The rest of the story

Some of y’all have been helping me to celebrate a not-so-little piece of work that was published last week, and I truly appreciate the enthusiasm for the manuscript and what it means for our understanding of mentoring in academic surgery. When I posted that this work was a labor of love for me I meant it; I started looking into questions around mentoring in surgery when I was a resident through my ASE SERF project.  At that time, what I really wanted to do was a qualitative project that would help us better understand what mentoring should look like. Alas, 16 year ago I had neither the resources, the time, the know-how, or the patience to do this.  I’m still proud of the work we generated that year but it wasn’t what I really wanted as my major contribution in this area.

So, fast forward to 2014 (yeah, I know, that’s a long fast forward). I started on one of my curiosity/ passion projects, intending to expand upon work we’ve done describing barriers to careers in academic surgery. Again, the first pass was survey based and more quantitative, and just like the original mentors work I worried that something was getting lost in translation.  I believe in the power of story, I had learned quite a bit about grounded theory method through our professionalism work, and I had a couple of VERY willing accomplices who are also patient when projects take a while.  In this case, “a while” means 3 1/2 years from Interview #1 to online publication of the first manuscript from the project.

The interviews that I started in January, 2014, and that extended over the course of the next 16 months were intended to illuminate the barriers to careers in academic surgery.  I believe they’ve done that, and the barriers manuscript associated with it is in the works.  However, I realized about 6 interviews in that I was going to have the stories to write the mentoring paper that I wanted to write in 2001-2002; mentoring was raised as a critical factor in every single interview about career barriers, and this happened without any nudge from the interviewer. Of course, once the interviews were done my collaborators and I spent a few months working out our conceptual model, and once that was done there was manuscript submission, revisions, more revisions followed by rejection, selection of a new journal, resubmission, revisions, then acceptance.

Submitting this manuscript was arguably one of the hardest things I have done; in truth it was harder emotionally than submitting my professional paper in graduate school was, primarily because of the level of personal investment I have in this topic. Mentorship is something I am passionate about, it’s something I think is incredibly important (thanks to the interviewees who confirmed my bias!), and I love the work that Leigh and Will and I generated about it.  When you send a manuscript like this one out you want everyone to love it as much as you do, even though you know that’s probably not what will actually happen. That rejection HURT, particularly because of how long it took to get there after trying really hard. Perhaps it reminded me a bit too much of my last bad boyfriend.

Anyway, back to the relevant story. As part of the mentoring process I wanted to share with people (particularly junior faculty!) the time line behind all of this.  I know that the tenure clock doesn’t encourage projects of this nature, and I recognize that’s one of the shortcomings of our academic system as it currently exists.  My take home message would be if there is something that you MUST figure out, if there are questions that you MUST ask, don’t let go of them. It might take you 15-ish years, a fair amount of heartburn, incredibly patient friends/ collaborators, and some late nights puzzling over getting something that seems really minor “just right.”

It will be worth it.


Leaving it all on the field

Last Friday night I stayed up later than I intended, focused on getting a manuscript submitted.  That’s not a particularly big deal (I wanted it to be done before I left on a quick weekend trip from which work was banned).

However, there are reasons that this manuscript is a Very Big Deal:

  • The topic. It’s a known that I have tremendous passion around women in academic surgery and mentors in surgery. This paper pulls those two things together in a way that simply hasn’t been done before.
  • The time. I worked on my very first project about mentors and surgery during my research time/ SERF fellowship as a resident. Shortly thereafter I wanted to dig into this more deeply, trying to identify what mentoring can and should look like for women in academic surgery.  I “accidentally” got the information I wanted in the context of a broader study I have been working on for the last three years. So, the time points here are 10 years on this idea, and 3 years on the data collection/ analysis/ writing.  It has been a long process.  As best I can tell, sticking with it has been worth it.

Friday night at 10:28 Mountain Daylight Time I submitted.  Saturday morning I got up and had that sense that accompanies the submission of any work that we put our “all” into, when I internalize, “What if they don’t love it as much as I do?”  The reality is that people may not share my passion for these topics and they may not value the use of grounded theory to dig into these topics.  For my less senior readers, I want to help normalize for you that sense you get when you submit your first manuscript or a manuscript that you poured your heart and soul into. When you’re sharing work you’re particualrly invested in, it can be hard to make yourself get it done because you know that you’re sharing a piece of who you are. That vulnerability…it never, ever gets easier as best I can tell. The last time I felt this way was when I submitted our first disruptive surgeons manuscript; again, something I’m really passionate about and want people to care about as much as I do.  And, again, reality dictates that not everyone will care and not everyone will want to hear about the stories that resulted in our theory…but a few people thought it was important enough and well-executed enough that it should be shared.  I can only wish the same for this new project.

So, why am I rambling about vulnerability and risk taking in our academic work?  Because it’s real.  Because this stuff takes time.  Because if you truly care about the work that you’re doing and what you’re contributing it’s going to be scary.

It’s also going to be amazing.




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!