Study skills and medical writing

1. Study skills and medical writing Professor B. J. Bain Department of Haematology

2. Declaration • The lecturer has no conflict of interest to declare

3. Study Skills and Medical Writing • Some of your teaching is didactic • Some of it requires you to seek out information for yourself or generate data by research and synthesize it into your own work • This lecture deals mainly with the latter • It also deals with medical writing • Essays • Practicals • Scientific articles

4. Study Skills • Science and the Patient starts your preparation for the BSc course • The BSc is different from the rest of the undergraduate medical course • It is more scientific • It is less clinical • Learning is more self-directed • Science and the Patient introduces you to self-directed learning skills

5. Study Skills • These skills are relevant to writing up your 2nd year practical (and to essay writing in year 4) • Some study skills are crucial for you whole medical career • Independent learning • Critical ability • This includes the ability to find information for yourself and assess its validity • You need to think for yourself and question what you are told

6. Wall of British Library Photography K. Bain

7. Study Skills • You need to be able to find information in the scientific literature; you should be using original scientific articles • Not just text books and lecturers’ handouts or Power Point Presentations • To a lesser extent, you need to be able to find and assess the validity of information in alternative electronic sources

8. Study Skills • The ability to write clear concise and accurate English is essential for your whole medical career • It is time to start practicing • So how do you do all this?

9. How to find relevant sources of information • Start with recommended text books and lecture handouts to make sure you have the necessary basic knowledge • When you have done that, search by topic on PubMed or using a search engine to find further up-to date information • Google, Yahoo etc give you a shortcut to relevant articles • PubMed gives you are more exhaustive list

10. Beware! • Beware of websites for patients (sometimes they are very good but their quality is variable) • Be cautious with Wikipedia • Wikipedia often gives high quality information • An article in Nature in 2005 found 162 errors in Wikipedia and 123 in Encyclopaedia Britannica (quoted in Wilkinson N, ‘Tis all in pieces, The Author, Spring 2010, p15) • Original articles are the most reliable source

11. How to find relevant sources of information • Textbooks are a secondary source • The primary source is the original scientific article • Primary sources can be right up-to-date; textbooks are always out of date • You need to learn how to read and assess an original article

12. How to find relevant sources of information • When you have found an article that looks relevant, read the abstract • If the abstract suggests it is relevant, read the article • It is sometimes useful to read the abstract, the introduction and the discussion first since that tells you what the authors think they have discovered

13. How to find relevant sources of information • Once you have done that, read the methods and the results • Sometimes authors misinterpret their own results so read what they actually did and see if you agree with their conclusions • For example, have they claimed to have established something when the results are not statistically significant?

14. How to find relevant sources of information • You may need to go back to earlier articles that are referred to if the authors have assumed knowledge that you do not have • When you find a relevant article in PubMed you will notice that there is also a link to related articles • You may also want to check for published corrections or later letters relating to the article

15. How to find relevant sources of information • You may also want to look at other articles that have cited the article you have found • For essays, don’t bother looking at articles in languages other than English (unless you happen to speak them) • However, for serious research you should try to read anything relevant, despite language problems—read the English abstract and if it seems relevant get some help

16. How to find relevant sources of information • You may be able to make sense of something by using an automatic translation • It will not be good English but it might be intelligible

17. How to find relevant sources of information • In critically reviewing an article there are two important questions to ask yourself • What have the authors discovered? • Is it important – scientifically or clinically? • Statistical significance does not necessarily equate to scientific or clinical significance • Ask yourself if it matters and if so why

18. Other skills • You need to understand and be able to use standard statistical tests • You need to be able to use a word processing package • You need to learn to write accurately, clearly and concisely, using appropriate scientific language

19. Writing an essay • Read the title carefully • Answer the question • Draw up an outline based on what you know and then seek relevant extra information • Start with a BRIEF introduction • Set out your essay in paragraphs so that there is a logical flow • Start by outlining briefly what you are going to do

20. Writing an essay • Then do what you said you were going to do • Finally end with a conclusion or synopsis • Count the words • Shorten if necessary • Always give a list of cited references • If you have drawn heavily on a single source or a few sources, put it or them in a bibliography

