How to get started writing manuscripts

0:00 Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills to build their own research program, whether or not they have a mentor. As clinicians, we spend a decade or more as trainees learning to take care of patients. When we finally start our careers, we want to build research programs, but then we find that our years of clinical training did not adequately prepare us to lead our research program. Through no fault of our own, we struggle to find mentors, and when we can't, we quit. However, clinicians hold the keys to the greatest research breakthroughs.

0:40 For this reason, the Clinician Researcher podcast exists to give academic clinicians the tools to build their own research program, whether or not they have a mentor. Now introducing your host, Toyosi Onwuemene. Welcome to the Clinician Researcher podcast. I'm your host, Toyosi Onwuemene, and it is an absolute pleasure to be talking with you today. Thank you so much for tuning in. Today, I'm talking about how to get started with manuscript writing, how to get started with manuscript writing. And the reason this particular episode comes to me today is because I recently engaged with a couple of trainees who wanted to work with me to write their first paper, and I realized that they don't have experience writing manuscripts.

1:32 And it's funny because if we go through college or we have done any measure of writing, you find that you've done writing, you've written term papers, you've written scientifically. But if you haven't actually worked through writing manuscripts, submitting it, revising manuscripts, then it's experience you don't have and you do need to gain. And so I think I didn't realize how much was needed in terms of training and helping them to get to where they needed to be as far as the writing. And for that reason, I realized that it's important to talk about how people can get started manuscript writing and what they need to expect along the way. Because we've written so much in the course of our career, right, we're always writing.

2:13 We've written in college. We are writing as med students. We're writing as residents, as attendings. There's a sense that what we've been writing, therefore, of course, we should know how to write a manuscript and submit it for publication, but it's not so straightforward. So I wanted to talk about a couple of things that we should be thinking about, especially if you've never done this before, if you have done this very little. One thing you may have done is contributed to a manuscript, but you may not have been a first author in a manuscript, which is a different set of responsibilities. So I just want to go through those today. So the first thing I want to invite you to do is to seek out opportunities to write. Now I'm big on finding opportunities that you're super interested in and really excited about, and that is good.

2:56 But I also realized that at the beginning, where you don't have much experience, you're really just seeking out experience. That's it. You just want to get on board. You just want to be able to help get the paper written. And so it is helpful when you first get started to co-author. So that's the first thing, seek out opportunities to co-author. You can start out as a first author and those opportunities seem less compared to the co-authorship. But if you can find a first author opportunity, good for you. That's great. Especially if you're working on a summer project or research project that you're ultimately going to be able to write up, that's excellent. And many people don't necessarily have those opportunities.

3:38 And that's why it's probably easier to get started as a co-author. And what's the benefit of getting started as a co-author? Well, you get to help see the manuscript after it's been written. The first draft is written probably by the first author in collaboration with the senior author. You have a chance to review, give your edits, and at least contribute to the manuscript in some significant way. Now the thing about being a co-author is that co-authors do not tend to do the heavy lifting of a manuscript. Now there are some manuscripts where it really isn't involved or writing opportunity where someone's writing the introduction, someone's writing the materials and methods, someone's writing the discussion, the results section.

4:20 There are those opportunities. Many times though, someone else is doing the work of putting together the first draft. And for that reason, as a co-author, many times the first time you see the manuscript, it's when it's already written in draft format. Now you still have opportunity to contribute, make it a stronger paper. And so your opportunity to be a co-author is an important, significant contribution, but it doesn't give you a good sense of how the whole paper should be written. You're really important as a co-author. And honestly, I'm so grateful for the co-authors who've helped me move my work forward. In one of my earliest manuscripts, I was a medical student when I first wrote the manuscript as a first author.

5:05 And when the revisions came back, I was knee deep in residency. I was super busy. There was not even really space to think about writing the manuscript. And so a co-author came along to help me do the revisions. And that was so important because honestly, the manuscript wouldn't have been published at the time in which it was published if I had not had that kind of help. So co-authors are super important. And as a co-author, you gain some experience, but you don't really gain a sense of what it takes to pull a manuscript together. So number two is that when you can, work towards a first author opportunity. Okay. I might hear you saying, yeah, yeah, easy enough to say. Most of us don't have access to first author opportunities.

