It’s time to make the donuts…

Or to write the manuscript, depending on how you look at things.

Spring is a big meeting season, as most of us in academic medicine are aware.  That also means that I am in the throes of mentoring one or two folks through writing their first manuscript(s), something that can feel pretty daunting (for both them and me). I’ve found that my advice on the writing process has been fairly consistent for years now, and new manuscript writers tell me that it usually works for them. So, without any additional fanfare, here’s “Manuscript Writing 101” from me.*

  • Check the Guide for Authors for your journal of choice. It’s best to know where you want to submit before you start writing; this can significantly impact how much you write (is there a word limitation?) and will influence how you structure your manuscript. If you have that information at the beginning and lay out your manuscript to conform, you don’t have to spend time later cleaning things up.
  • Start writing with the Methods section.  This is the part that is the most formulaic and requires the least creativity because the goal is to simply report on what you did for your study.  That means that you report IRB approval/ exemption (please don’t forget that!), you report your study design, you report your data collection methods, you report your data analysis methods.  Yes, I’m making it sound dreary with all of this reporting, and that may be true.  It also is a great place to start because it gives you the satisfaction of getting something onto the written page.  Staring at a blank page can be both frustrating and discouraging.
  • Results come next. Other than potentially discussing a sophisticated data analysis technique, results are the second-easiest section of a manuscript to write.  Again, you are just reporting the findings- no interpretation needed at this point.  Like the methods section, this is often fairly formulaic and can be walked through in a logical, stepwise fashion. Like the Methods section, while there may be some tedium associated with writing the Results, there is the inherent confidence booster of getting something written.
  • Conclusions/ Discussion. Different journals may have different titles for this section.  This is the first “fun” section that you get to write- and when I say fun, I mean that you get to interpret the results.  I always encourage people to look at their results section and identify one key story that is worth telling; there may be one or two subplots, but there should be a coherent story that the results support. You want to tell that story.  You want to put that story within the context of other related literature that is out there- both literature that supports your findings and literature that contravenes your findings- and you want to explain clearly WHY your study is new and different.  I refer to the story that you tell here as the, “So what?!?”  You need to sell the reader on the importance and the impact of what you’re telling them.  Of note, you should discuss the limitations of your study (and all studies have limitations, so don’t pretend that yours doesn’t). That may seem anathema to making your story the best, most interesting story ever, but if you don’t identify the flaws in what you’ve done, someone else will, and they might even try to expand upon them in ways that aren’t entirely accurate.  The good news is that discussion of limitations in a study can often segue nicely into a discussion of future directions for research based upon your findings.  And yes, you want to include future directions in any Discussion that you write.  If your project isn’t important enough to be built upon, it’s probably not important enough for publication.
  • Last, though not least, the Introduction. I know that it seems crazy to write the Introduction last, and it may well be. However, I spent years scrapping and almost entirely rewriting Intros that I wrote first because I realized that they didn’t suit what I put in the rest of the manuscript.  Now I always write my introduction last because I know what the story is that I want to tell and I am able to set a framework for why it’s relevant.  Don’t forget to indicate your hypothesis/ research question as part of your introduction- that’s the one thing that it’s reasonable to write before the rest of the manuscript.
  • Pro Tip: As I work on my Results and Methods sections, if I encounter ideas that I think are important for laying the groundwork in the introduction or that constitute key points for the story in the discussion, I’ll throw a few quick notes into those areas to help my memory when I get to writing those sections.  If I end up stepping away from a manuscript for days to weeks, I don’t have to do as much excavation to remember what I wanted to say.
  • Put it all together, edit for content and grammar, get your coauthors to review and comment, then SUBMIT!


*Please remember that the pathway described above assumes that you have already done all of the Very Unglamorous Grunt Work of the IRB, data collection and analysis, and even writing an abstract that gets accepted for meeting presentation. Your mileage may vary.


Experienced authors, do you have any other manuscript writing tips or tricks?  Please share!


Why I write

If you follow me on Twitter, you know that I was bemoaning a wicked case of writer’s block earlier this week.

I think it was multifactorial- I just came off of clinical service and was processing more than a few challenging situations.  Fall is always bumpy for me- the wild Vata energy of change, change, change unmoors me, and I struggle to stay grounded between when the winds start (usually mid-September) and when it first snows (hopefully this week).  And from a purely cognitive perspective, I needed a brain dump.  I’ve been going at a dead sprint since the 1st of October, the night before I flew out to the AWS Annual Conference and the ACS Clinical Congress.  It’s fascinating that when I objectively look at the pace of my life and the things that I do, it suddenly becomes crystal clear to me why I need breathing room every once in a while.

Describing it as a case of writer’s block, however, also gave me a context this week for really thinking about this space where I blog.  According to my dashboard, this is my 154th post here, and December 9 will mark 2 years for Life in the Wild West (we should celebrate with Cookie O’Clock!).  I’ve confessed more than once that I started the blog as a literary way of “throwing spaghetti against the wall”; what I didn’t know is how well it would stick, nor the impact I would find it having as both friends and strangers tell me that they read the blog regularly.  At first the Blog wasn’t something I spent a lot of time drawing attention to, maybe because I didn’t want to be everyone’s favorite crazy aunt.  Then Niraj Gusani “outed” the Blog at the Academic Surgical Congress in 2014 and it took off like wildfire (Niraj, I’m grateful, and I owe you many more cookies).  It now goes on my slides when I give a talk, and I have a link to it in my email signatures at work.  I’ve found it to be a place of healing and sharing, and it has quietly created a community that hopefully allows medical students, residents, and practicing physicians to realize that it’s not just any one of us, that many of our hard experiences in this profession are more common than almost anyone wants to admit.

I know that plenty of people think about the blog as “one more thing” I have taken onto my already very full plate, and I suppose there is some merit to their argument.  A blog post can take me anywhere from 15 to 40 minutes, depending on if I’m just riffing and thinking on the screen (tonight) or if I actually do some background work to make it more academic.  What I have realized over the last almost-two years is that the blog gives me a great place to process information and to share things I’m thinking about, often getting input from people with very different perspectives and lives than mine.  I have also learned that if anything, it has helped my academic productivity; it used to be that I would have large breaks between episodes of writing for my research, and it was always a challenge to get back into the flow.  I sense less struggle now when I return to my “academic” writing because I’ve been writing, I’ve stayed in practice.  It reminds me of a more public version of the Big Chief tablet (anyone else remember those?!?) my 7th grade English teacher required us to write in for 10 minutes at the start of every class.  It took me many years to realize how much that practice helped me become a better writer.

So, I write.  I write to share.  I write to normalize.  I write to fight shame (sometimes my own, sometimes trying to ward off others’).  I write because it’s part of what I do and who I am.