertenecen a la dimensión genérica del diagnóstico de la formación y desarrollo de la habilidad de expresión escrita en idioma inglés en géneros de las ciencias médicas; la última a la linguo-procesal. Del mismo modo, el profesor, debido a su importancia práctica, puede realizar un diagnóstico de la dimensión afectivo-motivacional, para conocer en qué medida ha influido en esta esfera, la apropiación de un nuevo conocimiento, cómo se han motivado los estudiantes y explorar sus apreciaciones hacia qué desean aprender. Más que un esquema formal, cada eslabón, es una fase lógica y necesaria del diagnóstico; sobre la base de las dificultades y fortalezas detectadas mediante el diagnóstico, es el profesor quien determina, qué hacer y cómo hacerlo. Del mismo modo, y como consecuencia, sobre la base de las transformaciones logradas, el profesor conoce cuáles son las prioridades en el PEA de la habilidad de expresión escrita, y entonces determina qué y cuándo diagnosticar de nuevo. Cada una de los eslabones del modelo didáctico para el diagnóstico de la formación y desarrollo de la habilidad de expresión escrita en la educación médica superior, puede subdividirse en cuantos subeslabones sean necesarios, conformado cada uno por el o los elemento(s) que se desee diagnosticar de acuerdo con las necesidades del o los estudiantes.

ESTRUCTURA DE RELACIONES DEL PROCESO DE DIAGNÓSTICO De acuerdo con la teoría holístico-configuracional, la estructura de relaciones es una categoría esencial, porque por medio de ella se expresan las regularidades que permiten comprender los movimientos y transformaciones del proceso y con ello explicar y predecir su comportamiento. Constituye lo concreto pensado, sintetiza la abstracción que expresa el comportamiento de la totalidad. Revelar las relaciones esenciales y


estables que se forman en el interior del proceso y que explicitan su comportamiento es, desde el punto de vista teórico, el mayor nivel en el proceso del conocimiento.2 El modelo didáctico para el proceso de diagnóstico de la formación y desarrollo de la habilidad de expresión escrita en idioma inglés en géneros propios de las ciencias médicas tiene un carácter eminentemente cualitativo; centrado en el estudiante y no en los productos de la actividad de aprendizaje, como eje central de la actividad diagnóstica, según el modelo anterior. Este rasgo del diagnóstico descarta la utilización de escalas numéricas y con ello la ubicación del estudiante en un nivel de desarrollo predeterminado. Se ocupa de la individualidad y el modo en que, como personalidad, el estudiante se implica y compromete con su propio aprendizaje y desarrollo profesional. No está concebido como una actividad adicional al PEA de la habilidad de expresión escrita, sino como una actividad más en este proceso, de ahí su carácter sistémico. Es por ello que pudiéramos referirnos a que el PEA –entre todas sus características– también tiene una que se refiere a su carácter de diagnóstico. La afirmación anterior se basa en el hecho de que el profesor no puede apreciar el PEA como el proceso sólo para enseñar, donde el estudiante aprende y todo lo que ello implique. También, debe interiorizarlo como el proceso, donde él siempre se encuentra atento a las dificultades que surgen, a las potencialidades que descubre en sus estudiantes, como grupo o de manera individual, y que aprovecha para replantear la concepción de la formación y desarrollo de la habilidad en ese preciso momento. En otras palabras, el profesor siempre está diagnosticando. Sobre la base de la concepción del modelo, el replanteamiento de conceptos claves para la formación y desarrollo de la habilidad de expresión escrita, se hace vital, no sólo en la dinámica del PEA, sino también en el área curricular. Sobre este último aspecto, la implantación del modelo facilita la ampliación del número de géneros de la profesión que se pueden introducir en cada especialidad, amén de otros, que aunque no exclusivos de las ciencias médicas, son también importantes para el futuro profesional; por ejemplo, los resúmenes escritos de artículos y ponencias, curriculum vitae, correo electrónico profesional; así como, se facilita el trabajo con elementos propios del estilo científico, tales como la acotación de bibliografía, la selección de palabras clave y otros. El diseño del PEA de la habilidad debe basarse no en la cantidad de veces que un estudiante práctica la habilidad para apropiarse de un género, sino en un desarrollo integral de esta, que permite la apropiación gradual de variados géneros, que se relacionan entre ellos, por sus propósitos, funciones y estilos particulares. En la concepción dinámica del PEA, se precisan con mayor nitidez los objetivos a lograr en el futuro profesional. Aunque el modelo se inserta básicamente en la función instructiva del proceso, sus influencias van más allá de esta, para contribuir al desarrollo individual y educacional del profesional de la salud en potencia.


En esa dirección, es esencial lograr en la transformación del estudiante cambios que apunten hacia una autoestima positiva del modo que las expectativas individuales (confianza en la obtención de logros y éxitos en este proceso), también, sean positivas, y por ende, la seguridad necesaria para esforzarse y perseverar a pesar de las dificultades que puedan surgir en las tareas de aprendizaje. En el plano de los contenidos, el modelo ofrece una nueva visión de qué debe enseñarse-aprenderse en la habilidad de expresión escrita; va mucho más allá del sistema de la lengua extranjera, para proveer al estudiante de conocimientos y habilidades fundamentales en la vida y el ejercicio de la profesión, a la vez que también, se adentra en el área de los sentimientos, con el claro propósito de transformarlo para el mañana, para enfrentar nuevos y más difíciles retos cada día. El modelo didáctico para el diagnóstico de la formación y desarrollo de la habilidad de expresión escrita también tiene incidencia en la concepción de los métodos y medios del PEA de dicha habilidad. En primer lugar, propugna la utilización de un enfoque de género en conjunción con los enfoques como proceso y producto. Más que un divorcio con la teoría y práctica anterior, significa un paso de avance en las vías para lograr la competencia comunicativa profesional del futuro egresado. Dicho enfoque centra la visión de la apropiación de la habilidad en la inserción del estudiante en una comunidad discursiva que le es ajena, tanto en ideología práctica como acceso a mercados de conocimientos y productos de este conocimiento, donde estos últimos se convierten en esenciales para la labor humanística del Sistema Nacional de Salud en todo el mundo. La utilización de formas auténticas de comunicación como modelos para la formación y desarrollo de la habilidad, ofrece la posibilidad valorar el proceso comunicativo en todas sus dimensiones y complejidades; a la vez que permite incrementar la significación del aprendizaje y con ello contribuir a la motivación para aprender más y con mejor calidad. Las formas de organización de la enseñanza en la disciplina Idioma inglés se centran más en el estudiante, en sus necesidades individuales –como ser que siente, conoce y actúa–, en sus compromisos sociales a la vez que lo transforman paulatinamente y proyectan hacia el futuro, con nuevas cualidades que le permiten realizar una labor, desde el pregrado, con mayor calidad. El logro de la competencia comunicativa profesional en el futuro egresado, como resultado deseado, se posibilita por medio de las transformaciones del PEA, realizadas sobre la base del diagnóstico. Es de destacar que los resultados del diagnóstico no son sólo aplicables a la formación y desarrollo de la habilidad de expresión escrita; los aspectos relacionados con las tres dimensiones del modelo en cualquiera de sus eslabones pueden ser de gran utilidad para la concepción del PEA de las otras habilidades del idioma. La factibilidad práctica de los elementos teóricos presentados se validaron por medio de una consulta a expertos pertenecientes a prestigiosas instituciones universitarias del país, entre ellas, las universidades de Oriente, de Ciencias Informáticas y la central de Las Villas y la CUJAE, de los Centros de Educación Médica Superior (CEMS) de todas


las provincias orientales, Sancti Spíritus y Camagüey y de los institutos superiores pedagógicos de Holguín y Manzanillo. En todos los casos, las propuestas presentadas se ubicaron entre los rangos de muy y bastante relevante.6 Puede plantearse además que en una experiencia pedagógica realizada con estudiantes de la Licenciatura en Enfermería durante el curso 2005-2006, se demostró la pertinencia de la propuesta al alcanzarse resultados altamente satisfactorios en la calidad de aprendizaje de la habilidad por parte de los estudiantes involucrados.6 En conclusión, la realización del diagnóstico de la formación y desarrollo de la habilidad de expresión escrita en idioma inglés en géneros propios de las ciencias médicas de acuerdo con el nuevo modelo didáctico, permite hacer del PEA de la habilidad antes mencionada, un servicio de excelencia en los centros de enseñanza médica superior, al transformar a todos los actores en dicho proceso, al transformar a los profesores en mejores profesores y a los estudiantes en mejores estudiantes y, por ende, ofrecer las posibilidad de prestar, ambos, mejores servicios a la Revolución. ANEXO

REFERENCIAS BIBLIOGRÁFICAS 1. Forteza Fernández R. Lenguas extranjeras, escritura y desarrollo: un reto para el profesional de las ciencias médicas. Acimed 2004;12(6). Disponible en:

2. Fuentes González H, Álvarez Valiente I, Matos Hernández E. La teoría holística configuracional en los procesos sociales. Pedagogía Universitaria 2004:9(1). Disponible en: eor% C3%ADa+hol%C3%ADstica+configuracional+en+los+procesos+sociales.+Pedagog %C3 %ADa+ Universitaria&hl=es&ct=clnk&cd=1&gl=cu

[Consultado: 12 de abril del

2007]. 3. Forteza Fernández R, Ávila Oliva L, Sánchez Rodríguez R. La creación del léxico médico: una aproximación desde la perspectiva de la lingüística sistémica funcional. Acimed 2004; 12(3). Disponible en: [Consultado: 12 de abril del 2007]. 4. Forteza Fernández R. Estudio lingüístico comunicativo de los planes de cuidado de enfermería como género: perspectivas didácticas. Acimed 2003;11(2). Disponible en: [Consultado: 15 de abril del 2007]. 5. Forteza Fernández, R. Los reportes de caso en medicina y estomatología: morfofisiología del género. Acimed 2006;14(1). Disponible en: [Consultado: 12 de abril del 2007]. 6. Forteza Fernández R. Dimensión genérica del diagnóstico de la formación y desarrollo de la habilidad de expresión escrita en la Educación Médica Superior. En: Memorias de TELEFE. La Habana : MES/CUJAE; 2006.


Recibido: 18 de mayo del 2007. Aprobado: 22 de mayo del 2007. MSc. Rafael Forteza Fernández. Filial de Ciencias Médicas de Holguín. Carretera del Valle, Pueblo Nuevo. Holguín. CP 80500. Correo electrónico: 1 Máster en Teoría y Práctica de la Enseñanza de la Lengua Inglesa. Profesor Auxiliar. Filial de Ciencias Médicas de Holguín.


BIREME. Descriptores en Ciencias de la Salud (DeCS). Sao Paulo: BIREME, 2004. Disponible en: 2 Díaz del Campo S. Propuesta de términos para la indización en Ciencias de la Información. Descriptores en Ciencias de la Información (DeCI). Disponible en:


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CME Article

Effective Medical Writing Pointers to getting your article published Peh W C G, Ng K H

Writing an editorial

ABSTRACT An editorial may be written by the editor or someone invited by the editor. It serves many other purposes, including critiques of original articles published in the same issue of the journal, concise reviews of topics that do not warrant a full-length invited review, and other topics on ver y recent developments that are deemed by the editor to be important to readers of the journal and the community. As there is typically a limited space in which to deliver its contents, the message contained in the editorial needs to be well thought out and concisely delivered. It should contain the correct sequence of the elements of critical argument, ideally supported by evidence, and

Peh WCG, MD, FRCP, FRCR Advisor Biomedical Imaging and Interventional Journal, c/o Department of Biomedical Imaging, University of Malaya, Kuala Lumpur 50603, Malaysia Ng KH, PhD, MIPEM, DABMP Editor Correspondence to: Prof Wilfred CG Peh Tel: (65) 6555 2689 Fax: (65) 6602 3796 Email: wilfred.peh@

issue of the journal, concise reviews of topics that do not warrant a full-length invited review, and other topics on very recent developments that are deemed

by the editor to be important to readers of the journal and the community. An invitation to write an editorial is considered a high honour, and most experts would readily accept it.

Most editorials are invited, although some editors






Unsolicited editorials are almost always sent for peer review, which are often more stringent than usual— given the influential nature of editorials—and are often reviewed by members of the editorial board or

a distinguished expert. As with other categories of articles submitted, it is useful to carefully study the

end with a clear conclusion.

target journal’s Instructions to Authors to understand

Key words : commentar y, editorial, medical

non-commissioned editorials, as well as to take a look

writing, opinion, scientific paper Singapore Medical Journal, 2 College Road, Singapore 169850

critiques of original articles published in the same

the journal policy with regard to editorials, particularly at recent issues of the journal to get an idea of the type,

Singapore Med J 2010; 51(8): 612-615

scope and style of published editorials.(1) For example,


states that “editorials are the voice of The Lancet, and

Editorials are a feature of most medical journals. The frequency and type of editorials published depend on the aims and mission of the journal, and to a certain

extent, whether or not an editorial is published may be regarded as a prerogative of the editor. Some journals publish one or more editorials in every issue, while

in other journals, they appear only occasionally.

the Instructions to Authors for The Lancet clearly are written in-house by the journal’s editorial-writing team”, i.e. there is no point in submitting unsolicited editorials.

Box 1. Purposes of an editorial: • Personal message from the editor to journal readers. • Commentary on a published article in the same issue.

Editorials contribute to the character of a particular

• Concise review on a topic of current interest (not

their personal imprints onto a journal.

• Drawing readers’ attention to very recent developments

journal, and may be a means by which editors add

In the past, as indicated by the term editorial, the

editorial message was written by the editor himself.

Currently, in the majority of journals, editorials have

evolved to serve many other purposes, including

warranting a full invited review). or innovations.

• Commentary on non-scientific topics, e.g. health policy, economics, law or ethics.


:::::::::::::::::::::::::::::::: B1 ::::::::::::::::::::::::::::::::::: Singapore Med J 2010; 51(8) 613

HOW TO WRITE AN EDITORIAL Unlike original articles, editorials do not follow the IMRAD structure for manuscript organisation. There is

editorials and highlighted two points, namely: (1) Whose

opinions do editorials represent? (2) Why do journals not regularly seek “balance” on controversial issues?(3) Among

usually no abstract, subheadings, or a formal conclusion

the “big five” general medical journals, only The Lancet has

pages in length, so the challenge is to compress the

editors. In most other journals, editorials are usually signed

section. Most editorials do not exceed two printed journal author’s message into a rather tight space, and yet present his ideas in a clear and logical sequence.

There is truth in Huth’s contention that writing

an editorial is more demanding than writing a research paper, and that there is indeed a format to an editorial. The

task of composing an editorial is easier if the elements of critical argument are kept in mind. Considerations include the length of the editorial, the amount of evidence it examines, and the number of possible answers.(2)

Box 2. Contents of an editorial [adapted from Huth ]: (2)

• Raises an issue or poses a question. • Suggests one or more possible answers. • Provides available evidence supporting the possible answers.

• Assesses counter-evidence. • Concludes with an answer.

When raising an issue or posing a question, the amount

of background information to be included should be appropriately tailored to the target audience. In providing the evidence to support the possible answers, the evidence base

for each key statement should be clear, and each statement should ideally be supported by citations to a limited number

of published papers. The concluding paragraph or closing

sentences should carry a clear answer to the question posed in the opening paragraph. If there is no clear answer, the editorialist may suggest possible avenues to better tackle the problem.

In some journals, editorials take the place of

commentaries, opinions or perspectives. Their purpose

is to put into perspective research findings that are particularly important, unexpected or difficult to understand. Although these editorials often include the

author’s personal opinions, they are meant primarily to

interpret, explain and advise.(3) Editorials may also be in the

form of a mini-review of a current hot topic, particularly if a full-length invited review is not warranted. In other journals,

commentaries and related articles appear in separate article categories, either because these papers are too long or because the editor does not wish to appear to lend support by giving the editorial a cachet of approval.(2)

Kassirer and Angell of the New England Journal of

Medicine (NEJM) addressed the issue of controversial

indicated that their editorials represent a consensus of the

by the individual authors, and they represent the opinions of the authors alone; they do not represent the official views of the journal itself or those of the journal’s owner. Only when

editors write about editorial policies do they speak for the journal itself. The distinction between editorials regarding general issues and those that announce or clarify editorial policy should therefore be readily apparent.(3)

On editorials that take strong positions on controversial

issues, Kassirer and Angell opined that editors do not have

the responsibility to seek an objective or balanced viewpoint in these editorials. They believed that publishing opposing

views on every controversial issue discussed in NEJM would be unwise and tedious, and that to present, over time, as many well-reasoned perspectives as possible on

important controversial issues should be the aim instead.

The correspondence section is viewed as the best place to air disagreements about published articles, and should be kept interesting and critical.(3)

Editorials should have a short title that relates to

the subject of the editorial, preferably a punchy one. In submitting a manuscript, all authors’ names and their institutional affiliations should be included. Details of the corresponding author, such as full postal address, email,

facsimile and telephone numbers, should be provided. Like other article submissions, items such as conflict-of-interest

statements, declaration of individual author contributions and transfer of copyright forms, should be completed and submitted.

Editorials are expected to be short, precise and concise.

There are prescribed limits to the number of words (typically 450–1,000), number of references (20 or fewer) and figures and/or tables (none or up to two). Most journals state that editorials are usually commissioned by the editor.

Box 3. Examples of different journal requirements for editorials: Journal

Word References limit

Tables/ Unsolicited figures submissions*

Ann Intern 1,000 ≤ 20 ≤ 1 Med BMJ 800 ≤ 12 Not stated Med J 450 ≤ 10 Not Aust stated NEJM 900 ≤ 10 ≤ 1

Will consider Will consider Discuss with editor first Will consider

*The majority are commissioned.


:::::::::::::::::::::::::::::::: B1 ::::::::::::::::::::::::::::::::::: Singapore Med J 2010; 51(8) 614

SUMMARY Although originally a means to deliver the editor’s message, editorials have evolved to fulfil various

Box 4. Take-home points: Editorials:

purposes. As there is typically a limited space in which

• Vary in purpose according to journal policy.

editorial needs to be well thought out and concisely

• Should have an objective, flow in a logical

to deliver its contents, the message contained in the delivered. It should contain the correct sequence of the elements of critical argument, ideally supported

• Should be short and concise. sequence and conclude with an answer.

by evidence, with a clear conclusion. REFERENCES

1. Peh WCG, Ng KH. Basic structure and types of scientific papers. Singapore Med J 2008; 49:522-5.

2. Huth EJ, ed. The editorial. In: How To Write and Publish Papers in

the Medical Sciences. 2nd ed. Baltimore: Williams and Wilkins, 1982: 69-71.

3. Kassirer JP, Angell M. Controversial journal editorials. NEJM 1997; 337:1460-1.


:::::::::::::::::::::::::::::::: B1 ::::::::::::::::::::::::::::::::::: Singapore Med J 2010; 51(8) 615

SINGAPORE MEDICAL COUNCIL CATEGORY 3B CME PROGRAMME Multiple Choice Questions (Code SMJ 201008A) Question 1. The purpose of an editorial includes: (a) Commenting on an article published in the same issue of the journal. (b) Announcement of editorial policy.


☐ ☐ ☐ ☐

(c) Commenting on health policy.

(d) Reporting of an interesting case.

Question 2. The contents of an editorial include:

(a) A title.

☐ ☐ ☐ ☐

☐ ☐ ☐ ☐

☐ ☐ ☐ ☐

☐ ☐ ☐ ☐

☐ ☐ ☐ ☐

(c) A materials and methods section.

(d) References.

Question 3. The following statements about editorials are true:

(c) There is no need to complete a conflict-of-interest statement. (d) They almost always represent the opinions of the journal and its owners. Question 4. The contents of an editorial include: (a) Highlighting an issue or problem. (b) Presenting available evidence to support possible answers. (c) Details of statistical analysis, including statistical methods. (d) A conclusion with an answer. Question 5. The typical requirements for an editorial are: (a) The body of the text follows the IMRAD structure. (b) There are usually 20 or fewer references. (c) There is a maximum of one table or figure. (d) There is no need for corresponding author details.

☐ ☐ ☐ ☐

(b) Most are written by authors submitting their first manuscripts.

☐ ☐ ☐ ☐

☐ ☐ ☐ ☐

(b) A structured abstract.

(a) The vast majority of editorials are unsolicited.


☐ ☐ ☐ ☐

Doctor’s particulars: Name in full: __________________________________________________________________________________ MCR number: _____________________________________ Specialty: ___________________________________ Email address: _________________________________________________________________________________ SUBMISSION INSTRUCTIONS: (1) Log on at the SMJ website: and select the appropriate set of questions. (2) Select your answers and provide your name, email address and MCR number. Click on “Submit answers” to submit. RESULTS: (1) Answers will be published in the SMJ October 2010 issue. (2) The MCR numbers of successful candidates will be posted online at by 22 October 2010. (3) All online submissions will receive an automatic email acknowledgment. (4) Passing mark is 60%. No mark will be deducted for incorrectanswers. (5) The SMJ editorial office will submit the list of successful candidates to the Singapore Medical Council. Deadline for submission: (August 2010 SMJ 3B CME programme): 12 noon, 15 October 2010.


