How to get published: where to start Dr Trish Groves Deputy editor, BMJ

How to get published:
where to start
Dr Trish Groves
Deputy editor, BMJ
What I aim to cover
Planning research
The research question
Why you need to publish
What editors want
How to write a paper
Useful resources
Publication ethics
How to please editors and peer reviewers
Why conduct and publish research?
say something important
share your work
change practice
promote thought or debate
get into high impact journal
advance your career
Keep your job
make money
Steps in starting research
turn your ideas into a research question
review the literature
enlist coauthors, statistician, supervisor
agree who’ll do what
design the study and develop your methods
think about the ethics of your study design
write your research proposal
apply for funding and ethics approval
The research question
What is a research question?
The researcher asks a very specific question and tests
a specific hypothesis. Broad questions are usually
broken into smaller, testable hypotheses or
Often called an objective or aim, though calling it a
question tends to help with focusing the hypothesis
and thinking about how to find an answer
What makes a poor research question?
a question that matters to nobody, even you
hoping one emerges from routine clinical data/records
– the records will be biased and confounded
– they’ll lack information you need to answer your
question reliably, because they were collected for
another reason
fishing expedition/data dredging – gathering new data
and hoping a question will emerge
What makes a good question?
Feasible (answerable with a robust method)
FINER criteria
Real research questions
Does the length of time between breast conserving surgery and
radiotherapy affect the risk of local recurrence of breast cancer in
older women?
Do hospitals with more orthopaedic specialisation have better
surgical outcomes after total hip or total knee replacement
those with less specialisation?
Is cardiac stress testing before elective non-cardiac surgery
associated with improved postoperative survival and hospital
How to focus your question
brief literature search for previous evidence
discuss with colleagues
narrow down the question – time, place, group
what answer do you expect to find?
Turning a research question into a proposal
who am I collecting information from?
what kinds of information do I need?
how much information will I need? *
how will I use the information?
how will I minimise chance/bias/confounding?
how will I collect the information ethically?
* sample size – ask a statistician for help
Minimising bias and confounding
Chance - measurements are nearly always subject to random
variation. Minimise error by ensuring adequate sample size and
using statistical analysis of the play of chance
Bias - caused by systematic variation/error in selecting patients,
measuring outcomes, analysing data – take extra care
Confounding - factors that affect the interpretation of outcomes
eg people who carry matches are more likely to develop lung
cancer, but smoking is the confounding factor – so measure likely
confounders too
Ethical issues – the wider aspects
• what information will you give participants before
seeking their consent?
• how much will the study deviate from current
normal (accepted, local) clinical practice?
• what full burden will be imposed on participants?
• what risks will participants/others be exposed to?
• what benefit might participants or others receive?
• how might society/future patients benefit in time?
• might publication reveal patients’ identities?
Exactly what are you planning to do?
P - who are the patients or what’s the problem?
I - what is the intervention or exposure?
C – what is the comparison group?
O - what is the outcome or endpoint?
More on PICO
– disease or condition
– stage, severity
– demographic characteristics (age, gender, etc.)
– type of intervention or exposure
– dose, duration, timing, route, etc.
– risk or treatment
– placebo or other active treatment
– frequency, risk, benefit, harm
– dichotomous or continuous
– type: mortality, morbidity, quality of life, etc.
Study designs
Population (P) Outcomes (O)
Interventions (I) or Exposures (E)
Centre for Evidence Based Medicine, Oxford, UK
Are you going to observe or experiment?
• observational – cross sectional, case series, case-control
studies, cohort studies
– identify participants
– observe and record characteristics
– look for associations
• experimental – before and after studies, comparative trials
(controlled or head to head), randomised trials (ditto)
identify participants
place in common context
observe/evaluate effects of intervention
Who will do what?
agree authorship
before starting the study!
