Publishing a manuscript: a guide for medical students

1. Publishing a manuscript: a guide for medical students Nicholas G. Zaorsky, M.D. 14 August 2013

2. Why give this talk? • Publications are important • acceptance to med school • residency/fellowship match • job search • future goals, discovery, leading a field • interest/commitment to a field • practical (i.e. non-USMLE) knowledge of a specialty • Few med schools have a course on publication

6. Take-home message: Learning to publish a paper is important yet difficult -- even radiation oncology residents, who perform the most research compared to any other field, finish with only 1IJROBP publication after 4 years training.

7. Goal of presentation:Teach physicians-in-training the general guidelines of how to publish a manuscript.

8. What we will cover today: General guidelines • Requirements for any publication • Types of submissions • Writing process • Submission process “Publishing a manuscript is like doing an H/P for a patient: your first attempt will be poor, but after some practice, you will be able to do it effectively and efficiently.”

9. Requirements for any publication • Mentor / senior author • Unique angle / fill a gap in literature • Target where you are submitting • Data / results • Publicity / “quotability” “I have spent more time not publishing a manuscript than publishing a manuscript.”

10. Mentor / senior author • Knowledgeable • Determined, persistent • Critical of your work • leaves many helpful comments • does not just say “looks good. submit.” • Flexible to meet / message • Clearly publishes a lot • listed as 1st or last author on publications • being on a manuscript ≠ being a good mentor

11. What are features of a unique work that fills a gap in literature? “There are at least two problems with medicine: (1) in 100 years, half of it will be proven to be false; (2) we don’t know which half.” Your research can fill a gap in the literature if itaddresses these problems.

12. What are features of a unique work that fills a gap in literature? • Has a clear hypothesis, endpoints • Should come from mentor • Previously unpublished / not well understood • Attending thinks it’s a good idea ≠ always a good idea • Has a target audience • Influence • clinical decision making • health care policy / reform • medical education

13. Example Hypothesis: Surgery and RT are the ideal management of chondrosarcomas of hyoid bone Unique angle: … actually, this is not published; we could write a review The audience: oncologists who will encounter this disease The review will influence clinical decision making

14. Target for submission Abstract / poster: National meeting • “Googleable” • Chance for oral presentation • Network at meeting • e.g.: • ASCO • ASTRO • ABS • Problem with all abstracts: limited impact on CV Manuscript: Journal • “Googleable” • Listed on PubMed • High impact factor • No / small fee • Well known in field • e.g.: • IJROBP (Red Journal) • Radiotherapy and Oncology (Green Journal) • Cancer

15. How do you link your results to your target? SEARCH: head neck cancer journal impact factor otolaryngology journal impact factor oncology journal impact factor journals of different disciplines may be interested in your work

16. How do you link your results to your target?

17. Do the aims/scope of this journal match up with your data?

18. Impact factor IF = [# of times this journal was referenced by someone else]/[# of times this journal referenced someone else] • Guidelines / breakthroughs: >~15 • Excellent: ~8-20 • Great: ~4-10 • Good: ~2-5 • OK: ~1 • Unlisted • New • Case reports / editorials • Recent “open access” • Not a real journal

19. Impact factor • What is “citable”? • What about journals that limit # of references? (↓ denominator) • Reviewers recommend referencing their own journal (self citing to ↑ IF) • Case reports unlikely to be in high-impact journal • IF does not always correlate with research quality

20. Download their articles to see if yours would fit the theme.

21. Data / results • The most import part of the paper. • If you cannot get data / results, do not bother with the rest. “When you write a manuscript, make the tables and figures first, and write the results section second.”

22. Publicity / “quotability” Before you write it, think: • Publicity: “Could the outcomes of this study get quoted in the news?” • Quotability: “Would this paper be referenced by other experts in the field?” If the answer is “no” to both, then your talents may be better spent on another project.

23. Publicity “Could the outcomes of this study get quoted in the news?”

24. “Quotability” h-index: A scientist has index h if h of his/herNppapers have at least h citations each, and the other (Np − h) papers have no more thanh-citations each. great papers that get quoted a lot h-index either great papers that will get quoted later OR things that will never get quoted by anyone

25. h-index in radiation oncology • Greater h-index correlates with academic rank • Resident: • bottom 10% of programs: 0.2 – 0.8 • top 10% of programs: 4 – 5 • Attending: • All rad onc attending mean: 8 • Junior to senior cutoff: 15 (p < 0.005) • Program director median: 9 (range, 0 - 38) • Chairperson median: 29 (range, 3 - 60) • Choi et al. Estimation of citation-based scholarly activity among Radiation oncology faculty at domestic residency-training Institutions: 1996–2007. IJROBP. 74(1):173-178. 2009. • Rana et al.Scholastic activity among radiation oncology residents at US academic institutions: A benchmark analysis of h-index. IJROBP. 84(3S):547. Abs #2876. 2012.

26. General guidelines • Requirements for any publication • Types of submissions • Writing process • Submission process

27. Types of submissions From a medical student’s perspective: Retrospective case series, reviews, and surveys are generally easiest to publish as a first author in a good journal.

28. General guidelines • Requirements for any publication • Types of submissions • Writing process • Submission process

29. Writing process • Mentor / senior author • Unique angle / fill a gap in literature • Target where you are submitting Do you need additional: coauthors? statistics? Manuscript Analysis Tables / figures • Data Until you can prove yourself, you will be stuck here. Results How were data obtained? Materials / methods When you are efficient, this should take 1-2 days. Once you are good, people will come with the preceding stuff to you. Why did you want to do this? Intro What is interesting about results? Discussion What is take-home message? Conclusion What is this paper about? Abstract

30. Writing process “When you write a manuscript, write it like you are telling a story.” “When you write the abstract, copy and paste it from parts of your manuscript.”