21. Writing an essay • If you think your essay needs illustrations, it is better to draw them yourself rather than use anyone else’s—you can scan them in or compose them electronically • If you think a table is needed, compose your own • If you do use someone else’s tables or figures this MUST be acknowledged—otherwise it is plagiarism

22. Writing an essay • Don’t plagiarise • Do cite anyone when you are quoting their ideas or using precise information they have given—if you say ‘53% of British adult males drink more than the advised number of units of alcohol per week’ they reader wants to know your source—cite it • Don’t cite anyone you haven’t read

23. Writing an essay What is plagiarism? Plagiarise, plagiarise Let no-one’s work evade your eyes That’s why the Good Lord made your eyes So don’t shade your eyes But plagiarise, plagiarise, plagiarise…... Remember always to call it research Nikolai Ivanovich Lobachevsky, a song by Tom Lehrer

24. Writing an essay • What is plagiarism? “The act of presenting another’s work or ideas as your own” www.tilt.lib.utsystem.edu

25. Writing an essay • What is plagiarism? www.palgrave.com

26. Writing an essay • What is plagiarism? www.cjpeters.com

27. Writing an essay • What is plagiarism? www.cmu.edu/teaching/resources/plagiarism.html

28. Writing an essay • What is plagiarism? www.cartonstock.com/directory/j/john_grisham.asp

29. Writing an essay Don’t ‘Cut and Paste’ Source: Roger Beale, FT Magazine, April 1/2 2006

30. Writing an essay • What is plagiarism? www.library.appstate.edu

31. An Example of Plagiarism (from a previously respected popular medical writer) 'He took paragraphs from my work, word for word' - psychiatrist faces plagiarism charge· Journal retracts article after US scholar complains· Raj Persaud says credits 'inadvertently omitted'Helen PiddMonday November 7, 2005The GuardianBritain's most ubiquitous psychiatrist was yesterday at the centre of a plagiarism row after it emerged that substantial portions of an article he had written for a medical journal were copied from the work of an American academic.

32. An Example of Plagiarism The article written by Raj Persaud in the February edition of Progress in Neurology and Psychiatry was withdrawn and a retraction printed, but it went unnoticed outside the mental health community. One of the youngest doctors to become a consultant at the highly respected Maudsley teaching hospital in London, and boasting eight degrees, Dr Persaud writes on mental health matters in a string of publications and has presented the Radio 4 psychology programme All in the Mind. The alleged plagiarism came to light when Thomas Blass, professor of psychology at the University of Maryland, happened upon Dr Persaud's article. He said he was shocked by the similarity between Dr Persaud's piece and his work……………..

33. Why the Media Refuses to Obey, by Raj Persaud, Progress in Neurology and Psychiatry, Vol 9, issue 2. "Milgram's study demonstrated with brutal clarity that ordinary individuals could be induced to act destructively even in the absence of physical coercion, and humans need not be innately evil or aberrant to The Man Who Shocked the World, by Professor Thomas Blass PhD, University of Maryland, in Psychology Today (March 2002) "[The study] demonstrated with jarring clarity that ordinary individuals could be induced to act destructively even in the absence of physical coercion, and humans need not be innately evil or aberrant to An Example of Plagiarism

34. Why the Media Refuses to Obey, by Raj Persaud, Progress in Neurology and Psychiatry, Vol 9, issue 2. act in ways that are reprehensible and inhumane. While we would like to believe that when confronted with a moral dilemma we will act as our conscience dictates, Milgram's obedience experiments The Man Who Shocked the World, by Professor Thomas Blass PhD, University of Maryland, in Psychology Today (March 2002) act in ways that are reprehensible and inhumane. While we would like to believe that when confronted with a moral dilemma we will act as our conscience dictates, Milgram's obedience experiments An Example of Plagiarism

