Your Roadmap to Better Writing
Gathering information
Sharpening your focus
Who is your audience?
What is your purpose?
Organizing your ideas
Basic structure
Structure of research reports
Other features of medical articles
Keeping your readers awake on the road
Creator to critic Suggested reading
We live in the age of information, but not everything that is transmitted is
intelligible enough to be understood. Editors of medical and scientific journals
are known to complain—in print—about articles that are difficult to
read. Most problems, they say, are caused not by complexity of scientific thought
but by poor writing. The result is manuscripts filled with puzzling jargon and
confusing construction—obstacles that cause readers either to abandon an
article or to misinterpret it.
Two other problems that medical editors encounter are manuscripts that digress
from their topic and those that fall short of editorial specifications. Authors
who have ignored submission criteria are likely to have had difficulty organizing
their material as well. Some may have lost their focus, perhaps even their interest,
in the topic. Such manuscripts need careful editorial attention, and preparing
them for publication is slow and painstaking—a frustrating experience for
all concerned.
The editors of JAAPA want to move manuscripts forward to publication
with as few impediments as possible. Most writing problems, we believe, can
be avoided if the author understands how to produce a focused, organized, accurate,
easy-to-read article—something that is worthy of a professional.
Gathering information
As you assemble material for your article, remember the following guidelines:
- Use up-to-date references. Although review articles can provide basic information,
most referenced information should come from articles that offer findings
based on sound research. Consider periodicals and on-line sources (PubMed
and the Cochrane database, for example). Avoid textbook references altogether.
How many references should you include? No answer can cover all topics, but
strive to include as many references as are needed, but no more, to support
your statements of fact, hypotheses, and conclusions.
- Be aware of your bias. You are the best resource for a large part of your
research. As you tap your knowledge and experience, be alert for your bias.
Look for other data, and do not ignore data that are inconsistent with your
point of view.
- Support your ideas. When medieval architects built towering cathedrals,
they constructed flying buttresses to support the walls. Professional articles
require the same cautionary care. When gathering research, remember that your
major points or arguments will be more legitimate when supported with examples,
statistics, comparisons or contrasts, and explanations.
Sharpening your focus
Visiting the entire state of Texas is a tremendous undertaking. So is writing
an article on the general topic of infectious disease. Narrow your focus so
that your topic is manageable.
General David C. Jones, former chairman of the Joint Chiefs of Staff, said:
"My guidelines are simple. Be selective. Be concise. Don’t tell someone
what you know; tell them what they need to know, what it means, and why it matters."1
No editor could give better advice.
Before you begin to write, ask yourself some questions about your topic:
- For whom are you writing?
- For what purpose are you writing on this topic?
- Do others need to know what you have to say?
- What is the one provocative thought you would like to leave with your readers?
- What is the scope of your article?
- Is your topic so broad that readers will become lost as they read it, or
swamped by excessive information?
- Will your topic lead to an article that just rehashes a chapter in a medical
textbook? Or will your article leave PA readers with new ideas or practical
strategies for addressing a clinical problem?
- What is the appropriate niche in JAAPA for your topic? (See Submission
Guidelines for more information.)
Who is your audience?
If a typical PA were sitting across from you, what would you want to say? How
much of that should you attempt to communicate at one time? How should you dress
your message so that it will be interesting? How well versed is your reader
likely to be in the subject?
Knowing your audience helps you choose a focus for the article. Many PAs are
still concentrated in primary care, and JAAPA sees its main audience
as primary care PAs. An article on Zarin’s approach to anterior cruciate
ligament reconstruction, for example, should discuss causes, findings, preventive
measures, and surgical options for athletes who have unstable knees—but
should not provide meticulous operative detail.
What is your purpose?
Before you write an article, you must know why you are doing it. Ask yourself:
Is this necessary? And why do I want to write it? Keep your purpose(s) in mind
when you define your specific objective. Ask yourself: What is the most important
point I want to communicate to other PAs? If you cannot think of anything, ask:
What do I want other PAs to do as a result of my article? The answer to these
questions is your specific objective. Write it down. It will help you remain
focused as you research and begin to organize your article.
Organizing your ideas
Writing an article that has clarity of thought and unity of idea requires organization
and structure. An outline is a good way to organize your paper, and it is the
sure cure for writer’s block. Before you begin an outline, however, write
down your specific objective. At this point, some other ideas may come to mind.
