First and second year medical students often are anxious about the “need” to publish but have trouble finding details about the process and goals of writing. Yes, it’s true. If you are going to be applying in a competitive specialty, you need to have at least one (but maybe a few more) publications. BUT (and this is really important, so please pay attention) there are two important things for you to know:
It’s called academic medicine because we are part of the academy! That means that we are trying to teach and change outcomes for the future. Don’t look on these papers as a “check box”. Find a meaningful question and learn from a mentor how to answer it. You will make a difference!
Secondly, you do NOT have to publish in the field you will ultimately choose. Publications are really a surrogate for being able to think, work in a team, and write. It’s showing that you can take a complex task and actually complete it. No one expects a first or second year student to know they want to be an expert in the pathology of Hodgkin’s disease! The key is to find a mentor who will teach you the process and show you how meaningful and fun it is to study something in depth and then share what you learned with others.
So how do you do this? It starts with a blank form:
So let’s break down the five steps from starting to publishing a clinical research project…. The times in parentheses are my estimates for how long this takes for a student who is on clinical rotations. If you are doing this full time as an month long research elective, it will take less time for each step. (But – note to self – you need to get the IRB request in 2 months before your research elective starts!)
Store your PDFs in Zotero – you can attach it as a file if it doesn’t automatically download. Don’t forget to add the Zotero plugin to Word if it doesn’t automatically install.
This last step is the key step (my opinion, others may have other strategies). My goal is to read each article ONCE. Therefore, I put EVERYTHING I think might be of interest from each article as I create my outline. It’s a lot easier to edit things out than add things in…
I start with an outline in Word that has headings something like this….
- Introduction
- Epidemiology
- Pathophysiology
- Natural history of the disease
- Presentation
- Treatment
- Outcomes
- Complications
So, I might read this paragraph in an article written by Smith et al in 2015 (I’m making this up – don’t quote anything written below!)
Pyloric stenosis was first described in 1886. Prior to the introduction of surgical treatment, the death rate was 50%. Surgery, which started in 1923 has now led to an almost 100% success rate with no mortality. The typical patient is male, and 4-6 weeks of age. They present with projectile, non-bilious vomiting and do not appear ill between episodes of vomiting.
So – using the outline in Word and Zotero I would do this…..
You then go on to subsequent articles and – even if they mention the same detail – you put it into the outline. For example, if you found 4 articles that said the typical age was 4-6 weeks, it would look like this: Typically 4-6 weeks (Smith, 2015) (Brown, 2011), (Jones, 2000) (Who, 1014)
Next, use your outline to start actually writing about the information you have gathered. As an example, switch to the “text” setting to change your note about age at presentation from “Typically 4-6 weeks (Smith, 2015) (Brown, 2011), (Jones, 2000) (Who, 1014)” to text that says “The average age at presentation is 4-6 weeks (Smith, 2015) (Brown, 2011), (Jones, 2000) (Who, 1014)”
How to save yourself hours by using Outline View properly
The Institutional Review Board is responsible for protecting patients participating in research. Even if you are “only” reviewing charts, they must be protected with respect to confidentiality, etc. This is not usually true for case reports, but since many journals require IRB approval, you may have to submit it anyway and have the IRB letter that says it’s exempt.
It takes approximately 6-8 weeks to get the IRB approval after it is submitted. If they require modifications, it can take longer. You can’t (and shouldn’t) look at charts until you get this approval.
You must have IRB approval before you can submit the list of patients from the hospital with the disease you are studying. If they are treated by doctors other than the faculty you are working with, the IRB may ask you to send a letter via the hospital medical staff office to the other doctors giving them the option to exclude their patients if they want to. (They virtually never do, but this is a required step)
The “term paper” is just what is sounds like. Depending on the topic, it will be ~6-15 pages long with ~20-60 references. Here is where the outline and Zotero are so important.
Change the “view” in your outline to “draft”. The outline levels will be in Blue and will now be section headings. Everything that you wrote as text will be just that – text. You can write in this view or go back and forth between the draft and the outline if you want to rearrange sections.
All of the links to the references you put into Zotero using “Add/Edit Citation” will be in your draft. At this point, you click on “Add/Edit Bibliography”. It will prompt you to choose which journal you want (Yes! It knows the format of all the major journals!) and then will automatically create the bibliography. If you add new references in at the top of the manuscript, or change the order of the sections, you click this again, and it recreates the bibliography in the correct order.
As you are creating the outline, you are also designing the “data sheet” to retrieve from the charts the details you need to prove your hypothesis.
Writing a term paper is a great way to become an expert in the topic you are researching, but it also helps you later. The hardest part of any final paper to write is the introduction and conclusion – which you mostly do by writing the term paper!
Once you’ve got to this stage, you want to skim through the articles again to see if there are any “big picture” points you might have missed and then write the summary – i.e. the abstract.
It is ALWAYS better to write the abstract after the manuscript if you can. But – many times the deadline for the abstract will be used as the motivation/pressure to write the manuscript. Each attending will do this a little differently.
Use this section as a “journal” for your submission and for notes during meetings.
Good luck with your projects! I hope this helped!
