Definition/Introduction

A clinician should continuously strive to increase knowledge by reviewing and critiquing papers, thoughtfully considering how to integrate new data into practice. This is the essence of evidence-based medicine (EBM).[1] When new clinical queries arise, one should seek answers in the published literature. The ability to read a scientific or medical manuscript remains vitally important throughout the career of a clinician.

When gaps exist in the literature, clinicians should consider conducting their own research into these questions. Though typically performed by academic doctors or physician-scientists, medical research is open to all clinicians in both informal and formal methods. Anyone who treats patients can collect data on outcomes to assess the quality of care delivered (quality improvement is research).[2] Though beyond the scope of this chapter, instruction for clinicians on how to conduct research and contribute to medical science is provided by many resources.[3][4][5]

Additionally, a clinician who integrates a new practice can study effects on patient outcomes, retro- or prospectively. Continuous practice improvement need not be shared with the larger population of treating providers, but dissemination to the entire scientific community allows widespread adoption, criticism, or further testing for replication of findings.

Issues of Concern

Clinicians who seek to conduct retrospective chart reviews, prospective studies, or even randomized, controlled clinical trials should access the many resources to ensure quality methodology.[5] Once you have followed the appropriate steps to conduct a study (Table 1), you should complete the process by writing a manuscript to describe your findings and share it with other clinicians and researchers. Other resources detail the steps in undertaking writing a review article, but this StatPearls chapter will focus on Writing a Scientific Manuscript for original research. See also the StatPearls chapter for the different types of research manuscripts.[6]

Clinical Significance

Steps to Conducting Research

1. Develop a research question
2. Perform a literature search
3. Identify a gap in the literature
4. Design a study protocol (including personnel)
5. Submit to an institutional review board for approval
6. Collect, responsibly store, and then analyze data
7. Write a manuscript to interpret and describe your research.

After conducting a quality investigation or a study, one should put together an abstract and manuscript to share results. Researchers can write an abstract in a short amount of time, though the abstract will evolve as the full manuscript moves to completion. Many published and presented abstracts do not reach full manuscript publication.[7][8] Although journals and conferences do often publish abstracts, studies with important results should be published in full manuscript form to ensure dissemination and allow attempts at replication.[9]

IRB protocols, study design, and data collection and aggregation require a team effort. Those involved in the research should discuss who will contribute to the full manuscript (i.e., qualify as an author) and thus the planned order of authorship to reduce complications at the time of manuscript submission. The author, who devotes the most effort to the paper, is typically the first and corresponding author. In contrast, the last author is often the most senior member of the team, often the principal investigator of the study. All individuals listed as authors should contribute to the manuscript and overall project in some fashion.[10]

The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist is perhaps the most valuable tool in the process of preparing your manuscript for submission[11]. 

Original research manuscripts have the following sections (in chronologic order):[11]

Title and Abstract

Introduction (Background and Objectives)

Methods (Design, Setting, Participants, Variables, Statistics)

Results (Participants, Descriptives, Outcomes, Subgroups)

Tables and Figures     

Discussion (Key findings, Limitations, Interpretations)

Conclusion

Conflict of Interest (COI), Author affiliations, Acknowledgments, Funding

References

Individuals involved in the IRB submission (prior to data collection) can write the introduction and methods of the manuscript before and during the process of data collection and analysis. This head start on writing makes the full manuscript composition task less formidable. The content of the introduction and methods should be well known to the study group prior to data collection and analysis. The introduction should be organized into a “problem/gap/hook” order: what problem does this study address, the precise gap in the literature, and the objectives of this study (in addressing the gap).[12] The methods should provide enough detail such that readers who would like to replicate the study could do so.

