One of the more valuable, if not overlooked, elements of resident education is the intellectual challenge associated with critically evaluating published research. Typically, peer-reviewed journal articles center on evidence-based clinical ophthalmology that has been screened for errors in method, misuse of statistical analysis and overgeneralization of results. And the more that residents are a part of this process — actively participating in expressing critiques, offering alternating opinions and correcting colleagues — the better they will be equipped to engage in the larger professional conversation and thus advance the field of ophthalmology.
This two-part series will look at how residents can start participating in this process by (1) hosting discussion through a journal club, (2) engaging in the peer-review method and (3) contributing to the discussion by writing. This month, YO Info will explore writing and provide tips on how residents can optimize their chances of having an article accepted for publication in a peer-reviewed journal, with insight from Henry D. Jampel, MD, MHS. The deputy editor in chief of Ophthalmology, Dr. Jampel is also the Odd Fellows Professor of Ophthalmology at the Wilmer Eye Institute; his career encompasses both laboratory and clinical research.
Is publishing for me? Writing peer-reviewed articles and understanding the publication process can be essential for a career in ophthalmology. Conceiving a topic, executing the investigation and synthesizing the results can be an excellent complement to the weekly routine of clinic and surgery. “All young ophthalmologists should consider writing a peer-reviewed article,” said Dr. Jampel. “This variety is important in keeping a professional life interesting. Furthermore, the sense of accomplishment from having produced a piece of work that will be widely viewed, and that potentially can positively influence patient care, is satisfying.”
Do the prep. “The prerequisite for preparing an original article is having an observation or series of observations that, if disseminated, will add to the knowledge base of a community of readers,” said Dr. Jampel. “Therefore, one should not consider starting until the observations have been made.” He suggests looking at two broad categories of sources for observations: a planned prospective trial and an unusual observation made in the course of clinical care. An example of the former is hypothesizing that drug A was more effective than drug B for a particular disease and then developing a controlled trial as a test. An example of the latter might be a unique complication in several patients stemming from an alteration in surgical technique.
But is my idea strong enough? “If one has some objectivity about one’s own work,” said Dr. Jampel, “it can be compared with published manuscripts in your journal of choice.” Therefore, ask yourself some honest questions: Does your topic possess as broad an appeal as the majority of published manuscripts? Is your study design as strong? Will the number of subjects in your study compare well? If you find yourself answering “no” to these questions, there’s a good chance that your manuscript is not suitable for that particular publication. Fear not, though; a second opinion is always helpful. Dr. Jampel recommends contacting other experts in the field who are willing to review your manuscript and provide additional feedback about your work’s potential merit.
How to begin. Consult first with individuals who have experience in clinical research and publishing so that you can determine if your idea is original, interesting and, of course, feasible. Dr. Jampel also suggests consulting with a biostatistician if you anticipate that a prospective trial is in order. And remember to start the process early: almost all clinical research requires evaluation by an institutional review board.
In most cases, manuscripts are written in their entirety prior to submitting; however, some journal editors will review your abstract and advise on whether or not that particular journal is an appropriate place for your work. Writing does not always have to be a solo adventure either. According to Dr. Jampel, coauthors can play an essential role, particularly if you are new to the process: “The presence of a prominent coauthor can lend credibility to a submission, provided that it is clear that the senior author played an important role in the conception, execution and interpretation of the project.”
It’s paramount to give yourself the necessary amount of time to put forward the best product. Because you will be busy with a number of other tasks while pursuing your clinical research, submitting even one publication can be a lengthy process. “Given that most of our fellows can’t complete a project and have it published in the course of a year-long fellowship,” Dr. Jampel said, “I think that a more realistic time line for a young ophthalmologist in residency training is two years.”
Rejection guaranteed. Because most journals receive far more manuscripts than can be published, you should expect that your submission will be rejected. However, in many circumstances, the publication’s reviewers will provide suggestions for improvement, which can help increase the likelihood of the paper being accepted by another publication. “It’s expected that a manuscript rejected by one journal will be submitted to — and eventually accepted by — another journal,” Dr. Jampel noted. “However, an individual manuscript cannot be submitted to more than one journal at a time.”
It’s safe to say that you can’t ever predict how the review process will turn out. “I submitted one manuscript that was almost flat out rejected by a leading journal,” said Dr. Jampel, “and I was asked to revise it extensively, and then it might gain acceptance. Eventually the manuscript was accepted, but I assumed it would be considered near the bottom in quality of the articles in that journal. I was pleasantly surprised when it was selected by the editor as one of the most noteworthy articles of the year in that journal. The mottos are ‘don’t give up’ and ‘you never know.’”
Interested in submitting an article? Each journal has very specific instructions — and can offer unique practice advice — about how to submit your article for publication. Although you might not have a finalized manuscript ready at hand, perusing and comparing a handful of journals’ author instructions can serve as good prep for when you are ready to take the next step.
Here’s a sample:
Next month we’ll look at hosting a journal club.
* * *
About the author: Mike Mott is a former assistant editor for EyeNet Magazine and contributing writer for YO Info.