5:47 And I would say that first author opportunities abound. Okay. So let me pause and just explain. So there are always things to be written. There's always opportunity to educate, to engage, to write about something that people care about. It's helpful if you have original research that you're writing up, but many of us don't start with original research. But perhaps it's a review article you could write. Perhaps there's a case that you could write up. I know a lot of people look down on case reports, but I have to say that case reports are still helpful. Okay. So manuscripts may not, journals may not accept case reports. So it's like, how do you write a case report where it's not really a case report, right?

6:29 How do you write like a teaching case or an opinion piece or something where you're not really writing it as a look at this interesting case, you're pulling out a nuance and you're educating. So there are many of these opportunities in journals where you can do a case report format as an education piece. So what I'm saying is that there's so many opportunities. Now many of us are waiting for a mentor to hand us an opportunity and say, Hey, here's this paper I dreamed of. You go write it. And sometimes those opportunities come. And when you can find these opportunities, it's great. Invariably as mentors become more senior, they tend to have projects that just need someone to help them get to the finish line.

7:13 And they may be able to pull out a manuscript that they started working on a couple of decades ago and they haven't finished. And that's great. But even when that's not available, it's possible for you to think, let's say you're within the construct of a mentor's program and you see what their work is, the bulk of what they're doing. You can even suggest to them a manuscript that you can author as a first author. So what I'm saying is that there are opportunities. You should go look for opportunities. And even when people don't know opportunities are present, you can present someone with an opportunity. You can say, Hey, love to do a systematic review with you.

7:54 I'd love to write a review article with you. This is your area of expertise. Can we do this together? So what I'm asking you to do, if you haven't already done it, is take initiative. I know it would be so nice if someone can just pull you aside and say, Hey, here's this paper, write it. Many times that will not happen. And if it doesn't, if it does good, right. But if it doesn't happen, you go looking for the opportunity. You create the writing opportunity for yourself. So maybe start with being a co-author, but then create the writing opportunity for yourself so that you can have the experience of being a first author. Okay. Number three is that if possible, find a project you care about.

8:36 Find a project you care about. Writing is hard. Even for those of us who love writing and I love writing, writing is hard. You're birthing words, you're trying to put them together and make them sound interesting and not boring, right? You have a lot of things to do with words that are hard. And so it's going to be hard, whether it's something you love writing about or something you hate writing about. So it's best to just figure out if you can write about something you actually care about. For example, let's say there's a manuscript opportunity about say receptor signaling and you're like, Oh, basic science. I don't really care about that. Okay. Ask about what other opportunities exist.

9:17 Don't just say, Oh yes, I'm so desperate. I'm going to take up this thing that I hate. And you may not hate it. You may be like, okay, receptor signaling, maybe not my jam, but it's interesting enough. That's fine. Remember when you first starting, your goal is to put in your reps. Your goal is to get the experience. Your goal is to figure out how to write. It is icing on the cake for you to have a project that you're really excited about, but it's not impossible. So I would say where you have choices and you always have choices, ask for manuscripts that are similar to that in the area you care about. So for me, for example, when I was coming up, I didn't want to do basic science. I didn't think basic science wasn't interesting.

9:59 I've always wanted to do research or write about scholarship. That's closer to the patients. I would prefer to write the case report, even if the basic science paper is more valuable because it's just more interesting. So anyway, I'm just saying that opportunities abound, don't feel pigeonholed. If someone offers you an opportunity that you're not excited about, it's okay to say, is there a different opportunity? And yes, sometimes people will be disappointed because they're like, well, you should be grateful and it's the way it always is and it's okay. But it is important that you get the experience. So if you had a choice of, should I wait for three more offers to see if I can get something that's more interesting? And here's an opportunity right now that I can work on, I would say that if you are still early in the game where you haven't necessarily gotten a lot of experience, putting a lot of reps, sometimes it's okay to take up the first manuscript and just get some experience in that.

10:50 Now I would say that with a caveat that once you start being successful in one area, people expect you to continue to be successful in that area. So let's take the example of the receptor signaling manuscript. You take the manuscript, you write it, you do a good job. And someone else is like, oh my gosh, you wrote a paper on the receptor signaling. Let's give you another manuscript in this area and another manuscript in this area. And before you know it, you could be knee deep in receptor signaling and you didn't even really care about it in the first place. Anyway, so that's to say that take opportunity and work on it, but be clear that, hey, this is a one time so I can learn because it's not something I want to do long term or be strategic about finding something you actually care about so that if you end up getting three or four or five or string of manuscripts to write, you still feel good about it.