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CME Article

Effective Medical Writing Pointers to getting your article published Peh W C G, Ng K H

Writing a pictorial essay ABSTRACT

displays to being part of the body of published medical

A pictorial essay is a type of educational article

knowledge. As pictorial essays are one of many types of

that aims to provide both textual and visual

articles that appear in medical journals, authors need to be

portrayals of a topical issue. It usually consists of

aware of the specific requirements for their preparation,

a short unstructured abstract, brief introduction,

and whether a particular journal publishes this category

subheadings to organise the material and a

of articles. Similar to all other manuscript types, the

summary. The number of references is limited to

submitted manuscript for a pictorial essay should also be

a few key articles, typically, eight to 15, or fewer.

constructed exactly according to the prescribed guidelines

The text is usually short, often approximately

set by the target journal, which can usually be found in the

1,000 to 2,000 words in length, with much of

journal’s Instructions to Authors.(1)

the message contained in the figure legends. of figures, typically up to 20 figures or 30 figure


parts. The main criteria for publication are

Pictorial essays should consist of the following headings:

currency, educational value and high quality of

unstructured abstract, brief introduction and subheadings


to organise the topic in a logical manner. There may be an

This type of article allows for a large number

optional discussion section. There should be a summary

Singapore Medical Journal, 2 College Road, Singapore 169850 Peh WCG, MD, FRCP, FRCR, Advisor Biomedical Imaging and Interventional Journal, c/o Department of Biomedical Imaging, University of Malaya, Kuala Lumpur 50603, Malaysia

Keywords: figures, illustrations, medical writing,

at the end of the article. Unlike original articles, pictorial

pictorial essay, scientific paper

essays do not follow the IMRAD structure of manuscript

Singapore Med J 2010; 51(3): 186-189



Box 1. Structure of a pictorial essay:

Pictorial essays, also known as pictorial reviews, are


teaching articles that rely mainly on the quality and

Unstructured abstract

educational value of its images and their accompanying

Short introduction

legends. Therefore, in contrast to many other article

Subheadings to organise material

categories, the length of text is limited and there are

Discussion (optional)

usually many figures. The message conveyed should be


current and practical, and should not introduce any new

References (limited number)

information. Although this article category is often found

Illustrations (large number)

in radiology journals, many other journals, including the Singapore Medical Journal, also publish pictorial essays.

The title should be short, attractive and informative,

Pictorial essays, through its numerous illustrations, aim

and should accurately convey to the reader the contents

to provide visual information in an attractive way to the

of the pictorial essay in as few words as possible.(2)

Ng KH, PhD, MIPEM, DABMP, Editor


Some examples of pictorial essay titles published in

the Singapore Medical Journal over the past two years

Correspondence to: Prof Wilfred CG Peh Tel: (65) 6379 3293 Fax: (65) 6379 3944 Email: wilfred.peh@

exhibits or posters that have been presented at major


scientific meetings. One important reason for authors

Gastrointestinal tuberculosis

aiming to convert their posters into pictorial essays is that

Breast calcifications: which are malignant?

their material gets transformed from being merely transient

Radiographical approach to jaw lesions

Pictorial essays are often based on educational


:::::::::::::::::::::::::::::::: B2 ::::::::::::::::::::::::::::::::::: Singapore Med J 2010; 51(3) : 187

Computed tomography of blunt abdominal trauma in

Example 3


Title: Radiographical approach to jaw lesions

Ultrasonographical diagnosis of acute gynaecological



Cysts of the jaw

Magnetic resonance imaging of variants of the knee

Odontogenic tumours

Tumours and other lesions related to bone

The abstract is usually unstructured. Abstracts

Inflammatory lesions

for pictorial essays are almost always shorter than for

Systemic diseases manifested in the jaws

75–150 words. The abstract should concisely summarise

In Example 1, where the pictorial essay reviews

the contents of the pictorial essay, and contain sufficient

endoscopic and radiological findings of non-human

information to be a stand-alone entity. The introduction

immunodeficiency virus-associated gastrointestinal

should be brief, typically one to two paragraphs long, and

tuberculosis, the topic subheadings are divided into

provide background information about why the authors

anatomical regions that are affected by tuberculosis.

had chosen to address the topic in a pictorial essay and

In the pictorial essay on the mammographical

its relevance in current clinical practice. The teaching

appearances of breast calcifications (Example 2),

objectives of the pictorial essay should be stated at the

the topic subheadings describe the three categories

end of the introduction section.

of calcifications according to the ACR BI-RADS

Unlike original articles or case reports, the main body

classification, as well as calcification mimics (or

of the text usually does not have standard headings, e.g.

pseudocalcifications). The pictorial essay in Example

IMRAD for original articles. Subheadings are used to

3 aims to differentiate among common jaw lesions

organise the topic in a logical way, with these subheadings

by describing characteristic radiographical features;

chosen according to the subject matter. The text is

hence, the subheadings are based on various lesion

usually short, and should follow a prescribed word limit,


typically approximately 1,000–2,000 words, according

to the individual journal’s Instructions to Authors. The

key articles, typically 8–15, or fewer. Unlike other

main body of the text typically ends with a summary or

categories of papers, such as original articles, case

conclusion, usually consisting of a paragraph that delivers

reports and review articles, pictorial essays allow for

the take-home message.

a larger number of figures. A typical pictorial essay

• •

original research articles, and are typically limited to

The number of references is limited to a few

may contain up to 20 figures or 30 figure parts, with the Box 2. Examples of subheadings for the main text of

maximum allowable number or range, depending on the

pictorial essays:

requirement of individual journals. Tables are optional,

Example 1

and may be useful in complementing information in

Title: Gastrointestinal tuberculosis

the main body of the text, but whether they are allowed


depends on individual journal policy. As the text is


usually short, much of the message resides in the figure

Stomach and duodenum

legends. Figure legends are therefore a key feature of


pictorial essays and require meticulous preparatory



Large bowel

Extra-enteric involvement

visual portrayal of a particular topic, authors

As a pictorial essay depends heavily on the

need to pay special attention to the selection of Example 2

illustrations, with emphasis on their educational

Title: Breast calcifications: which are malignant?

value and quality. Types of illustrations found in


pictorial essays include radiological images (e.g.

Typical benign calcifications

radiograph, computed tomography, magnetic resonance

Intermediate-concern calcifications

imaging), photographs (e.g. clinical, intraoperative,

High probability of malignancy

specimen, endoscopic, laparoscopic, enteroscopic),


histological photomicrographs, electron micrographs,


:::::::::::::::::::::::::::::::: B2 ::::::::::::::::::::::::::::::::::: Singapore Med J 2010; 51(3) : 188

physiological signal tracings (e.g. electrocardiogram,


electroencephalogram, echocardiogram), laboratory

A pictorial essay is a type of teaching article that aims to

graph (e.g. chromatogram, karyogram) and line drawings

provide an up-to-date visual portrayal of a specific topic.

(e.g. schematic diagram). Guidelines on preparing

This type of article allows for a large number of illustrations

various forms of illustrations can be found in the

which should have educational value and be of high

Singapore Medical Journal’s Effective Medical Writing


series article entitled “Preparing effective illustrations. Part 2: photographs, images and diagrams. (3)

Box 4. Take-home points:

Box 3. Common problems with pictorial essays:

2. The teaching message is based on a large number of

1. A pictorial essay should be up-to-date and educational. high-quality images supplemented by legends.

Excessively long manuscript.

Too much text.

3. The text and reference list are short.

Poor organisation of contents/poor sequence of


subheadings. •

Too many references.

No teaching value or clear take-home message.

Poor-quality illustrations.

Similar (or repeated) illustrations.

1. Peh WCG, Ng KH. Basic structure and types of scientific papers. Singapore Med J 2008; 49:522-5. 2. Peh WCG, Ng KH. Title and title page. Singapore Med J 2008; 49:607-9. 3. Ng KH, Peh WCG. Preparing effective illustrations. Part 2: photographs, images and diagrams. Singapore Med J 2009; 50:330-5.


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(a) A visual portrayal of a topical issue.

(b) A report of a single interesting case.

(c) A description of a new surgical technique.

(d) A critical review of a newly-published textbook.

☐ ☐ ☐ ☐

☐ ☐ ☐ ☐

Question 2. The structure of a pictorial essay includes:

(a) A short introduction.

(b) A detailed materials and methods section.

(c) An unstructured abstract.

(d) At least 50 references.

Question 3. The following statements about a pictorial essay are true:

(a) They may be found in radiology journals.

(b) They are never found in non-radiology journals.

(c) The teaching message is conveyed through images and the accompanying legends.

(d) The manuscript should be constructed exactly according to the journal’s Instructions to

Question 1. A pictorial essay aims at:

☐ ☐ ☐ ☐

☐ ☐ ☐ ☐

☐ ☐ ☐ ☐

☐ ☐ ☐ ☐

☐ ☐ ☐ ☐

☐ ☐ ☐ ☐

☐ ☐ ☐ ☐

☐ ☐ ☐ ☐


Question 4. The following are common problems with a pictorial essay: (a) Excessively long text. (b) Too many references. (c) Large number of illustrations. (d) Repeated illustrations. Question 5. The main criteria for publication of a pictorial essay include: (a) High-quality illustrations. (b) Educational value. (c) Originality. (d) Clear take-home message.

Doctor’s particulars: Name in full: __________________________________________________________________________________ MCR number: _____________________________________ Specialty: ___________________________________ Email address: _________________________________________________________________________________ SUBMISSION INSTRUCTIONS: (1) Log on at the SMJ website: and select the appropriate set of questions. (2) Select your answers and provide your name, email address and MCR number. Click on “Submit answers” to submit. RESULTS: (1) Answers will be published in the SMJ May 2010 issue. (2) The MCR numbers of successful candidates will be posted online at by 7 June 2010. (3) All online submissions will receive an automatic email acknowledgment. (4) Passing mark is 60%. No mark will be deducted for incorrect answers. (5) The SMJ editorial office will submit the list of successful candidates to the Singapore Medical Council. Deadline for submission: (March 2010 SMJ 3B CME programme): 12 noon, 31 May 2010.


:::::::::::::::::::::::::::::::: B4 :::::::::::::::::::::::::::::::::::

Article Scientific Writing: Strategies and Tools for Students and Advisors

Vikash Singh†* Philipp Mayer‡

€ r Mikrobiologie und Tierseuchen, Freie Universita€t From the †Institut fu Berlin, Robert-von-Ostertag-Strasse 7-13, D-14163 Berlin, Germany, ‡science-textflow, Talhofweg 5, CH-8408 Winterthur, Switzerland

Abstract Scientific writing is a demanding task and many students need more time than expected to finish their research articles. To speed up the process, we highlight some tools, strategies as well as writing guides. We recommend starting early in the research process with writing and to prepare research articles, not after but in parallel to the lab or field work. We suggest considering scientific writing as a team enterprise, which needs proper organization and regular feedback. In addition, it is helpful to select potential target journals early and to consider not only scope and

reputation, but also decision times and rejection rates. Before submission, instructions to authors and writing guides should be considered, and drafts should be extensively revised. Later in the process editor’s and reviewer’s comments should be followed. Our tips and tools help students and advisors to structure the writing and publishing process, thereby stimulating them to develop their own C 2014 by The International Union of strategies to success. V Biochemistry and Molecular Biology, 42(5):405–413, 2014.

Keywords: journals; publishing; software tools; writing guides

Introduction Scientific writing is a critical competence for careers in science. Graduate students and researchers have to write to communicate their findings and to develop their profiles as renowned scientists [1]. Science is highly competitive and success in science is often measured by the number of publications and citations. Researchers and students who are able to communicate well are not only successful in gaining recognition for themselves but also for their institute and university. In the long run, publications pave the path to job positions, collaborations, and better funding. Thus, it is crucial for students and researchers to achieve proficiency in scientific writing. Students and researchers are usually well trained and motivated in designing, performing experiments, and ana€ r Mikrobiologie und Tierseu*Address for correspondence to: Institut fu chen, Freie Universita€t Berlin, Robert-von-Ostertag-Strasse 7-13, D-14163 Berlin, Germany. E-mail: Conflict of interests: Vikash Singh declares that there are no competing interests in relation to the manuscript. Philipp Mayer delivers workshops and provides coaching support in the field of scientific writing ( Received 15 January 2014; Accepted 5 July 2014 DOI 10.1002/bmb.20815 Published online 23 July 2014 in Wiley Online Library (

Biochemistry and Molecular Biology Education

lyzing data. However, many of them received no formal training in scientific writing [2] and struggle with various challenges during the writing process (see ref. [3] for a description of cognitive and socio-cultural demands of writing). As a consequence, many relevant findings do not reach their target audiences. Students and researchers often make the mistake of understanding the preparation of scientific articles as a separate phase in the research process to be done after completing experiments [4, 5]. In addition, many students and advisors are not aware of available tools and guides. Through this essay, we highlight a few important tips for efficient scientific writing which could also be considered for theses, proposals, review articles, and other text types. We also suggest various writing guides and software tools that make scientific writing less demanding and more exciting.

Early Beginning is Beneficial Scientific writing is a learning process, and one masters this skill through experience. Therefore, we recommend starting early. The first step in this process is extensive and attentive reading in order to get an overview of the published literature, also to acknowledge the structure and style of research articles. It is here during this stage where many students do not invest sufficient time to read enough so as to gain a sound grasp over their literature. Once, the student has established

28 405

:::::::::::::::::::::::::::::::: B4 ::::::::::::::::::::::::::::::::::: Biochemistry and Molecular Biology Education


Stages of Writing Process PREPARING a) Note taking

b) Structuring thoughts

c) Reference management


Software-tools for different stages of the writing process





OneNote com/de-de/onenote




The Brain













http://www.thirdstreetsoftware. com/site/SenteForMac.html

Rationale and Recommended Tools

Writing is easier with personal ideas and information from the literature at hand. Evernote and OneNote both support various formats (e.g. texts, photos) and devices (e.g. notebook, smartphone).

Organize your thoughts and your information before you begin to write. If you like mind maps try Freeplane. If you like flowcharts try If you like lists try WorkFlowy.

Reference management software helps organizing article PDFs, inserting citations and preparing bibliographies. EndNote is rich in features and time-tested. Mendeley offers innovative collaboration functions and is free.

Strategies and Tools for Students and Advisors


:::::::::::::::::::::::::::::::: B4 :::::::::::::::::::::::::::::::::::



Stages of Writing Process

d) Collaboration

DRAFTING e) Avoiding distractions

f) Achieving productivity

g) Speech recognition

Singh and Mayer






Google Drive*



Dark Room*




http://www.hogbaysoftware. com/products/writeroom

ZenWriter zenwriter.html

focus booster*

http://www.focusboosterapp. com

Write or Die

Dragon Naturally Speaking dragon/index.htm

Mac (OS X Mountain Lion) PH11481

Windows (7 and 8) is-is/windows-8/using-speechrecognition

Rationale and Recommended Tools

These tools aid in writing collaboratively and in sharing manuscripts. Public instances of Etherpad allow collaborative writing and editing. Wuala offers cloud storage with advanced encryption.

These tools help to focus on writing. Which one to choose is a matter of taste (and of operation system).

For the drafting stage, some time pressure is beneficial for most of us. Have a look at Write or Die to find out what we mean.

There are different reasons to use speech recognition software: to save time, to do it on the go, for a change. Dragon NaturallySpeaking is known for its recognition accuracy.

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Stages of Writing Process REVISING h) Grammar, punctuation and spell checking






Rationale and Recommended Tools These tools help to avoid mistakes and to improve writing skills. All three products are effective but not for free.

Workbench i) Readability

j) Layout

Readability Test Tool*

Word (Microsoft Office) en-001/word-help/test-yourdocument-s-readabilityHP010354286.aspx

InDesign products/indesign.html



Publisher (Microsoft Office) en-001/publisher/


Based on sentence and word length, the readability test tool calculates several indices.

Some publishers ask authors to design the layout of their research articles. In these cases, and for theses and books, layout software is helpful. InDesign is a high-end and high-priced tool. A free alternative is Scribus.

These tools facilitate the process of writing research articles and help to improve text quality. *freeware (software free of charge) or freemium (basic services for free, premium services with costs).

his/her knowledge over the literature, the second step is checking the usefulness of available software tools and writing guides. Appropriate tools and guides for students and researchers in the life sciences are listed in Tables 1 and 2. The third step is to check the services of local writing centers. Many universities offer services to help students to develop their writing skills. We recommend that students preparing research articles, dissertation theses, or other texts make use of the university writing centers. The writing centers not only serve as sources for improving writing skills but also provide students with templates in order to facilitate the writing process.


Then it is time to plan one’s own research article. Outlining and drafting one’s first research article as early as possible is crucial. A detailed outline facilitates the writing process [6] and the outline of a research article holds the key toward its success. Structural templates facilitate this outlining process (see Fig. 1). Although an outline and a draft are far from a final version and will not reflect the full amount of work to be performed, it surely provides a student with aerial views of the research project and also signifies the most important experiments and critical areas that need more consideration. Additionally, by writing piece by piece provides new researchers with the perception of what to do and when,

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Recommended writing guides for students in the life sciences



Albert, T. (2009) Winning the Publications Game – How to Write a Scientific Paper Without Neglecting Your Patients, 3rd ed., Radcliffe Publishing, Oxford, New York, 114 p.


Alley, M. (1996) The Craft of Scientific Writing, 3rd ed., Springer Science 1 Business Media, New York, 282 p.*

 Classical textbook, archetype for many other writing guides  Well-written, you can read it in a few sittings  Clear and concise

Cargill, M., O’Connor, P. (2013) Writing Scientific Research Articles – Strategy and Steps, 2nd ed., Wiley-Blackwell, Chichester, 223 p.

 Clearly structured (the author’s teaching experience becomes obvious)  Easily-accessible  Instructive exercises and examples

Council of Science Editors, Style Manual Commitee (2006) Scientific Style and Format - The CSE Manual for Authors, Editors, and Publishers, 7th ed., Council of Science Editors, Reston (VA), 658 p.

 Extensive and authorative desk reference  Style conventions are presented (e.g. abbreviations, numbers, chemical notations, species names)

Davis, M., Davis, K., Dunagan, M. (2012) Scientific Papers and Presentations – Effective Scientific Communication, 3rd ed., Elsevier, London, 368 p.

 Focus on communication skills for scientists  Besides the preparation of research articles various other topics are covered (e.g. posters, proposals, theses, oral presentations, communication with nonscientists)

Day, R.A., Gastel, B. (2011) How to Write and Publish a Scientific Paper, 7th ed., ABC-CLIO, LLC, Santa Barbara (CA), 300 p.

 Extensive coverage of topics related to scientific writing and publishing  Engaging style  Practical advice without inappropriate simplifications

Fraser, J. (2008) How to Publish in Biomedicine – 500 Tips for Success, 2nd ed., Radcliffe Publishing, Oxford, New York, 191 p.

 Easily-accessible: no reading of long blocks of text needed  Extensive coverage of topics related to scientific writing and publishing  Practical advice

Gladon, R.J., Graves, W.R., Kelly, J.M. (2011) Getting Published in the Life Sciences, Wiley-Blackwell, Hoboken, NJ, 356 p.

 Convincing approach to writing with take-home messages developed first  Comprehensive coverage of topics related to scientific writing and publishing

Glasman-Deal, H. (2010) Science Research Writing for Nonnative Speakers of English, Imperial College Press, London, 257 p.*

 Structural templates for article sections are provided  Grammar issues well explained  Useful vocabulary lists

Greene, L. (2010) Writing in the Life Sciences – a Critical Thinking Approach, Oxford University Press, New York, 512 p.

 Detailed description of involved steps  Stimulating connections between citical thinking and clear writing  Many examples

Gustavii, B. (2008) How to Write and Illustrate a Scientific Paper, 2nd ed., Cambridge University Press, Cambridge, 168 p.

 Straightforward, friendly advice  Helpful tips how to present numbers, prepare tables and design graphs  Concise

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Stepwise approach from idea to submission Unconventional, encouraging, subversive advice Easy to read Concise

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Hall, G.M., Ed. (2013) How to Write a Paper, 5th ed., BMJ Books, John Wiley & Sons, Chichester, 170 p.

 Perspectives of different experts presented  Topics included which are neglected in other writing guides (e.g. electronic submission, ethics of publishing, open access)

Katz, M.J. (2009) From Research to Manuscript – a Guide to Scientific Writing, 2nd ed., Springer Science 1 Business Media, 205 p.

 Convincing advice how to integrate writing in the research process  Helpful tips for the preparation of tables and figures

Lebrun, J.-L. (2011) Scientific Writing 2.0 – a Reader and Writer’s Guide, 2nd ed., World Scientific Publishing, Singapore, 265 p.*

 Unconventional presentation of information  Enjoyable to read  Helpful focus on reader’s needs

Matthews, J.R., Matthews, R.W. (2008) Successful Scientific Writing– a Step-by-Step Guide for the Biological and Medical Sciences, 3rd ed., Cambridge University Press, Cambridge, 240 p.

