Some tips on preparing an abstract and manuscript

First of all, congratulations on getting to that phase of your GI fellowship where abstract and/or manuscript preparation becomes an issue. By this stage of your career, you are "differentiated" as a gastroenterologist and likely to have at least some interest in pursuing an academic career. All gastroenterology fellows are required to spend time in research or some form of academic activity; I hope you have found your time to be enjoyable and productive. By now, you will also have found a mentor within your fellowship program and, hopefully, you have established a good working relationship with him/her.

Abstract preparation

There are few things more difficult to write than a good abstract. You are required to describe the reasons for your project, its design, its results, and your interpretation of those results, while keeping to a very strict word and character count. You also need to make the submitted abstract eye-catching and appealing to the reviewers. For DDW and the ACG meetings, abstracts are prepared and submitted entirely on-line and it is not permissible (indeed impossible) to exceed the maximum number of words and characters.

Obviously you find your project interesting and important (at least, I assume you do); your main job is to convince the reviewers of its relevance and importance.

• A catchy or (semi-) provocative title may help:
  • Instead of "A retrospective review of the association of X and Y in patients with PQR", try something along the lines of "X – but not Y – predicts Z in patients with PQR"
  • Instead of "A randomized, double-blind, placebo-controlled trial of XYZ in patients with Blogg’s syndrome", try something like "Evidence that XYZ provides significant benefit in Blogg’s syndrome". (Note, however, some thoughts on the remarkably tricky word "significant" later in these notes).
• Reviewers generally like short punchy titles and love the word "evidence"!
• Make your sentences as short and focused as possible. (Like that one.)
• Use abbreviations appropriately – but remember to define each in full the first time you use it. It can sometimes help to define a novel abbreviation in the title; that way you can use only the abbreviation in the body of the abstract and avoid having to spell out the term in full, which would contribute to your word/ character count. Note also that some abbreviations are in such common use in our specialty that it is (arguably) unnecessary to define them (i.e., PPI, UC).
• Avoid proprietary names of drugs and diagnostics; always use generic names.
• Wherever allowed, a table or figure is enormously helpful. Remember the old adage "A picture is worth a thousand words". However, don’t spoil things by unnecessarily repeating data from the table/figure in text form in the Results section; this is just wasteful of space (and of your reviewers’ time and patience). It is quite permissible in the Results section to state "See Table/Figure X" (indeed, I would recommend this).
• It is, in my opinion, unforgivable to state "Full (or further) results will be given at the time of presentation". That should automatically disqualify your abstract from acceptance.
• While you may consider your research groundbreaking, your reviewers may require some persuasion. Therefore, fairly delineate the pros and cons of your study.
• Avoid ending with "…further research is indicated". Instead, state what your study shows and what the next unanswered question is.
• Ah, "significance" …Unless you are describing a statistical analysis, an alternative word is almost always preferable to "significant". (As someone writing about medical writing once said, "Significant has lost all significance.") Statistical significance is (or should be) clear and objective; anything else is purely subjective. Although you may consider your results to be "clinically significant", try using another description (i.e., meaningful, relevant, or important) and be prepared to justify it quantitatively.
• Do not be disheartened if your abstract is rejected or if it is accepted for poster presentation (when you had been hoping for a high-profile oral presentation). Sometimes it is preferable to present your work in poster form; you will likely attract only those attendees who have a genuine interest in your study and you are likely to get more constructive comments than you might at an oral session. In any case, poster and oral presentations will all look the same when listed in your CV.

Some tips on manuscript preparation

It is impossible, within the space available, to cover all aspects of manuscript preparation and submission. However, I will try to make some useful points, as someone who has experience as an author, reviewer, and editor.