Authorship and contributorship
these denote credit and accountability
but many authors on papers have done little
people’s names are left off papers
authors do not know the authorship criteria
contributorship statement more inclusive
Authorship credit should be based only on substantial
contribution to:
• conception and design, or data analysis and interpretation
• drafting the article or revising it critically for important
intellectual content
• and final approval of the version to be published
All these conditions must be met.
Participation solely in the acquisition of funding or the collection
of data does not justify authorship.
All authors included on a paper must fulfil the criteria
No one who fulfils the criteria should be excluded
contributors (not all necessarily authors) who took part
in planning, conducting, and reporting the work
guarantors (one or more) who accept full
responsibility for the work and/or the conduct of the
study, had access to the data, and controlled the
decision to publish
researchers must decide among themselves the precise
nature of each contribution
Who did what?
Helen C Eborall, post-doctoral research fellow1, Simon J
Griffin, programme leader2, A Toby Prevost, medical
statistician1, Ann-Louise Kinmonth, professor of general
practice1, David P French, reader in health behaviour
interventions3, Stephen Sutton, professor of behavioural
Contributors: SS, DPF, ATP, A-LK, and SJG conceived and
designed the original protocol. All authors were involved in
amending the protocol. HCE coordinated the study throughout.
Data entry was carried out by Wyman Dillon Ltd, Lewis Moore,
and HCE. HCE cleaned the data and ran preliminary analysis
with input from Tom Fanshawe. ATP analysed the data.
ADDITION trial data were supplied by Lincoln Sargeant and
Kate Williams. HCE wrote the first draft of the manuscript with
ATP and SS. All authors contributed to subsequent and final
drafts. HCE is guarantor of the paper.
Writing a research paper
General guidance on writing papers
International Committee of Medical Journal Editors
uniform requirements for manuscripts submitted to
biomedical journals
reporting guidelines for research, at the EQUATOR
network resource centre
More on study methods and reporting
Centre for Evidence Based Medicine
Statistics at Square One
BMJ advice to authors
Writing a paper
1. The message
…is the research question?
…is the right article format for your study?
…does the audience need to know?
Writing a paper
2. Title: style
descriptive: Number of heads in adults: audit
declarative: Most adults have one head
journalistic: Heads you win
questioning: How many heads do adults have?
Carefully check the journal’s instructions to authors and
look at other articles in that journal
Writing a paper
3. IMRaD
Introduction: why ask this research question?
Methods: what did I do?
Results: what did I find?
Discussion: what might it mean?
Writing a paper
4. The introduction
brief background for this audience
3-4 paragraphs only
what’s known, and what’s not, about your research question
don’t bore readers, editors, reviewers
don’t boast about how much you have read
the research question
state it clearly in the last paragraph of the introduction
say why it matters
Writing a paper
5. Methods
like a recipe
most important section for informed readers
inclusion and exclusion criteria
outcome measures
intervention or exposure
give references for standard methods
follow reporting guidelines as explained at
explain ethics issues
Writing a paper
6. Results
include basic descriptive data
text for story, tables for evidence, figures for highlights
confidence intervals
essential summary statistics
leave out non-essential tables and figures
don’t start discussion here
Writing a paper
7. Structured discussion
don’t simply repeat the introduction
– statement of principal findings
– strengths and weaknesses of the study
– strengths and weaknesses in relation to other studies
(especially systematic reviews), and key differences
– meaning of the study: possible mechanisms and implications
for clinicians or policymakers
– unanswered questions and future research
go easy on the last two
Abstract: general rules
all authors must
approve it
editors may screen by
for BMJ:
usually 300-400 words
use active voice
p values need data too
%s need denominators
no references
trial registration details
Structured abstract
objectives - research question
design –prospective, randomised, placebo controlled, case control, etc
setting – primary or secondary care? number of centres, country
participants – entry and exclusion criteria, numbers entering and
completing the study, sex, ethnic group as appropriate
interventions - what, how, when and for how long
main outcome measures - those planned, those finally measured
results - main results, 95% confidence intervals, statistical significance,
number need to treat/harm
conclusions – primary conclusions, implications; don’t go beyond data
trial registration - registry and number (only for clinical trials)
BMJ pico
abridged articles for print BMJ
eg Cohort study
study question
summary answer
participants and setting
design, size and duration
main results and the role of chance
bias, confounding, other cautions
generalisability to other populations
study funding/competing interests
Writing up
quality improvement projects
Quality improvement projects
what to report in publications
Not necessarily completely original
Describe in detail:
Context, organisational changes, interpersonal interactions
How did you manage and sustain change?