 Practical, well-founded advice  Information is easily accessible  Comprehensive coverage of topics related to scientific writing (e.g. literature search strategies, preparation of visuals)

Schimel, J. (2012) Writing Science – How to Write Papers that Get Cited and Proposals that get Funded, Oxford University Press, New York, 221 p.

 Stimulating, unconventional advice for advanced writers  Narrative structure of research articles well explained

Skern, T. (2009) Writing Scientific English – a Workbook, Fac₏ts verlag, Wien, 191 p. ultas Universita

 Straightforward advice for beginners  Language issues covered (helpful for non-native speakers of English)  Instructive exercises (it is a workbook)

Zeiger, M. (2000) Essentials of Writing Biomedical Research Papers, 2nd ed., McGraw-Hill, New York, 440 p.

 Extensive, clear, practical  The structure of research articles is well explained  Instructive examples and exercises

*These books do not focus on the life sciences but address readers of the natural sciences. Nevertheless, these books are helpful for students in the life sciences.

thus helping them in avoiding unnecessary work. This makes the work more efficient, by better time management and planning. A helpful description of steps toward a research article is provided by ref. [7]. Writing is not a single step, pre-set rigid process; rather it is a step-by-step learning process with a learning curve that requires regular feedbacks and continuous evaluation of the written matter [3, 8]. Thus, one should aim to write and work in small increments [9]; analyze what one has done, what went well and what can be improved.

Working in Teams Scientific research and scientific texts are collective outputs of a few people, a group or an institution. Thus a group has power, and writing articles as a group is beneficial as it leads to enhancement of both efficiency and output. Writing articles in groups not only adds a new perspective to


aims, arguments, and conclusions but is also a smart strategy to obtain necessary feedback. Seeking feedback is helpful for efficient scientific writing. Feedback helps to detect inconsistencies, inappropriate text structures, unclear messages, wordy text parts, and errors and will lead to improved text quality. In addition, feedback helps students to recognize their strengths and weaknesses. Students should seek their advisor’s feedback frequently as they write. Regular feedback leads to suggestions and foster students’ learning processes. Thus feedback is a critical element for the development of writing skills. Professional team work in writing articles helps to reduce the workload for the first author. A productive team could be formulated with colleagues, supervisors, and coothers. The workload, as well as responsibilities and roles of involved people, should be specifically assigned, and this helps to keep the time schedule in check and meet deadlines. To facilitate collaboration and file sharing, user friendly internet tools are available (Table 1).

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Typical components of research articles in the life sciences (adapted from refs. [24] and [25]). Each component reflects one or several paragraphs.

Having a leader in a writing team is recommended. A leader acts as a unifying force that helps to maintain stability and cohesion [10]. Furthermore, in the presence of a leader there is reduced frustration, repetition, redundancy and uncertainty among the team members [11]. Also, the selection of a leader avoids the situation where the most dominant person takes over unofficially in the group and preferentially considers his/her own views and thoughts [10]. However, writing in teams is not always a pleasant experience: It can lead to deadlocked discussions; waste of time, frustration (see e.g. ref. [12]), Advisors and students should not forget that teamwork in general is a demanding management issue. Therefore, people involved in writing teams should invest time and effort in the organization of processes [12], and should be aware of potential pitfalls and should be flexible enough to negotiate.

article [4]. This is beneficial because different journals follow different schools of thought, have different article types, and different stylistic and bibliographic requirements. Therefore, writing an article directed towards a specific journal not only helps to choose the appropriate content and style but also saves time and avoids unwanted modifications and deadlocks during the final preparation of the article. According to Harnad et al. [13] about 24,000 peerreviewed research journals exist worldwide. This means that there are enough publishing opportunities in almost every field of science. While selecting a target journal it is advised to carry out an analysis of aims and scope of the journal, to examine the type of articles that are being published with respect to their structure, methodology and research topic. Additionally, crucial aspects that need due consideration while selecting journals, especially by graduate students and new researchers, are decision times and acceptance rates. The “Decision time” for a journal is defined as the time between manuscript submission and the editor’s decision. The information regarding decision time could be obtained in three ways [4]. (a) All journals print dates of submission and acceptance together with publications. (b) Some journals also provide decision times on their web pages. Lastly (c) one may also ask for the decision time of a journal by sending a polite email to the managing editor. Information regarding acceptance rates might be found on journal websites. Another parameter that is often referred to by researchers while selecting a journal is the “impact factor” [14]. The impact factor (IF), devised by Eugene Garfield, reflects the average number of citations to articles published in the journal [15, 16]. The IF is used to compare the importance and standard of different journals in a particular discipline [14]. Journals with high IF are considered of high significance and often researchers are evaluated based on the IFs of the journals they have published in ref. [13]. Nonetheless, the IF is merely arithmetic, and IF should not be used as a parameter to evaluate the level and quality of scientific work performed by a researcher [17]. Furthermore, the IF has various shortcomings [17–19] and should not be considered as the sole criteria for assessing journal reputation. Other metrics that could be used for selecting target journals are Eigenfactor [19], Immediacy Index, Hirsch Index [20, 21], and SCImago Journal rank [19, 22]. Additional criteria to be considered are, for instance, informal reputation of the journal, open access options, copyright regulations, publication costs, and peer review systems.

Selecting a Journal

Nurturing the Manuscript

We recommend choosing the target journal early in the writing process. Indeed, we suggest having the journal already selected while preparing the rough draft of the

Once a student has finished writing a manuscript, thesis, or dissertation. There must be adequate time for internal reviewing among colleagues, for nurturing its content and

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:::::::::::::::::::::::::::::::: B4 ::::::::::::::::::::::::::::::::::: Biochemistry and Molecular Biology Education improving the style. During this phase, students are advised to strive for clarity in their manuscript. The best way to achieve clarity and continuity within the manuscript is by having clear and precise paragraphs. The beginning of the paragraph should state the main purpose or topic of the entire paragraph while the ending could be used as an introduction to the following paragraph. By doing this in practice, writers can establish a flow of information from one paragraph to the next. The second critical aspect that needs to be checked is accuracy. In order to strive for accuracy, students are advised to check their data, their line of reasoning and their references. Third, we recommend focusing on language issues such as grammar, spelling and punctuation. Grammar and spellchecking software (see Table 1) helps to avoid mistakes and various writing guides (see Table 2) provide practical tips for betterment of the manuscript. In this stage, we recommend to ask for outside help. One may want to benefit from professional editing services. The costs of editing a manuscript usually ranges between US $100–$350, depending on the length of the text and the amount of work required. If the services of a writing centre are accessible, students should make use of their services in this stage. The revising step is often a neglected part; this is critical as this step leads to quality in scientific manuscripts. Hence, students are advised to make sure to have enough time for revision, use checklists, software tools, and writing guides. Once the authors have finished re-revising (improving) their manuscript, it is then ready to be submitted to the journal. After submission of the article, editors will acknowledge that they received the manuscript.

Responding to Decisions Manuscripts are usually reviewed by two or more experts independently [23]. These experts (reviewers) write a review report and editors decide whether to reject or accept the manuscript. At first glance, the feedback of reviewers and editors may seem harsh and ask for substantial changes in the manuscript or the conductance of additional experiments. However, text feedback should never be intended to judge the abilities and skills of the authors. Reviewer’s and editor’s comments can be helpful in improving writing skills. Moreover, manuscripts will subsequently get better if the authors act as advised. Most editors and reviewers are trying to improve the paper, not to destroy it, with their suggestions. In case of acceptance with minor revisions, it is necessary to analyze carefully what the comments mean and to react swiftly to the given feedback by kindly acknowledging the criticism. It is helpful to provide a point by point response acknowledging reviewer’s and editor’s comments together with the modified manuscript. If authors do not agree with the critique, they should justify their decision. And finally: There is no reason to despair upon rejection. Authors can always try another journal.


Conclusion Here, through this essay, we have highlighted ways to make scientific writing a creative, effective, and manageable process rather than a cumbersome one, as often felt by students. If students start early with writing, consider it as a team enterprise, learn from advice given to them by advisors, colleagues, editors, and reviewers, select journals carefully, and revise extensively, successful writing and publishing is possible. In addition, various software tools and writing guides are available which speed up the writing process and help to improve text quality. However, these tips and tools should not be seen as rules or mandatory regulations that students must follow for successful writing and publishing. Students are advised to opt for best possible individual strategies that suit their habits, attitudes, and interests.

References [1] Murray, R. (2009) Writing for Academic Journals, McGraw Hill, Maidenhead. [2] Lindsay, D. (2011) Scientific Writing 5 Thinking in Words, CSIRO Publishing, Collingwood. [3] MacArthur, C.A., Graham, S., Fitzgerald, J., Eds. (2006) Handbook of Writing Research, The Guilford Press, New York. [4] Belt, P., Mottonen, M., Harkonen, J. (2011) Tips for writing scientific journal articles. In: Industrial Engineering and Management Working Papers. University of Oulu, Faculty of Technology/Department of Industrial Engineering and Management. Available isbn9789514293801/isbn9789514293801.pdf [March 18, 2014]. [5] Gardiner, M., Kearns, H. (2011) Turbocharge your writing today. Nature 475, 129–130. [6] Frey, P.A. (2003) Guidelines for writing research papers. Biochem. Mol. Biol. Educ. 31(4), 237–241. [7] O’Connor, T.R., Holmquist, G.P. (2009) Algorithm for writing a scientific manuscript. Biochem. Mol. Biol. Educ. 37(6), 344–348. [8] Flower, L., Hayes, J.R. (1981) A cognitive process theory of writing. Coll. Compos. Commun, 32, 365–387. [9] Boice, R. (1985) The neglected third factor in writing: Productivity. Coll. Compos. Commun. 36, 472–480. [10] Marsen, S. (2007) Professional Writing - The Complete Guide for Business, Industry and IT, Palgrave Macmillan, Basingstoke. [11] Beer, D.F., McMurrey, D. (2005) A Guide to Writing as an Engineer, Wiley, New York. [12] Mamishev, A.V., Williams, S.D. (2010) Technical Writing for Teams – The STREAM Tools Handbook, John Wiley & Sons, Hoboken, New Jersey. [13] Harnad, S., Brody, T., Vallie`res, F., Carr, L., Hitchcock, S., Gingras, Y., Oppenheim, C., Stamerjohanns, H., Hilf, E.R. (2004) The access/impact problem and the green and gold roads to open access. Serials Rev. 30, 310–314. [14] Bornmann, L., Marx, W., Gasparyan, A.Y., Kitas, G.D. (2012) Diversity, value and limitations of the journal impact factor and alternative metrics. Rheumatol Int 32, 1861–1867. [15] Garfield, E. (1972) Citation analysis as a tool in journal evaluation. Science 178, 471–479. [16] Garfield, E. (1955) Citation indexes for science; a new dimension in documentation through association of ideas. Science 122, 108–111. [17] Seglen, P.O. (1997) Why the impact factor of journals should not be used for evaluating research. BMJ 314, 498–502. [18] Brown, T. (2011) Journal quality metrics: Options to consider other than impact factors. Am. J. Occup. Ther. 65, 346–350.

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[19] Ramin, S., Sarraf Shirazi, A. (2012) Comparison between Impact factor, SCImago journal rank indicator and Eigenfactor score of nuclear medicine journals. Nucl. Med. Rev. Cent. East. Eur. 15, 132–136. [20] Hirsch, J.E. (2005) An index to quantify an individual’s scientific research output. Proc Natl Acad Sci USA 102, 16569–16572. [21] Larsen, P.O., Maye, I., von Ins, M. (2008) Scientific output and impact: Relative positions of China, Europe, India, Japan and the USA. Collnet J. Scientom. Inform. Manag. 2, 1–10.

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[22] SCImago Journal & Country Rank. [March 18, 2014]. [23] Wager, E., Godlee, F., Jefferson, T. (2002) How to Survive Peer Review. BMJ Books London. [24] Swales, J.M. (1990) Genre Analysis - English in Academic and Research Settings. Cambridge University Press, Cambridge. [25] Zeiger, M. (2000) Essentials of Writing Biomedical Research Papers, 2nd ed., McGraw-Hill, New York.

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Using the journal BMJ Case Reports to promote the publication of clinical case reports Blanca San Jose´ Montano See end of article for author’s affiliation.


Objective: The study updates and enhances clinicians’ knowledge about clinical case reports (CCRs) and encourages publication of such articles. Methods: The author developed and offered a session about BMJ Case Reports to medical and surgical ´ departments in the University Hospital of Mostoles. The session reviewed the contents and add-on services of the journal, conventional and alternative indicators of journal quality, use of CCRs to share valuable clinical lessons, and manuscript preparation and submission. Results: The main result of these sessions was submission of eight CCRs to BMJ Case Reports, of which four were accepted. One submitting author was invited to serve as peer reviewer for the journal. Other clinicians are preparing five new CCRs for submission to BMJ Case Reports or other journals. Conclusions: The learning sessions were successful in promoting writing and publication of CCRs. Young staff and postgraduate residents seemed especially encouraged to publish CCRs that had already been presented in their departmental sessions. As a librarian, I gained experience in CCR publication and reinforced my position as an essential supporter of the hospital’s teaching and publishing activity. Keywords: Clinical Case Reports, Health Sciences Libraries, Health Sciences Librarians, Publishing, Scientific Journals, Medical Education, Continuing Medical Education, Research Informationist

Clinical case reports (CCRs) are detailed reports that describe the diagnosis or management of one or more patients [1]. Their purpose, according to Sir William Osler, is to ‘‘produce valuable education and research resources’’ [2]. CCRs have a long tradition in medical literature [3] and have been published as a regular section in many medical journals. However, the 1980s saw a rise in negative opinions of CCRs due to their low level in the hierarchy of evidence [4] and their lack of specificity for medical decision making [5]. Since the late 1990s, however, CCRs have been increasingly published, with the genre adapting to new challenges [5, 6] and the launch of new journals specifically devoted to publishing CCRs. ´ The University Hospital of Mostoles in Spain is a second-level general hospital (295 beds) with a very active clinical practice (145 postgraduate residents). Also, since 2014, it has been an important undergraduate teaching site for 2 universities

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(approximately 138 students). CCRs derived from health care activities are routinely used as a teaching tool in every department. However, in recent years, clinicians at our hospital have almost stopped publishing CCRs in medical journals: 24 CCRs were published from 2005 to 2014, with only 3 published between 2012 and 2014. The health sciences library of the University ´ Hospital of Mostoles supports health care, teaching, and research performed in the hospital. As its librarian and research informationist, I participate in the entire research, teaching, and learning lifecycles [7] and encourage lifelong learning and publishing based on the hospital’s health care activity. In 2015, a new journal subscription provided a new opportunity for clinicians at the hospital. The journal BMJ Case Reports (ISSN: 1757-790X; casereports.bmj. com) publishes a large volume of CCRs in all branches of medicine and has a unique business



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model in which institutional subscribers can establish a fellowship that waives individual fellowship fees for affiliated authors. I used the introduction of this new journal to update and enhance clinicians’ knowledge about CCRs and to encourage them to publish this type of article. METHODS

I developed a learning session to raise clinicians’ awareness of BMJ Case Reports and to use its specific features to update and reinforce knowledge about medical publishing. I offered this session to all medical and surgical departments (thirty-four units) in their own continuing education programs. The session was divided into four parts: 1. Journal contents and add-on services: alerts, really simple syndication (RSS) feeds, videos, blogs, and top-rated articles. 2. Indicators of journal quality and increasing publication impact: indexing in major international databases; journal impact factor (although BMJ Case Reports does not have an impact factor because case reports are rarely cited, therefore its impact factor would be expected to be low); alternative metrics (‘‘altmetrics’’) of the use and impact of scientific publications based on attention in mass media, blogs, Twitter, Facebook, and so on; and the open access movement and deposit of manuscripts into publicly accessible repositories to improve their reach. 3. CCRs as an avenue for sharing valuable clinical lessons: CCRs potentially have a high sensitivity for detecting novelty [4, 5]. They serve as the first line of evidence [6] and can be powerful tools for discovering new diseases, unusual clinical syndromes, disease associations, and unusual side effects of therapy or responses to treatments [8, 9]. In its ‘‘Instructions for Authors,’’ BMJ Case Reports provides a variety of cases and topics that they consider to provide the most valuable clinical lessons. 4. Manuscript preparation and submission process: To strengthen the level of evidence of CCRs and satisfy editors’ expectations, the quality of case reporting must be high, and authors must be careful not to generalize, overinterpret, or misinterpret their observations. For this reason, BMJ Case Reports requests a precise, focused primary message and a well-organized and structured report, submitted using a required manuscript template [5, 10]. Both


the patients’ informed consent and their perspectives on their diseases or management are very important. RESULTS

From January to December 2015, I gave learning session in twelve departments. The session was favorably received by participating physicians, who reported that they updated and refreshed their knowledge of medical publishing and journal quality indicators and other metrics. Young staff and postgraduate residents seemed especially encouraged to publish CCRs that had already been presented in their departmental sessions. The main result of these learning sessions was the submission of eight manuscripts to BMJ Case Reports. Four manuscript were accepted after revisions that were requested by the editors and peer reviewers [11–14]. The revisions generally pertained to improving writing style and article structure and extending the discussion, and they were an important learning experience for the authors. The other four manuscripts were rejected because they described very common cases that did not have clear teaching points or that were similar to previously published CCRs in BMJ Case Reports. Furthermore, one submitting author was asked to serve as a peer reviewer for another manuscript. The four published CCRs were written by members of the Department of Internal Medicine in collaboration with members of the Departments of Pathology and Oncology. At present, other clinicians are preparing five new CCR manuscripts: three for BMJ Case Reports and two for other journals. Furthermore, as a librarian, I gained experience in CCR publication and reinforced my position as an essential supporter of the hospital’s teaching and publishing activity. DISCUSSION

Although my intention is to encourage the publication of CCRs, the criteria for evaluating research activity published by the Spanish National Evaluation of Research Activity Committee does not support this goal. In their 2014 [15] and 2015 [16] recommendations, they state that ‘‘as a general rule, clinical cases, conference papers and letters to the editor should not be considered as ordinary contributions.’’ However, this statement underestimates the importance of formal medical communication based on real, day-to-day clinical practice. In addition to their power to detect novelty,

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CCRs are also a convenient genre for neophytes to take their first steps in medical writing [3]. Arguably, new criteria that acknowledge the impact of CCRs may increase the visibility of this type of publication. ACKNOWLEDGMENTS

I thank Dr. Manuel Varela for his translation support and advice. I also thank the editorial staff at the Journal of the Medical Library Association, particularly Katherine Akers, for providing significant editorial assistance. COMPETING INTERESTS

The author has no competing interests. REFERENCES 1. Gopikrishna V. A report on case reports. J Conserv Dent. 2010 Oct;13(4):265–71. DOI: 4103/0972-0707.73375. 2. Chelvarajah R, Bycroft J. Writing and publishing case reports: the road to success. Acta Neurochir (Wien). 2004 Mar;146(3):313–6; discussion 316. 3. Morris BA. The importance of case reports. CMAJ. 1989 Nov 1;141(9):875–6. 4. Vandenbroucke JP. In defense of case reports and case series. Ann Intern Med. 2001 Feb 20;134(4):330–4. 5. Nissen T, Wynn R. The clinical case report: a review of its merits and limitations. BMC Res Notes. 2014 Jan;7:264. DOI: 6. Albrecht J, Werth VP, Bigby M. The role of case reports in evidence-based practice, with suggestions for improving their reporting. J Am Acad Dermatol. 2009 Mar;60(3):412–8. DOI: 2008.10.023. 7. Jaguszewski JM, Williams K. New roles for new times: transforming liaison roles in research libraries. Washington, DC: Association of Research Libraries; 2013. 8. Nissen T, Wynn R. The history of the case report: a selective review. JRSM Open. 2014 Apr;5(4): 2054270414523410. DOI: 2054270414523410. 9. Carey JC. The importance of case reports in advancing scientific knowledge of rare diseases. Adv Exp Med Biol. 2010 Jan;686:77–86. DOI: 10. BMJ Case Reports [Internet]. [cited 3 Feb 2016]. ,

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11. Garc´ıa Carretero R, Manotas-Hidalgo M, Romero Brugera M, El Bouayadi Mohamed L. Pleural effusion of malignant aetiology: cell block technique to establish the diagnosis. BMJ Case Rep. 2016 Mar 18. DOI: http://dx.doi. org/10.1136/bcr-2016-215140. 12. Garc´ıa Carretero R, Romero Brugera M, RebolloAparicio N, El Bouayadi Mohamed L. Primary bone metastasis as first manifestation of an unknown primary tumour. BMJ Case Rep. 2015 Sep 3. DOI: http://dx.doi. org/10.1136/bcr-2015-211302. 13. Garc´ıa Carretero R, Romero Brugera M, RebolloAparicio N, Rodeles-Melero J. Dysphagia and aspiration as the only manifestations of a stroke. BMJ Case Rep. 2016 Feb 11. DOI: 14. Garc´ıa Carretero RC, Sanchez-Redondo J, BarrioAlonso MJ, Lopez-Marti MP. Lung carcinoma presenting as a solitary, painless frontal bone lump. BMJ Case Rep. 2015 Dec 16. DOI: ´ de 26 de noviembre de 2014, 15. BOE No290. Resolucion ´ Nacional Evaluadora de la Actividad de la Comision Investigadora, por la que se publican los criterios espec´ıficos aprobados para cada uno de los campos de ´ [Internet]. Agencia Estatal Bolet´ın Oficial del evaluacion Estado; 2014 [cited 1 Feb 2016]. p. 98204. ,https://www. pdf.. ´ de 26 de noviembre de 2015, 16. BOE no 286. Resolucion ´ Nacional Evaluadora de la Actividad de la Comision Investigadora, por la que se publican los criterios espec´ıficos aprobados para cada uno de los campos de ´ [Internet]. Agencia Estatal Bolet´ın Oficial del evaluacion Estado; 2015 [cited 1 Feb 2016]. p. 113060. ,https://www. pdf..

