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Writing for scientific medical manuscript: A guide for preparing manuscript

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 SPECIAL ARTICLE

Writing for Scientic Medical Manuscript: a Guide

for Preparing Manuscript Submitted to Biomedical Journals
Siti Setiati, Kuntjoro Harimurti

ABSTRACT conducted a clinical trial according to good clinical

Publishing a manuscript of study results in a medical or practice. While for the reader, publication of a study may
biomedical journal is not as easy as we imagine. There are provide greater knowledge on research of medical/health
some components that should be noticed in publishing a care science which may bring advantages to enhance
medical scientific journal. Although every journal has medical services for patients.
different manuscript format, in general, a manuscript contain Nancy Dixon indicates several special advantages
some components, which consist of: introduction, methods, of the published study result, i.e.:
results, and discussion. Before submitting the manuscript, be
• There is current knowledge which will enhance
sure that it has been consistent with instructions to authors
of the desired journal. Submitted manuscript should be
medical practice and will be usefull for doctors who
enclosed by a cover letter, a statement about any sponsor work in an organization or other countries;
or other potential relationship that may cause conict of • Other people will be able to analyze the study result
interest, a statement that the manuscript has been read carefully and will be able to give constructive critics
and agreed by the author(s), and any information about and suggestions to the writer;
a corresponding author. Writing skills is very important to • A study result may change the existing medical
obtain a good manuscript of study result, in order to achieve practice or at least may encourage a debate or
greater possibility for publication. Writing skills can be further study;
learned through various books or electronic sources such as • It may create a network of similar interest or
internet which discuss about writing techniques.
colleagues.
Key words: manuscript, biomedical journal, writing skills. On the other hand, publishing a manuscript of study
result in medical or biomedical journal is not as easy
INTRODUCTION as we imagine. For novice investigators in Indonesia,
it is still difcult to have their manuscript published in
“The amount of writings of a profession is a measure
of its vitality and activity, whilst their quality is a rough prestigious journals either at national, regional or interna-
indication of its intellectual state”- Sir Robert Hutchison tional level. There are many reasons for it, starting from a
(1871-1960) Lancet 1939;2:1059. bad or insufcient substance or study methods to lack of
When a doctor decides to conduct a study, at the condence to submit their manuscript of study result.
same time the doctor should decide to write and publish There is a reason for unpublished or refused
the study result as well. manuscript, which is frequently forgotten by most of
Michael Faraday, a physicist, declares an adagium investigators, i.e. incorrect and inappropriate way of
“Work; nish; publish”. If you start to work but you writing. Most of them consider their task as investiga-
will not nish it, why do you start it? Moreover, if tors are to collect and analyze data with patches of
you nish the work but you will not publish it, why sentences in their reports, and consider that creating
do you nish it?
Writing and publishing a study result is important a good and comprehensive reading as the task of the
either for the investigator or the reader. For the investiga- concerned journal editor. For a new journal which still
tor or writer, publication is evidence that he/she has has a small number of manuscript contributions, these
considerations may be acceptable, but for an established
journal which has received many manuscripts, it is very
Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine
University of Indonesia-dr. Cipto Mangunkusumo Hospital, Jakarta easy for the editor to diagnose of manuscripts with
inappropriate writing without any consideration for the
substance and study methods.
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Vol 39 • Number 1 • January - March 2007 Writing for Scientic Medical Manuscript

