EFFECTIVE MEDICAL WRITING AND CRITICAL INTERPRETATION OF THE

EFFECTIVE MEDICAL WRITING AND CRITICAL INTERPRETATION OF THE LITERATURE

PREPARING A SCIENTIFIC PAPER

What is the purpose? • Graduation • Advance knowledge • Learn about the value of published manuscripts and how to evaluate what you read (Critical Thinking)

Should I write it? • Is the topic relevant? Will it benefit the orthopaedic patient or community? • Is it already in the literature? • Does our institution have the resources to carry out the study? • Do I have time to complete the entire project? • Does the project require the buy in or support of another party? B. Morrey

How to go about it • Plan, plan (“Plans are nothing, planning is everything” DDE, 1941) • Have a mentor

STEP 1 Ask a question

STEP 2 Refine the question

STEP 3 Critical Literature Review OOPS!!

ANSWER FOUND: • Write a review paper • Or, better, a metaanalysis • Or, ask another question (Back to step #1)

STEP 5 • Find out how relevant your question is • The first step in the peer review process • Use colleagues, mentor, enemies, cynics

STEP 6 Write the introduction and state the hypothesis

Always ask a question that will yield an answer and, thus, a publishable result

STEP 7 • Formulate a study design. • What is the best way to address the question(clinical, lab, etc. ) ? • The Randomized Clinical Trial is the gold standard.

STUDY DESIGN • RCT • Cohort study: prospective or retrospective • Prospective is always preferred

Even with cohort study you need comparisons • Historical controls • Case matched • Population matched

Historical Controls • Weak • Key variables not addressed or identified • Not contemporary (Nobody does it that way now!!) • Key outcomes not measured or reported (Ex: hip ROM & xrays vs. WOMAC)

Case or population matched (prospective) • Key variables can be defined up front and patients or populations can be matched • Outcomes can be defined • A power study can be done

STEP 8 • Do the experiment • Have a finish line and date • Have an alternative (abortion) plan.

STEP 9 • • Keep good records Timely recording Accurate recording Lab notebook/file

STEP 10 • When data collection nears completion, write Materials and Methods • Materials= study subjects • Methods in sufficient detail so that any one could repeat the experiment • Statistics

STEP 11: RESULTS • • Clear, concise Good graphics Significant only Distinguish statistical and clinical significance

STEP 12: DISCUSSION • Hypothesis- prove or disprove • Compare with other studies in literature (pro and con) • Brief conclusion : the take home message • Remember that most papers only have one message

STEP 13 • Local peer review : friends, family, foe • What is not clear? • Heckman test • Abjure pride of authorship

STEP 14: AUTHORSHIP (Who qualifies? ? ) • Significant ongoing contribution • More than technical • Can defend entire paper in a public forum • No courtesy authorship

STEP 15 Send manuscript to the journal that will perform the most rigorous peer review (overshoot!)

STEP 16 • Never give up • Revise and resubmit • Virtually all manuscripts get published!!

HELPFUL HINTS • • Follow the Instructions to Authors Brevity Focus on Subject Limit speculation/opinion Use easy to read format Use a few key illustrations Never give up!

CRITICAL INTERPRETATION OF THE LITERATURE

Is the paper hypothesis driven? • What is the hypothesis? • Was it tested?

Is the question relevant to clinical practice? Clinical significance vs. statistical significance

It has been said that a fellow with one leg frozen in ice and the other leg in boiling water is comfortable, on average. J. M. Yancey

Was the proper methodology used to address the question posed in the hypothesis? • Research design • Statistics

Are the results reported clearly and concisely? Are they consistent with the question asked?

Is the discussion reasonable or speculative?