Getting Your Research Papers Published (An Editor Simplifies the process)

Those who write JUST GET MORE OUT OF LIFE. Something unique about academia is how people doing similar amounts of work can be paid differently and get advanced faster based on how many papers they have written. So write the papers, get promoted, turbocharge your career and get to the highest paying tier - which often comes with a nicer, more reputable rank like a professor. But more importantly this is a means to showcase the good work you are already doing to your professional community!

If have been a prolific contributor to the scientific literature and have been a journal editor for 10 years so I will do my best to REALLY simplify this process for you.

Before you write first avoid publishing blues:

At the outset discuss authorship expectations with all relevant parties and have it written in an email to avoid confusion later. Select your target journal, study the journal's manuscript preparation guide on their website, and plan to submit a paper that is shorter, yes, shorter than the journal’s average. If you get into a disagreement about anything related to a paper with your co-authors, I personally err on saving the relationships and don’t get petty about fighting over credit in one paper. Rarely is it worth it but it is possible that you are really early in your career or the stakes are higher especially near your promotion or tenure and may think differently.

Some basic concepts:

If you select the wrong journal, especially when the type of article you are submitting is not a good fit, you will end up with a desk rejection, which means the editor will reject your paper without even a peer-review. An experienced mentor can help you select the most appropriate journal and article type for your submission. If you have an offbeat submission, you can always email the editor directly for guidance.

I print 3 articles on similar topics I am working on from my target journal and use it as a quick reference for styling and formatting. I find this way easier than going through fine print on the journal’s website. Format your paper such that if the editor forwarded it for publication, the copyeditor’s could simply send the article for printing without changing anything. The more you say the more you can be criticized for and the more citations you will need. Define early in your paper, what the scope of your work is and stick to it, do not take any unnecessary tangents or overcomplicate things.

In essence, a scientific paper needs to communicate 4 things

WHY DID YOU START?

WHAT DID YOU DO?

WHAT DID YOU FIND?

And WHAT DOES IT MEAN?

And this translates perfectly to the four sections of a paper - Introduction, Materials and Methods, Results and Discussion.

Introduction-why did you start?

Materials and methods-what did you do?

Results-what did you find?

Discussion-what does it mean?

The title:

It’s super important to get this right!

The title of your paper should accurately describe the paper's content. Be specific about the scope of the study (number of patients in study), indicate its study design (prospective or retrospective), state the subject, and not the conclusion. Avoid abbreviations and acronyms. I personally like longer titles which are descriptive of the amount of effort involved in your study, make them interesting, but also easy to understand. For example: If we had titled this article we published as “Understanding why patients No-Show: Our experience” it would not have highlighted the fact that this was a huge study of 3 million patient visits and is our 16-year multicenter experience.” and took more than 2 years to complete.

I have this preference because when being judged for promotions most reviewers will just read the titles of your papers in your CV and look at the pdfs of your best papers you have submitted, which is typically around 5 or so. There isn’t really time for well-meaning reviewers to download the pdfs of all of your papers listed in your CV and read them in detail. You get the idea.

I also like titles that are eye-catching and arouse curiosity to entice the reader to read your work - like the Charismatic Radiologist or the serious business paper we wrote based on my observations from a trip to Disneyland with my family titled Lessons from the happiest place on Earth.

The abstract:

This is not the same as the presented abstract in this scientific meeting. You need to strictly adhere to the journal's instructions. It should be in complete agreement with the rest of the text of the paper. Don’t include anything which is not in the body of the paper. Conclusion should be specific and conservative since no study is ever perfect or the final verdict on any topic. The abstract is the last part of the paper that you should write.

A good paper should be able to communicate everything a reader needs to know through the abstract, tables and figures with clear descriptive legends. If someone wants to replicate your study they can read the paper!

Introduction:

This selection should provide background information for why you decided to pursue the project. What knowledge gap are you trying to fill? Avoid any new, unusual or vague terms, just clearly describe the purpose of your study in this section and keep it brief.

Materials and methods:

This should be the simplest section to write and could be written even before your data collection is complete. This section should be written in a manner a reader could replicate your study by following along in a systematic manner. Statistical methods you used should be clearly identified and described with input from a statistician. No results should be written in this section.

Results:

This section should start with the major positive findings. Include a table describing the characteristics of your study population, this is called Table 1. Present results in a logical order and do not repeat in detail information that is given in tables and figures. The results should be reported in the target journals format. If necessary use subheadings and so not repeat your methods and things you are discussing subsequently in the discussion section. Do not use more than the journal's average number of tables. While presenting Statistical information, report relative risk and 95% confidence intervals. Use statistical terms correctly for example substantial is a good word to use if what you're describing is not statistically significant. Provide exact P values when possible.