AUTHOR’S AFFILIATION Blanca San Jose´ Montano, org, Health Sciences Librarian, Ho s p i ta l U ni ver s i ta ri o d e ´ ´ ´ Mostoles, Rio Jucar s/n, Mostoles 28935, Madrid, Spain Received March 2016; accepted May 2016



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How to Write Articles That Get Published

Education Section

DOI: 10.7860/JCDR/2014/8107.4855


ABSTRACT Publications are essential for sharing knowledge, and career advancement. Writing a research paper is a challenge. Most graduate programmes in medicine do not offer hands-on training in writing and publishing in scientific journals. Beginners find the art and science of scientific writing a daunting task. ‘How to write a scientific paper?, Is there a sure way to successful publication ?’ are the frequently asked questions. This paper aims to answer these questions and guide a beginner through the process of planning, writing, and correction of manuscripts that attract the readers and satisfies the peer reviewers. A well-structured paper in lucid and correct language that is easy to read and edit, and strictly follows the instruction to the authors from the editors finds favour from the readers and avoids outright rejection. Making right choice of journal is a decision critical to acceptance. Perseverance through the peer review process is the road to successful publication.

Keywords: Medical writing, Publication in biomedical journal, Preparation of manuscript

Introduction Writing and publishing scientific papers is the core business of every researcher [1]. The scientific output medical researchers generate is not only important for society to improve health through advancement of knowledge but also for the individual researcher’s career [2]. Effective scientific writing, however, is not easy [1]. Scientific paper has a required structure and style. However, a research article is not only a technically rigid document, but also a subjective intellectual product. Therefore, it requires good skills in both structuring and phrasing. These skills are acquired through experience, and can also be taught [3]. ‘Uniform Requirements for Manuscripts Submitted to Biomedical Journals: Writing and Editing for Biomedical Publication’ gives the required technical and structural details of scientific papers [4]. Also, there is no dearth of literature on scientific writing and publishing. Ironically, most graduate programmes in medicine do not offer hands-on training in writing and publishing in scientific journals. Therefore, most authors learn the art and science of scientific writing the hard way; though there are papers that provide step-by-step guide to writing [5]. What constitute a good paper- worthy of publication? There are no straight answers. Some define a good paper as a clear, coherent, focussed, well-argued document that uses unambiguous language [3]. Editors and reviewers appreciate manuscripts that are easy to read and edit [4]. However, no foolproof rules exist for success in publishing a manuscript. Good scientific content of a paper alone does not guarantee its publication in a good journal [5]. This article presents a review of the selected articles on writing and publishing in biomedical journals and aims to provide beginners the basics of effective scientific writing, and tips on successful publishing. Writing a Scientific Paper: Getting started. When planning a scientific paper, Berk’s memo to the authors in the American Journal of Roentgenology is worth following [6]. He felt that getting the things right the first time improved the chances of acceptance and avoided revisions. He set out 5 guiding principles for the inexperienced authors : They are : 1. Determine the specific focus of your article, 2. Select the right journal, 3. Decide the type of article, 4. Follow the guidelines for authors published in the selected journal, 5. Revise, revise, and revise. Remember, ‘the most of the important work of composing a manuscript occurs during the study design that is critical for determining the resultant manuscript’s publication [7]. Therefore, study design and methodology requires Journal of Clinical and Diagnostic Research. 2014 Sep, Vol-8(9): XG01-XG03

careful planning; they form the touchstone on which results and conclusions are tested.

Preparing a Manuscript The scope of work determines the type of article. The choice of journal depends upon the field a journal covers, area of research, time frame for publication, and the journal’s impact factor- a proxy for relative importance of the journal within its field. ‘Uniform requirements for manuscripts submitted to biomedical journals: writing and editing for biomedical publication’ provides the guidelines for preparing manuscripts for any journal [4]. The text of observational and experimental articles is usually divided into sections with the headings, introduction, methods, results, and discussion, the so-called “IMRAD” structure. Other types of articles have different structure. Therefore, it is necessary to familiarize with and strictly follow the instructions to the authors of the target journal. To begin with read a paper written in the format you plan to write. Prepare a skeleton of your paper [8]. Note down the key points in each section. It is neither desirable nor practical to actually write the article sections in sequential order. Introduction and the discussion may wait till at the end. Abstract may be written the last. Keep the language simple, concise and easy to understand. Follow UK or US English as desired by the journal. Remove all unnecessary words. Use active voice rather than passive. The sentences should begin with the operative word and end with the message. Expand the abbreviations when used for the first time. Check the grammar and spelling. A word processing tool may be helpful. However, many biomedical words do not exist in the vocabulary of the word processing tools. Here, the textbooks or a medical dictionary may be helpful. Following text sequentially discusses the elements of the individual sections of a scientific paper. Peer-review and reasons for rejection are discussed subsequently. Title: A good title should attract and inform the readers and be accurate [9]. It should make it stand out from other literature in the field [10]. Titles may be phrased in a variety ways. Some examples of descriptive and informative titles are given below: -

Correlation of Tear Fluorescein Clearance and Schirmer test scores with Ocular irritation symptoms (a descriptive title)


What Are the Biomarkers for Glaucoma?


Dry eyes: are new ideas drying up?

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Kirti Nath Jha, How to Write Articles That Get Published


Angiopoetin-2 levels are elevated in exudative pleural effusions (informative title)

As a rule, the title should contain all the words that the readers use for searching relevant literature. The authors may, to begin with, consider a number of titles and finally choose the most appropriate. Co-authors and peers may provide useful suggestions. Some journals also ask for short running titles in limited characters to be used at the top or bottom of the journal page. Provide a short running title whenever asked. Abstract: The abstract reflects the main story of the scientific paper. While reading articles most readers go no beyond the abstracts. Therefore, the abstract should attract the readers to go further. Abstract may be structured or unstructured. Most journals ask for a structured abstracts within given word limit. Structured abstract is divided into: 1. Background: What is known and why is this study needed? 2. Methods: What did you do ? 3. Results: What did you find ? 4. Conclusion: What does it mean ? Write the abstract in past perfect tense, active voice, and with no citations. Provide word count, if asked, and key words for indexing, preferably confirming to medical subject heading (MeSH) vocabulary. MeSH vocabulary is available on . Introduction: A crisp introduction is an essential ingredient of a good paper. A good introduction will ‘‘sell’’ the study to editors, reviewers, readers, and sometimes even the media [11]. It should tell what is known, what is unknown , and also the rationale behind the study. The introduction should start with the background of previous research, and state the aim, the research question, and the study design. Give in the introduction only the strictly pertinent references and do not include the data or conclusions from the work being reported. Methods: The methods tell how the study was conducted and how the conclusions were arrived at. Methods of an original study have four basic elements; study design, setting and subjects, data collection, statistical methods, and ethical approval. Describe the type of study (prospective/ retrospective/ experimental/ observational), the subjects or the study population (human/ animal), the sample size and sample size calculation, recruitment of study population, methods of randomization, blinding, inclusion and exclusion criteria, measurement tools, outcome measures, and statistical analysis. The methods provides the readers insight into correctness or otherwise of design. Also, details of methods allow the readers to replicate the intervention or experiment so that they can try and test for themselves the efficacy of an intervention and the validity of conclusions. While describing new surgery or experiment provide sufficient details. When you followed a standard procedures described elsewhere, provide the relevant references. Results: Results answers the research question without interpretation. Structure the results like the material and methods [12]. Be objective and use past tense. Remove all the superfluous details that does not form the part of study question, outcome measure or a factor affecting it. Start the results with recruitment process, and a description of demographic characteristic of the population. For controlled trials first describe the experimental group followed by the control group. Give both the percentage and the actual numerical values with decimals e.g. 90%(54/60). Wherever applicable present the values with mean, standard deviation (SD) and 95 % confidence interval. Describe the primary and secondary outcome, and also the unexpected findings. Give p-values with 95 % confidence interval to state the beneficial / adverse effects established by a test of statistical significance. Also provide effect sizes e.g. odds ratio or relative risk with 95 % confidence interval. 2

Do not over interpret the results. Over interpretetation of result may weaken the impact of conclusion and result in rejection of your paper. Tables, charts, graphs and figures reduce the text and makes visual impact for easy reading. Number the figures, tables, charts, graphs and the photographs serially. Mention them in the text at appropriate places. Prepare the clinical photographs and diagrams on separate pages in desired format (e.g. JPEG, TIFF, or PNG of desired file size and resolution). Provide as a separate file for the legends for figures, charts, and the clinical photographs. Place the legends after the references. Additional media, like video, in desired file format of given file size, may be submitted for online journals. Discussion: Discussion interprets the results. Keep it concise. Begin the discussion with brief recapitulation of the main findings (the answer to the research question) without repeating the results. Repeating results in the discussion is a common mistake. Refrain from bringing in new findings. Compare your results with the findings of similar studies by other authors and explain the reasons of variation. Emphasise the new findings. Interpret the unexpected. Underline the implications of your findings. Also, describe the strengths and weaknesses of your study. Finally provide a conclusion - the take home message. References: References authenticate the scientific facts and statements. Include only the essential references. Cite most accessible reference, and the primary source rather than reviews. Eliminate archaic and irrelevant references, and references for established facts. Check the references for accuracy. Follow the referencing style suggested by the target journal. Most biomedical journals today follow Vancouver style or APA (American Psychological Association) style. There may be a limit for the number of references for a given type of article. Some journal offer online software for checking accuracy of the listed references. Limited number of references can be arranged manually. Especially designed referencing software is useful for maintaining and managing large volume of references. Annotation of references - sentence case or superscript- also varies. Follow the individual journal’s guidelines. Submission: Revise your paper thoroughly before submission. Read it critically as you would another author’s paper. Ensure you have strictly followed the instruction to authors. Failure to adhere to the instructions may result in summary rejection of your paper. Check and recheck the language and grammar for errors. Create separate files for the cover letter, the abstract, the blinded article file (without author details); figures, charts, tables, and images, legends, and permission from copyright holder for use of published materials, etc. Provide in the cover letter the title, main findings, and their relevance. Ensure correctness of author details (name, surname, degree, etc.), authorship (first author, co-author, guarantor, corresponding author), and their mailing address and the institutional affiliation. Provide all the information desired by the editor including contribution of individual authors. Some journal require details of contributions of each author e.g., conception and design, data collection, statistical analysis, manuscript preparation and revision. Declare the conflict of interest, if any. Online submission shall remain incomplete unless you sequentially upload all the required sections, and the copyright transfer form signed by each author. The copyright transfer form should mention the corresponding author. Preserve the raw data and the final submission for future reference. Reasons for Rejection: Rejection is an unpleasant situation, but common in scientific publishing. Initial rejection occurs at the editorial level. During the peer review, reviewers assess the quality of paper according to 2 main criteria: contribution to the field and the adequacy of research design [13]. Deficiency in the study design was the most commonly cited reason for outright manuscript rejection according to a study that queried the editors and reviewers [14]. A study that studied peer review evaluations of a large number of papers concluded that ‘the main determinant of the


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recommendation for acceptance or rejection of a given manuscript was the relationship between the experimental design, the results, and the conclusion. Inappropriate experimental design was again strongly associated with rejection [15]. Failure to adhere to the ‘instruction to the authors’ is another important reason for rejection. Plagiarism in any form is another reason for summary rejection. Available software readily check the submission for plagiarism. Also articles found unsuitable for the journal on account of their content, language, grammar, and format are summarily rejected. There are excellent works that have identified the’ principles to improve the likelihood of publication of a scientific manuscript’ and the reasons why manuscripts are not accepted for publication’ [6,13,16]. Lack of what improves the likelihood of acceptance, is the cause of rejection. Common reasons for rejection other than those mentioned above include: poor study design, insufficient problem statement, incomplete, inaccurate, or outdated review of literature, suboptimal reporting of results, getting carried away in the discussion, and poor writing [17]. Language poses a problem for researches from non-English-speaking countries. Some publishers provide paid language-services for manuscripts. Peer review, Responding to Reviewers and Resubmission: Peer review is considered the virtue of science communication [18]. Peer review is an essential tool the journals apply to maintain high quality and standard of the articles published in their journals. The process starts after your paper is past the editorial scrutiny. It supplements the authors work in making it more acceptable to the wider readership. Some journals ask suggestions for potential reviewers, and also those reviewers you will wish not to review your paper. Reviewers may accept, reject or suggest minor/ major revisions. Provide point-wise response to the reviewer’s comments and in time resubmit the revised manuscript incorporating the suggestions for change. Highlight the changes in the revised manuscript. Remember, revision gives no guarantee for acceptance. But failure to respond and resubmit closes the door.

Conclusion Writing and publishing is integral to research. Scientific manuscript has a required structure and style; the available literature provides adequate guidelines. Online abstracts and full text references, language services, and referencing software have made preparation of manuscript easier. Read the instructions carefully and adhere to them strictly. A beginner has to travel the learning curve of the writing, peer review, and publishing. Originality of content, valid study design, good manuscript- conforming to language, style, and format- are prerequisite for successful publication. Attention

to details at every stage and perseverance through the arduous process of research, manuscript preparation, peer review and publication is essential for success.

Literature Search A PubMed search of the database (1990 to 2004) was conducted. Following key words were used: writing, publishing, biomedical journals, and peer review. Additional sources included publications cited in other articles. Relevant articles were reviewed and included.


[1] Kotz D, Cals JWL, Tugwell P, Knottneru JA. Introducing a new series on effective writing and publishing of scientific papers. Journal of Clinical Epidemiology. 2013;66:359-60. [2] Knottnerus JA, Tugwell P. Communicating research to the peers. J Clin Epidemiol. 2007;60:645-47. [3] Hengl T, Gould M. Rules of thumb for writing research articles 2002. http://www. accessed 08March 2014. [4] Uniform Requirements for Manuscripts Submitted to Biomedical Journals: Writing and Editing for Biomedical Publication. ; 1-36. [5] Kliewer MA. Writing it up: a step-by-step guide to publication for beginning investigators. AJR. 2005;185:591–96. [6] Berk RN. Preparation of manuscripts for radiology journals: advice to first-time authors. AJR. 1992;158:203-08. [7] Provenzale JM. Ten principles to improve the likelihood of publication of a scientific manuscript. AJR. 2007;188:1179–82. [8] Kotz D, Cals JWL. Writing Tips Series (Effective writing and publishing scientific papers- part I:how to get started). Journal of Clinical Epidemiology. 2013;66:397. [9] Hartley J. Academic writing and Publishing- A practical guide.2008. New York: Routledge. Pp. 23. [10] Kotz D, Cals JWL. Writing Tips Series (Effective writing and publishing scientific papers- part II: title and abstract). Journal of Clinical Epidemiology. 2013;66:585. [11] Kotz D, Cals JWL. Writing Tips Series (Effective writing and publishing scientific papers- part III: how to get started). Journal of Clinical Epidemiology. 2013;66:702. [12] Kotz D, Cals JWL. Writing Tips Series (Effective writing and publishing scientific papers- part V:how to get started). Journal of Clinical Epidemiology. 2013;66:945. [13] Georges B. Reasons reviewers reject and accept manuscripts: The Strengths and Weaknesses in Medical Education Reports, Educating Physicians: Research Reports, Academic Medicine. 2001;76(9):889-96. [14] Byrne DW. Publishing your medical research paper. What they don’t teach in medical school 1998. Baltimore: Lippincott Williams & Wilkins. [15] Turcotte C, Drolet P, Girard M. Study design, originality and overall consistency influence acceptance or rejection of manuscripts submitted to the Journal. Can J Anaesth. 2004;51(6):549–56. [16] Pierson DJ; The top 10 reasons why manuscripts are not accepted for publication. Respiratory Care. 2004;49:1246-52. [17] Celik Y. To Publish or Perish: Strengths, Weaknesses of a Medical Paper (I) International. Archives of Medical Research. 2011;1(1):47-53. [18] The pitfalls and rewards of peer review. Lancet. 2008;371:447.


Professor, Department of Ophthalmology, Mahatma Gandhi Medical College & Research Institute, Pondy-Cuddalore Main Road, Pillaiyarkuppam, Pondicherry, India.

NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR: Dr. Kirti Nath Jha, Mahatma Gandhi Medical College & Research Institute, Pondy-Cuddalore Main Road, Pillaiyarkuppam, Pondicherry-607 402, India. Phone : 9443655640, E-mail : Financial OR OTHER COMPETING INTERESTS: None.

Journal of Clinical and Diagnostic Research. 2014 Sep, Vol-8(9): XG01-XG03

Date of Submission: Nov 14, 2013 Date of Peer Review: Feb 17, 2014 Date of Acceptance: Aug 19, 2014 Date of Publishing: Sep 20, 2014

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Perspect Clin Res. 2010 Jan-Mar; 1(1): 33–37. PMCID: PMC3149406

How to Become a Competent Medical Writer? Dr> Suhasini Sharma Director, Medical Writing & Medical Review, Sciformix Corporation Copyright : © Perspectives in Clinical Research This is an open-access article distributed under the terms of the Creative Commons AttributionNoncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Go to:

Abstract Medical writing involves writing scientific documents of different types which include regulatory and research-related documents, disease or drug-related educational and promotional literature, publication articles like journal manuscripts and abstracts, content for healthcare websites, healthrelated magazines or news articles. The scientific information in these documents needs to be presented to suit the level of understanding of the target audience, namely, patients or general public, physicians or the regulators. Medical writers require an understanding of the medical concepts and terminology, knowledge of relevant guidelines as regards the structure and contents of specific documents, and good writing skills. They also need to be familiar with searching medical literature, understanding and presenting research data, the document review process, and editing and publishing requirements. Many resources are now available for medical writers to get the required training in the science and art of medical writing, and upgrade their knowledge and skills on an ongoing basis. The demand for medical writing is growing steadily in pharmaceutical and healthcare communication market. Medical writers can work independently or be employed as full time professionals. Life sciences graduates can consider medical writing as a valuable career option. Keywords: Medical writing, Regulatory, Publication, Technical guidelines, Skills, Resources New knowledge and information is constantly being added to the field of medicine by way of an ever increasing number of research studies, growing clinical experience, and new ideas and thoughts. All this information needs to be effectively communicated to different audiences, e.g. the physicians and other healthcare professionals, patients and consumers and the drug regulators. Medical writing is the discipline of writing scientific documents by writers in the field of medicine – the “medical writers”. Medical writers may not be the original scientists who did the actual research, but work with the physicians/scientists involved in the generation of data, and help present the information in an appropriate manner. The importance of good medical writing cannot be ignored as science depends on clear and accurate reporting – an otherwise meticulous research can appear flawed if it is poorly presented. The medical writer needs to have a clear understanding of the medical concepts and ideas, and be able to present the data and its interpretation in the way the target audience will understand. Medical writers combine their knowledge of science and their research understanding to present information at the right level for the target audience. Moreover, the writing needs to meet the specific requirements for different types of documents. Medical writing has become established as


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an important function in the pharmaceutical industry, because it requires specialized knowledge and skills to be able to write scientific documents which are well- structured, and presented in a clear and lucid manner. The demand for medical writing has gone up considerably in the last few years. The reasons are many – more research studies are being conducted today in the biomedical field; pharmaceutical companies are developing more new drugs and medical devices, and various scientific documents need to be generated for submission to regulatory authorities during their approval process; the number of biomedical journals has gone up considerably and many more scientific articles are now published than before; similarly, with the addition of a new and a powerful medium like the ‘internet’ a lot of medical information is generated as ‘web content’ for medical professionals as well as for the general public. According to the CenterWatch analysis the medical writing market has doubled in size in the last five years, increasing from an estimated $345 million in 2003 to $694 million in 2008. Moreover, according to a separate survey, medical writing is also the fourth most frequently outsourced service.1 As pharmaceutical companies outsource more and more work to Asia, Indian graduates can look at medical writing as a valuable career option, and develop knowledge and skills required to take this up as a full-time profession. Go to:

Types of Medical Writing Medical writing involves writing different types of documents for different purposes, and for different audiences. Following are examples of different kinds of medical writing:

Medical Journalism • Newspaper & magazine articles. These are mostly for general public and lay people and need to be written in simple, non-technical language.