11:38 So you want to make sure that if possible, you find a project you care about. If not, just recognize that you still are gaining because you're learning the ropes of writing a manuscript. Okay. Number four, and this is really important, and I think this is something that doesn't come naturally to clinicians, is you've got to create space for writing. Now I hear you saying, of course, I recognize that Saturday I'm going to write from 8 a.m. until 5 p.m. The manuscript will be done in a day. It will not be done in a day because scientific writing doesn't magically appear like that. Now I do know a couple of scientists who've been doing this a long time who can literally churn out a paper in eight hours.

12:21 I've seen it done. I know it's possible, but when you're starting, I think that's a little bit of a high expectation for yourself. And I know you're thinking back to college. When you pulled the all-nighter, you were able to create a manuscript or a paper that you got an A on. I totally get it. But scientific writing is a little bit different. And so I would say that even though you know you can do it in eight hours, I would say don't do it. Don't do it because it takes a long time to do. And if you're going to craft good writing, you're going to take time to craft it. So you want to create space for the writing, not just one weekend day where you're going to just binge write your weekend days, especially if you're in the midst of residency and you're working six days a week.

13:03 Your day of rest is not a day of writing. And you may be like, oh no, I got to get this done. I got to get this done. And this is the only day available and it's okay for me to not take a break. I would say that, hey, hey, writing manuscripts is not about just churning out something and then saying, I did that. I'm done. It really is just a, it's a process you're beginning to be able to carry on long term. If you want to do research, then you're a writer by trade. Your work is writing. And so the whole idea of being able to binge write something in eight hours is kind of just counter to your role as a writer. You are a writer. As long as you're doing research, you are a writer.

13:45 And so create space for your writing job. If you haven't done it, if you haven't figured out how to do it and happy to coach you through it, this is what I do. And I mean, it was a game changer for me. I was always looking for the eight hours space to write and eight hours doesn't come very easily, but do you know what comes easily? 30 minutes. Most of us can find 30 minutes to write a day. And so if we write for 30 minutes here and then we pause and we write for 30 minutes there, right tomorrow, and we pause, we write for 30 minutes the next day, we will always achieve more than we do with an eight hour binge writing because eight hours of binge writing, first of all, not really sustainable. You get tired. I mean, remember when you took the MCATs and you went in that room for eight hours?

14:27 Holy cow. It is hard to do. Writing is brain work. It is hard to do. And so again, I'm not saying that you're not a superstar. I'm not saying you can't just like pull it together in eight hours. I'm not denying your expertise and your skill. I'm just saying that writing is your job and the best writing happens over time because every day that you put it down and you lift it back up again, you have the time to think about it and bring a little bit more creativity to your writing. So if you want to move forward and be a scholar in any way, lead a research program, be part of a research program, recognize that writing is your job.

15:09 And so create space to be able to write every day. Create space to write every day. You will always get more accomplished. Again, this is the story of the tortoise and the hare. You will always get more accomplished when you create space for writing daily. Okay. The next thing, number five, is engage for the long haul. Now, this is not me saying, oh, it could take you eight hours on a Saturday, but please stretch it out over the course of a week. That's not that. It's that scientific writing takes time. And more increasingly, scientific writing is a collaborative effort. So most of the time, you're not going to see a scientific paper that's written by one person.

15:50 Maybe if it's an editorial, sure. Sometimes a review could be written by one person. But for the most part, it takes a lot of collaborators to come together to produce a scientific article. And guess what? Your collaborators are not waiting for you to send them the one article that they're going to say, oh, great, I've been waiting for this one article to come all week. I'm now going to sit down and write on it for eight hours. No, they have all this other stuff going on. You send them your manuscript to critique, and they're like, great, in two weeks, I'll get back to you. And then two weeks later, you're like, hey, I haven't gotten any feedback. And they're like, oh, yeah, I forgot. I will tell you that I have one such manuscript that for two years, this author has not gotten to look at the manuscript. Now, you have to be careful.