At this point, it is important for me to tell you clearly that regardless of your statistical experience, in most instances you would want to hire a statistician who should ideally design the excel sheet in which you collect your results. Ask your supervisor for allocating some funds to hire one if you don’t have one in house. If you don’t want to tell your supervisor how critical your need for a statistician is - send them this video! If you are indeed blessed with an in-house statistician make sure to be friends with them, they are commonly inundated with projects and you need to be patient with them. It’s always worth the wait in my experience. Sometimes there are biostatistics students who are looking for projects to work on and need authorship in papers. A statistician should always be an author on your paper, there’s no debate here. I have had papers published as senior author where the statistician did such great work that when I saw the final product I could not even believe that this is our work. An amazing statistician who we have worked with on many projects wrote the results section for us along with providing us with the tables and figures with their legends. In the last 15 years of working with him, we have had just 1 complex statistics question and all he said was “I will take care of it” and he did! Enough said, be resourceful and find yourself a good statistician.

Tables:

These should be simple self-explanatory, in the journal's format and not a Verbatim repetition of text described in the paper. Use appropriate units for every variable, exact p-values, appropriate rounding and keep the format consistent with other tables in your manuscript. Be careful with bright colors and grading as some can look rather obnoxious in print.

Figures:

Figures should be used to illustrate the major points. Label axes and other elements in your figures clearly. Don't just use figures from the poster that you submitted. I usually like to have a very thin white line as the margins of the figures with appropriate arrow clearly visible annotations. Have clear detailed legends such that each figure is a complete teaching nugget by itself. If you're a radiologist like I am, just know that any paper without excellent figures will likely be rejected. Make your images pop and spend time to select the highest quality of images available. Make sure that no patient information is included as part of your image. This can be reliably done by taking a screen capture of the image as patient information is often embedded in many image formats.

Discussion:

Start with the most important point in this section. Present no new data in the section and focus on the implications of your results. Stick to the subject, keep it focused and compare your study with previous studies published in the literature on the same topic. Acknowledge the weakness and deficiencies of your study.

No study is ever perfect and acknowledging the weaknesses of your study disarms the reviewer and is likely to increase the odds of acceptance. Discuss alternative explanations for your results. Write clearly and in plain grade english. Keep the section as short as possible. You may have to redefine the scope of your work here to minimize the number of citations you need. There should be no grammatical errors in your paper, do a final review for english grammar and formatting before submitting.

What might not be obvious early in your career is that the authors and editors share a symbiotic relationship. Editor’s too want the best authors to send their best work to their journal. Journals often compete for the same content especially those topics that are trendy. Authors who have a great track record of publishing high quality papers and meeting publication deadlines are more likely to get picked to submit invited commentaries by the editor. Sign up to be a reviewer, submit high-quality reviews, get to know the editor, run your ideas by them even before you have written the paper, seek them out in meetings to say hello, and better yet try to recruit them as your mentor. Just a short conversation with an editor of a journal you want to publish in - can sometimes help you find information regarding what topics the journal is interested in for the forthcoming issues and what their needs are. The information is usually only known to editorial board members or associate editors. Once you find that information, GO WORK HARD TO FILL THAT NEED. 

Bonus tip:

Let me now share my blueprint writing strategy for working with inexperienced researchers and minimize rejections. So when I am working with someone who is still learning scientific writing we have a teaching session in my office or zoom, basically things we’ve discussed so far in this video. This upfront teaching saves exponential time over the course of the project. Then I give them the word files of a paper I have previously published in the same category in the same journal to minimize formatting errors. Once they have that - all they have to do is remove content from the previous topic and change it to the new topic. I diligently save all the files of our submissions to be able to do this effectively. Use templates and minimize reinventing the wheel.

There are predictable reasons why the manuscripts are not accepted for publication. You do not have to make these mistakes. Learn from them and increase the odds of your work getting accepted. 

Here are the TOP 10 REASONS why papers don’t get accepted:

#10 Picking the wrong Journal. It's not funny how commonly this happens. Young authors often don't know much about a target Journal and submit papers which instantly get a desk rejection. For example, I run a radiology journal and see a few dental articles coming through. Clearly the young researcher did not get any guidance about journal selection from their mentors. You need to become familiar with what types of articles your target journal publishes - topics, format, article length, number of tables and figures and overall journal focus. Subscribe to e-TOC’s of several journals you want to publish in and just scan through the topics as you get these emails in your Inbox. After a few months you will really understand which topics are a good fit for which journal.

#9 Submitting something that isn't what the journal publishes. Even though you may have selected a good journal for your speciality you could end up submitting an article type which is a misfit. You can submit a high quality original research and submit it to a journal that only publishes review articles for example. INSTANT DESK REJECTION again. Ask your mentors or senior colleagues. Anyone with a bit of experience should be able to help you out with this one.

#8 not following Journal instructions - this one is easy. The higher the journal’s impact factor the more likely they are to be picky about formatting and journal staff will likely return your submission if you do not follow instructions. You don’t want the editor to see a manuscript which does not have attention to detail - You will look really bad and will be recognized the next time you submit another paper. Don’t spoil your reputation. Pay attention to small details, it’s important.

