Publish or Perish: Insider Tips for Publishing in Peer-Reviewed Journals for Fellows

As an oncology fellow you have chosen what is arguably the most research-driven field in all of medicine. Indeed, the lives of your patients depend, in large part, upon the expeditious flow of novel and increasingly safe and more effective therapies from the lab to clinical practice. This seemingly lofty goal is now more attainable than ever, but requires that knowledge be shared and information exchanged in reputable peer-reviewed journals.

Patients are clearly the primary stakeholders in this endeavor, but the list of those who rely on a solid track record of publications as a means to a critical end is a lengthy one. To varying extents, the ability to publish impacts everything from research funding to clinicians’ reputations to the good standing or very existence of programs and entire institutions—and the competition is stiff.

While researchers and clinicians are not necessarily expected to be world-class writers, a well-written article that effectively communicates the topic at hand and adheres to the journal’s standards, style, and guidelines is, indeed, more likely to be published than one that doesn’t live up to these standards.

But can an article really be rejected based solely on an author’s inability to produce a well-written manuscript? “Absolutely,” said Kelly Brooks, managing editor of Journal of Oncology Practice. “The content might be appropriate for our journal, but all manuscripts are peer-reviewed. If the editors think the writing quality isn’t worthy of inclusion in the Journal, they may certainly reject it for that reason,” she cautioned.

Luckily for you, few, if any, would-be authors ever bother to read an article about the ins and outs of getting published, and instead move blindly through this unfamiliar and often confusing territory. For this reason, any effort you make to inform yourself about this process will give you a proverbial leg up.

Behind the Scenes

Understanding the process that leads to a paper’s acceptance or rejection is the first step toward attaining the above-mentioned advantage. Much like going to a job interview, preparing an article for submission to a peer-reviewed journal would be somewhat of a fool’s errand if you did not first get a sense of what the decision-makers are looking for.

While the process varies somewhat from journal to journal, newly submitted manuscripts generally get their first perusal at the hands of the editor-in-chief, who is usually a renowned expert clinician who evaluates the submissions less for the quality of their writing than for their timeliness, relevance, and potential interest to readers.

Once accepted by the editor-in-chief, the paper must pass muster with the editorial review board, a group of clinicians and academicians—all experts in their fields—who are charged with the task of evaluating the submission for content, scientific accuracy, appropriateness for their journal, and relevance to the journal’s readers. Based on these criteria, review board members can accept or reject a manuscript outright, but can also return the paper to the author(s) with a request for clarification, revisions, or even a complete rewrite. At that point, acceptance for publication becomes contingent upon the author’s ability to make the requested revisions to the satisfaction of the board.

“We have, indeed, rejected papers after asking for revisions,” said Brooks, “because the author(s) ultimately couldn’t produce a well-written paper.”

It is only after these requested revisions have been made and approved that the paper moves on to the journal’s editorial staff, whose job is to ensure that the article is as clear, concise, and error-free as possible. Ideally, the editing process serves as a series of checks and balances, with an initial edit performed for content and scientific accuracy (by the managing or senior clinical editor), followed by a second edit for features such as flow, organization, and proper style (by the copy editor) and, finally, a proofreader’s line-by-line inspection for typos and errors in spelling and grammar. In this way, the paper is seen by multiple individuals, each of whom contributes a fresh perspective and pair of eyes, hopefully catching errors and inconsistencies not seen by the previous editor.

While most editors prefer this system of checks and balances, it is not unusual for a single person to perform all these steps, depending on the size of the journal and its staff. Even the best editor will acknowledge that errors are more likely when a single person performs all of the needed editing steps, underscoring the need for authors to submit papers that are as “clean” as possible. In fact, the more changes a paper requires, the greater the risk not only of introducing errors but also of changing the author’s intended meaning, even if subtly. An author who submits a paper in need of a “heavy edit” also runs another risk; namely, that the author’s “voice” will be lost, and the article will ultimately reflect the writing style of the editor rather than that of the author.

At some point during the editing process the author(s) might again be asked for clarification or additional information, this time by the editors. Once the editing and revisions are complete, some (but not all) journals will send the author a PDF of the typeset proof, providing one last chance to make sure the article reads the way the author intends.

Despite the possible bumps in the road, this process can and should go smoothly. To that end, the following tips are intended to give you the aforementioned leg up in getting your paper published, and in making the process as painless as possible, from submission, to acceptance, to publication. (See “Tricks of the Trade: Getting Ready to Publish.”)

Know Your Readers

Medical writing is not a one-size-fits-all proposition. On the contrary, writing for journals requires that the same content be presented differently, depending on the needs and knowledge of your readers. Knowing your readers should, in fact, be considered the first commandment of any type of writing, and requires not only that you identify your readers, but also that you determine their levels of comprehension as well as what they do and don’t need to know.

Let’s assume, for example, that your area of expertise is gynecologic oncology and your article deals with a specific surgical technique. An article written for a journal whose readers are largely nononcologists will be read more with academic interest than with the intent to learn the ins and outs of the technique. In other words, the readers will need sufficient background information to bring them up to speed on a topic that’s not within their area of expertise, but will not want or require the amount of detail needed by someone who intends to employ the technique you’re describing. If you intend to submit your article to a general oncology journal, keep in mind that some of your readers will be those from your subspecialty but the majority will not. In this case, less background information is required but the description of the technique might focus more on potential candidates, benefits, and outcomes, all of which would be of interest to oncologists who might refer their patients for such treatment. Finally, if the article will appear in a journal read primarily by those in your subspecialty, any background information should be summarized and the technique in question might be described in more of a step-by-step fashion for readers who might, themselves, ultimately consider performing such a procedure. The trick is to strike a delicate balance between providing your readers with the information they want and need and not insulting them with lengthy explanations of information considered to be common knowledge.