16:32 Choose your collaborators carefully. But the point is that it does take time. It takes time because it's not fully dependent on you. That's a good thing, right? It's good that you have collaborators because the synergy that you bring together really creates an outstanding manuscript. And the more people you bring together, the longer it takes. So this whole idea, again, I don't want you to take it as a judgment, but just I'm talking about why it's not practical. You set aside eight hours, and you're like, great, I've worked on it. And the manuscript is going to come back to you from your collaborators. And then you're looking for another eight hours, which usually nobody has, right? But again, if you have a practice of writing regularly, say 30 minutes a day, then you can find those 30 minutes when the manuscript is ready to move forward.

17:20 So recognize that it's going to take time and be ready for that. Don't say, and someone come to me and say, I want to write a manuscript with you, but I only have three months. It takes longer than three months to write any manuscript worth its salt. Because first of all, you got to do the work of gathering the data for the manuscript, and if it's not an original research article, you got to be able to pull the data together, even for a review. The paper is already written. You got to go find them, and then you got to sort them out, organize them, and then present them and pull them together into your manuscript. It takes time. So the point I'm making is that it takes time. And if you're going to do this, you got to be ready to engage for the long haul. So get your mind ready.

18:01 Don't be shocked that it took six months to write the manuscript and another three or four months to get it through revisions. It takes a long time. That's why you don't want to only have one manuscript that you're working on, because when one manuscript is in revisions by your co-authors, you can be working on the next one. But just be ready that it takes time. And again, writing is part of your scientific career. It's what you're going to be doing. And so create space to do it over the long haul. Number six is expect many revisions prior to submission. So you're working on it. Your first author, great for you. You have a senior author that hopefully is working closely together with you to shape this manuscript.

18:43 And then you have other co-authors who really do need to contribute intellectually to this manuscript to be considered co-authors. So they're going to come back with feedback and you're going to incorporate it. So I will tell you that I had a manuscript that I was invited to be a co-author on and I was like, oh, here are all my edits. And they were like, oh, we don't have time for your edits. I was like, well, I guess I can't be an author then. And I've grown up a lot since then. I probably would figure out a way to make sure that my revisions counted. But I think I found out that I was an honorary author and I was taking my job seriously as an author. And so you should because there are requirements as to who counts as an author according to LCJME rules.

19:28 And I don't know if that's the right acronym, but it's the committee that kind of makes rules about who's an author and things about the ethics of writing and publishing. So anyway, so they specify who an author is and you do need to contribute scientifically. So if you're going to contribute scientifically, you need space to contribute scientifically. So for someone to hand you a paper and say, it's due tomorrow. I hope you can get me your edits by tomorrow is not really realistic because it takes time for you to clear space on your schedule and make room for the writing. So I think a good rule of thumb is two weeks, knowing that it will probably take them a week longer to get it around. But just recognize that they're going to tell you that, hey, these are all the changes we think should happen.

20:11 And if you really are honest in including them as collaborators, you're going to need to revise based on the recommendations they've given you. Those are your co-authors. Your senior author, if they're doing what they're supposed to do, is going to have a lot of edits because they've been doing writing a long time. This is why they're senior. They've been doing this. So they have a sense of what the reviewers are looking for, what makes for a good manuscript. They're going to give you a lot of feedback and it's okay. Sometimes I've had trainees that I'm working with and I will give them feedback and I'll say, this is excellent. And then they look at it and it's got red all over and that's the red of the track changes, not the red pen. I don't use those anymore.

20:52 But I think they're demoralized because they're like, I thought I was done. And then you have all these edits for me. I do have all these edits for you. And then you're going to submit to me and then I'm going to have more edits for you. And then you submit, I'm going to have more edits because it takes time to craft a good manuscript. When you're starting out, it takes even longer. And so you're going to want to just be ready that, okay, I'm going to submit this. It's going to be put through some revisions. I'm going to submit it. I'm going to have to do some revisions and there's going to be a lot of iterations. So perhaps the point I'm making here, this point number six, is that it is an iterative process. You've got to be ready for that. And don't be disappointed just because your mentor didn't like the first draft.