Once data is collected and analyzed, authors can write an abstract to organize major themes of the research, understanding that the abstract will undergo edits once the manuscript is complete. Similarly, the title can change with revisions, as authors determine the most salient trends in the data. Most readers will only read the title +/- abstract. Thus these are the most important sections of the paper. The title should be concise and should directly describe the results of the trial– this correlates with more citations. The abstract must convey the crucial findings of the paper, ideally divided into sections for easier reading (unless the desired journal does not allow this).[13]

With the larger picture in mind, authors should create tables and figures that visually convey the themes of the data analysis. Working with statisticians or data experts, authors should devote a great deal of time to this component of the manuscript. Some general concepts:[14]

• Only include tables/figures that you believe are necessary.
• Make sure tables/figures are of high quality, simple, clear, with concise captions.
• Do not repeat language in results that appear in tables/figures, i.e., the tables/figures should stand alone.
• Consider how the figure will look in grayscale (in case the journal if not in color)

As with the abstract and title, the tables and figures will likely undergo further edits prior to the completion of the manuscript. The abstract and tables/figures should intuitively evolve together to convey the ‘story’ of the research project.

At this point, refer back to the introduction and methods composed during data collection. Make revisions as necessary to reflect the overall narrative of the project. Ensure you have adhered to the originally determined objectives or hypotheses. 

Next, focus on the results and discussion. The results should contain only objective data with no interpretation of significance. Describe salient results than do not already receive explanations within the figures and tables. The discussion section begins with a lead paragraph highlighting the most important findings from the study. Then the discussion interprets the current results in light of prior published literature. Ensure citation of keystone papers on this topic, including new papers that have been published since embarking on the current project. Frame your results, describing how this study adds to the literature. The discussion section usually includes study limitations. Attempt to anticipate criticisms of the methodology, the results, the organization of the manuscript itself, and the (ability to draw) conclusions. A stronger limitations section preempts journal reviewer feedback, potentially simplifying the revision/resubmission process.

The conclusion section should be concise, conveying the main take-home points from your study. You can make recommendations for current clinical practice and for future research endeavors. Finally, consider using citation management software such as Endnote or Mendeley. Though initially cumbersome, these software platforms drastically improve revision efforts and allow for easy reference reformatting.  All authors should review the manuscript multiple times, potentially sharing with other uninvolved colleagues for objective feedback. Consider who should receive acknowledgment for supporting the project and prepare to disclose conflicts of interest and funding.

Although authors should have an initial idea of which journal to submit to, once the manuscript is near completion, this decision will be more straightforward. Journal rankings are beyond the scope of this StatPearls chapter. Still, generally, one should devise a list of the journals within a specialty in order of highest to lowest impact factor (some sites categorize into tiers). High-quality prospective research and clinical trials have a higher likelihood of acceptance into the more prestigious journals within a specialty or to the high-quality general science or medicine journals. Although many journals have an option for open access publication, and numerous legitimate, open access journals now exist, beware of ‘predatory journals’ that charge a fee to publish and may not be indexed in Pubmed or other databases.[12]

Journals have diverse guidelines for formatting and submission, and the manuscript submission process can be tedious. Prior to submission, review Bordage’s paper on reasons for manuscript rejection.[15] Most journals require a title page and cover letter, the latter of which represents an opportunity to lobby for your paper’s importance. When (not if) you experience manuscript rejections, take reviewer comments and recommendations seriously. Use this valuable feedback for resubmission to the original journal (when invited) or for subsequent submission to other journals. When submitting a requested revision, compose a point by point response to the reviewers and attach a new manuscript with tracked changes. Attempt to resubmit manuscripts as promptly as possible, keeping your work in the hands of journals (allowing you to work on other research).[14]

Nursing, Allied Health, and Interprofessional Team Interventions

The above logistic steps will differ for review articles, case reports, editorials, and other types of submissions.[16] However, the organization, precise methods, and adherence to journal guidelines remain important. See work by Provenzale on principles to increase the likelihood of acceptance for original and revised manuscripts. After submission, revision, resubmission, and proofing, you may experience the fulfillment of an official publication. Academics should promote their scientific work, enhancing the dissemination of research to the wider scientific community.[17][18][17][19]