Progress may be cyclical, iterative, not linear
Message may lie in difficulties, not outcomes
SQUIRE guidelines
Standards for QUality Improvement Reporting Excellence
MRC framework
For developing and evaluating complex interventions
MRC guidance for evaluation of complex
Craig, P. et al. BMJ 2008;337:a1655
Structure of quality improvement reports
outline of problem (patient centred)
key measures of improvement
process of gathering information
analysis, interpretation, better understanding
strategy for change
effects of change - reassessment
next steps - lessons learnt - message
Quality improvement report:
writing tips
How is its message relevant to improving the
quality or safety of patient care?
Does it describe processes and changes that
improve patient care?
Is the evidence robust?
Is the message generalisable? What’s in it for
others to learn?
How to please editors and reviewers
Before you start your study
have a clear research question
seek statistical advice
use the right study design
keep an open mind and minimise bias
agree who will be principal investigator
agree who will be authors and contributors
agree to publish even negative results
How to please editors
choose the right journal
read the journal
follow advice to authors
submit online and follow instructions
How to please editors and peer reviewers
make sure the message is clear in the paper and
abstract, not just in the cover letter
include extras eg STROBE checklist
cite (and send) any closely related papers
send previous peer review reports
communicate clearly and promptly
Which journal should you choose?
generalists or specialists?
national or international?
not just Impact Factor
not just prestige
will people read your work?
respond to it? debate it?
replicate it? tell others of it?
will anyone use it?
will it reach the public?
What do editors want?
relevance to the audience
real potential to improve decision making
truth and transparency
clear writing that people want to read
excitement/ “wow” factor
Why does BMJ publish?
Pure academic interest isn't
enough for most BMJ readers,
who mainly comprise doctors –
- whether they're practising
clinical medicine, working in
public health, developing and
Implementing health policy, or
working mostly as researchers
We aim to provide our readers
with articles that will help them
to make better decisions
What we ask reviewers to do
be open and honest
be constructive, and help the authors to improve the
paper even if the BMJ rejects it
most importantly, reviewers advise editors on:
the article’s originality
the article’s importance
What happens during peer review
BMJ ask reviewers to sign their reports and declare any
competing interests relevant to manuscripts
reviewers advise the editors, who make the final
decision (aided by an editorial manuscript committee
meeting for some articles, including original research)
BMJ peer review process
1000 for
500 then
500 with
Editor and
BMJ team
4-7% with
No word
BMJ pico
BMJ appeals
Serious appeals welcomed
Criticisms addressed
Up to 20% accepted
But only one appeal
Make it good
Transparency and integrity
BMJ’s transparency
policy will help you to
report work honestly
and fully
What amounts to misconduct?
Research misconduct means fabrication, falsification, or
plagiarism in proposing, performing, or reviewing
research, or in reporting research results
Fabrication: making up data or results and recording or reporting them
Falsification: manipulating research materials, equipment, or processes,
or changing or omitting data or results such that the research is not
accurately represented in the research record
Plagiarism: the appropriation of another person's ideas, processes,
results, or words without giving appropriate credit
Research misconduct does not include honest error or differences of
New tool to detect plagiarism: CrossCheck
web based tool which searches for overlapping content:
specialist search engine (iThenticate)
uses “text fingerprinting” and “string matching”
gets behind access controls (free tools can’t do this)
9 billion articles in CrossRef database, and counting
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