Write down any ideas that seem to support or relate to your specific purpose;
the more, the better. Then look at the list and discard the ideas that are not
related to your purpose or are not required for readers to understand what you
are saying. Remember that information unrelated to your specific objective only
clutters your article.
Next, look at the list and identify the main and supporting ideas. Main ideas
stand out because they are equally important and are so essential to your stated
purpose that forgetting one would make your article appear incomplete. Supporting
ideas can be identified as ideas that expand your main points and give greater
detail and credibility.
Determining main and supporting ideas helps you set priorities so that you
can impose order on the article. You will then be able to lead readers, step
by step, through the unfolding discussion. Your main ideas eventually become
the topic sentences of paragraphs.
Basic structure
Aristotle noted that any form of writing that moves through time needs three
parts: a beginning, a middle, and an end. These give the writing stability.
Dissertations and essays of any sort generally have a basic three-part structure.
The beginning, or introduction, sets the tone of the essay, gives it direction,
and states the thesis. The middle, or body, is where main and supporting ideas
are set down to amplify the thesis, involve the audience, and fulfill their
expectations. The end, or conclusion, restates the thesis, summarizes the reader’s
journey, expands the implications, and announces arrival at the destination.
Introduction: Any introduction should lead the audience gracefully
into the topic. As with a speech, the introduction should feel like the beginning
of a planned trip, not an accident. Establish rapport with your audience with
a tone that makes them trust and respect you and that tells them you have something
important to say.
Begin your introduction with a general but pertinent statement. Proceed to
paint an overview of the topic. If appropriate, include a brief, selective review
of the literature here. Be sure to refer to the purpose of your paper. Tell
readers why the subject is important to them. And state your thesis and main
points at the end of the introductory paragraph. This is one of two key positions
of emphasis in the article. (The other is the conclusion.)
Clever writers also anticipate opposition and prepare for it in the thesis
statement with a clause such as "Despite many advantages . . ." or "Although
the old technique. . . ." By using a subordinate clause, you assign the opposition
to a subordinate position. Because the position of importance in any sentence
is at the end, your thesis thus receives additional emphasis.
Body: Once your thesis has been announced, it stimulates interest
and carries readers into the body of the article, where your main and supporting
ideas are discussed. Writing the body of a manuscript takes a lot of concentration
and perseverance. Retaining reader interest here is crucial. At the least, arrange
your discussion paragraphs in the order in which you promised them in the introduction.
Conclusion: The conclusion of an article is often left unfinished
by authors or ignored altogether. Without it, however, the article is incomplete.
Because readers remember the last thing they read, you should summarize your
pertinent findings, restate the thesis, confirm that you have supported it,
and make conclusions. The article then comes full circle and readers feel enlightened
and satisfied.
Structure of research reports
Research reports have the same structure as most manuscripts: introduction,
discussion, and conclusion. Following the introduction of a research report,
however, are two parts found only in research articles: methods and materials,
and results.
The introduction of a research report should begin with a brief description
of the problem being studied and a clear statement of why the problem is important
professionally or clinically. Cite only key previous studies as background.
State the outcome measures used and explain why they were chosen.
In materials and methods, describe how the study was performed. Give sufficient
detail so that another investigator can duplicate the study. Explain how the
population was selected; describe eligibility and exclusion criteria, stating
how they were assessed and what baseline measurements were made.
The results section should contain all data collected from the study and any
results of statistical analysis. Account for all subjects from the start of
the trial to completion. Reserve comments on the data or statistical findings
for the discussion.
In the discussion, describe the clinical significance of the study, its strengths
and weaknesses, and its potential biases and how they might affect results.
Other features of medical articles
Medical articles have additional features that are important to consider when
assembling a manuscript.
The abstract: An abstract directs readers to what the article
contains. It should state the purpose of the article; summarize its main points;
describe the design, setting, subjects, interventions, and basic procedures
that were followed; state the main findings; and declare principal conclusions.
JAAPA requires a full abstract but not more than 150 words with all research
manuscripts. For review articles, on the other hand, a more compact version
(50 words or less) is requested. This kind of abstract should be limited to
a clear pronouncement of the objective(s) of the article. Department pieces
do not require abstracts.