Most journals always provide a special page for PREPARING A MANUSCRIPT FOR SUBMISSION TO
“Instructions to Authors”, as absolute prerequisites for A MEDICAL JOURNAL
manuscipt submitted to the journal editors. In addition to Editors and reviewers of a scientic medical journal
the minimal prerequisites, other principles of medical/ spend a lot of time to read the submitted manuscripts,
biomedical scientic writing should also be recognized therefore, they will extremely appreciate a manuscript
by investigators who propose to write and to publish which is easily read and has been edited. “Instructions
their study result. This article will explain in brief about to Authors” is made to standardize the submitted
principle and techniques of scientic medical writing manuscripts and also to simplify the workload of editors
(especially for original article) which may be used as and reviewers. Therefore, read it carefully before
a basic principle for investigator and novice writer in you write or submitt any manuscript to the journal
order to have a manuscript which, according to the editorial staff .
common principles and if it is submitted to a scientic Although every journal has different manuscript
medical journal for publication, at least will be interest- format, in general, a manuscript contains some compo-
ing to the editor or peer-reviewer to read it. nents, which consist of: introduction, methods, results,
and discussion.
WHAT DO THE READER AND EDITOR WANT? The structure known as an acronym of IMRAD is
Before starting to write an article of study result or not always used by all journals with similar term, but
other article and submitting it to a certain journal, there essentially the structure reects a process of scientic
are a basic questions that should be considered by an evidence-based study conducted by an investigator. A
investigator who wishing to write his/her work: long manuscript occasionally needs several subtitles for
a. Who will be the main readers of my article? some components (especially in result and discussion
b. Who else will read the article? section) in order to clarify meaning.
c. What are the backgrounds of the main readers and Manuscript is a double-spaced article with sufcient
other readers? What are they? space margins which will facilitate editorial staff to make
d. What will make the readers interested in this article? editorial changes for every lines and to add comments or
What will be the main concern of the readers? questions directly on the same paper. If the manuscript
e. How great is experience of the readers about is submitted in the form of electronic media (disc,
subjects that will be written? compact-disc, e-mail, etc), it should be in double spaces,
f. Do the readers understand the situation and because it may be printed for editorial changes and
condition explained in this article? reviewing.
g. Why should they read this article? In the writer’s Components that commonly exist in a manuscript
opinion, what will be learned by the readers from prepared to be submitted to medical journal are as
this article? follows:
h. What does the writer expect after the reader has Title Page
nished reading this article? Title page should contain information as follows:
Most readers expect details of what have been done. a. Title of article. Title should be simple, concise and not
They do want to know why the study was conducted, complicated. However, occasionally, an extremely
and why there is the brief review about previous concise title may provide lack of information. In the
studies, approach and method used in the study result, current electronic era, the title of an article should
interpretation and conclusion of the study. include some information that will give a sensitive
An editor of a medical journal has more expecta- and specific result if electronic search is per-
tions than the readers, craves for interesting and formed.
amusing article for the readers. The editor also hopes an b. Author, name of department(s) and institution(s).
an important article that may enhance knowledge and Some journals include authors with their degrees
provide novel thought or ideas of certain study subjects. while others do not. Author(s) is person(s) who gives
Editor also craves for an article which is appropriate to substantive intelectual contribution of the conducted
the aim (or: mission) of the journal, according to the research. The International Committee of Medical
predetermined “Instructions to Authors” and a well Journal Editor (ICMJE) declares that an author
written article. Finally, an editor loves to publish an should meet all of the following conditions: (1) has a
article which gives a correct and accurate illustration substantial contribution on proposal and design, or
of the conducted study. data accuracy, or analysis and data interpretation,