Medical Education • For Physicians – textbooks, Continued Medical Education (CME) programs, slide decks, e-learning modules • For Patients – patient education material

Medical marketing of healthcare products • Promotional literature targeted at healthcare professionals, product monographs, brochures, handouts • Sales force training manuals, e-learning modules • Internet content for physicians and patients (consumers)

Publication/Presentation • Journal articles / manuscripts (research articles, case reports, review articles) • Abstracts • Posters & presentations for scientific meetings and conferences


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Research Documents • • • • •

Clinical trial protocols Investigators′ Brochure Informed Consent Documents Study reports Research proposals

Regulatory Documents • • • •

Package Inserts (prescribing information) & Patient Information Leaflets Clinical study reports, web synopses Subject narratives Regulatory submission documents – Common Technical Document (CTD) modules such as nonclinical and clinical overviews & summaries, expert reports, safety & efficacy summaries; Aggregate safety reports such as Periodic Safety Update Reports ( PSURs), bridging reports, Periodic Adverse Drug Experience Reports (PADER), Annual safety reports (ASR)s; policy papers etc.

Each of the above types of medical writing is meant for a distinct set of audience, e.g. medical professionals, patients & general public, medical sales representatives or drug regulators. Hence, the language used and the level of technical information has to be appropriate to the level of understanding of the respective audience. For example, while documents meant for medical professionals and regulators can be highly technical and can include scientific data and its explanation, those meant for patients and general public need to simple and free of technical jargon. In addition, documents for regulatory submission are required to fulfill set formats and structures, and their contents are guided by regulatory rules and guidelines. Hence, a medical writer involved in the preparation of these documents needs to be conversant with the regulations and prescribed formats for such type of documents. It is possible, therefore, that the knowledge and skills required for writing different types of medical documents are different, and one may decide to specialize in a specific type of medical writing, depending on one's aptitude and liking. Go to:

Who requires medical writers? Medial writers mostly work with the pharmaceutical industry. However, there are many other setting in which medical writers are required: • Pharmaceutical / healthcare product companies including medical device companies • Contract Research Organizations (CROs) & Business/Knowledge Process Outsourcing companies (BPOs/ KPOs) • Scientific content and healthcare communication companies (Functional Service Providers) • Media & Publishing companies and Medical Journals Academic medical institutions, Medical/scientific societies • Healthcare Websites The scope for medical writers is therefore tremendous and growing. This is also a profession which one can practice either independently as a freelancer, or as an employee in an organization,


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depending on one's experience, level of expertise and liking. So, learning medical writing can be the beginning of a life-long profession. Go to:

Requirements for becoming a Medical Writer The basic pre-requisite for becoming a medical writer is of course, familiarity with medical concepts and terminology. An academic qualification in one of the life sciences such as medicine, or paramedical sciences such as pharmacy, microbiology, nutrition and dietetics, biochemistry, biotechnology can provide the right background which makes the writer familiar with scientific concepts and research data. Another important pre-requisite is the ability to write. As the basic requirement on the part of a medical writer is to communicate scientific information to the target audience, some degree of command over the language, reflected by an ability to write grammatically correct text, and an ability to express and present information clearly and succinctly is most important. In addition to the above basic requirements, one needs domain knowledge & language skills.

Domain knowledge • Medical & therapeutic area knowledge – since the medical writer communicates scientific information related to the medical field, it is needless to say that he/she understands medical terminology and concepts. Writing technical documents related to specific therapeutic area e.g. cardiology or neurology, can be greatly facilitated by knowledge in that filed. However, since medical writers seldom work in a single therapeutic area, it may not be possible for one to have a prior thorough knowledge of each therapy area. It would be a good strategy to have basic knowledge of different medical specialties, and build upon that as one goes on writing documents in different therapy areas. • Drug development process , pharmacology, drug safety – medical writers involved in the preparation of clinical research and regulatory documents such as trial protocols, investigator brochures, clinical study reports of different phases (I-IV) of clinical trials, efficacy and safety summaries require a thorough understanding of the drug development process, the clinical research and various guidelines related to these. Those writing reports of early clinical development also require a good grounding in pharmacology and an understanding of pharmacokinetic concepts. Similarly, medical writers writing safety reports need to understand the drug safety process and requirements of safety reporting prescribed by different regulatory authorities. • Statistics – Medical writers come across statistics when they write about clinical trials and when they write about research studies. The statistical results of clinical research must be communicated in a manner that allows clinicians to assess critically the quality and reliability of both the study design and any conclusions that might affect clinical practice. Every medical writer has to deal with confidence intervals, regression analyses, randomization schemes, P values, and t-tests. An understanding of statistics is necessary for good medical writing. One of the ways of developing this is attending workshops on medical statistics conducted by professional statisticians. • Technical guidelines – EU, USA and Japan have evolved a set of common guidelines (International Conference on Harmonisation [ICH] guidelines) related to drug development and registration. In addition, the national regulatory authorities have their own specific requirements. Numerous guidelines are available on how to write clinical study reports


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(ICH E3), investigator′s brochures, patient information leaflets, clinical overviews, periodic safety reports (ICH E2C) and other documents required for regulatory submission. These instructions require thorough reading. Information about these technical requirements is usually available on the ICH website or websites of the Regulatory Authorities. Knowledge of these guidelines is a “must” for a regulatory medical writer. Moreover, new guidelines emerge, old ones are revised, and a medical writer has to keep up to date. Publication guidelines like Good Publication Practices, guidelines for reporting clinical trials (e.g. CONSORT), the International Committee of Medical Journal Editors' (ICMJE) guidelines for manuscripts are available. In addition, all medical journals have their own instructions for authors.

General Knowledge and Skills • Language & grammar – a medical writer has to communicate scientific information. In addition to understanding the scientific aspects, the writer needs to present the information in a clear manner and at a level of understanding appropriate to the target audience. Use of grammatically correct language, simple and short sentences, active voice, appropriate punctuation marks, and a logical flow of ideas can go a long way in making the information understandable to the readers. Avoiding the use of highly complex technical jargon also makes the writing more lucid, especially for nonmedical audiences. • Literature / reference searching – huge amount of scientific information is now available in the public domain. In addition to the books and medical journals, databases like Medline, PubMed, EMBASE, Micromedex are commonly used for sourcing medical information. Searching through all medical databases and healthcare websites for information relevant to your purpose is like searching for a proverbial needle in the haystack. Keeping in mind what exactly you are looking for, knowing where to search and selecting only the authentic sources, planning your search strategy, use of correct keywords for searching and then carrying out the search as per the set plan is more likely to bring up useful information. Reviewing your search results to consider if the information is relevant, and systematically classifying and filing useful information for later retrieval is equally important. • Interpretation and presentation of research data – writing scientific documents involves review and interpretation of research data, presentation of those data in text, tables, and graphs, and developing logical discussion and conclusions as to what the data means. Medical writers must have sufficient knowledge of the research topic, and should be able to understand the research design and data so as to interpret and present it to their readers. Presenting data in the form of tables and graphs is a skill which needs conscious efforts to develop. • Ethical & legal issues – issues of concern to medical writers are – giving truthful and complete information including negative findings, following copyright laws, not indulging in plagiarism, following authorship criteria for research manuscripts, and respecting journal review process. So, what makes a good medical writer? The following qualities distinguish a good medical writer from a mediocre one: • • • • • • • •

Ability to understand the purpose and requirements of the project Ability to write at a level appropriate to the target audience Thorough research of the subject Ability to think, logical organization of thoughts and ideas Scientific accuracy Attention to details Ability to work across teams (often remotely) as well as independently Good communication & coordination with various people involved in the process


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• Good time management, and meeting deadlines and commitments Go to:

Steps in writing scientific documents • Understanding the project brief – Before starting to write, it is necessary for the medical writer to understand the purpose of the document being written and what the sponsor wants to achieve through it. In addition, it is necessary to know the timelines to follow, data that would be required to be studied and the review/approval process to be followed. • Literature search & review of information – adequate planning and time spent on literature search and review can yield valuable information which a medical writer can use appropriately to support the document being written. A correct search strategy and classifying retrieved information in usable chunks is very important. • Authoring & compiling the document – drafting the first version of the document usually takes up most time. Familiarity with the type of document, its purpose and contents is necessary to build the draft. Use of a pre-defined template makes the work easier. Apart from the scientific part of the content, having adequate language skills and following the inhouse or client style-guide at this juncture is useful to reduce subsequent review and revision time. In addition to the main text, the document may contain a number of appendices. These are usually supplied by the sponsor. However, it is the responsibility of the medical writer to ensure that correct and current appendices have been compiled in the final version of the document. • The review process – the review process for scientific documents involves review of contents and editorial/ formatting review. The former is usually undertaken by a senior medical writer with more experience, and a subject matter expert who may be a clinician or therapy area expert. Quality check (QC) of contents involving cross-checking all verifiable information with the source data is also required. This is usually done by a peer medical writer. However, every medical writer must do a thorough ‘self review’ of the first draft of the document before it goes for further review. • Formatting & editing – formatting (checking text font and size consistency, line and paragraph spacing, headers and footers, margins, page numbers etc) and editing (language e.g. US or British English, spellings, punctuation marks, correct use of tense, appropriate reference style etc ) of documents is a skill which needs to be learned by every writer to make their document more presentable and acceptable. Documents that are required for publication or electronic publishing need to be rigorously copy-edited, proof-read, and checked for formatting requirements. • Approval and sign off – all scientific documents need approval and a sign-off from the designated approver, usually an expert. The approver may be in-house or external and adequate time must be allowed for the approver to review and sign-off the document. • Electronic publishing – electronic publishing involves making the material available in digital format for on-line access. A number of software tools are now available for e-publishing, and a modern day medical writer may need to have some familiarity with their use. Go to:

Training and Professional Resources for Medical Writers There is no formal degree / diploma or certification course in medical writing. Training in this discipline usually involves


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• In-house training – organizations that employ medical writers generally provide the necessary general and project-specific training to new recruits. This may involve training in drug development process, exposure to drug safety and medical statistics, different kinds of regulatory documents and their requirements, and in-house templates, work processes and style guides. • Short courses / workshops by professional bodies – one or two day training courses or workshops may be organized by professional bodies on specific topics e.g. CSRs, protocol writing or statistics etc. • On-the job ‘mentor-guided’ training – this is usually given by a senior medical writer more experienced in writing different kinds of documents. Training is more focused on specific type of documents the organization is handling. • Motivated “self-study” – this is the mainstay of a medical writer's training. A writer who is self-motivated and curious can do a lot in training himself/herself on different types of medical writing. Go to:

Conclusions Medical writing is both a science and an art. It requires an understanding in medical science and an aptitude for writing. In addition, a thorough knowledge of specific requirements for different types of medical documents, and keeping up to date with the relevant guidelines is a must. The demand for medical writing is growing steadily over the years. The pharmaceutical and healthcare industry offers number of job opportunities for medical writers. Graduates and post-graduates in life sciences who have the right skills and aptitude can consider taking up medical writing as a full-time profession. Go to:

References 1. Korieth K. The CenterWatch Monthly. The CenterWatch Monthly. 2008 Dec;15(12):8–13. Articles from Perspectives in Clinical Research are provided here courtesy of Medknow Publications


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Epidemiology and Health REVIEW

Open Access

Disadvantages of publishing biomedical research articles in English for non-native speakers of English Mohsen Rezaeian Social Medicine Department, Occupational Environmental Research Center, Rafsanjan Medical School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran

OBJECTIVES: English has become the most frequently used language for scientific communication in the biomedical field. Therefore, scholars from all over the world try to publish their findings in English. This trend has a number of advantages, along with several disadvantages. METHODS: In the current article, the most important disadvantages of publishing biomedical research articles in English for non-native speakers of English are reviewed. RESULTS: The most important disadvantages of publishing biomedical research articles in English for non-native speakers may include: Overlooking, either unintentionally or even deliberately, the most important local health problems; failure to carry out groundbreaking research due to limited medical research budgets; violating generally accepted codes of publication ethics and committing research misconduct and publications in open-access scam/predatory journals rather than prestigious journals. CONCLUSIONS: The above mentioned disadvantages could eventually result in academic establishments becoming irresponsible or, even worse, corrupt. In order to avoid this, scientists, scientific organizations, academic institutions, and scientific associations all over the world should design and implement a wider range of collaborative and comprehensive plans. KEY WORDS: Biomedical research, Medical writing, English language, Disadvantages


example, publishing in English not only helps to communicate scientific findings more easily, but also it makes scientific findings more widely accessible and therefore more likely to be cited. Furthermore, English is a living language, meaning that it contains prefixes, suffixes, and other word-building elements that enable the logical construction of new words. These factors explain why scholars in most developed and developing countries where the mother tongue is not English have a tendency to publish their findings in English [3,4]. Moreover, universities in such countries encourage this tendency by preferentially promoting faculty members who have publication records in prestigious English-language journals. This trend unfortunately also has many disadvantages, which need to be dealt with very carefully and delicately by scientific communities all over the world. Otherwise, the disadvantages of this trend might eventually outweigh its advantages, resulting in the academic establishment becoming irresponsible or, even worse, corrupt, especially in developing countries where the mo­ ther tongue is not English. Therefore, in this piece, I will focus

English has become the most frequently used language for scientific communication in the biomedical field. Evidence suggests that a constantly increasing trend for English to predominate in biomedical publications may have begun in approximately 1900 [1], and this trend has a number of advantages [2]. For Correspondence: Mohsen Rezaeian Social Medicine Department, Occupational Environmental Research Center, Rafsanjan Medical School, Rafsanjan University of Medical Sciences, Rafsanjan 7717735959, Iran Tel: +98-3915234003, Fax: +98-3915225209 E-mail: Received: Apr 20, 2015, Accepted: May 1, 2015, Published: May 1, 2015 This article is available from: 2015, Korean Society of Epidemiology This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.



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Epidemiology and Health 2015;37:e2015021

on the most important disadvantages of this trend, especially in medical research, and provide some suggestions of how to avoid or mitigate those disadvantages.

issues that are relevant for publication in prestigious international journals. Therefore, they have a low rate of publication within prestigious medical journals [13]. The third most important disadvantage is that academic English writing is very difficult for many non-English-speaking scholars [14]. The most important reason for this is that one cannot directly translate from another language into English. Certain accepted terms exist for a range of concepts and the incorrect use of such terms can alter the meaning, many rules have extensive exceptions that can only be learned through rote memorization, several difficulties exist in tense usage, and various words have different meanings depending on the context. It has been established that research funding and English proficiency are strongly related to publication in the top-ranked general me­ dical journals [15]. Furthermore, a number of non-English-speaking scholars, especially from developing countries, are also unfamiliar with some critical issues in publication ethics. The most important reasons for this are that publication ethics is not usually taught in universities and that few or no governing bodies are in place [16]. Therefore, some non-English-speaking scholars might innocently or deliberately violate generally accepted codes of publication ethics and commit research misconduct, such as failing to disclose all conflicts of interest, committing plagiarism, or, even worse, engaging in salami publication, publishing duplicate publications, or engaging in data fabrication or falsification [17]. These dynamics might result in the academic establishment in these countries becoming corrupt. A study investigating the retraction of publications in MEDLINE from 1966 to 2008 for plagiarism demonstrated that the retraction rate was higher among first authors affiliated with lower-income non-English-speaking countries [18].

DISADVANTAGES One of the most important disadvantages of this trend is that scholars in developing countries where English is not the mother tongue might overlook, either unintentionally or even deliberately, the most important local health problems. Such problems might be overlooked either because they are not suitable for publication in prestigious international English-language journals or because the authors fail to convince the editors and/or reviewers of these journals of the importance of such issues. As a result, in countries with a higher burden of some important but neglected local issues such as poverty, malnutrition, and infectious diseases [5-7], or other issues that negatively impact public health, such as natural or man-made disasters [8-11], fewer research projects are carried out in response to these problems. This dynamic might result in the academic establishment in these countries becoming irresponsible. A previous study has shown that, despite an increasing quantity of publications on health policy and systems research in low-income countries, only 4% of these publications had a first author from the countries in question. Moreover, the capacity for conducting local research has not sufficiently increased in low-income countries [12]. The second most important disadvantage is likewise related to limited budgetary support for medical research. Due to budget shortages, scholars in developing non-English-speaking countries are not able to carry out groundbreaking research, even on

Table 1. Summary table of problems and suggestions associated with the current system of English-language academic publication Problems


Limited medical research budgets

Allocating adequate budgetary resources for medical research and carrying out collaborative research Overlooking the most important local health problems Allocating adequate health research budgets and carrying out collaborative research Low record of publicationin prestigious medical journals Allocating adequate budgetary resources for medical research, carrying out collaborative research, and selecting more scholars from developing countries to serve as the editors and associate editors of prestigious health journals Unfamiliarity with academic English writing Implementing English-language writing courses, using self-employed science editors, and providing affordable English-language editing services Unfamiliarity with some critical issues in publication ethics Urging scholars to use relevant publication guidelines, implementing appropriate research methodologies courses, and carrying out collaborative research Publications in open-access scam/predatory journals Detecting and publicizing open-access scam/predatory journals, and waiving publication charges in prestigious open-access journals Lack of academic publishing platforms, lack of up-to-date skills and Investment in biomedical research infrastructure, allocating adequate budgetary techniques, lack of comprehensive public health databases, inade- resources for medical research, carrying out collaborative research, and implequate information-seeking behavior, inadequate capacity for teamwork menting appropriate research methodologies courses



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Rezaeian M: Disadvantages of publishing biomedical research articles in English

There are a number of other fundamental problems which, taken together, create a constellation of disadvantages in the current system of academic publishing. Problematic dynamics that exacerbate this situation include the lack of academic publishing platforms, the lack of up-to-date skills and techniques, the lack of comprehensive public health databases, inadequate information-seeking behavior, an inadequate capacity for teamwork, and other similar problems (Table 1).

organizations could potentially shift some of their research funding towards this important endeavor [26]. Similarly, a parallel policy should be adopted by the prestigious open-access medical journals. Moreover, they should discount or even waive their publication charges for well-research­ ed manuscripts. Although such policies have been already put in place by some journals,which waive publication charges for authors in genuine financial hardship [27], such policies are not universal. It is absolutely necessary to remember that most of the research which is carried out in non-English-speaking countries might receive dramatically less funding. For example, more than half of my research proposals have received less than US$1,000 of funding. Therefore, it is simply impossible for scholars from these countries to pay up to US$580 [28] for English-language editing and/or up to US$2,900 [29] for publication charges. In addition, scientists, scientific organizations, academic institutions, and scientific associations from all over the world, such as the World Association of Medical Editors, should also develop and implement a collaborative plan to detect open-access scam/predatory journals in the biomedical domain and publicize them, especially for non-English-speaking scholars [30]. Last but not least, some other practical suggestions would include conducting English-language writing courses for biomedical scholars all over the world, urging them to consult books and articles on English academic writing [31], and asking them to make use of self-employed science editors. Biomedical research organizations and universities, especially in non-Englishspeaking developing countries, could also employ experienced English editors [32]. The implementation of the above suggestions, along with investments in biomedical research infrastructure [33,34] and developing appropriate courses in research methodologies, may help overcome other problems that have been mentioned, such as the lack of academic publishing platforms, the lack of up-todate skills and techniques, the lack of comprehensive public health databases, inadequate information-seeking behavior, an inadequate capacity for teamwork, the inadequate appreciation of diverse types of research misconduct, and other problematic dynamics (Table 1).