Tables and figures: As you write the first draft, note the places
where you think a figure—clinical photograph, anatomic drawing, diagnostic
image, graph, etc.—or table would be appropriate. Seek out tables and figures
that are interesting and add value to your article, or take the time to develop
your own. These elements are usually worth a multitude of words in a journal,
especially in teaching articles. They break up long stretches of text and engage
readers in greater activity by setting up data or examples for closer and different
scrutiny.
Tables and figures in the public domain (such as material from any government
agency) can be used without requesting permission and, often, paying a fee.
To use published material that is not in the public domain, the editors of JAAPA
must write to request permission from the copyright holder, author, or artist.
We will do that during editing of your manuscript; authors should not write
to request permission themselves. You can also submit your own tables and figures
(photographs, computer graphics, and graphs are acceptable as the basis for
further refinement by the design staff). Keep in mind that JAAPA has
access to a bank of professional scientific and medical artists who can turn
your sketches into accomplished, instructive illustrations. The editorial staff
can work with you on the specifics; if you are uncertain how to proceed with
this aspect of manuscript preparation, please call the editors.
A good table is concise, complete, and congruent. Select data for a table that
explain the study, examine the hypothesis or thesis, and allow comparison with
other studies. A table can have many elements but still be concise, preferably
giving only one or two trends. Columns and rows of data with counts of people
or events should be totaled for the reader. Numbers in the tables should be
congruent with the words of the text.
Avoid using sparse data—that is, data that could be presented in one or
two sentences in text—for graphs or tables. Avoid duplication of text material
in tables, figures, and boxes (also known as sidebars, such as for presenting
a case study or a news update). Refer to all tables, figures, and boxes by number
in the text.
Deciding whether to use a table or a graph can be difficult. Here is a useful
rule: Data that show pronounced trends and make an interesting picture should
take the form of a graph.
Keeping your readers awake on the road
We have all had the experience of falling asleep while reading. Remember struggling
to keep your eyes open, your mind focused, your head erect, and your elbows
bent? Most likely you were reading something academic, something that you felt
you had to read or were required to read. Remember blaming yourself? Well, it
might not have been your fault. Some writers subvert their writing by using
too many words or opting for dull, lifeless language. This type of writing seems
to have become epidemic in our society, and it defeats the purpose of communication.
Here are a few suggestions on steering clear of what the writer George Orwell
called "mass language":
- Avoid clichés (phrases that you are used to seeing in print).
- Do not use long, Latin-based words, foreign phrases, or scientific words
if you can think of everyday English equivalents.
- Tighten—cut the number of words—wherever you can.
Prefer active voice to passive voice. Be certain, however, that
changing a passive statement to an active form does not erase some subtlety
of meaning.
Voice is the form of the verb that tells whether the subject acts or receives
the action. When the subject does the action, the verb is active. When the subject
receives the action, the verb is passive. Active voice is more direct, concise,
and vigorous; passive voice often takes a form of the verb to be. Compare "Writers
should avoid passive voice" to "Passive voice should be avoided by writers"
and you see the distinction. This does not mean that you should always avoid
the passive. Sometimes it is necessary. But remember that frequent use of active
voice makes your writing more forceful and keeps readers awake.
Avoid awkward construction. Complex sentences contain several
ideas that are interwoven with clauses and phrases. When a complex sentence
is not constructed skillfully, it becomes confusing and awkward. Verbs are often
separated from their subjects, relative pronouns aren’t placed close enough
to their antecedents, and modifiers are misplaced. In the end, the reader receives
incomplete or inaccurate information or no information at all.
Read and reread your sentences. Ask others to do the same with your writing.
If sentences do not make sense because they are too long, too complex, or too
convoluted, reconstruct them by keeping related words together or by creating
several simple sentences.
Give your sentences strength. Place important words at the beginning
or end of a sentence to give them emphasis. Make positive statements instead
of negative ones. Sentences that contain "not" weaken a statement. They make
the writer appear wishy-washy. Compare "He was not very often on time" to "He
usually came late."
Parallel construction also strengthens writing. No complex sentence is successful
without it. Abraham Lincoln was a master writer who used parallel construction
to express parallel ideas. Study this excerpt from Lincoln’s Second Inaugural
Address. The parallel words are italicized.
With malice toward none; with charity for all; with firmness
in the right, as God gives us to see the right, let us strive on to finish the
work we are in: to bind up the nation’s wounds; to care for
him who shall have borne the battle, and for his widow and his orphan, to
do all which may achieve and cherish a just and lasting peace among ourselves,
and with all nations.