31. Writing process: coauthors A.A., B.B., C.C., D.D., E.E., F.F., … , Z.Z. • Senior author • Provides most guidance • Affects author’s h-index: yes • Importance for CV: ++ • Co-authors • Statisticians • Data collectors • Experts on the topic • Department chairs • Review / comment on your manuscript • The equivalent of “consultants” for a patient • Affects author’s h-index: yes • Importance for CV: + • First author / • *Co-first author(s) • Writer(s) of the manuscript • Legwork • +/- data collection • Affects author’s h-index: yes • Importance for CV: ++ • Corresponding author • Unless otherwise specified, one person responsible for sending solicitation, receiving invitation, submission, responses to journals, press release • By convention, typically someone who won’t have Δ contact information or is remaining at the institution *: keep in mind as a possibility; you can list this as first authorship on your CV

32. Writing process “Be generous with your author lines.” “There should be ≥2 trainees on each author line -- it benefits everyone, now and later.”

33. Writing process • Organize data • Analyze data • What will the tables look like? • What will the figures look like? • Maximize your efficiency:data → results → full manuscript • MS Word • Complementary programs

34. Organize data • Place data in to one Dropbox folder • Background PDFs: (name) (year) (j) (brief title) • XLSX files: • analyzability is key • Empty cell ≠ “unable to assess” • DOCX files: (title) (type) (version/revised by) • Images • Share the folder with appropriate coauthors

35. Maximizing efficiency MS Word Complementary programs

36. Maximizing efficiency • MS Word • Ribbon • Symbols • Split Window function • Proof\Custom dictionaries • Save\AutoSave\Dropbox • Table properties… 0.01” margins • Merging cells • Using one MS template • Deleting metadata • Complementary programs • MS Office • Excel • PowerPoint • Photoshop • EndNote • Dropbox • FoxIt • KatMouse • Chrome • Google Dictionary extension • LastPass extension • Rapportive extension • Google Scholar • Institutional PubMed Portal • JustBeamIt • Lifehacker Bookstore; Department copy; Download Freeware; Ninite.com

37. MS Word • Ribbon • Symbols • Split Window function • Proof\Custom dictionaries • Save\AutoSave\Dropbox • Table properties… 0.01” margins • Merging cells • Using one MS template • Deleting metadata

38. Complementary programs

39. Excel / PowerPoint • Use for: • Figures • Quick analysis • Creating a figure: • Copy and paste figures directly into PPTX slide and save as a vector, ± rasters • “Save as…” • “Print screen” feature and save as a raster • Photoshop • MS paint

40. Figures / images • Surrogate marker for your manuscript • Black and white preferable, esp. for print • Color OK online • RYGB is best • Intuitive (e.g. red = oxygenated blood; blue = deoxygenated blood) • Sans serif font (e.g. Arial) • Clearly labeled axes • Thick lines • Consistency with the manuscript

41. Humans prefer RYGB colors, sans serif fonts

42. Figure / image types Vector • Mathematical formula to make lines • Quality • Listening to symphony • “Resolution”: ∞ • Better than raster for quality • File types • Can be embedded in .PPTX file without loss of quality Raster • Digitized version with pixels • Quality • Symphony on MP3: it’s good enough for most purposes • Resolution is key • Minimum: 1200 x 800 • DPI is a meaningless term • Minimum: imposed as ≥ 300 • File types: • JPG, GIF, TIFF • Can also be embedded in .PPTX file ± loss of quality

43. Figure / image types Vector Raster A

44. Figures / images • What is wrong with this Figure? British English Image x y dimensions squished Inconsistent use of periods Inconsistency in “4D PET CT” Superscripted and missing parenthesis Inconsistent sig figs Color variation in text and bars SDs not equal Purple axes Why is the volume the dependent variable? Forgot to crop pointer Why is it a rasterized image when it could be a vector?

45. Figures / images “A picture is worth a thousand words.” “You can’t polish a turd.” “Your submission has been sent back to you because your figures do not meet the journal guidelines.” - Editorial office

46. Dropbox (root folder): • Make 1 folder for each collaborative project • Share with coauthors • Know manuscript completion status • Synchronize large amount of data • Access all references, PDFs • Data backup • UTD files are with you anywhere you go (e.g. statistics department) • MS Temp files • Smartphone pictures auto-synchronization • e.g. signatures • Master ENL file • You can still send recent versions of manuscript via email

47. EndNote • Install it, check the MS Word bar • Read the manual • Edit\Preferences… • Folder locations • Temporary citations • Duplicates\automatically discard duplicates • Edit\Output Styles • Download your target’s PDFs for reference • Tools\Open Term Lists\Journals Term Lists

48. EndNote • Save 1 master library in your Dropbox • References: • Create references • Import from PubMed • search with 3 names / words; # patients; “unique” words • Avoid duplicates • Drag references into manuscript • Manage your style • Click update • Managing sequential references

49. FoxIt PDF Reader • Superior alternative to Adobe Acrobat • Version 5.4.5 is the best, IMO • Highlight • Insert text, images, shapes • e.g. signatures (as the original JPGs, or drawn on with the program’s e-pen) • Search • e.g. • “What predicts FFBF in HDR-BT for PCa?” • “Find a reference for this statement.”

50. KatMouse • PACS has a multi-window scroll feature • KatMouse brings this feature to Windows • Select which programs are • included • excluded