35. Why the Media Refuses to Obey, by Raj Persaud, Progress in Neurology and Psychiatry, Vol 9, issue 2. teach us that in a concrete situation with powerful social constraints, our moral sense can be all too easily overwhelmed." The Man Who Shocked the World, by Professor Thomas Blass PhD, University of Maryland, in Psychology Today (March 2002) teach us that in a concrete situation with powerful social constraints, our moral sense can easily be trampled." An Example of Plagiarism

36. Why the Media Refuses to Obey, by Raj Persaud, Progress in Neurology and Psychiatry, Vol 9, issue 2. Milgram's interest in the study of obedience partly emerged out of a deep concern with the suffering of fellow Jews at the hands of the Nazis and an attempt to fathom how the Holocaust could have happened. The Man Who Shocked the World, by Professor Thomas Blass PhD, University of Maryland, in Psychology Today (March 2002) Milgram's interest in the study of obedience also emerged out of a continuing identification with the suffering of fellow Jews at the hands of the Nazis and an attempt to fathom how the Holocaust could have happened. An Example of Plagiarism

37. Writing an essay • What is plagiarism? • What would you think if you read the following in a student essay: “Following the identification of hepatitis C virus it became apparent that this infection is widespread and presents a serious risk to patients with transfusion-dependent thalassaemia. The prevalence of anti-HCV antibodies varies in different parts of the world from 11.7% in Turkish Cypriots to 75% in Italians”

38. Writing an essay • You might suspect plagiarism

39. Writing an essay • You might suspect plagiarism • If you want to convey this information how do you deal with it?

40. Writing an essay • You might suspect plagiarism • If you want to convey this information how do you deal with it? • First find the original references

41. Writing an essay • You might suspect plagiarism • If you want to convey this information how do you deal with it? • First find the original references • Next establish the facts

42. Writing an essay • You might suspect plagiarism • If you want to convey this information how do you deal with it? • First find the original references • Next establish the facts • Then put it in your own words

43. Writing an essay • You might suspect plagiarism • If you want to convey this information how do you deal with it? • First find the original references • Next establish the facts • Then put it in your own words • Then indicate your sources

44. Writing an essay • You might end up with something like this “Since hepatitis C can be transmitted by blood transfusion it is a serious risk to patients, such as those with thalassaemia major, who need regular blood transfusion. This was particularly so in the past before there was adequate testing of donor blood. Wonke et al in 19901 reported that a quarter of 73 thalassaemia major patients had anti-HCV antibodies. The prevalence was…

45. Writing an essay • … 12% in those transfused only in the UK and 44% in those who had been transfused elsewhere. Lau et al2 found a higher prevalence of seropositivity in Hong Kong, 34 of 99 patients having anti-HCV. Both these studies observed a correlation between seropositivity and impaired liver function” • However, at this stage you run into a problem

46. Writing an essay • You would like to give the information about the even higher prevalence reported in Italy (which was mentioned in the textbook from which the extract was taken) but neither of the references with Italian names are available electronically • What do you do?

47. Writing an essay • You would like to give the information about the even higher prevalence reported in Italy (which was mentioned in the textbook from which the extract was taken) but neither of the references with Italian names are available electronically • What do you do? • You have at least 4 choices

48. Writing an essay • Send for both references on interlibrary loan and hope one of them has the information you are looking for • Do a literature search for hepatitis C + transfusion + Italy and see if anything useful turns up • Leave it out • Cite the person who cited it (in this case Weatherall DJ and Clegg JB, The Thalassaemia Syndromes, Blackwell Science, Oxford, p. 309)

49. Writing an essay • If you were sure which reference the information came from it would be best to put it in the form: Cancado RD, Guerra LGM, Rosenfeld MOJA, et al. (1993) Prevalence of hepatitis C virus antibody in beta thalassaemia patients, Fifth International Conference on Thalassaemia, p. 176, Nicosia, Cyprus, cited by Weatherall DJ and Clegg JB, The Thalassaemia Syndromes, Blackwell Science, Oxford, p. 309.

50. Writing an essay • If you use someone else’s words use quotation marks • However it is very irritating to the reader if there are a lot of direct quotes—use your own words • Use direct quotes only if the actual words matter: “I have a dream” www.writespirit.net/.../martin_luther_king_talks