• Use your mentor; that is what he/she is for! Your mentor will have experience of this whole process and will have his/her own writing style. You would do well to adopt that style, at least until you are sufficiently experienced to "go it alone".
• Well in advance of "writing up" your study, decide on the target journal for which you are aiming. Again, your mentor should be of help here, but you may also want to get the opinions of other faculty members in your division. Try to identify those faculty members who are frequent reviewers for different journals; their advice on journal submissions may prove invaluable. If you choose to "aim high", be prepared for disappointment and frustration; the higher up you go, the lower the acceptance rates are. Of course, the corollary to this is that the kudos of getting published in a more prestigious journal may well be very valuable for your next job application or grant proposal. Again, consult your mentor and be realistic.
• Understand that fewer and fewer journals now even consider case reports. (The reason for this is that other readers seldom or never cite case reports in their own writing; that has a negative impact on the journal’s all-important impact factor.) Only consider working on and submitting a case report if it contains really novel information that promises to provide new insight into a particular condition. Something like "An unusual presentation of XYZ" is unlikely even to be considered by a major journal – even if the title also contains the inevitable "… and a review of the literature".
• Although it sounds obvious, read the instructions to authors! All journals have their own strict house style and it pays to understand it and adhere carefully to the requirements. Failure to do so will lead to rejection – or at least to a frustrating revision.
• Read the instructions again! Pay particular attention to the word limit for both the Abstract/Summary of the paper (because that is as much as most people will ever read) and the actual body of the manuscript, because …
• Less is more! Once you think you have a manuscript that is ready for submission – and even once your mentor/senior author has "signed off" on it – wait! I suggest you "stick it in a drawer" for up to a week and then re-read it with a highly critical mindset. Ask yourself a number of questions:
  • Could it be made shorter without losing any important information? (Surprisingly, the answer is often "Yes".) Every word has to justify itself; expunge any unnecessary verbiage
  • Have I used any unnecessarily high-faluting words like "expunge" or "verbiage"? Keep it simple and readable without insulting the intelligence of your intended readership
  • Have I re-stated the obvious? This most often happens in the Introduction. For example, if you are writing for a GI journal, there is no need to make statements such as: "Crohn’s disease is a chronic inflammatory condition of unknown etiology"
  • Is there any unnecessary repetition within the text?
  • Is there any unnecessary repetition between the text and tables/figures? There are few things more irritating to a reviewer than to see the same data given in both text and table form. Editors have a limited number of journal pages to fill and they want to include as many good and interesting articles as possible to satisfy their readership. Reviewers are increasingly being asked to identify any ways to shorten manuscripts
  • Nowhere is there more temptation to waffle on than in the Discussion section. All too often I am asked to review manuscripts in which the Discussion is simply an extravagant and wordy repetition of the Results section. The Results section is supposed to be for "what we found"; the Discussion is for "what it means" or "what it might mean". Keep the Discussion short and focused. Each paragraph should focus on a single point. It is always a good idea to concisely state the strengths and – more importantly – the limitations of your study; that should form the majority of your Discussion.
• Learn to take criticism graciously. Few manuscripts are accepted outright on first submission. However, if your manuscript is rejected outright without having gone out for peer review, it is time for a discussion with your mentor. Perhaps your choice of target journal was simply a poor one. If your manuscript gets sent out for external peer review, be prepared for criticisms and suggestions of the (hopefully expert) invited peer reviewers. You do not have to agree with – or to accept – every suggestion or comment made, but you do need to be able to respond to them all. If you think that a reviewer has made an unreasonable suggestion or criticism, be prepared to defend your own position in your letter to the editor that will accompany your re-submission. Do not, however, get into an unnecessary argument with a reviewer.
• If you get a rejection after peer review, use the reviewers’ comments constructively in preparing your manuscript for submission elsewhere. Note, however, that some journals may use the same reviewers, particularly for highly specialized fields of work. You will not endear yourself to a reviewer if he/she is asked to comment on your work for another journal and finds you have accepted few or none of his/her suggestions from the first review.
• Remember, Rome was not built in a day. Nothing comes without practice.
• Authorship can be a tricky issue. There are clear guidelines available from most journals about what should constitute "authorship". I was taught that anyone named as an author on a paper should be prepared to stand up in a public forum and describe and discuss the work meaningfully. I do not put that forward as the only criterion for authorship, although I have found it to be a reliable and realistic one. Anyone involved with the work who falls short of deserving authorship should, however, be acknowledged at the end of the manuscript as he/she has contributed, even if only in a minor way. Most journals require specific information about each individual author’s contribution to the study.

I do not suggest that these points form a definitive guide on how to prepare an abstract or a manuscript. However, I think that at least some of them should make the preparation and submission process more efficient. You won’t necessarily agree with them, but I hope that you will find at least some of them useful. Remember that everything – including medical or scientific writing – improves with practice.