#7 Bad writing. Get help. Find a mentor. Just because you have a good grasp of English as a language does not automatically make you a proficient writer of scientific research. Just because I did not understand this nuance I went through 17 rejections in the first 2 years of my career. I learnt this lesson quickly, albeit the hard way and eventually all of these papers were accepted.

For fun, let me read you this paragraph someone actually wrote:

“The algorithm fathoms in a synergetic manner globally, and an antagonistic depth quest locally.”

Whatever that means!

Don't get me wrong, while this paper was likely very useful and informative, you can only imaging the frustrations of the reviewers and editors over such overcomplication in the english language!

I will say this as clearly as I can here - Say what you mean, MEAN WHAT YOU SAY and don't use big words.

The secret sauce to good medical writing is 3-fold: have something useful to say; say it as briefly as you can, then GET OUT OF THERE. Use short words; short sentences; short first paragraphs AND if it's possible to cut a word out always cut it out. Avoid passive phrases when you can use an active phrase. Don’t use a jargon word if you can think of an everyday English equivalent; don’t use clinical slangs or cliches, unconventional abbreviations, Pejoratives or unnecessary information about patients.

#6 Getting carried away in the discussion. Articles are commonly rejected for erroneous or unsupported conclusions, interpretation of results not concordant with the data provided, non-concordance of findings to the current practice and policy, and failure to consider alternative explanations. Okay that was a mouthful! In other words, LET YOUR DATA DO THE TALKING. Avoid any conflicts of interest particularly if you have industry conflicts, and acknowledge all study limitations.

#5 Suboptimal reporting of results. A good statistician can help here and ideally should be writing the results section for you unless you have a degree in biostatistics. You already know where I stand on this one!

#4 Inadequate description of the methods. Write your materials and methods as soon as you design the study, before you forget the details. You will be glad you wrote this early and psychologically are building momentum in your paper preparation.

#3 Poor study design. Now this can kill a paper, it’s a fatal flaw. If you get these words in your review, try submitting to another journal. To avoid this everyone including the senior mentors and statisticians should attend the initial study design meeting. Internally critique the research methodology and take diligent notes of the weaknesses being discussed. These are things to be mentioned in the limitations sections of the article.

#2 Not revising and resubmitting the paper. Now you’ve done everything right up to this point and get a request for revisions with a long list of changes requested. The longest list I have seen is 80 changes requested for one of our papers. Ask for more time from the editor, if you need it as a last resort. Life happens and many editor’s will be accommodating if you ask nicely. In most cases 4-6 weeks should be plenty to revise a paper. Diligently address all comments. Be respectful to the reviewer's comments. You can disagree a little bit but use citations to support your opinions.

Here is my method to respond to comments when submitting a revision:

Write a detailed cover letter to the editor with your revisions - Address comments point by point with every issue raised by the reviewers. - submit both annotated and clean versions. Goal is to make it really easy for the editor, so that the article does not need to be sent back to the reviewers and the editor can just accept the revisions themselves quickly.

Thank the reviewers, praise their insight and acknowledge their expertise.

Don't be nasty or unprofessional EVER.

DON'T - JUST DON’T respond with a point-by-point rebuttal for all issues raised by the reviewers!

At #1 “Drumroll Please” is NOT writing the paper in the first place! You and I both know this. We’ve all been there. Get over that writer’s block. We all have something important to say so just say it and once you have an article written, keep flogging it until it ends up in print. I had one that was accepted in the 3rd journal I submitted it to. Another paper got trashed in one journal only to have another editor from a different journal love it so much that it was featured on the cover page! Peer-review is not perfect! The mantra is if it is good enough to be written about it is good enough to end up in print. Be persistent!

Now bonus content, here is my 5-step writing process:

Step 1. Make a one-page outline with sections and bullet points for each section. This is your blueprint.

Step 2. Finalize the tables and figures with legends.

Step 3. Get permissions for any tables you want to use from another article - this can take a few weeks to obtain so the earlier you start the better. Assign sections to co-authors esp those sections that are not in your area of expertise and agree on internal deadlines. Send periodic reminders and check in frequently.

Step 4. Right one small section at a time and BUILD momentum. This process is called chunking- it is a very effective technique. Compile all sections from your co-authors.

Step 5. Accept a crappy first draft. Getting the first draft out is the hardest part of the paper so get that out of the way quickly. Shamelessly send it to your co-authors and ask them to edit. Don’t get emotional here. First drafts always suck!

Let me know in the comments in the video above which ideas resonated with you and which didn’t. Anything I did not cover; you think I should have? Share if you have a different approach for writing a research paper? I welcome any feedback, ideas, suggestions and respond to all comments.

Acknowledgements and background: In 2008, I attended a faculty development session at the University of Washington conducted by Dr David Pierson who has since retired. This video and blog have been prepared from my notes which I still possess and cherish. That one hour and my mentor Dr Douglas Katz who have taught me the nuances of scientific writing for which I will be forever indebted.

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