SUGGESTIONS In my opinion, scientists, scientific organizations and associations, and academic institutions all over the world should think carefully about these disadvantages and try to overcome them through collaborative and comprehensive planning. For example, carrying out collaborative research between English-speaking scholars from developed countries and non-English-speaking scholars from developing countries is a well-established course of action. Although successful examples of such collaboration exist throughout the world [19-22], the current extent of such collaboration is not sufficient. We should also think of other practical plans. For example, shifting more of the health research budgets of international organizations, such as the World Health Organization or non-governmental organizations, towards relevant health problems within developing countries could be considered. One of the prerequisites for allocating such budgetary funds should be that the work must be carried out collaboratively among Englishspeaking scholars from developed countries and non-Englishspeaking scholars from developing countries. Alternatively, international and non-governmental organizations could request non-English-speaking scholars to follow standard publication guidelines throughout the entire course of their research [23]. Moreover, prestigious international English language medical journals should implement a plan to select more editors or associate editors from developing countries in order to reflect their responsibility towards the health of all the people of the world [24]. In a sense, we are all living in a global village. Therefore, such journals should also consider including a section focusing on the publication, either in print or online, of well-conducted research that highlights relevant local and national health problems in the developing world. Prestigious international English-language medical journals, especially those published by eminent publishers, should also adopt a new peer review policy in which it is not possible to reject a manuscript only because of weaknesses in academic English [25]. Instead, they should provide affordable English-language editing opportunities for worthwhile manuscripts that are submitted by non-English-speaking scholars. International

CONCLUSION Despite the advantages associated with non-English-speaking scholars publishing scientific findings in English, we should be aware of its disadvantages as well. These disadvantages could eventually result in academic establishments becoming irresponsible or, even worse, corrupt, especially in developing countries where the mother tongue is not English. In order to avoid this,



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Epidemiology and Health 2015;37:e2015021 demiology, and public health. BMC Public Health 2006;6:301. 14. Vasconcelos SM, Sorenson MM, Leta J. Scientist-friendly policies for non-native English-speaking authors: timely and welcome. Braz J Med Biol Res 2007;40:743-747. 15. Man JP, Weinkauf JG, Tsang M, Sin DD. Why do some countries publish more than others? An international comparison of research funding, English proficiency and publication output in highly ranked general medical journals. Eur J Epidemiol 2004;19:811-817. 16. Ana J, Koehlmoos T, Smith R, Yan LL. Research misconduct in lowand middle-income countries. PLoS Med 2013;10:e1001315. 17. Rezaeian M. A review on the diverse types of research misconduct. World Fam Med J 2014;12:43-44. 18. Stretton S, Bramich NJ, Keys JR, Monk JA, Ely JA, Haley C, et al. Publication misconduct and plagiarism retractions: a systematic, retrospective study. Curr Med Res Opin 2012;28:1575-1583. 19. Nchinda TC. Research capacity strengthening in the South. Soc Sci Med 2002;54:1699-1711. 20. Chandiwana S, Ornbjerg N. ChaReview of North-South and SouthSouth cooperation and conditions necessary to sustain research capability in developing countries. J Health Popul Nutr 2003;21:288-297. 21. Lansang MA, Dennis R. Building capacity in health research in the developing world. Bull World Health Organ 2004;82:764-770. 22. Macfarlane SB, Evans TG, Muli-Musiime FM, Prawl OL, So AD. Global health research and INCLEN. International Clinical Epidemiology Network. Lancet 1999;353:503. 23. Rezaeian M. The application of publication guidelines should extend to cover their designing stage and protocol writing. Ann Epidemiol 2013;23:815. 24. Keiser J, Utzinger J, Tanner M, Singer BH. Representation of authors and editors from countries with different human development indexes in the leading literature on tropical medicine: survey of current evidence. BMJ 2004;328:1229-1232. 25. Rohra DK. Representation of less-developed countries in Pharmacology journals: an online survey of corresponding authors. BMC Med Res Methodol 2011;11:60. 26. Paton C, Househ M, Malik M. The challenges of publishing on health informatics in developing countries. Appl Clin Inform 2013;4:428433. 27. Mrak RE, Griffin WS. Funding free and universal access to Journal of Neuroinflammation. J Neuroinflammation 2004;1:19. 28. Editage by CACTUS. Pricing for editing services [cited 2015 Feb 27]. Available from: 29. PLOS. Publication fees [cited 2015 Feb 27]. Available from: http:// 30. Butler D. Investigating journals: the dark side of publishing. Nature 2013;495:433-435. 31. Tychinin DN, Kamnev AA. Beyond style guides: suggestions for better scientific English. Acta Histochem 2005;107:157-160. 32. Ludbrook J. Writing intelligible English prose for biomedical journals. Clin Exp Pharmacol Physiol 2007;34:508-514. 33. Peprah E, Wonkam A. Biomedical research, a tool to address the health issues that affect African populations. Global Health 2013;9:50. 34. Maher D, Sekajugo J, Harries AD, Grosskurth H. Research needs for an improved primary care response to chronic non-communicable diseases in Africa. Trop Med Int Health 2010;15:176-181.

scientists, scientific organizations, academic institutions, and scientific associations all over the world should design and implement a wider range of collaborative and comprehensive plans.

ACKNOWLEDGEMENTS I would like to thank Lesley Pocock and two anonymous reviewers for their valuable comments on an earlier draft of this article.

CONFLICT OF INTEREST The author has no conflicts of interest to declare for this study.

REFERENCES 1. Monge-Nåjera J, Nielsen V. The countries and languages that dominate biological research at the beginning of the 21st century. Rev Biol Trop 2005;53:283-294. 2. Meneghini R, Packer AL. Is there science beyond English? Initiatives to increase the quality and visibility of non-English publications might help to break down language barriers in scientific communication. EMBO Rep 2007;8:112-116. 3. Waheed AA. Scientists turn to journals in English. ScientificWorldJournal 2001;1:239-240. 4. Butler D. French scientists turn to journals in English. Nature 2000; 405:500. 5. Satyanarayana K, Srivastava S. Poverty, health & intellectual property rights with special reference to India. Indian J Med Res 2007;126: 390-406. 6. Blakely T, Hales S, Kieft C, Wilson N, Woodward A. The global distribution of risk factors by poverty level. Bull World Health Organ 2005;83:118-126. 7. Atinmo T, Mirmiran P, Oyewole OE, Belahsen R, Serra-Majem L. Breaking the poverty/malnutrition cycle in Africa and the Middle East. Nutr Rev 2009;67 Suppl 1:S40-S46. 8. McMahon MM. Disasters and poverty. Disaster Manag Response 2007;5:95-97. 9. Kim N. How much more exposed are the poor to natural disasters? Global and regional measurement. Disasters 2012;36:195-211. 10. Rezaeian M. Wars versus SARS: are epidemiological studies biased? Eur J Epidemiol 2014;29:453-454. 11. Rezaeian M. War epidemiology: an urgent plea. Epidemiology 2015; 26:e10-e11. 12. Adam T, Ahmad S, Bigdeli M, Ghaffar A, Røttingen JA. Trends in health policy and systems research over the past decade: still too little capacity in low-income countries. PLoS One 2011;6:e27263. 13. Soteriades ES, Falagas ME. A bibliometric analysis in the fields of preventive medicine, occupational and environmental medicine, epi-






Issued Date



Academic publishing and the myth of linguistic injustice

Hyland, KL

Journal of Second Language Writing, 2016, v. 31, p. 58-69

2016 Š <2016>. This manuscript version is made available under the CC-BY-NC-ND 4.0 license


Elsevier Editorial System(tm) for Journal of Second Language Writing Manuscript Draft Manuscript Number: 3016R2 Title: Academic publishing and the myth of linguistic injustice Article Type: Full length article Keywords: academic publishing; linguistic injustice; peer review; EAL writers Corresponding Author: Prof. Ken Hyland, Corresponding Author's Institution: University of Hong Kong First Author: Ken Hyland Order of Authors: Ken Hyland Abstract: Academic publication now dominates the lives of academics across the globe who must increasingly submit their research for publication in high profile English language journals to move up the career ladder. The dominance of English in academic publishing, however, has raised questions of communicative inequality and the possible 'linguistic injustice' against an author's mother tongue. Native English speakers are thought to have an advantage as they acquire the language naturalistically while second language users must invest more time, effort and money into formally learning it and may experience greater difficulties when writing in English. Attitude surveys reveal that English as an Additional Language authors often believe that editors and referees are prejudiced against them for any non-standard language. In this paper I critically review the evidence for linguistic injustice through a survey of the literature and interviews with scholars working in Hong Kong. I argue that framing publication problems as a crude native vs non-native polarisation not only draws on an outmoded respect for 'native speaker' competence but serves to demoralizes EAL writers and marginalize the difficulties experienced by novice L1 English academics. The paper, then, is a call for a more inclusive and balanced view of academic publishing.


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Academic publishing and the myth of linguistic injustice

Ken Hyland University of Hong Kong

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Academic publishing and the myth of linguistic injustice

Academic publication is now an enormous industry which dominates the professional lives of academics across the globe, with perhaps six million scholars in 17,000 universities producing over 1.5 million peer reviewed articles each year (Bjork et al, 2009). The reach and significance of this industry has never been greater because it is through publication that knowledge is constructed, academics are evaluated, universities are funded, and careers are built, and each year its influence becomes ever more intrusive and demanding. Publication is where individual reputations and institutional funding coincide; the result of managerialism and an accountability culture which seeks to measure ‘productivity’ in terms of papers, and citations to those papers. In this context ‘knowledge’ is regarded as a thing which can be parcelled up and measured and those that produce it are seen as deserving of rewards. The more knowledge produced, the greater the reward.

Scholars around the world have therefore found their promotion and career opportunities increasingly tied to an ability to gain acceptance for their work in high profile journals indexed in the Web of Knowledge SCI databases and usually published in English. This counting of output, for example, helps explain the 4-fold increase in submissions to the 4,200 journals using the ScholarOne manuscript processing system between 2005 and 2010 and why this increase is led by academics from countries which have not traditionally been strong in research. So while submissions from traditional publishing powerhouses such as the US and Japan increased by 177% and 127% respectively during these 5 years, those from China and India increased by 484% and 443%, and Iran and Malaysia saw more than 800% increases in submissions (Thomson Reuters, 2012). Overall, the US share of world submissions dropped by 3.3% over this period while China`s increased by 5.5%, moving it from 14th to 5th in world output in just 10 years (Royal Society, 2011). More recent figures from SCImago (2014) show China just behind the

US in submissions.



Submissions, however, are not accepted articles and the dominance of English in academic publishing has raised questions of communicative inequality and the possible ‘linguistic injustice’ against an author’s mother tongue (Clavero, 2010). Native English speakers are thought to have an advantage as they acquire the language naturalistically while second language users must invest more time, effort and money into formally learning it and may experience greater difficulties when writing in English. Attitude surveys reveal that English as an Additional Language (EAL) authors often believe that editors and referees are prejudiced against them for any non-standard language uses while Flowerdew (2008) even claims that EAL writers are “stigmatized” by journal editors and reviewers – the “normal.” In this paper I critically examine the evidence for linguistic injustice – or editorial prejudice - through a survey of the literature and a small study of EAL contributions to leading journals. To support my argument I draw on interviews conducted with 25 EAL scholars of various first language backgrounds, disciplines and publishing experience together with a handful of Native English speaking scholars1. I argue that framing publication problems as a crude Native vs -non-Native polarisation functions to demoralize EAL writers and ignores the very real writing problems experienced by many L1 English scholars.

Global publishing and disadvantage On the face of it, the expansion of international publishing to all corners of the planet is a positive development, both for academics and for developing nations seeking to become part of the “knowledge economy.” Globalization offers greater opportunities for increased scholarly dialogue by broadening the corpus of academic literature, providing new avenues for research and collaboration, and opening more channels for reporting location-specific research. The greater participation of multilingual researchers in this web also offers massive benefits to global knowledge itself. As Liu (2004: 2) observes, EAL researchers “help reform, expand, and enrich the knowledge base of core disciplinary communities” and 1

All participants work in a leading research-intensive university in Hong Kong and were interviewed using an open-ended schedule of questions which focused on their educational background, writing challenges, publishing experiences and collaborative writing. 2


Canagarajah (1996) concurs that these scholars are able to bring outside perspectives to offer fresh insights on old problems. Perez-Llantada (2014: 192) also sees discoursal changes as “Anglophone norms merge with culture-specific linguistic features”. Thus the participation of this broader base of researchers in academic publication enriches knowledge, raises previously unexplored issues in the mainstream, enhances rhetorical practices, and draws attention to untapped resources (also Flowerdew, 2001).

Despite the surge in submissions from BRIC (Brazil, Russia, India and China – the ‘emerging economies’) and other non-established nations, however, the “Western” nations (and Japan), continue to dominate the world output of scientific papers. The United States remains the biggest spender on research and produces the most research papers, accounting for 29% of the total number of published papers, followed by Japan with 8% and the United Kingdom, Germany, and China with 6% each (World Bank, 2012). This means that these five countries are responsible for 55% of the world’s journal articles, while 23 countries accounted for 90% (Ware & Mabe, 2009). Thus, while acceptances in Institute for Scientific Information (ISI) ranked journals2 for the major players remained fairly stable at around 50% of submissions between 2005 and 2010, the massive increases in submissions by China and Iran yielded no appreciable increase in accepted papers while India, Taiwan, Korea and Brazil all saw acceptances fall by at least 4% (Thomson Reuters, 2012). So although increased financial investment has stimulated the participation of EAL researchers in global publishing, this has not had an equal impact on published output or on the influence of their papers as measured by citations to them.

The fact that publication rates have lagged behind increases in submissions does not necessarily mean that the quality of these submissions has not increased, merely the intensity of competition. Numerous 2

The ISI is a unified citation index to the academic literature representing the most prestigious journals. Part of the Thomson Reuters ‘Web of Knowledge’, the ISI includes databases for the sciences, social sciences and humanities and includes Annual Journal Citation Reports (JCR) which give an Impact Factor (IF) for each journal in its indexes.



obstacles prevent submitted manuscripts becoming published papers and participation in academic publishing clearly makes sophisticated demands on writers. But while all newcomers feel challenged and intimidated by writing for publication, attention has largely focused on the difficulties of non-Anglophone authors. Anecdotal evidence suggests that Native speakers of English are unfairly advantaged in scientific publication by virtue of their Native - non-Native speaker status (e.g., Clavero, 2010; Guardiano et al. 2007) as it is easier for them to access the literature in English and to craft texts linguistically acceptable to the gatekeepers of international journals.

This view receives some support from several quantitative studies which have found that submissions to medical journals from countries with low English proficiency scores, low Gross Domestic Product, or little research funding are less likely to be accepted for publication irrespective of their scientific quality (e.g. Man et al, 2004). Saposnik et al (2014), for example, analyzed all 15,000 contributions submitted to the journal Stroke between 2004 and 2011 and found that acceptance rates were higher for submissions from countries where English was the Native language. Similarly Okike et al (2008) and Ross et al (2006) found a preference for articles from authors in the US and Canada, a preference which was reduced by 34% with a blinded review process (Ross et al, 2006). It is important to point out that the effects of English proficiency on the clarity or organisation of submitted texts was not examined directly in these studies, but assumed on the basis of where the corresponding authors resided. In fact, Saposnik et al speculate on the reasons for lower acceptance rates from these countries: It is possible that some reviewers are more critical of the quality of research or give lower priority scores to borderline articles written by non-English speakers. Contrarily, regional constraints (eg, low investment in research, suboptimal research training, limited education in how to write scientific articles, etc.) may also explain the parallel lower submissions and acceptance rates for nonâ&#x20AC;&#x201C;English-speaking countries and for those with low expenditures in research. Other financial incentives (eg, scientists receiving bonuses per performance and submitting higher number of lower quality publications) may also play a role.

(Saposnik et al, 2014: 1866)



This catalogue of possibilities reflects a wider uncertainty about the role of language in the acceptance or rejection of papers for submission.

EAL writer perceptions It is certainly the case that many EAL authors report a sense of inequality compared with NES scholars when writing in English. Surveys of Polish (Duszak & Lewkowicz, 2008), Slovakian (Kurilova, 1998), Mexican (Hanauer & Englander, 2011), Spanish (Ferguson et al, 2011) and southern/eastern European (Lillis & Curry, 2010) researchers reveal that many EAL authors feel some sense of disadvantage relative to Anglophone scholars. Almost 80% of the Mainland Chinese doctoral researchers in Li’s (2002) study felt disadvantaged compared with their Native English-speaking counterparts, for example, and Hwang’s (2005) Korean academics resented the time it took them to write papers, believing that Native English speakers gained that time for research. Hanauer and Englander (2011), have even sought to quantify this perceived relative burden. Their study of Mexican scholars from a range of scientific disciplines indicates that subjects saw writing a scientific article in English as 24% more difficult and generating 21% more anxiety than writing papers in Spanish.

These studies undoubtedly suggest that many writers experience English academic conventions as an impediment and this is often accompanied by a sense of disadvantage in relation to Anglophone scholars. Flowerdew’s (1999) questionnaire survey of 600 Hong Kong academics found that over two thirds felt they were at a disadvantage compared with Native English Speakers when writing for publication, with about half citing language issues as the main problem. But while many felt hampered by “less facility in expression” and a “less rich vocabulary”, follow-up interviews showed that 75% were confident that they would get their research published. Perez-Llantada’s (2014) Spanish scholars and Tardy’s (2004) international graduate students also identified problems in having to use English, particularly the time needed to learn English to a high level, but both groups acknowledged the benefits of having a common language for scientific exchange. Murray & Dingwall’s (2001) study of 250 Swiss academics similarly 5


found mix responses. While 41% believed using English was a slight disadvantage, 27% felt it was an advantage and 24% saw it as having no effect at all. These results parallel Ammon’s (1990) survey of German scientists where 55% reported no sense of disadvantage.

Overall, then, these surveys offer a mixed picture and reflect the context-dependent nature of attitude surveys, conveying something of the very different support and resource circumstances individuals work under and their own educational experiences and backgrounds. While many respondents complain that writing in English is time-consuming and laborious, substantial numbers feel no disadvantage at all. How authors answer questions about disadvantage are likely to be influenced by who they believe they are in competition with, whether they are asked to assess advantage in normative or moral terms, and how competent they believe they are in English (Ferguson et al, 2011). Nor is it clear whether the respondents are aware of the difficulties experienced by the Native-English speakers they are comparing themselves with or whether they are basing their views on untested assumptions. Even proficient NES academics suspect that others write more easily and quickly than themselves. Personal and national circumstances are also important, so we might expect scholars from small multilingual countries, like Switzerland, to feel less disadvantaged than those from countries with a very different language systems to English, such as Korea and China.

In fact, one of my Hong Kong informants saw the ability to write in several languages as a distinct advantage: I think monolinguals are trapped in their own language and isolated from so much experience and knowledge. The ability to write and read in several languages can be a real advantage.

(Polish speaker - Linguistics)

Another comment summarized much of the attitudinal research: I wouldn’t say English is an obstacle but it’s a challenge because it’s not my first language. Mastering the academic style is very challenging. Not just knowing how to write grammatical English but whether I can write in such a sophisticated way 6


that the reviewers of prestigious journals would like to publish my manuscript. (Cantonese speaker - Education) Attitudes are cross cut by proficiency, first language, discipline and publishing experience and, of course, many EAL authors successfully publish their papers.

Non-Anglophone authors: texts and practices The substantial literature reporting EAL authorsâ&#x20AC;&#x2122; perceptions is not matched by studies of submitted texts or the processes used to create them. While several studies have found non-standard uses in EAL texts, the fact they are necessarily small scale and cover a range of different contexts and disciplines makes it difficult to generalize about issues of equity. They show, however, that academic writing in English can present considerable challenges to non-Anglophone scholars, although these do not always prevent them gaining acceptance for their work.

A small comparative study of English language papers published by Sudanese and British medical researchers, for example, found a great deal more adherence to the conventions of impersonalization in the British papers, with more hedging, nominalization and careful explanation (El Malik & Nesi, 2008). Loi (2010) found that a sample of Chinese research article introductions in educational psychology employed a simpler rhetorical structure compared to those in English, and Burrough-Boenisch (2003) highlights the problems that multilingual authorsâ&#x20AC;&#x2122; may have with word order, word choice, and register. The fact that these studies were conducted using published papers suggests that the problems found were not terminal. In fact, Moreno et al (2012) found that the lower English proficiency levels of their Spanish researchers was only one factor in the difficulties they experienced in writing articles.

In addition to text analyses, there is a body of case study research which has focused on the processes of text creation, pointing to the protracted time and effort needed to write for publication in English (e.g. Lillis & Curry, 2010; Burrough-Boenisch, 2003). St John (1987), for instance, found that her Spanish



researchers spent considerable time over precise expression through changes in word order and lexis. Similarly, Gosden (1995) discovered that the research writing practices of junior scientists mainly involved mechanical editing to improve expression, using Japanese-English reference texts. They also translated from their L1 a great deal, often phrase by phrase, and borrowed from expert authors texts. Li’s (2006) longitudinal account shows how a Chinese doctoral student of physics slogged through six drafts and several painstaking resubmissions before her paper was finally accepted for publication.

Overall, this research suggests that texts by EAL authors may differ in some regards and that writing may be more laborious for them. Once again, however, we lack the comparative data which might help put these difficulties into perspective. Research into the problems experienced by Anglophone authors is thin on the ground and has only begun to attract scholarly interest relatively recently (e.g. Habibie, 2015; Hyland, 2015). Myers (1990) and Berkenkotter and Huckin (1995), however, document the struggles of even well-published and experienced Native English speaking authors trying to justify the importance of their experiments to a potentially sceptical research community. In short, assertions that EAL authors have greater difficulties in writing than their Native English counterparts are largely speculative – while self-reports tell us it is, we just don’t know if it is the case or not. Writing for publication is a specialised competence which both Native and non-Native English speakers must acquire, a fact which is obscured by two key assumptions of the linguistic disadvantage orthodoxy.

Problematic assumption 1: the Native/non- Native divide While the need for a certain proficiency in a foreign language inevitably creates an added burden for authors, there are difficulties in framing linguistic disadvantage in terms of a Native/non-Native divide. The Native speaker’s advantage is attributed to a combination of “natural” acquisition and the idea that Native speakers own and control their mother tongue. The term, however, has been hotly debated since it was introduced by Bloomfield in the 1930s (e.g., Love & Ansaldo, 2010). Davies (2003), for example, has offered a critical view of the concept of ”Native speaker” and Escudero and Sharwood-Smith (2001) 8


suggest we should understand it as a gradient term whereby individuals approximate more or less to a Native-speaker prototype.