21:34 The first draft is the draft no one is ever going to read because it's the draft that just helps you put things on paper and then you're going to transform it. And when you compare your first draft to the final manuscript, it's going to be a world of difference. The first draft is kind of the thing that gives you power to pull the words out of you. And then you can really get to writing. So don't be disappointed when your first draft is trashed. And I hope that it's trashed in a respectful way because your writing must always be respected. But just recognize that, hey, it is part of the process. Revisions are part of the process. So expect to revise. Don't be disappointed when you get revisions.

22:15 And when you get many revisions, each time they come, just go ahead and work through them. Okay? All right. Number seven is expect to revise and resubmit. Now I've had instances and probably out of maybe 40 some manuscripts that I've written, I've had two that have been accepted outright, which it's just a rare event. And don't count on it, right? Because the reviewers want to help shape your writing too. It's rare that they take a manuscript and they're like, oh my gosh, my writing is so good. I'm not going to have any edits. All the time reviewers want to help shape the manuscript. And so whenever your reviewers send you critiques, just appreciate it because it takes a lot to review somebody else's work and then give them feedback for improvement.

23:02 But it's going to come back to you more often than not. So be ready. So you submitted the manuscript three months ago. You're like by now there should be a decision from the journal. And then it comes back major revisions. It's okay. It's part of the process. And what you want to do is work with someone who's been through a revise and resubmit to see how you structure the response to reviewers and how you pull it together to make a really good and compelling response to reviewers document. So I probably am going to do a podcast episode on how to respond to reviewers because it came up in a recent conversation I was having with some of my mentees about writing and I didn't realize that they didn't know how to do that.

23:44 And so anyway, whatever you don't know, just ask. Don't expect that you should know it because this whole process is hard and your mentors realize that. But sometimes they forget because they forget how much they've learned over time. And you know, over time you really do learn a lot. And so if you have never done something before, don't be... What's the word? I'm not even sure what I'm trying to say. Don't pretend that you know. And then go spending all this time looking up how to do it. Ask for what you need. Say, hey, I've never done one of these before. Do you have an example that I could look at? And people would love to share examples with you. Now you want to look at the example and you want to follow it.

24:25 You want to look at the example and then make up your own thing. You do want to use the resource you're given. But what I'm asking you to do, I'm inviting you to do, is not to pretend that you know and then go spend all this time trying to figure it out, but just admit that you don't know. You shouldn't be shamed for that. No one should judge you for that. And if they do, they're in the wrong. I'm judging them. But I'm just saying that it takes a lot to learn to write a manuscript well. And people don't always remember what they used to wonder about that they don't wonder about anymore. They already know. So ask for what you need. Ask for the support that you need so that you can do this job of writing manuscript well.

25:05 Okay. So that's my, that's those are my thoughts as far as how to get started in manuscript writing. I'm going to summarize. First of all, you want to seek out an opportunity to co-author. If you can, number two, you want to actually work towards a first author opportunity where you're doing all the heavy lifting. If three, number three, if possible, you want to find an area that you're actually interested in. However, even if you're not able to find an area that you're interested in, recognize that putting in the reps is part of growing. And so accept what you have and work at it so that you can grow and increase your capacity and your strengths as a writer. Number four, create space for writing. It takes a long time. Don't try to do it all in one weekend.

25:47 Your weekends are for rest, but make sure that writing is built into your daily schedule and make it a habit, a habit that you do every day. Number five, engage with the long haul. It takes a really long time, especially when you have collaborators. Don't get frustrated. Don't quit. Don't think that it's going to take months. Okay. Expect many revisions prior to submission. Hey, a revision is an opportunity for your manuscript to be better. Accept them as gifts and don't let them weigh you down. Definitely do them. Don't be overwhelmed. And finally, expect a revise and resubmit. You're going to write a beautiful paper. You're going to be so proud of it and the reviewers are going to just tear it down and it's going to be okay. You're going to take their feedback and transform the paper, make it even better and the rest of the world to be better for the work that you've put out there.

26:32 All right. That's all I have for you today. Thank you so much for tuning in. I look forward to talking with you again next time on the Clinician Researcher Podcast. Have a great week. Thanks for listening to this episode of the Clinician Researcher Podcast where academic clinicians learn the skills to build their own research program, whether or not they have a mentor. If you found the information in this episode to be helpful, don't keep it all to yourself. Someone else needs to hear it. So take a minute right now and share it.

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