51
Siti Setiati Acta Med Indones-Indones J Intern Med

(2) critically prepare or revise important manuscript tion, observation method and analysis), the main result
contents through intelectual ability, and (3) provide (mentioning about the importance of effect and statistical
nal agreement on the revised article for publication. significance, if possible), and principal conclusion.
People involved in the study but do not meet Abstract should be able to present the novel and
all of requirements as mentioned above can be important aspects of the conducted study.
regarded as “clinical investigator” or “participating Since there are some important parts of an abstract
investigator”, and will have their name on “Acknow- commonly used as index of various electronic database
legdement” section. and most of the readers only have abstract of the study,
c. Disclaimer, if any. it should be assured that the abstract reveals overall
d. Corresponding author. Author’s name, correspon- study report accurately. Unfortunately, there are many
dence adress, telephone number, fax and e-mail are abstracts inappropriate to the manuscripts.
included. Corresponding author may be the author Key words are 3 to 10 words or concise-phrase that
who “guarantee” integrity of overall manuscript, but may reveal the main topic of the study, usually it is
may be not. Corresponding author should noticeably stated along with the abstract. Keywords should include
declare that he/she does not mind if the above words registered in the list of Medical Subject Heading
information is published. (MeSH) of index medicus.
e. Available author’s name and contact address if there
Introduction
is a request of manuscript copy, or a statement that
Introduction contains the study background
manuscript copy cannot be provided by the author.
(revealing the importance of a problem so that it should
f. All of aid sources and assistance such as fund,
be studied, supported by data of available literatures),
equipment, medicines, etc.
study objective and hypothesis that will be tested or
g. Running head. Some journals ask for running head
questions that will be answered by the study. Parts of
or a brief title of article which has been condensed
introduction is written as a narative arranged in logic
into less than 40 characters (including letters and
sequences in 1 or 2 paragraphs.
spacing) on the footer of title page. This running
As an analogy of a building, introduction is a
head may appear on the published article, but it may
“door” to get into the “house” of all part in study
be only used by the editorial staff for manuscript
report. Therefore, introduction section should be able
documentation.
to ‘drive’ the readers to understand and agree the
h. Word count. Word count for all of manuscript
investigator’s/writer’s idea that the study performed is
content (abstract, acknowledgments, gure explana-
necessary and reasonable.
tion, title of tables and references are excluded) will
help the editor or reviewer to determine whether the Methods
information is appopriate to the length of manuscript Methods only contain available information at the
and to decide whether the submitted manuscript does time of planning and study protocol; therefore, other
not exceed the limited word count determined by the information obtained after the study performed should
journal. Separated word count for abstract is also be included in results section.
useful for similar reason. In this section, the study design should be explained
i. The number of illustrations and tables. (along with relevant explanation for each design), time
and place of the study conducted, subject selection
Special Page for ‘Conict of Interest’ Statement
(including the control group), inclusion and exclusion
To anticipate any potential conict of interest among
criteria as well as study population. Variables of study
the writer, editor or reviewer (either because of the
and correlation among the variables should be clear.
received fund or other facilities, or writer, editor and
Technical information about measurement (examina-
reviewer come from the same institution); therefore, if
tion) including the executor, equipment and medicine
necessary, the writer may explicitly state whether there
used (if possible, mention about the brand-name and
is any potential conlct of interest occurred.
manufacture), informed-consent of the subject, etc
Abstract and Key words should also be included in details.
An abstract is a substantial part of overall Analytical statistic which is used in the study (such
manuscript in brief. Although there are various abstract as hypothesis test, signicance test, statistic power and
forms–which depend on each journal-, generally, abstract condent interval) should also be included in details, so
should include the context of background of study, the that other people who have data access may clarify the
study aim, basic procedures or methods (subject selec- reported result. The common analytical method may
52
Vol 39 • Number 1 • January - March 2007 Writing for Scientic Medical Manuscript

