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International Medical Graduates

Getting Published

Frank Davidoff, MD, MACP
Former ACP Senior Vice President
Editor Emeritus, Annals of Internal Medicine
Wethersfield, Connecticut

Ten toughest issues in getting a paper published in a major medical journal:

1. Pick your topic very carefully.

  • Is it interesting?
  • Is it important?
  • Why?

2. Decide very early on the purpose of your paper, and state it very clearly. Are you:

  • Testing a hypothesis?
  • Generating a hypothesis?
  • Writing a commentary?
  • Reviewing an area?

3. Don't work alone

  • Connect with a group, or find a mentor
  • Use help on both scientific issues and writing (clear writing is a problem for everyone, not just for those whose second language is English; bad science won't be improved by good writing, but good science can be ignored because it isn't well described)
  • If the work involves experimental design, analysis of data, and quantitation of any sort, involve a statistician right from the start
  • Read and follow the advice in Tom Lang's book (Lang and Secic, How to Report Statistics in Medicine, published by ACP), also Bailar and Mostellar's article on guidelines for statistical reporting (Ann Intern Med, 1988;108:266-73
  • Get others to critique your work along the way (including the final manuscript); present it at seminars and conferences and ask for comments and questions
  • Read Ed Huth's book, Writing and Publishing in Medicine (Williams and Wilkins-Lippincott, 1999)

4. Pick the journal where you submit your paper very carefully, after getting familiar with the journal's purpose and content - your paper needs to match the interests of the journal as closely as possible

5. Get familiar with publication standards: the Uniform Requirements for Submission of Manuscripts to Biomedical Journals (at www.icmje.org) can be very helpful. Also get to know the current recommendations for publishing studies of certain types, including randomized controlled trials (for example, the CONSORT guidelines), studies of diagnostic tests, meta-analyses, economic analyses, and case reports.

6. Read the journal's Information for Authors (or Instructions for Authors) very carefully and before you write your paper, and follow them to the letter

7. Before sending in your manuscript, call or e-mail the editor to inquire whether they would be interested in your paper; or send a single copy of the Abstract (with a cover letter) or of the draft manuscript to the editor for an opinion on whether the paper would be suitable for the journal

8. Pay special attention when writing certain kinds of papers, particularly:

  • Case reports: it's tempting to write these, because they seem easy to write, but medical journals today publish relatively few case reports. A case needs to be more than just rare or "interesting" to be worth publishing: it should have a very clear and very important purpose: a serious but under-recognized drug reaction; a new disease; an important new clue to diagnosis or successful management
  • Reviews: "narrative" reviews - that is, reviews that cover whatever the writer happens to know about, have on hand, or be interested in - are potentially biased. It's much better to write a systematic review, which involves a lot more labor but exhaustively searches the world's literature, and selects studies to be covered in the review on the basis of pre-defined quality standards. Read the book on systematic reviews by Mulrow and Cook (Mulrow C, Cook D. Systematic Reviews. Philadelphia, PA, ACP, 1998).

9. Learn how the reviewers of your paper will think by learning the skills of critical assessment, and applying them on rounds and in journal clubs. It also helps to review papers for journals, if you can. Your mentor may be able to help you to get to do this.

10. Don't give up. If your paper is rejected, think of the editors' and reviewers' comments as a free expert consultation, and revise your paper in response to all of their criticisms and suggestions. Most papers aren't accepted on the first submission, but many that are initially rejected eventually get published somewhere (about 65% of the papers rejected by Annals are published elsewhere within 3 years).

Brief Bio:

Frank Davidoff is a graduate from Columbia University, New York. He did his residency in Internal Medicine and a fellowship in Endocrinology at Massachusetts General Hospital, and was Director of the Diabetes Unit at Beth Israel Hospital in Boston, Massachusetts for 8 years. In 1987 he was appointed Senior Vice President for Education of the American College of Physicians and served until March 1995 at which time he was appointed Editor of the Annals of Internal Medicine. He served as editor until 2001. He received his ABIM in 1966, and is a Master of the ACP and a Fellow of the College of Physicians of Philadelphia. He is a founding member of the Society of General Internal Medicine. Dr. Davidoff has served on Study Sections of the NIH, and advisory panels of the National Academy of Sciences, National Research Council, American Board of Internal Medicine and the National Board of Medical Examiners.

This article was prepared for the ACP IMG Web site in 2000.

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