Ferguson et al (2011: 42) see two main problems in using the term to frame linguistic disadvantage: The first is that academic writing, or academic literacy, is not part of the Native speaker's inheritance: it is acquired rather through lengthy formal education and is far from a universal skill. A second is that the non-Native speaker category, like the Native category, is a very loose one, encompassing individuals of very varying levels of proficiency, some of whose languages are linguistically related to English and some of whose are linguistically distant. While the idea of Native speaker might imply the advantages gained by having internalised the language through "natural acquisition", rather than through deliberate learning, academic English is no one’s first language. In fact, ”Native-speakerhood” refers more accurately to the acquisition of syntactic and phonological knowledge as a result of early childhood socialization and not competence in writing, which requires prolonged formal education. We don’t learn to write in the same way that we learn to speak, but through years of schooling.

The register of academic writing is a specific domain of expertise comprising a sub-set of lexicogrammatical features and rhetorical conventions which have evolved to perform certain valued functions for those who use them. While its regularities and peculiarities vary across disciplines, it is a linguistic code which captures the cultural profile that emerges through the identity investment of academics in creating particular kinds of meanings that insiders will recognize and understand. As a result, many literate and well-educated NESs lack the necessary know-how and experience to produce publishable papers while countless EAL scholars, benefiting from the experience gained from EAP courses and years of doctoral apprenticeship, find themselves more ‘academically bilingual’.



Several of my informants in Hong Kong, for example, cited their training and experience as reasons why they actually found it easier to write in English than their first language: I only publish in English. I think I can only write in English (laughs). Because we were trained to do that all through the PhD years. Then you find you can’t write in Chinese. It is not just the writing but thinking about research might be different. That’s why, you know, after a while getting used to their way and you wouldn’t be able to do a different way. (Cantonese speaker – Business studies) I am more used to writing in English and for English speaking audiences. I seldom write in Chinese because I don’t have time. I have had a few articles translated into Chinese. They are about bilingual education. If I had more time, I would try. It’s faster to get someone who is good at it, to translate it than for me to write the paper in Chinese. (Cantonese speaker -Education) I don’t write in Chinese. Before I did my PhD I taught for a while in Mainland China at a University and I published one or two papers in Chinese but those were not really proper research. Since I came to Hong Kong I have been publishing in English. (Putonghua speaker – history) I think it’s just the way I have been educated and the way I have been socialized into academia was to write in English, yes. I published one paper a long time ago in Polish but I haven’t written in any other language than English since then. (Polish speaker – linguistics) The arcane conventions of academic discourse are perhaps equally daunting to Native English speakers who also struggle to produce polished prose (Casanave & Vandrick, 2003) and US students appear as prone to anxiety about their academic writing as international students (Swales, 2004: 57).

Moreover, with perhaps a quarter of the world’s population able to speak English to some degree (Graddol, 2000), labelling any particular individual as a Native or non-Native speaker has become increasingly problematic. There are, moreover, non-Native English speakers in the academic centre at leading research universities as well as at the periphery, and those who have studied in an Englishspeaking country or are members of international research groups as well as those who have never left home.



Claims of EAL speaker disadvantage are therefore far from straightforward and, in fact, the Native/nonNative distinction seems to break down entirely at advanced levels of academic writing. A corpus study by Römer (2009:99), for example, found that Native and non-Native apprentice academic writers develop their academic discourse competence in similar ways, and that Native speakers also have to learn the language (and phraseology) of academic writing. This ‘apprenticeship’ or ‘enculturation’ into the norms of academic rhetorical practice is for NES research students, as it can be for NNESs, often a painful and protracted experience. Berkenkotter and Huckin’s (1995) detailed case study of Nate, for example, shows an intelligent and reflective Native English speaking student slowly developing an ability to integrate subject matter knowledge with unfamiliar situationally appropriate linguistic and rhetorical conventions. They portray this as a “lengthy and difficult process”, largely because it involves the individual acquiring a new and “very clearly structured set of symbols which he can use in locating himself in the world” (Hudson, 1996: 14).

Research shows that a key issue for many novices is the lack of a disciplinary appropriate conceptual framework which allows them to speak with authority: like NNES academics, L1 authors must develop a sense of self as an academic writer (e.g. Badenhurst et al, 2015). Cameron et al (2009) and Shirey (2013), for example, talk of the strong emotions of self-doubt, anxiety and erosion of confidence experienced by novice L1 academic writers, many seriously troubled by the fear of rejection (Oermann & Hays, 2011). Similarly, Aitchison et al’s (2012) study of 36 doctoral students and their supervisors in the sciences found writing to be ‘emotional work’ which created strong feelings of both joy and pleasure, pain and frustration. None found writing easy or enjoyable and it involved considerable struggles for all of them.

Swales (2004: 56), in fact, argues that the most important distinction in publishing is not between Native and non-Native English speakers but 11


between experienced or “senior” researcher/scholars and less experienced or “junior” ones – between those who know the academic ropes in their chosen specialisms and those who are learning them. Like language proficiency, academic literacy is also a variable competence which develops with practice and experience. Moreno et al’s (2012) 1,717 Spanish postdoctoral researchers, for example, felt that the experience of writing for publication in English was far more important than language proficiency in gaining acceptance for papers. Irrespective of whether a writer is a Native or non-Native, craft skills, the ability to navigate submissions and a general publication savvy improve with practice (e.g. Mur Dueñas, 2012).

Experts certainly seem to have the edge over novices in academic text production, with both a greater command of the discipline’s rhetorical resources (Hyland, 2011) and understanding of how a paper might best be steered through the review process (e.g. Myers, 1990). Pagel et al (2002), for example, found that postdoctoral fellows in a leading medical research school had greater difficulty with writing and publishing than faculty members. One reason for this is that graduate students struggle to imagine an appropriate audience in constructing arguments which readers find persuasive. Several of my novice researcher informants noted that this was a significant problem for them: Structuring is pretty complicated for me. I still spend a lot of time trying to think where I should put information and the structure of each section. Let’s say with the introduction, how you organize it in a way that makes sense. They don’t want too much information but they want enough and in a way they can use. (biology student) This was a problem reinforced in interviews with their professors: A lot of our post docs need a lot of help, a lot of spoon-feeding. Not just what to do in the lab but how to write. They really seem to be at a loss about how to organize the information for journals.

(Chemistry prof)

These conversations, moreover, demand awareness of the main disciplinary paradigms and the community zeitgeist as writers must address research topics which will interest colleagues, framing their research claims within these topics. 12


The Native-non-Native distinction is therefore a crude instrument with which to explain publishing success and to assume that NESs share the same communicative competence ignores the extensive research into the specialist literacy skills demanded by academic writing. We need, then, to separate communicative performance from mother-tongue status when looking at English for publication and to see that expertise develops with practice.

Problematic assumption 2: the primacy of language While the stereotype of “non-Native speaker” is frequently invoked to explain the vulnerability of novice EAL writers in the review process, non-discursive physical and financial barriers may well be greater than linguistic ones (e.g. Wood, 2001). The degree of training and experience in scientific writing, geographical location, or even the number and type of collaborators, may be more powerful determinants of publication success. Two key factors here are those of situatedness and isolation.

Despite taking place on a global stage, scholarly writing is always a situated practice which occurs in local academic communities. It is carried out and learnt through very local and concrete interactions with particular texts and particular others and so bares the stamp of specific cultural traditions and ways of seeing problems. This situatedness of the researcher creates powerful affordances for global research as it allows multilingual scholars to bring insider awareness about local contexts or issues that mainstream academic communities are not aware of (e.g. Cho, 2004). It can therefore often seem to be a very peripheral participation indeed to those working alone or on the edge of academic activity.

Academics on the periphery may feel out-of-the-loop on current developments in their field and become frustrated that they are unable to consult with peers and mentors about matters. Gosden, refers to these impediments as isolation which can refer to a range of issues: The broad term ‘isolation’ covers many causes, for example: not carefully reading ‘Instructions to Authors’; unfamiliarity with the journal and its academic level; not 13


previewing previous literature well and relating to others’ work, possibly due to a lack of literature/library facilities; a lack of awareness of what constitutes publishable research; and unfamiliarity with the broad (and unwritten) ‘rules of the game’.

Gosden (1992: 133)

This sense of isolation from the mainstream is obviously a major impediment to researchers in Less Developed Countries (LDCs) but also afflicts anyone working ‘off-network’ in poorly-resourced institutions with small library budgets and little research activity in relatively wealthy parts of the world.

Isolation seems to be felt particularly by junior academics returning to their home countries to take up positions in less prestigious places after completing graduate level study at research intensive universities abroad. They can experience an acute sense of exclusion from the mainstream conversations of the discipline in what Geertz (1983) refers to as the ‘exile from Eden syndrome’ whereby “one starts [an academic career] at the center of things and then moves toward the edges” (1983:158). Scholars who miss the opportunity to discuss issues with their mentors and attend conferences has been reported for Egyptian (Swales, 1990), Hong Kong (Flowerdew, 2007) and Japanese (Casanave, 1998) returnees. The notions of situatedness and isolation thus help to foreground both the unique contributions multilingual scholars make to global scholarship and the distance they often feel from the centre.

There are various aspects of ‘isolation’ and a particularly serious hurdle for peripheral scholars is overcoming a lack of up-to-date technologies, poor access to the literature and insufficient funds to conduct appropriate experiments. One of my interviewees spoke of his experience in this way: When I worked in a (provincial) university in China I faced many challenges always. I had no professor to help me and the library was small. Most articles are not open access and Amazon will not send books to China because of credit card problems. There is no grants. It is very hard to do research.

(Chinese student)

Restricted access to the literature prevents researchers entering academic conversations in a relevant way, making their contributions sound badly framed or “old news” (Canagarajah, 1996). Not all EAL authors face the same problems of course, nor are these difficulties restricted to EAL academics. Canagarajah



(1996: 440) notes that his arguments might equally apply “to the periphery within the center: the marginalized communities and poorly facilitated institutions in the technologically advanced nations”.

But while Anglophone scholars working in climates of cutbacks to university funding also suffer, it is those researching in less-developed countries who suffer the most. There is, as a result, a statistically significant difference between the high and low income countries in terms of the rejection rate of submitted manuscripts (Patel & Youl-ri, 2007) with acceptances of only 4.8% in top psychiatry journals (Singh, 2006) and just 0.3% in anaesthesiology (Bould et al, 2010) for authors in low income countries. A study of 400 published clinical trials found a considerable manuscript selection bias against low income countries due to a mistrust of the data (Yousefi-Nooraie, et al, 2006), and it is almost a law of publication that the percentage of articles from Less Developed Countries decreases as the Impact factor of the journal increases (Rohra. 2011). Simply, research conducted in the richest countries is more likely to be accepted for publication with the acceptance rate of papers from countries increasing by 27% with every million US$ invested in research (Saposnik et al, 2014).

Peripheral scholars also have to contend with a system which celebrates local knowledge generated in the Anglophone centres of research as an unmarked universal discourse with a claim to global relevance. Several of my informants in Hong Kong recognised the hegemonic status of ‘global knowledge’: You have to set the study in a bigger context, one that is going to echo with the wider discipline. Nobody is really that interested in what is going on in HK schools, nobody outside HK that is, and you have to put it into their terms. Critical perspectives or how it contrasts to overseas studies.

(Applied Linguistics researcher)

Framing the local as global, or as a point of exotic contrast to the centre, is a key strategy helping academics in non-Anglophone locations to secure their work for publication in ISI-indexed venues. Another strategy is working with overseas partners. So, about half the ISI indexed papers with an African-affiliated author are co-authored with partners from outside the continent. In fact, some 85% of



the papers published from Mali and Gabon involve collaborations with researchers on other continents (Tijssen, 2007).

In sum, the disadvantages of physical, scholarly and financial isolation may be greater than those of language. Certainly, these factors are frequently associated with poor linguistic skills, at least in nonEnglish speaking periphery countries, but a crude Native vs non-Native dichotomy fails to capture a far more complex picture.

Non-Anglophone authors in international journals Despite all the problems, more non-Anglophone researchers are writing successfully for publication than ever before, outnumbering NESs in many fields. In applied linguistics and language teaching, the increase seems particularly marked. Swales (2004: 41), for example, shows “a steady and welcome decline” in the dominance of papers by US authors in TESOL Quarterly, while Hewings (2002) observes a doubling of the articles originating outside the US and UK in English for Specific Purposes. More recently, Gentil and Tardy (2015) have tracked the same decrease in US and English-centre authors published in the Journal of Second Language Writing since 1992. While these applied linguistics journals might be expected to attract more English-proficient submissions, 60% of articles in The Journal of Thoracic and Cardiovascular Surgery are now from EAL authors (Benfield, 2007) and EAL submissions dominate leading journals like Science and Nature (Wood, 2001).

Medical journals have long been at the forefront of publishing EAL authors, although hard evidence for the same kind of growth in other fields is difficult to find. Table 1 is an initial attempt to offer an indication of changes in this area. This shows the results of a “quick and dirty” study of the five journals with the highest 5 year Impact Factors in each of six disciplines in the hard sciences and social sciences in the decade from 2000 to 2011. These therefore represent the top cited sources in key academic fields. The categorisation of authorship was based on the family name and country of affiliation of the first 16


author, with the handful of non-Anglo Saxon names in English speaking countries counted as NES. While admittedly a rough and ready classification, the figures suggest something of the substantial increase in EAL authors to the growth of published papers over the last decade. Table 1: First author for articles published in top 5 journals by Impact Factor 2000 2011 NES EAL NES



424 (61.4%)

267 (38.6%)

740 (58.7%)


Elec Engineering

214 (46.0%)

251 (54.0%)

256 (24.7%)

780 (75.3%)


109 (27.8%)

283 (72.2%)

714 (31.1%)



340 (79.4%)

88 (20.6%)

270 (68.5%)

124 (31.5%)


288 (74.8%)

97 (25.2%)

242 (61.2%)

153 (38.8%)


312 (79.0%)

83 (21.0%)

284 (69.8%)

123 (30.2%)

2506 (43.3%)

3284 (56.7%)


1687 (61.2%)

1069 (38.8)

The sample shows there were three times more papers overall from EAL authors in 2011 compared with 2000. Physics represents the only decline in the proportion of papers from EAL sources, but this is more than matched by the increase in the number of published articles in this discipline. Overall, EAL submissions are increasingly getting into the most prestigious ISI-ranked journals, although the greatest increases are in the least context-dependent and rhetorically demanding science fields. For many authors, then, it seems that Native-speakerness confers fewer advantages than might be supposed.

Is there linguistic injustice in gatekeeping practices? So where does this leave claims about linguistic bias? Do editors and reviewers really stigmatize L2 authors? It is certainly the case that many journal editors have reacted to the surge of non-Anglophone submissions with some alarm. This comment from the editors of Oral Oncology expresses the wider concern: An emerging problem facing all journals is the increasing number of submissions from non-English-speaking parts of the world, where the standard of written English may fall below the expectations of a scientific publication. (Scully & Jenkins, 2006) 17


The editors of international applied linguistics journals interviewed by Flowerdew (2001) also noted common language problems such as surface errors, the absence of authorial voice, and nativized varieties of English, while editors of the European Journal of Cardio-Thoracic Surgery highlighted problems of word choice and syntax (Benfield & Howard, 2000). Clearly, editors expect manuscripts to be thoroughly edited on submission (e.g. Heng Hartse & Kubota, 2014) possibly by English teachers (Na & Hyland, unpublished).

Reviewers also frequently note language problems and comments on grammar, style or rhetorical conventions are frequently included in reviews (e.g. Mungra &Webber, 2010; Kourilova, 1996). All my informants had experience of this: Sometimes they can be quite brutal, but I know I have been sloppy and should take more care with my language.

(NES sociology doctoral student)

Yes, reviewers may criticize our grammar. They often do this, in fact (laughs). We put it right when we revise the paper.

(Physics Assistant Prof)

It is possible that the frequency of these comments, and occasionally their bluntness, may lead EAL writers to believe that language has played a decisive role in the rejection of their contributions.

But while reviewers often refer to language problems, this tends to be vague and fails to identify specific problems (e.g. Shashok, 2008; Kourilova, 1998). Certainly, in applied linguistics at least, reviewers do not typically take the non-Native speaker status of authors in account in making decisions and the quality of the language is rarely a decisive factor in rejection (Belcher, 2007; Coniam, 2012; Gentil & Tardy, 2015). This may also be true in other fields too, as growing numbers of non-Native speakers take on gate-keeping roles- leading to greater acceptance of non-standard forms. There may also be increasing tolerance from Anglophone journal editors (Salager-Meyer, 2008), so Rozycki and Johnson (2013), for example, found widespread use of simplified grammar in prize-winning papers published by non-Native English speakers in in IEEE journals, engineeringâ&#x20AC;&#x2122;s most prestigious publications. 18


Instead, reviews of both Native and non-Native English scholars’ submissions tend to strongly focus on aspects of the research itself, rather than its presentation. Looking at the comments in 40 scientific letters, for example, Gosden (2003) found that reviewers mainly addressed technical detail (27%) and the discussion (34%). Hewings (2004) reported that reviewers responding to submissions to the Journal of English for Specific Purposes mainly evaluated the paper’s overall quality and contribution (22%) as well as the quality of claims (19%) and the analysis (18%). Judgements of the papers as a whole were largely positive whereas comments on the way the paper was written and on the claims were largely negative. Looking at his own 122 reviews for the language teaching journal System over 8 years, Coniam (2012) found his negative comments most often addressed the acceptability of claims (in 80% of the reviews), the methodology (in 65%), the sufficiency of data (60%) and the clarity of research questions (58%). Content and methodology also dominated critical comments in both Mungra and Webber’s (2010) study of Italian scholars submitting to medical journals in English and in Mur Dueñas’ (2012) sample of Spanish researchers’ submissions in Finance.

Interviews with editors and studies of reviewers’ comments, then, tend to find no evidence to support claims of prejudicial treatment or undue attention to language in editorial decisions. In one study which set out to look for bias against EAL writers, Belcher (2007) explored the reviewers’ comments on nine papers submitted to English for Specific Purposes, three from each of the Near and Middle East, the Far East, and Latin America/ non-Anglophone Europe, together with a sample of Native-English speaker submissions. She found that only 2 reviews out of the 29 contained no comments on language or style at all, and that language was commented on more frequently than any other feature, but in no case was language alone a reason for rejection. In fact, Belcher found that reviewers comments showed that unsuccessful EAL authors’ papers contained the same content and expression problems as those of rejected L1 English authors. She observes that: For some off-network Native-English scholars, even staying in control of surface textual features seemed challenging. Thus, it appears, from this small sample, that at least some 19


number of rejected papers, whether authored by EL or EIL scholars, networked or offnetworked, share many of the same shortcomings.

So some language problems might result from an author writing in a second language, but the same problems also characterize the writing of L1 users of English. In fact, Benfield and Howard’s comparison of submissions to the European Journal of Cardio-Thoracic Surgery found only slightly more reviewer criticisms of writing in non-Anglophone submissions. Several editors in Flowerdew’s (2001) study made similar comments, suggesting that the most salient problem in international scholars’ submissions was not language fluency but a lack of resources and research writing expertise. One of my Hong Kong interviewees expressed a similar view: I believe language is not the main concern. My gut feeling is that if they like your topic, they give you chance to resubmit. They also give very detailed comments on grammar if they really want you to get published. They will allow you to correct. But if they don’t like your topic, they are more general about language. So I am confident that writing skills will not be an obstacle. Although it is not perfect and we still receive some negative comments, if your topic is interesting enough, you still have a chance to revise.

(Cantonese speaker-Nursing)

I am not, of course, claiming peer review to be perfect: it is a flawed process and bias exists. Peer review is subject to human imperfections and it is unreasonable to expect it to offer an objective means of judging truth. Science is a competitive world and cases of misconduct do occur (e.g. Ernst & Resch, 1994; Godlee, 2000) but such problems tend to be rare (e.g. Ward and Donnelly, 1998). There is, however, little evidence to support the idea that there is a widespread and systematic bias against writers whose first language is not English. Such dichotomizing conceptualizations are not only largely unfounded, they are also unhelpful: demoralizing for novice writers and offensive to the many reviewers, editors and mentors who seek to support non-Anglophone authors in getting published (Casanave, 2008; Englander & Lopez-Bonilla, 2011).



The question of what reviewers mean by ‘language’ is also relevant here. Authors often remark that reviewers’ comments on nonNative-like features in their manuscripts are often indefinite and unhelpful (Kourilová,1998). As Kerans points out, most reviewers lack the metalanguage needed to talk about rhetorical problems thus… they rush to blame ‘the English’ vaguely whenever they are confused by [an English L2] writer’s manuscript.

(Kerans, 2001: 339).