not be explained. However, if there is certain new or exaggerating sentences about the study result, as well as
occasional hypothesis test or statistical test, then it should hesitant sentences.
be explained or references should be provided. Explain At the end of discussion section, mention about
about statistical terms, abbreviations and symbols. the conclusion of the study. Indicate correlation between
Mention about the computer program used in the the conclusion and the aim of study, avoid statements
study. and conclusions which are not supported by data
adequately.
Results
Present the study result with logical sequences References
through texts (naration), tables, and illustration; starting References should be numbered in the order in
from main result or the most important result rst. Do not which they are mentioned in the text. References of text,
repeat any information that has been presented in tables tables and illustration are numbered by Arabic number in
and illustration into text, except for emphasizing or parentheses. Style of references of various literatures
highlighting important ndings. Additional information can be seen on examples recommended by ICMJE
and technical details may be put in the appendix section (www.nlm.nih.gov/bsd/bsdhome.html), while the data
so that it can be revealed without disturbing the naration. of titles of journals can be seen in index medicus.
Provide the absolute number of data not only as a Other things that should be noted in writing
percentage. Avoid non-techinical statistical terms, such references:
as “random”, “normal”, “signicant”, “correlations”, • Try to directly refer to original research articles and
and “sample”. not to the review articles because review articles do
Use tables and illustrations only for information not always indicate accurate results.
which has better value on tables and illustration compared • Avoid using abstrats as references
to text form, because usually the editor determined a • Articles accepted but not yet published may be
limited number of tables and illustrations. Use an added by “in press” or “forthcoming”, and it should
illustration as an alternative of table with a lot of have written consent saying that the articles will be
components, and do not duplicate data on illustrations referred and provide a verication that the article
and tables. Tables or illustrations should be appropriate has been accepted to be published.
to text. “Wild” tables or illustration that do not indicate • Information of refused articles by certain journal
on text should be avoided. Explain about uncommon should be written on text as “unpublished observa-
abbreviations and symbols on the footnote of tions” with a written consent of the source.
related tables. Usually, an editor would like a • Avoid citing a “personal communication” unless it
professional illustration is ready to be printed. provides essential information not available from
For manuscript which will be submitted to a public source. If it should be done, name the
journal, provide tables and illustrations on seperated person and date of communication on the text in
pages. parantheses.
Be careful about details of number writing, numerical • Although some of journals conduct accuracy check-
accuracy, terms, and statistical symbols, and technical ing of citation and references, the author should
details of tables and illustration production, which assure that nothing is missed.
are reffered to as a guide to ICMJE (can be seen on
www. icmje.org, 2006) and Sastroasmoro monogram FINAL PREPARATION OF MANUSCRIPT
(1999). After the manuscript has been written according to
Discussion “instruction to authors”, let it be (do not read it) for
Reveal novel and important ndings of the study. Do several days, and give it to other people to be read
not repeat every details of data presented on introduction before submitting it to the desired journal. As a result of
or Result section. In experimental study and some of not ‘touching’ your manuscript for a few days, you will
observational studies, discussion usually begins with get inputs and questions from the people who read your
concise and clear explanation about main result of the work and after you read it once more, usually there
study, and followed by analysis of possible mechanism or will be additional ideas about something that should be
explanation of such ndings, compare and differ it with added, deleted or briey revised.
other relevant studies, and mention about drawbacks Read over the whole manuscript, starting from the
of the study, and analysis of implication in clinical title to the references. Check every word and sentence
practice and possibility of further studies. Avoid carefully, avoid typing error. Revise any complicated
53
Siti Setiati Acta Med Indones-Indones J Intern Med

