Dr Rowe is pound-for-pound one of the best EM researcher in Canada, especially considering he completed the majority of his research on a shoe-string budget while managing a formidable career. His prolific and high-quality research has resulted in the publication of one book, 28 book chapters, and over 385 peer-reviewed manuscripts. It goes without saying he has a wealth of experience that, he humbly admits, came with many failures along the way. He is now the Associate Dean of Research at the University of Alberta, a Canadian Tier 1 Research Chair, and a former Senior Associate Editor of CJEM. He recently presented on the topic of ‘Publishing your Research’ at the University of Saskatchewan Research Day and his talk was full of pearls. Above all, he stresses perseverance and an ethical duty to publish as this research for the benefit of our patients.
The Decision to publish: Why is publishing important in Emergency Medicine?
- Small studies in small centers are key – This research lays the foundation for bigger studies.
- EM needs its own body of knowledge – While we see some of the same patients that our consultants do, we are not able to answer our research questions by looking at their practices. The population that presents to the ED and the population that is referred to them are just too different.
- There is a significant publication bias in EM that needs to be corrected. Only 51% of emergency medicine RCT’s actually get published. In other fields only 44% get published after the abstract presented at a conference. In Australia this is 35% and in the UK, 57%.1 This is a result of researchers not having enough time (56%), having trouble with co-authors (28%), and feeling that their work will not be accepted by a journal.2 This is especially true for negative studies as positive ones get published sooner and more frequently.
Unfortunately, publication bias influences systematic reviews and systematic review influence patient care. Guidelines are developed based on the published evidence. Ultimately, the truth may be obscured if we do not publish – especially when the results are negative.
“It is unethical to conduct research and NOT to publish it.” – Sir Ian Chalmers
This being the case, you know you need to publish your research. How can you get started?
Dr. Rowe’s Ten Steps to Publish your Research:
Step #1: Do high quality work
There are now reporting and quality guidelines for almost every type of study – so find them and use them. For example, for RCTs always use CONSORT guidelines for reporting and for Systematic Reviews use the Cochrane risk of bias3, QUADAS-24, or another validated tool to appraise papers, and follow the PRISMA guidelines5 for writing it up.
Step #2: Decide on a project
As clinicians, Brian suggests we always frame our questions in the PICO-D format (Population, Intervention, Control, Outcomes, Design). This ensures that our questions are clear before we start working to answer them. From there, three things should be considered before selecting a research project: passion, planning, and questioning the conventional wisdom.
- Passion – You need to chose something that you’re passionate about. This will ensure that the project thrives to completion.
- Planning – If you have an idea, you probably aren’t the first. Share your idea with colleagues, do extensive literature searches, and read related articles. Finding similar papers or research approaches to your own will give you ideas for your methodology and ensure that your study will add something to our understanding of that particular disease or dilemma.
- Question the conventional wisdom – Editors are more likely to publish articles that result in counter-intuitive findings. If you can provide a novel take on a topic or approach it in a different way you are more likely to have success.
Step #3: Gather some friends
Collaborate with various co-investigators. This will increase your likelihood of success and make your project more enjoyable. Some collaborators to consider:
- Librarians will ‘help you avoid repetition and give you a sample of your competition.’
- Statisticians will help with methods, sample sizes and data analysis.
- Methodologists will help with methods and choosing the right outcome measurement(s).
- Study coordinators have experience in the practical realities of data collection and timelines.
- Clinicians will give your project relevance – ‘what is you paper going to add to our understanding of x?’
You might not have these professionals within your Division or Department, but you probably do at your institution (e.g. hospital, university, regional health authority). Recruiting a great team will ensure the production of a great product. Of course, you need to make sure to credit them appropriately for their work. This may include an acknowledgement or authorship if they’ve met the criteria (check out the ICMJE authorship criteria6 for more on this).
Step #4: Consider the best “home” for your paper
Every paper has a home. It’s your job to find the that home. Do not be afraid to aim high as you will occasionally be surprised by what happens. Your article may get rejected by a small journal only to get accepted by a bigger one – this has happened to Dr. Rowe! In all cases, be sure to match the topic to the journal. Often the articles that you cite will guide you towards an appropriate journal for submission with the journal you cite the most often often being your first choice.