Along these same lines, Journal of Oncology Practice copy editor Wayson Jones provided some words of advice from “down in the trenches,” noting that jargon and phrases coined within your discipline should be avoided, especially when writing for clinicians outside your area of expertise.

“A good copy editor who’s confronted with such language will do his or her best to ‘translate’ it into more commonly understood verbiage, and doing so introduces the possibility of changing the author’s intended meaning,” he said.

Tricks of the Trade:

Getting Ready to Publish

The following tips will help to give you a leg up when you consider submitting an article for publication.

• Purchase a copy of the latest version (10th edition) of the AMA Manual of Style or access it online (www.amamanualofstyle.com).
• To identify the readers of a particular journal, check the masthead and contact a staff member from the sales and marketing team. These are the people in the best position to give you an accurate breakdown of the journal’s readership.
• Never submit an article without first reading a number of articles from your target journal. If you don’t have a copy handy, check the journal’s Web site for current and past issues.
• Give your first and subsequent drafts to a colleague whose knowledge and experience are similar to those of your intended readers. Ask for and accept constructive criticism.
• When preparing original research for publication, clarify your target journal’s policy about news stories appearing in medical trade publications. While, in theory, publication of a summary of your findings in such a trade magazine shouldn’t affect your chances of being published in a peer-reviewed journal, different editors have very different views on this topic. As with most things in life, it’s better to be safe than sorry.

Heed the Guidelines

Once you have effectively tailored your article’s content to the needs of your readers, the task becomes one of “styling” the article to conform to the journal’s standards. The vast majority of medical journals apply the standards put forth in the AMA Manual of Style, an indispensable resource for anyone and everyone who writes or edits for medical publications. While it is generally a very safe bet to use the AMA Manual of Style as a guide, the information in your target journal’s guidelines for authors/manuscript submission should supersede that in the AMA Manual of Style when inconsistencies exist.

Even so, if you were to ask a room full of copyeditors about their biggest pet peeve, you’d probably hear something along the lines of, “Everything they need is right there in the author guidelines. Isn’t anyone reading them?” Copy editors come by their frustration honestly. Despite the fact that peer-reviewed journals offer relatively specific guidelines for manuscript submission and style (in print, online, or both), a surprising number of authors either don’t bother to read them or only scan them and basically choose to ignore the information they provide. And that information is invaluable. It includes the formats in which to submit text, tables, and figures; preferred spacing and font style/size; styling of references and footnotes; information required for author biographies; and statements of potential conflict.

A good copy editor will usually have a relatively sound working knowledge of the topics covered in his or her journal, but an author should never assume that the knowledge of any member of the editorial staff approaches the level of a physician’s expertise. Jones provides some words of caution along these lines, citing failure to properly structure tables and figures as an example of an oversight that can lead to big problems.

He said, “Some authors try to cram too much information into a table, or ignore the guidelines and send a table that’s formatted improperly or not at all, leading to misaligned rows and columns that force editors to guess.”

This, warns Jones, leaves the copy editor with the task of attempting to line up headings and subheadings with corresponding data, inviting potential errors. Similar problems can arise from figures not designed according to the journal’s standards, forcing the copy editor to try, for example, to make sense of unintelligible symbols superimposed on clinical art. The same issues can arise from improperly expressed statistics, medication dosages, and units of measure.

Admittedly, all author guidelines are not created equal; some are more specific than others and some are in need of updating. Even so, these instructions are your best resource for properly preparing a manuscript for submission. And because the guidelines are written by those who will be editing your article, it only makes sense to adhere to them as closely as possible.

If you read the guidelines but still have questions, 2 excellent options remain. The first of these options is to contact the editor named in the guidelines or in the journal’s “call for papers.” That editor would, no doubt, much rather take a phone call or respond to an e-mail than have to chase down an author in mid-edit to clarify matters of style. Your second option is to use the journal itself as a guide; in it you can find 1 or 2 articles similar to yours (eg, original research, case studies) and use those articles as models. Doing so also will give you a sense of the preferred tone of the journal’s articles (ie, formal vs more conversational).

Revise and Respond

The last bit of advice relates to the need to respond to any and all requests for clarification, and to do so in a timely fashion. A good editor will insert queries that leave no doubt about the information being requested, and will also tell authors exactly how to respond to those queries and by what date. Journals live and breathe by deadlines, and failure to respond to all queries or to do so by the specified date will likely jeopardize your article’s slot in the upcoming issue. To avoid such a situation, it’s also important to ensure that you or the author designated the primary contact for the journal is easily accessible during the review and editing process.

Whether you are the first or last author on your article, the time and effort invested in the process will determine whether your insights and knowledge will ultimately be shared with their intended recipients. The task is at once rewarding and challenging. It requires patience, care, and attention to detail—qualities already well known to oncologists.

Laura Bruck is a Cleveland, Ohio—based freelance medical writer and editor who has served as a copy editor, senior clinical editor, and managing editor for a variety of peer-reviewed journals and medical trade publications since 1987.

This edition of Oncology Fellows is supported by Genentech, a member of the Roche Group.