Provide bridges and road signs. Each discussion paragraph explores
or explains a single narrow topic related to the mission of the article. The
paragraph comprises a topic sentence (a statement that tells readers the main
idea to be discussed); discussion sentences; and a transitional element of one
or more words. Transitional words are essential because they link paragraphs
and ideas, thereby preventing misinterpretations. Like bridges, they connect.
For maximum benefit, transitional words should be placed within the first few
words of the sentence. They are placed in the first or last sentence of a paragraph.
In this way, they provide unity to the article and prepare the reader for what
comes next. Here, by category, are some useful transitional words to remember:
- Addition: furthermore, in addition, moreover, similarly, and, also, likewise,
too
- Opposition: but, however, although, nevertheless, still, yet
- Cause and effect or consequence: hence, therefore, thus, consequently
- Conclusion: so, therefore, for, as a result, consequently, in summary
- Exemplification: for example, for instance, to illustrate, that is
- Intensification: in fact, indeed, even, as a matter of fact
- Sequence: first, second, last, in conclusion
Just as transitions act as bridges, orienters act as road signs, showing readers
the way and providing a point of view. They should be placed at the beginning
of a sentence. Orienters can be any of the transitional devices just mentioned,
or they can be something similar to the following types of words and phrases:
- Time and place: during the last decade, in the South
- Qualifiers (ie, words restricting the range of certainty of an assertion):
under these circumstances, with these restrictions
- Perspective: generally, usually, pragmatically
Creator to critic
Once your ideas are on paper in logical order, the temptation is great to send
the manuscript off to be published. But writing an article does not end with
the first draft. From now until your manuscript is published, writing requires
you to switch roles several times from creator to critic and back to creator
again. Most people need a few hours or a few days to make these switches.
When you are ready to evaluate your first draft objectively, plan to read what
you have written three times. Read it first for clarity, accuracy, and adequacy
of information. Are your main points and supporting points clear to the PA reader?
Do you have enough information? Too much? Should you have included more, or
fewer, explanations of terms and concepts? Is some information irrelevant to
PAs? Revise accordingly!
Read the manuscript a second time for arrangement of ideas. Does the title
accurately reflect the subject? Do the abstract, introduction, and conclusion
state the purpose? Does the conclusion provide a wrap-up? Do ideas in the body
of the manuscript flow smoothly and logically? Is the body well organized? Do
topic sentences reflect main ideas? Revise again!
Next, evaluate the manuscript for readability. Is it awkward? Does it have
too many words or phrases? Is the grammar correct? Is the language lively? Have
you followed JAAPA’s requirements for manuscript preparation? Revise!
Once you are satisfied that the manuscript is as good as you can make it, it’s
time to submit. See Submission
Guidelines for more information.
Reference
1. Staley HA. The New Tongue and Quill: Your Practical and
Humorous Guide to Better Communication. Washington, DC: Pergamon-Brassey’s
International Defense Publishers; 1990:20,24.
Suggested reading
Bernstein TM. The Careful Writer: A Modern Guide to English
Usage. New York, NY: Atheneum; 1991.
Leggett G, Mead CD, Charvat W. Prentice-Hall Handbook for
Writers. Englewood Cliffs, NJ: Prentice-Hall; 1990.
Strunk W Jr, White EB. The Elements of Style. Old Tappan,
NJ: Macmillan; 1979.
Weiss-Lambrou R. The Health Professional’s Guide to
Writing for Publication. Springfield, Ill: Thomas; 1989.
Williams JM. Style: Ten Lessons in Clarity and Grace.
4th ed. New York, NY: HarperCollins; 1990.
Zeiger M. Essentials of Writing Biomedical Research Papers.
New York, NY: McGraw-Hill; 1991.
Copyright 2002 by Medical Economics/Thomson Healthcare and the American Academy
of Physician Assistants. All rights reserved. Photocopy rights: None of the
contents of this publication may be reproduced, stored in a retrieval system,
or transmitted in any form or by any means (electronic, mechanical, photocopying,
recording, or otherwise) without the written permission of the publisher.
Your Road Map to Better Writing for JAAPA is updated and adapted from Benson
CV. A roadmap for better writing: A guide to writing for JAAPA. JAAPA.
1994;7:53-64.
Last updated 01/04
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