Step #5: Prepare a solid manuscript
To do so, here are some key tips that will help you to do that in a time-efficient manner:
- Remember that journal editors are busy and have a lot of papers to review. Make their lives easy by adhering to the “Instructions for authors”!
- Use Reference Management Software – Endnote is the traditional choice while Mendeley, Zotero, and Papers are picking up steam. This is especially important in the event that you have to submit your article to more than one journal (most of the time) due to rejections. There is nothing more frustrating than having to reformat your references. Fortunately, these programs can do that for you.
- Get input from other authors, especially experienced writers.
- Write succinctly and pay attention to spelling, grammar, and language.
- Do not make any common mistakes in the Methods section. The biggest errors are using methods that do not ask the question that you are posing or not describing them in sufficient detail to allow replication.
- Do not make any common mistakes in the Results section. Do not state that ‘there was a trend’ with a non-significant p-value (this makes it sound like you are implying that something is significant when it just isn’t). Be sure to report all of the results in this section – nothing new should be showing up in the discussion.
- Ensure that your statistics are clean. Justifying sample sizes with power calculations, reporting p-values and confidence intervals, and performing all appropriate analysis increases your paper’s credibility.
- Write a solid cover letter. It should be polite and concise while providing a compelling reason for why they should publish your study.
Step #6: Write like a pro
Some key tips can improve the quality of your writing dramatically.
- First, if you know you are not a strong writer – get training! There are resources that you can use to help improve your ability and, of course, practice makes perfect. Templates may help you to organize your thoughts so use them if needed.
- Start writing the minute you have the idea. You can actually wrote a significant portion of a manuscript without any data and writing early can help anticipate problems with the methods.
- Nail the Title and Abstract. They are far more important than many authors recognize. Ideally, the title will be catchy and tell a bit of a story. The abstract should end with a key finding that isn’t “more research is needed.”
- The introduction should be brief, with the clearly outlining the study objectives.
- The Methods section should be guided by a relevant set of reporting guidelines.
- The Discussion should focus on the main finding and why it is important in relation to the current literature. Limitations should be acknowledged explicitly and justification should be provided for why the research is important despite them. Do not try to hide your research’s limitations!
- Editing is key. In the editing process be sure that you are not over the word limit (even Watson & Crick’s paper on the double helix7 in the 1950’s fit on two pages!). All co-authors should review the manuscript and, if possible, you should get input from other experienced authors. Taking the time to ensure that the paper is edited thoroughly is worth it. I find it useful to read the entire document backwards so that your mind isn’t filling in the blanks. Revise, revise, and re-revise
‘A good paper is like fine wine…it needs to age and mature a bit.’ – Anonymous
Step #7: Know how to appease decision editors
Editors often make decisions about your paper in less than 5 minutes. You can appease them by using the following advice:
- RIOT Criteria – Make sure that your work is Relevant to readers, Important or Interesting, Original, and True – good methodology and plausible results
- “Revise and Submit” – If they say “revise and re-submit” you’re ‘probably in’ so do what they suggest (if it is reasonable) and do it quickly. Be sure to respond to every comment specifically and thank them for their helpful reviews. If you simply cannot make the revisions required because, for example, it would compromise the intended objective, then try another journal. Make sure to use the comments that they gave you in the next submission.
“I’ve been rejected more times than a pimple-ridden teenager.” – Dr. Brian Rowe
Step #8 Approach to rejection
In the world of journal submissions, rejections are common. You are not alone. High quality journals like CMAJ only accepts 5-7% of submitted manuscripts (NEJM only accepts 2%) so try to have a thick skin: don’t take it personally and don’t give up. Take a break, and then use the criticisms to make your paper better.
Step #9 Learn along the way
There are many ways to get better as you go. One of the best is to serve as a reviewer. This allows you to contribute to our profession, learn a ton about what constitutes a good paper, and can result in invitiations to write an editorial (which is a publication in itself). Remember that, just like becoming a good presenter, becoming a good researcher takes time and effort. Work at it. Write, write, write (and get feedback from colleagues).
Step #10: Build your success
Once you have published, begin by savoring your success. Many papers do not get this far and by doing so you’ve contributed to our field and the care of our patients. Then, Look for opportunities to publish more. Answer a “Call for Authors” from journals as they seldom turn you down. Once you’ve established yourself, begin to provide mentorship to someone who is trying to publish and work to meet collaborators. National conferences are great for networking. Remember that you don’t have to be first author all the time!