In her study of text revisions in response to reviewers’ language criticisms, for instance, Englander (2006) suggests that it is not the English that is usually the problem but that authors violate the reviewers’ expectations of academic writing. It is control of the register rather than the language which is at issue. This is not to say that difficulties with English syntax, lexis or discourse do not greatly complicate the task of non-Anglophone academics, but it calls into question a coarse Native vs. nonNative dichotomy and encourages us to think beyond linguistic bias. A lack of resources and writing expertise could be far more important obstacles for both EAL and Native English authors.

Some final observations In this paper I have sought to raise some questions about a pervasive view which asserts that EAL scholars are disadvantaged in the cut-throat competitive world of academic publishing by virtue of their status as second language writers. In recent years this view has gained the privileged position of an unchallenged orthodoxy, so that many EAL novice writers automatically invoke the stereotype of “nonNative speaker” when finding themselves vulnerable in the review process (Huang, 2010). It is, however, a framing largely based on unexamined assumptions and a lack of research into Anglophone practices.

The ‘disadvantage orthodoxy’ position, in fact, provides a limited picture of writing for publication and does a serious disservice to both Native and non-Native English speaking writers. It has two damaging consequences:



1. By focusing on language shortcomings it perpetuates a myth of L2 deficit which discourages EAL authors and tells them to look for prejudice rather than revision. 2. It marginalizes the challenges faced by NES authors by depicting Kachruâ&#x20AC;&#x2122;s Inner Circle as a kind of safe house where academic publication can be taken for granted. Quite clearly, however, Anglophone scholars, especially those at the beginning of their careers, have to cope with the same publish or perish demands and the same arcane writing conventions to keep their jobs and climb the ladder. Put most simply, writing as an L1 English scholar does not guarantee a successful publishing career any more than working as an isolated, off-network EIL author condemn one to failure. Authorial agency and individual experience, too often ignored in these debates, are key dynamics. Aspects of isolation such as limited access to resources and rhetorical models can obviously limit publishing opportunities for both NES and EAL scholars, but individuals are not simply products of their environment and these factors need not be determining ones.

There are, I feel, important implications in all this for second language writing scholarship and practice. First, my argument aligns with the widely accepted view that we need to see L2 writing as embedded in wider social, institutional and political contexts rather than as something which exists in isolation from them. The difficulties experienced by writers of any first language are not due to deficit or negligence but broader discourse practices which are often invisible to writers, reviewers and editors. This not only points to the need for greater inclusivity in teaching, ensuring that academic writing courses target Native as well as non-Native English speaking students, but also argues against a static model of instruction where writing is simply the donkey-work done after research is completed. Writing is a way of knowing, and those who write understand it is a difficult and messy business. Exposing students to othersâ&#x20AC;&#x2122; processes as well as othersâ&#x20AC;&#x2122; texts may help to convey something of this and help reassure novice writers that even celebrity authors have their blocks and rejections (Hyland, 2015). Teachers seeking to distinguish issues and strategies for either monolingual or EAL scholars enrolled in English for Publication Purposes courses will find the task is by no means straightforward. 22


Second, it seems clear that issues of linguistic disadvantage, or even injustice, become largely irrelevant at these advanced levels of academic writing where authors are seeking publication for their work. Here both NES and EAL novice authors are engaged in employing new and unfamiliar literacy skills to craft their texts for exacting specialist readers. It is a site where technical issues of grammatical accuracy have less relevance than rhetorical knowledge, persistence and an awareness of an authorial self. This revision of the notion of competence (or expertise) is not a new argument and readers may recognize resonances with Canagarajah’s (2013) views on “the end of L2 writing” or Kobayashi and Rinnert’s (2013) position that theories of multicompetence, genre, and identity, not L1 vs L2 dichotomies, can better elucidate the character of multilingual writers. What is apparent, however, is that literacy is not a single monolithic accomplishment but a series of socially situated, discipline-sensitive practices which have to be learnt as needed. Discourses are ‘ways of being in the world’ (Gee, 1999: 23) created from culturally available resources which involve interactions between the conventions of the literacy event, the ways that communities maintain their interests, and the values, beliefs and prior experiences of the participants. They are not part of a Native speaker heritage.

Lastly, I want to underline the important point that the current orthodoxy which attributes publishing success to mother tongue perpetuates an idealised monolingualism that still underlies a lot of thinking in applied linguistics. Languages are linguistic practices which have evolved to get things done in particular spheres and not cognitive structures existing inside the head of idealised monolingual Native speakers. Academic writing for publication is a practice of a literary elite, but it is an elite which is not restricted to Native English speakers. Scholars who publish in a second language now represent a majority, but they continue to struggle with minority status. However, attributing publication to that fact alone oversimplifies a more complex picture and does not help solve the very real problems experienced by both EAL and Native English speaking writers.



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*Brief Biostatement

Ken Hyland is Professor of Applied Linguistics and Director of the Centre for Applied English Studies at the University of Hong Kong. He is well known for his work on academic discourse and EAP and has published over 180 articles and 23 books on these subjects.


Highlights (for review)


Dominance of English in academic publishing raises issues of ‘linguistic injustice’

Mixed evidence from studies of author perceptions, texts and editorial decisions

Assumptions of native speaker advantage and primacy of language unfounded

Situatedness and isolation key factors in publishing success

Geographical location, publishing experience and collaborators have more impact



Editing, Writing & Publishing • J Korean Med Sci 2016; 31: 1874-1878

The Pressure to Publish More and the Scope of Predatory Publishing Activities Armen Yuri Gasparyan,1 Bekaidar Nurmashev,2 Alexander A. Voronov,3 Alexey N. Gerasimov,4 Anna M. Koroleva,5 and George D. Kitas1,6 1

Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Dudley, West Midlands, UK; 2South Kazakhstan State Pharmaceutical Academy, Shymkent, Kazakhstan; 3Department of Marketing and Trade Deals, Kuban State University, Krasnodar, Russian Federation; 4Department of Statistics and Econometrics, Stavropol State Agrarian University, Stavropol, Russian Federation; 5 Department of Economics and Organization of Production, Industrial University of Tyumen, Tyumen, Russian Federation; 6Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK Received: 19 August 2016 Accepted: 13 September 2016 Address for Correspondence: Armen Yuri Gasparyan, MD Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Dudley DY1 2HQ, West Midlands, UK E-mail:

This article overviews unethical publishing practices in connection with the pressure to publish more. Both open-access and subscription publishing models can be abused by ‘predatory’ authors, editors, and publishing outlets. Relevant examples of ‘prolific’ scholars are viewed through the prism of the violation of ethical authorship in established journals and indiscriminately boosting publication records elsewhere. The instances of ethical transgressions by brokering editorial agencies and agents, operating predominantly in nonAnglophone countries, are presented to raise awareness of predatory activities. The scheme of predatory publishing activities is presented, and several measures are proposed to tackle the issue of predatory publishing. The awareness campaigns by professional societies, consultations with information facilitators, implementation of the criteria of best target journals, and crediting of scholars with use of integrative citation metrics, such as the h-index, are believed to make a difference. Keywords:  Predatory Publishing; Open Access; Authorship; Professional Societies; Citation Metrics; Best Target Journals

WHY SCHOLARS PUBLISH ARTICLES? There are many reasons for publishing journal articles in our times. Scholarly articles are primarily required for career advancement and international recognition that can be reflected in values of several citation metrics (1,2). At the time of launching the first scientific journal Philosophical Transactions of the Royal Society in 1665, the main reason of publishing scholarly works (letters) was to distribute information among professionals, encourage formal discussion, and archive all related accounts for future generations. Such an idealistic approach to the scholarly communication at the time of limited opportunities for publishing and absence of citation metrics has facilitated preserving scientific wisdom, influenced scientific and technological progress, and left an enduring legacy of professional journal publishing. All top academic journals are now embracing that approach and serving platforms for scholarly communication. Most authors and readers take that for granted.   With the expanding opportunities for communication and a changing publishing landscape, the value of well-preserved journal articles is paradoxically much less appreciated than it was centuries ago. In fact, evidence suggests that the vast majority of abstracts (65%-79%) presented at congresses of professional societies never transform into full articles and do not influence the scientific discourse (3-5). Although bibliographic databases of Elsevier and Thomson Reuters are expanding coverage of conference proceedings and abstracts fulfilling certain quality criteria, such items are not counted as complete reports and are not recommended for citing (6). Given numerous deficiencies in reporting, even systematic reviews presented in the form of abstracts cannot be considered as reliable evidence-based accounts (7). Low rates of publishing full articles, which are based on congress abstracts, can be partly explained by the authors’ indiscretion and their academic institutions’ ‘soft’ policies towards publication activity. The uncertainties in distinguishing the quality and importance of abstracts

© 2016 The Korean Academy of Medical Sciences. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

pISSN 1011-8934 eISSN 1598-6357


Gasparyan AY, et al.  •  Pressure to Publish and Predatory Publishing and full articles form a ground for flawed crediting schemes, acknowledging any type of publication. In such an environment, numerous ‘predatory’ congresses have emerged, providing ample opportunities for publishing abstracts for a fee without any selective approach and no chance of indexing by prestigious bibliographic databases (8).

ARTIFICIALLY BOOSTING PUBLICATION RECORDS Unfortunately, academic advancement in most countries is currently dependent on the number rather than quality of scholarly works (9). In an attempt to boost publication records and get academic degrees and titles, some authors embark on either listing their names in solid research articles without fulfilling the authorship criteria or producing ‘wasteful,’ redundant items, just filling space in journals without any scientific purpose. A recent MEDLINE-based analysis revealed a highly questionable practice of publishing more than 1 research paper per 10 working days by some world-renowned authors (10). Such a prolific publication activity results in hundreds, if not thousands of articles recorded by scholars who often hold influential academic posts, head journal editorial boards, and abundantly publish in their own journals that serve as hubs for evidence accumulation.   Another instance of artificially boosting publication records was recently discussed on Jeffrey Beall’s blog (11). He analyzed the case of an author with hundreds of editorials and redundant letters which were indexed by MEDLINE. The author pointed to a number of issues related to a wide variety of academic disciplines in the form of short (2-3 paragraphs) notes. None of these notes contained any rational or new point, being merely a recapitulation of already published facts. The same author also gained ‘fame’ for actively contributing to predatory journals by submitting his notes and heading editorial boards.

SCOPE OF PREDATORY PUBLISHING ACTIVITIES The digitization of publishing creates almost unlimited opportunities for streamlining the distribution of scholarly ideas, comments, research data and overviews through the journals of established and start-up open-access publishers (12). Publication activity of any individual in any corner of the world can be now realized without the amount of effort required 2-3 decades ago. The emerged ‘cascading’ schemes allow manuscripts, rejected by established and high-impact journals, to find their home in gold open-access periodicals of the same or other publishers with lower rank and/or lower submission rates. In a desperate attempt to attract manuscripts and make a profit, many start-up open-access publishers launch a large series of journals with ambitious titles, such as “International…,” “World…,”

“European,” “American…,” “Science…,” which mimic those of established ones but add no value, receive no approval of prestigious professional societies, and only damage reputation of contributing authors and editorial board members. Both the cascading schemes and new open-access journals of unprofessional publishers often undermine the importance of basic ethical norms, peer review, and research reporting validation. The speed of publication in journals that circumvent ethical barriers is largely dependent on open-access charges, which is viewed by J. Beall as the main factor corrupting the publishing market (13).   On his blog (, J. Beall blacklisted English predatory journals exploiting gold open access and phi­ shing articles of inexperienced authors from poor research environments, who are concerned with the quantity rather than the quality of their publications. These authors, their research facilitators and grant funders are to be blamed for prioritizing any ‘international’ English publication regardless of the indexing and archiving prospects.   Some predatory publishers have managed to get indexing by Web of Science and Scopus, and attracted numerous experienced authors willing to pay for indexed and widely visible articles. The subsequent dramatic increase in the volumes of these journals, however, was not followed by proportionate expanding of the reviewers’ bank. The most relevant example is the Life Science Journal that lost its indexing status in 2014 after years of overly ‘productive’ publishing. Likewise, the Asian Pacific Journal of Cancer Prevention with its latest impact factor of 2.515 and 1,385 annual publication record (Journal Citation Reports®, Thomson Reuters, 2014) lost Web of Science coverage and related impact factor in 2015.   The number of predatory publishers and standalone journals blacklisted by J. Beall in 2016 stands at 923 (only 18 in 2011) and 882 (126 in 2013), respectively (14). Few prolific publishers with hundreds of ethical journals, such as Dove Medical Press (New Zealand) and Multidisciplinary Digital Publishing Institute (MD­ PI, China), which were initially categorized as predatory by J. Beall, were delisted from his blog after providing compelling evidence of adhering to the established ethical standards. However, the list still includes Frontiers and Kowsar Publishing with numerous indexed journals that claim to adhere to the recommendations of the Committee on Publication Ethics (COPE).   Predatory journals have diverse professional and geographical coverage. Multidisciplinary, research-intensive and rapidly developing disciplines with prospects of producing numerous articles are viewed as ‘cash cows’ by predatory publishers. The emerging scientific powers and low-income countries prioritizing international publications and incentivizing their authors for any English article are primarily targeted (15,16).   An analysis of the development trend of a large sample of predatory open-access journals, which were listed on J. Beall’s  1875


Gasparyan AY, et al.  •  Pressure to Publish and Predatory Publishing blog, revealed a rapid increase of the volume of articles from 53,000 in 2010 to 420,000 in 2014 (17). Interestingly, engineering, biomedicine and social sciences were the most active disciplines in terms of contributing predatory articles. Of 262 identified corresponding authors, 34.7% represented India, 16.4% were from Africa, and 9.2% from North America.   In a desperate attempt to add English publications to their CVs, non-native English-speaking authors may plagiarize or commit other forms of misconduct (18,19). The instances of translating Chinese publications and republishing them in English indexed journals have come to the fore recently (20). Brokering editorial agencies and individual agents, exploiting the pressure on unscrupulous Chinese researchers and academics to publish more, sell authorship and manipulate with author names in the by-lines of manuscripts accepted by prestigious journals (21). Brokering agencies are also actively operating in other countries with rapidly increasing volumes of publications, and particularly in Iran and Russia, where articles in high-ranked periodicals are offered for a fee (22,23).   Predatory publishing practices can take different forms and involve non-English open-access and subscription journals as well (24). Non-English journals escape blacklisting because most Anglophone experts do not read and do not analyze contents of these journals. In contrast to English predatory journals, non-English ones rarely solicit articles by generating spam invitations, and often publish submissions from ‘friendly’ organiza-

Open access and

Open access and subscription subscription journal journal and book publishers

and book publishers

   

Producing redundant, Producing redundant, sloppy, sloppy, or otherwise or otherwise unethical unethical articles for articles for boosting boosting publication publication records records

TACKLING THE ISSUE OF PREDATORY PUBLISHING Predatory publishing activities are here to stay as long as there is a pressure to publish more. Research and academic institutions crediting their faculty and fellows for prolific activities perpetuate the vicious circle of generating poor and inconclusive research data, redundant reviews, and pointless letters (25). Scientific authors’ unawareness of what constitutes predatory activity and haphazard targeting of scholarly journals contribute to the flourishing of poor quality, useless, and unethical journals. The scope of predatory activities is diverse, and all those involved in scientific communications can be dragged into such activities (Fig. 1).   Fortunately, several professional societies have launched a campaign against questionable open-access publishers and journals by referring to J. Beall’s list and increasing awareness of unethical publishers among new scholars (26,27). In 2015, global associations of editors and publishers, such as the COPE and the Open Access Scholarly Publishers Association (OASPA),

Standalone open

Brokering editorial agencies agencies andand agents Brokering editorial agents

Standalone open access and access and subscription journals

subscription journals

Compromised peer review Compromised peer review Inadequate editorial policiespolicies Inadequate editorial Lack of transparency over theover publication charges charges Lack of transparency the publication Poor/irrelevant indexing and archiving Poor/irrelevant indexing and archiving

Unethical (co)authors (co)authors Unethical

tions and individual agents. Single issues of such non-English predatory journals may accommodate many articles from ‘frien­ dly’ institutions with ‘reviewer comments’ written and presented by authors themselves, with decoratively posting submission and acceptance dates in the article footnotes.

Conferences Conferences

Charging poorly Chargingfees fees for for poorly checked checkedand and (non)indexed (non)indexed abstracts abstracts

   

Lack of transparency over theover services fees and fees Lack of transparency the and services Pricelists dependent on ranks target journals Pricelists dependent onofranks of target journals Corrupt linkslinks to journals Corrupt to journals Violation of authorship and other ethical norms Violation of authorship and other ethical norms

Hijacked journals’ journals’ Hijacked websites websites

Bogus factor’ Bogus‘impact ‘impact factor’ agencies agencies

Fee-based for Fee-basedservices services for directing directingsubmissions submissions toto bogus boguscopies copies ofofestablished established journals journals

Issuing misleading Issuing misleading metrics metrics without counting without counting citations or citations or using using incomplete citation data incomplete citation data

Predatory publishing activities Predatory publishing activities Fig. 1. Scope of predatory publishing activities.


Fig. 1. Scope of predatory publishing activities


Gasparyan AY, et al.  •  Pressure to Publish and Predatory Publishing have formed a coalition and initiated the “Think. Check. Submit” (TCS) campaign to help researchers assess the credentials of publishers and choose trusted journals for their research ( The TCS campaign offers a simple checklist of questions to help authors, and particularly those from non-Anglophone countries, identify reputable journals, which are endorsed by peers, have transparent editorial policies, relevant indexing and adhere to the ethical guidance of the global editorial associations. Additionally, a group of software specialists, researchers and publishers developed a digital platform to match English manuscript titles and abstracts with relevant and trusted journals ( Finally, experts from various professional backgrounds have publicized statements on the ‘pollution’ of the scientific evidence accumulation (28,29) and proposed criteria of best target journals, which may sideline outlets with unethical publishing mo­ dels (30,31).   The role of librarians or information facilitators with a broader look at publishers and the quality of their journals is becoming critical in our times (32). Their knowledge and expertise may help other stakeholders of scientific communications to choose a limited number of best references for reading, submitting manuscripts and citing, regardless of their access modes (33).   Research administrators who implement standards for research evaluation based on a combination of scientometric indicators can play their role in publicizing good research in periodicals with wide readership, high citation rates and endorsements from peers and minimize chances of artificially boosting publication records. At present, among numerous indicators for evaluation of an individual’s research productivity and impact, the h-index with its integrative approach to the number of articles and their citations in Scopus and Web of Science stands out as the most appropriate tool. That index has been used glo­ bally for more than a decade and proved to be a reliable indicator for authors with a long-standing career (34,35). The choice of a bibliographic database for recording the h-index depends on the indexing status of journals in a given discipline, peculiarities of research environments and regional priorities, with Scopus viewed as the most comprehensive platform for authors from Europe and non-Anglophone countries (36). Apparently, the h-index has its inherent limitations that should be taken into account for evaluating performance of early career researchers and those with a large number of multi-authored and self-cited articles (37,38). As showcased in an analysis of the Nobel laureates’ research performance, the h-index cannot be a proxy metric for assessing the innovativeness and scientific quality of articles (39). Additionally, the journal h-index, among other citation metrics, can help identify best journals with established traditions, wide visibility, and high citation rates and prevent submissions to predatory outlets that lose in the citation com

petition.   Prestigious abstract and citation databases, such as Scopus and Web of Science, still index a number of open-access and subscription journals that are not transparent over the peer review and publication charges. Indexers of these prestigious databases, who are concerned with the ‘pollution’ of their platforms, regularly consult J.Beall’s list, take into account their users’ complaints, and delist journals embarking on various transgressions. For that reason, authors and research evaluators alike are advised to visit the updated list of indexed journals prior to publishing and crediting (40).   Many professional societies across the world publish periodicals in English and other languages that serve interests of relevant communities regardless of the indexing status and citation counts. Prestige of these periodicals is dependent on the use of published articles, which can be assessed by downloads, sharing on social media, and positive points received from the surveyed membership. Incentivizing professional society members for contributing to their journals can be an additional defensive measure against predatory journals (41).   Efforts aimed at improving skills for scholarly writing in English and local languages, systematically searching through bibliographic databases, and raising awareness of predatory activities are urgently needed in countries, where brokering editorial agencies and agents have streamlined flows of most manuscripts to predatory outlets and hindered science growth (15). Strengthening the positions of regional and local professional societies and encouraging their members to publish in local journals can be also viewed as a step away from predatory media.

DISCLOSURE The authors have no potential conflicts of interest to disclose.

AUTHOR CONTRIBUTION Conception: Gasparyan AY, Nurmashev B, Kitas GD. Design of the Figure: Voronov AA, Gerasimov AN. Support with reference selection: Koroleva AM, Kitas GD. Writing 1st draft: Gasparyan AY. Revision: Gasparyan AY, Nurmashev B, Voronov AA, Gerasimov AN, Koroleva AM, Kitas GD. Final approval and responsibility for the whole article: all authors.

ORCID Armen Yuri Gasparyan Alexander A. Voronov Alexey N. Gerasimov Anna M. Koroleva George D. Kitas  1877


Gasparyan AY, et al.  •  Pressure to Publish and Predatory Publishing


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