sentence by expressing your ideas through the least reviewer which will be important for revision. Use it
number of words. If you are able to delete words to revise the manuscript, and submit it to other journal
without changing the meaning, then do it. Avoid adjacent afterwards.
word repetition, but repetition on some ideas can be
made necessary. Keep in mind that there is limited pages SEVERAL NOTES ON ‘WRITING’
in the journal and the editor will appreciate concise Refer to Sir Robert Hutchison statement cited in
manuscript. The naration should ow smoothly- in every the beginning of this article, which is important for
sentence and in every paragraph – with logical sequences. professional doctor to write in sufficient number
But there is one importance, which is usually ignored, and quality so the vitality and intelectual state as a
in performing literature review relevant to the studied profession could be acknowledged. However, there is
topics since there is high possibility of many novel some experience that the enthusiasm of writing among
studies that have been published during the study. Error doctors is low. Some have reason for routine activities
in lliterature review will make all of the study reports and daily practice and other exclaims on inabillity
become ‘obsolete’ (especially in background and of good writing. There are a lot of ideas created in
discussion section), which bring small possibility to be their head, but they are unable to make it into an
accepted by the journal reviewer. comprehensible article. Unfortunately, this inability
After everything has been completed, the next step only exists as an emotion or feeling, which means
is submitting your revised manuscript to the desired that there is feeling of inability without any
journal editorial staff. Make sure that you have attempt to write it. While there is a principle guide
completed every component that being asked by the for a novice author: First get it down and then get it
journal. Every details, such as the number of copies right. How could we know that we are unable to write
(including tables and illustrations) on demand should correctly if we never start to write? Writing skill is
be completed. Do not rely on the editorial staff that they similar to other skills, if you want to write fast and
will make copies of your manuscript and distributing it correctly, then you have to practice it.
to editors and reviewers. Currently, there is possibility In general, there are two types of authors: ‘gatherer’
of submitting manuscript through electronic media, and ‘hunter’. A ‘gatherer’ author collects all of sources
either by disc, e-mail, or directly to the desired journal that might be relevant to the article, reading all of
website. Pay attention to the determined requirements for the compiled sources, use it to organize an idea then
submitting manuscript through such methods. starting to write. This ‘gathering’ attitude is suitable
Submitted manuscript should be enclosed by cover if you would like to make a literature review, and this
letter containing statement that the manuscript is original is an attitude learned by students during their formal
work of the author and has not been published before education. But this attitude is not always suitable to
in a journal or other media. It also contains statements every article. ‘Gatherer’ authors may make various
about any sponsor that potentially may cause conict of serious mistakes even before starting to write:they
interest, the manuscript has been read and agreed by hesitate about their target reader, they do not have
the author, and any information about corresponding obvious aim of writings, they are not certain about
author. Other information that should be known by the important messages that will be given, and they have
journal editor must be stated in the cover letter, for no attention on organizing ideas.
example, if the manuscript has been submitted to other Experienced authors incline to have ‘hunter’
journal and has been refused, then you should enclose attitude in writing. They determine about what article
comments of previous editor and reviewer as well as should be made and for whom it should be written. They
your comments about it. know what specication should be done, and determine
Finally, it is the time to wait for response. Response the strategy to achieve those specications as part of
may be in the form of: (1) approved for publication outline. Subsequently, they find sources which are
without any substantial revision; (2) considered for appropriate to the constructed outline. Created ideas can
publication with substantial revision; or (3) refused for be written rapidly, and they are written in comprehensible
publication. If the manuscript should be revised, then sentences and have the least misinterpretation. Those
do it based on comments of critical appraisal from the ideas are organized in common sense so that information
editor or reviewer. If the manuscript is refused, do not can be followed by the readers. This type of authors can
be dissappointed. Usually, the editor will point out their perform editting on their own articles.
reason on why the manuscript cannot be published in To achieve this ’hunter’ attitude is not easy. Begin
addition to comments and suggestion of editors and
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 Vol 39 • Number 1 • January - March 2007 Writing for Scientic Medical Manuscript

to write as ’gatherer’ author continually and improve REFERENCES

your article quality consistently, including learning 1. International Committee of Medical Journal Editors. Uniform
from other articles of ’hunter’ authors, or ask somebody Requirements for Manuscripts Submitted to Biomedical
to read our article. As a result, we know whether our ideas Journals: Writing and Editing for Biomedical Publication.
February 2006. (www.icmje.org)
can be followed by the readers. People whom we asked to
2. Dixon N. Writing for publication – a guide for new authors. Int
read and to give comments on our article are not always J Qual Health Care. 2001;13(5):417-21.
experienced people. Sometimes ‘foolish questions’ 3. Naylor WP, Muñoz-Viveros CA. The art of scientic writing:
of a junior may improve our judgement about the How to get your research published! J Contemp Dent Pract.
drawbacks of our article. 2005;(6)2:164-80.
4. Sastroasmoro S. Panduan penulisan makalah ilmiah kedokteran.
Writing skill can be learned through various books Jakarta: Bagian Ilmu Kesehatan Anak Universitas Indonesia;
on writing techniques, either in general or special 1999.
writing for scientic medical/biomedical journals which
are greatly published recently, including electronic
sources such as internet. Do not hesitate to ask or open
your dictionary, and books of writing guide for special
terms, so that our article are always appropriate. Thus,
once more: rst get it down and then get it right.

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