Beginning a Manuscript: Checklists and Guidelines, References and Resources

Objectives: The objective of this module is to acquaint writers with the basic principles of biomedical writing and introduce some of the many biomedical and health content guidelines. 

Practicum: After reading this module, complete the easy assignment found here. The purpose of this exercise is to introduce learns to our online assignment system. You will need to create an account, sign in, complete the easy exercise and review your results. If you have any difficulty, contact your course coordinator.

 “Well begun is half finished” – or so the expression goes. In fact it is true; if we start off properly, much of the paper seems to write itself. How then can we start well?

Among the valuable advice often given to writers is to have a roadmap: to know where the paper is going before we commence writing. This advice applies both to the style and the content of the paper. With regard to the style or “flavour” of a paper, it is most important that the writer define a clear theme. In experimental papers, structured reviews and meta-analyses this most often translates into a single hypothesis which is precisely defined and rigorously tested. It is said that the most common reason for scientific papers being rejected is the lack of that single, clear hypothesis. 

Writers may signal the direction of their paper with a very overt statement such as, “This study tested the hypothesis that …” or perhaps “This study was intended to determine whether…A…or…B…” Obviously, the thought processes which led to the creation of our research were not so constrained, but it is often possible and certainly it is very useful if we can fashion our research protocol to address one or a logical series of digital – yes or no – questions.

Observational papers and clinical reports (case studies and case series) are a somewhat different matter in that the underlying research is not structured to challenge a hypothesis. Nonetheless, the purpose of presenting the paper must be made crystal clear to the reader from early on. If the reader doesn’t know why we have written the paper, how can they know why they are reading it? Consequently, we are advised to advertise the purpose of our study as early as possible in the manuscript – certainly within the abstract and, if practical, even within the title. These days, most of us decide which papers to read in full based on the title and abstract accessed through an electronic service such as PubMed. If the title and abstract don’t capture the attention of the reader, the paper will not be read.

Once the purpose of the study is clear, the appropriate methods are largely evident and from the execution of these methods the results appear. The discussion revisits the purpose of the study, but now, with the new information provided by the results, attempts to answer our research question. This is the IMRAD pattern of most original data papers – Introduction, Methods, Results and Discussion. These days, structured reviews and meta-analyses follow much the same pattern. Even case studies approximate this design, but with the methods and results expressed in a case description which incorporates the patient history, examination results and interventions provided. Thus, the general architecture of papers is quite clear. Why then are they sometimes so troublesome to write?

Going back to our original premise, one answer is that the author did not have a well defined hypothesis to begin with. In too many cases, this is because the act of research was driven by the need to demonstrate a quantity (rather than quality) of research activity to some authority. In this publish-or-perish age of corporatized universities, graduate students and under-resourced investigators may be obliged to simply do what can be done with the available equipment and supplies, rather than to ask meaningful questions. Research driven by budgets and personnel policies rather than enquiry makes for tough writing and very flat reading. Low budget research may also allow us to circumvent funding bodies which demand comprehensive proposals. However, when we have first gone through the process of applying for funding, we often find that we can copy and paste a great deal from our funding application into our manuscript. This is our reward for having thought about our research rigorously before we commenced. Furthermore, this should alert all of us to the importance of having a very clear research question and methodology in advance of starting our research, even if we are do not need to apply for funding.

With a clear purpose in mind and the general IMRAD framework, the road becomes clearer. The International Committee of Medical Journal Editors provides more specific guidelines for content (http://www.icmje.org), and these have been endorsed or serve as a model for most biomedical journals. The ICMJE’s “Uniform Requirements for Manuscripts Submitted to Biomedical Journals” are updated from time to time, and the most recent version should be downloaded from their website before commencing each new manuscript.

In addition to the Uniform Requirements, specific content guidelines exist for the more common genres of biomedical manuscript. We will refer to these in more detail in the chapters to come. However, these should be consulted prior to contemplating a manuscript, and even at the point of designing our research, as this will ensure that our design takes into consideration the information that we will require later for our writing. These widely endorsed guidelines include:

If we have actually chosen the journal to which we intend to submit our manuscript, then we will also wish to consult their specific instructions to authors. An electronic compendium of “Instructions to Authors in the Health Sciences” is maintained by the University of Toledo and provides links to the instructions for more than 3,500 biomedical journals (http://mulford.mco.edu/instru/). 

Key points:

1. The contents of papers are often prescribed by guidelines for specific genres (CONSORT, STARD etc.). Hence, selecting and arranging content is not a major challenge in writing a good paper.
2. A paper is built around the purpose of the research which it describes. If the research did not have a clear purpose to begin with, it will be extremely difficult to create a convincing paper.

Modules in this course: