EDITORIAL

MICROSURGERY

32:8085

2012

A GUIDE TO WRITE A SCIENTIFIC PAPER FOR NEW WRITERS A scientic paper is a published report describing original research results.1 It should provide sufcient information for assessing the observations, repeating the experiments, and evaluating the underlying intellectual processes or logic. In other words, a good scientic paper should include a well-designed and reproducible method, coherent and understandable results, and a reasonable and comprehensive discussion. Why should a physician write and publish their investigations and ndings? Gerard Piel, who was the publisher of the Scientic American magazine, said, Without publication, science is dead. The continuity and advancement of science require that researchers to publish. On the other hand, Ebel et al. also stated that only the researcher who is competent in the art of written communication can play an active and effective role in contributing to science.2 Additionally, publication is also necessary for several personal reasons. Scientists cannot obtain funding for their researches either from the government or private enterprises, or achieve professional advancement at universities or academic institutions, if they do not publish their work and ndings.3 Most literature references are incomplete because most investigators search only among articles in English. The data from innumerable studies written in the native language of the authors have been missing from otherwise systematic reviews because of translation difculties. Beneld et al.s study on the language of science noted that the most signicant differences in the articles published by native and nonnative English speakers concerned language and the quality of writing.4 A new writer, especially a physician who is not a native English-speaker, usually does not publish for this reason or is rejected by journals due to the poor comprehension and deciency of writing in English.
Published online 28 November 2011 in Wiley Online Library (wileyonlinelibrary. com). DOI 10.1002/micr.20960
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Therefore, in this article we share our personal experiences to teach physicians, who are new to writing and who are not native speakers of English, how to write scientic papers and encourage them to do so.
GETTING STARTED Have a mentor

A mentor is an important and basic requirement for physicians who want to write but are new to writing,5 especially when they are not native speakers of English. A good mentor can guide you in the right direction with regard to the practice that precedes writing a good scientic paper. Thus, securing a good mentor is the rst priority for a new writer and plays a key role in improving his or her writing skills. What are the characteristics of a good mentor? A good mentor tends to be self-assured, to give and receive constructive criticism, and to understand how to challenge the mentee when and where appropriate. He or she should be characterized by the following: (1) a willingness to spend time and share experiences, (2) a good reputation for fostering the development of others, (3) up-todate knowledge, (4) ability to facilitate independence and balance, (5) an attitude that provides encouragement and motivation, and (6) demonstrated effective mentoring skills.68 For example, in our institute, Prof. Fu-Chan Wei, is a world wide well-known micro-surgeon. He truly devotes himself to spend time to clinics and shares his experience with young fellows. How to identify a good mentor? Although, this usually depends on the physicians specialty and the type of research to work on, the following suggestions may assist in this process: (1) engage in self-assessment (think about your needs and on what do you want your mentor to do for you), (2) consider and make a list of possible mentors, (3) develop an invitation that gives the potential

2011 Wiley Periodicals, Inc.

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Figure 1. General guidelines for scientic writing. [Color gure can be viewed in the online issue, which is available at wileyonlinelibrary. com.].

mentor a subtle mean of declining, (4) ask the person to be your mentor, and (5) be patient.9 After nding a mentor, you should contribute to the maintenance of a good mentormentee relationship.10 At the same time, you must be prepared to work hard, perform your assigned tasks and be able to communicate your needs to your mentor.11 The mentee must be willing to be mentored, to accept criticism, to learn from mistakes, and to strive to give his or her best at all times. These constitute the prerequisites for learning.
GENERAL GUIDELINES FOR SCIENTIFIC WRITING (FIG. 1)

1. Have an idea before starting to write: Before starting to write a paper, the author must identify and have the idea that he wants to communicate through the paper. This idea can be a new model, a new technique, or new results.12 For example, in Kaohsiung Chang Gung Memorial Hospital, Taiwan, we have a lot of free tissue transfers. We are always trying to create new surgical interventions to improve our outcomes. This reason let us create innovative ideas that we can later share through our written papers. 2. Conduct an accurate and adequate literature review: Incomplete, inaccurate, and outdated literature reviews and references can be reasons for a paper not to be accepted for publication.13 An adequate and up-to-date literature review14 informs the author of the strengths and weaknesses of his or her study and whether it is worth writing, given the extant literature. The literature

review may be performed using the Internet or by screening the latest issues of scientic journals and the proceedings of recent conferences.15 Common searches include electronic databases (MEDLINE, EMBASE, and the Cochrane Library) and bibliographies (traditional review articles, textbooks, conference proceedings, and review studies). In our opinion, we should conduct adequate scientic paper reviews for new ideas and not plagiarism of present papers. 3. Chose a target journal for publication: The selection of the wrong target journal can lead to the rejection of your manuscript.16 Before writing, the author must identify the journal in which he or she wishes to send his of her paper for eventual publication. It is only by choosing the target journal before writing that authors can identify their potential readers and understand their needs.17 It is also important to follow the publication guidelines regarding word count and article structure and to reread these instructions before submitting your paper to prevent rejection on format-related grounds. In our eld, the target journals for microsurgical reconstruction are: Plastic and Reconstructive Surgery; Journal of Plastic, Reconstructive, and Aesthetic Surgery; Annals of Plastic Surgery; Journal of Trauma, Microsurgery; and Journal of Reconstructive Microsurgery, etc. In our experience, you must keep in mind that a high impact factor journal may not always be your rst choice. This depends on your specialty. 4. Outline each section: During the early stages of writing, it is useful to organize and enumerate each section in terms of major headings, subheadings, and paragraphs.18 If the outline is sufciently detailed, the
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Lin and Kuo

5.

6.

7.

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writing process should expand from individual points to entire paragraphs.19 Use topic sentences that state your main idea clearly and directly: The subject of a sentence always comes rst in scientic writing.20,21 A well-written topic sentence enables the reader to know the focus of the paragraph in advance and facilitates understanding of the rest of the document. Subsequent sentences should be organized into a coherent and uent explanation of the main topic. Transitions should be used to establish continuity between sentences, because they help the reader follow the story the author is relating.21 Choose words with care and precision: Words that enhance the quality of writing are characterized by clarity, simplicity, and accuracy.20 Clarity implies using the simplest and most accurate word to express each idea, giving an understanding of what information is relevant and irrelevant.22 Accuracy entails using the correct words to express exactly what you mean. It is important to continually try to improve the clarity of your writing, rene the accuracy of the words you use, and maintain consistency by using the same word for the same idea in all your writing.21 We suggest that you consider the following recommendations as you write: (1) avoid using words that most people are unfamiliar with, (2) do not use colloquial speech or slang, (3) do not use contractions (e.g., dont should be do not), (4) never use different words for the same scientic term, and (5) the word data is plural.23 Avoid long sentences: Shorter sentences have greater impact.21 Unnecessarily long, rambling sentences are difcult to read.24 Sentences should be short or medium in length (typically 1520 words) and include only one or two subordinate clauses.15 The use of numbers: When a number starts a sentence, that number should be presented in words. Numbers under 10 should also be spelled out, whereas numbers over 10 can be presented in gures.25 Let your colleagues help you: When you have nished writing, let your colleagues help you with constructive criticism. Allow them to keep your manuscript for 12 weeks to read, check, and ensure that your article is conclusive and understandable.26

The success of your writing depends on understanding the answers to the following questions. What do readers want? To write a paper, you must keep your readers in mind.21 Readers usually want the following: (1) to understand the authors work in detail,29 (2) to obtain new and useful information,30 and (3) to learn from clear and relevant graphics.31 What do editors want? Editors expect the following from publishable articles: (1) interesting papers that excite their readership, (2) well-written papers that are consistent with the journals aims and conform with its instructions for authors, and (3) papers that provide an accurate depiction of the work performed.29 Why do reviewers accept manuscripts? Reviewers consider the following ve criteria to be the most important in decisions about whether to accept manuscripts for publication: (1) the importance, timeliness, relevance, and prevalence of the problem addressed; (2) the quality of writing style (i.e., that it is well-written, clear, straightforward, easy to follow, and logical); (3) the study design applied (i.e., that the design was appropriate, rigorous, and comprehensive); (4) the degree to which the literature review was thoughtful, focused, and up-to-date; and (5) the use of a sufciently large sample.13 Why do reviewers reject manuscripts? The following constitute the top ve reasons why reviewers reject papers: (1) inappropriate, incomplete, or insufciently described statistics; (2) over-interpretation of results; (3) use of inappropriate, suboptimal, or insufciently described instruments; (4) small or biased samples; and (5) text that is poorly written or difcult to follow.13,16
Second step: Starting to Write The title. The title makes the rst impression on readers

HOW TO IMPROVE YOUR WRITING TECHNIQUE: MASTERING THE FOLLOWING THREE STEPS First step: Think

Fuzzy writing reects fuzzy thinking.27 Before writing a paper, you should think about the following: (1) Why are you writing? (2) What did you do? (3) What did you nd? and (4) What does it mean?25 These four questions correspond to the Introduction, Methods, Results, and Discussion sections, respectively.28
Microsurgery DOI 10.1002/micr

and includes three elements: (1) the identity of the organism(s) studied, (2) the particular aspect(s) or system(s) studied, and (3) the variable(s) manipulated.32 A good title contains the fewest words needed to adequately describe the content of the paper. It allows the readers to grasp the content of the paper and decide if they wish to read it. Thus, the title should be clear, informative, and capture the attention of readers.28 Combining the key words into three or four different possible titles and showing them to colleagues to choose the best represents one good approach to selecting a title.15 Abbreviations should never be used in the title.28 Writing the abstract. The Abstract is a summary of the design and ndings of your study.14 It should include the highlights of the manuscript, inform the reader of the subject of the paper, and outline the new results.15 The abstracts of scientic papers include four subsections: the background (the principal objectives and range of the study), the methods used, a summary of the results, and the key conclusions. Although, located at the beginning

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of the paper, the Abstract is actually written last because it is easier to compose after the manuscript is completed.5 MEDLINE limits abstracts to 250 words, after which it just abruptly ends the section.33 However, the abstract should have not more than 150 words for a main or a review article in the Journal of Microsurgery. The Abstract plays a major role in an article by enabling readers to decide whether they want to read the entire paper.34 Only data contained in the paper should be included in the Abstract; excessively detailed data or probability values do not belong in this section. Additionally, the Abstract seldom contains references to other articles and avoids jargon and abbreviations.18,28 Writing the introduction. According to Euripides A bad beginning makes a bad ending. One Chinese proverb states, A good beginning is half the battle. The introduction must place the readers in the narrative and provide an appropriate perspective for understanding the work.26 Thus, it should be informative and attractive to the readers. The main purpose of the Introduction is to introduce the paper and stimulate the readers interest.18 A good Introduction should include the following information: (1) a brief review of the pertinent literature, (2) a presentation of the problem(s) investigated, and (3) a description of the method(s) used in the study. The Introduction should be written in present tense (Table 1) and, in general, include two or three paragraphs. The Introduction typically starts by outlining the general framework used in the study and usually ends with the authors specic questions or hypotheses. The rst paragraph presents the most important and up-to-date references and discusses the subject. The second paragraph focuses on the unresolved issues or problems that form the core of your study. Citations of four or ve valid, relevant publications related to the target issues should be presented in chronological order (older papers rst, newer ones later) in this paragraph.15 The nal paragraph should always end with the purpose or the hypothesis of the study (e.g., the hypothesis or purpose of this study is. . .). Do not include any of the data or conclusions from your study in the Introduction.35 Writing the methods section. The main purpose of this section is to fully explain the experimental design and provide sufcient detailed information to enable an appropriately trained person to replicate your experiments. If a reviewer harbors serious doubts about the reproducibility of your method, the reviewer will recommend rejection, regardless of the degree to which your results are appealing. The Methods section should consist of the following information: (1) the materials used in the study, (2) how these were prepared for the study, (3) the research protocol, (4) the outcomes and how they were measured, and

Table 1. Verb Tense in Different Sections Section Introduction Methods Results Discussion Verb tense Present tense Past tense Past tense Your study: Past tense Other studies: Present tense

(5) the methods used for data analysis.36 This section is usually written in the past tense using an active voice.5 The rst paragraph should explain the experiment or study design, including the inclusion and exclusion criteria. Subsequent paragraphs should describe what materials you used and how you prepared for the study. For example, the author should describe how the data were collected (e.g., chart review or from patients themselves in a clinical study). The last paragraph notes the statistical tests used to analyze the data.33 If any of your methods had been fully described in a previous publication, you can cite the previous article instead of describing the procedure again.26,32 Do not include data or results in the Methods section. Ethical considerations: All projects with human and/ or other animal subjects must have up-to-date documentation of ethical approval.36 Indeed, many journals require that ethical approval to be obtained for studies involving humans or other animals; such approval should be obtained from the appropriate institutional review board before publication. Data analysis: The last portion of the Methods section describes the statistical analysis, including the statistical tests performed, the sample sizes, and their comparisons, and the kind of statistical software (name, version, and release number) used. Condence intervals, standard deviations, and probability (p) values are important for expressing statistical relationships and differences and should be made explicit in this section.36 Indeed, you may need the assistance of a professional statistician to complete the data analysis if you are not acquainted with the statistical methods.5 Writing the results section. The Results section is the core of the paper. Do not include any discussion of the ndings, the methods used for data analyses, or the references in this section; this section should consist only of data. It is essential that the author identies which results require interpretation in support of the goals of the study and which can be excluded.18 Try to present data in tables or gures (photographs, drawings, graphs, or ow charts) for the sake of clarity if verbal descriptions are too long or complicated.25,26 Do not repeat data within the text if you have presented them in tables and gures.35 All tables and gures should be clear, reliable, and numbered sequentially34 (the title
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number is placed above in tables and below in gures) so that readers do not need to refer to the text to understand them. Indeed, all tables and gures are placed at the end of the text. The titles of tables and gure legends should be edited to achieve maximum clarity and to ensure that the style required by the journal was followed. Careful organization of the tables and gures is crucial for enabling this sequence to tell a story.18 If your manuscript includes a table or gure that has already been published, permission should be obtained from the copyright owner (usually the publisher rather than the corresponding author). Ultimately, the data should always contain statistics. The statistical signicance of any differences should be reported, accompanied by the statistical test used to evaluate the signicance.33 Writing the discussion section. The purpose of the Discussion section is to explain the meaning of the results to the readers.37 It is also the most difcult part to write. Indeed, many papers are rejected despite interesting data due to imperfect interpretations or explanations of the results. The Discussion section should (1) state and explain the major ndings of the study, (2) compare and contrast your ndings with those found by similar studies,5 (3) address the studys limitations and strengths,25 (4) discuss the importance and clinical relevance of your ndings, and (5) offer suggestions for further research. Your ndings should be neither overemphasized nor inated, nor should you criticize or attack other studies in the Discussion section.37 In general, the rst paragraph should discuss the major ndings and state whether the hypotheses were supported or rejected.33 Subsequent paragraphs should compare and contrast the ndings of your study with those of similar research.5 You can also discuss alternative hypotheses and why these were inconsistent with your data as well as to mention the future studies needed to test such alternative hypotheses. The last paragraph of the Discussion section should contain a concise summary, regardless of statistical signicance, and offer recommendations for further research.33 Do not repeat detailed descriptions of the data and results in the Discussion section.32 Editing the references. Different journals vary in their reference formats. Before submitting your article, make sure that you have followed the format of your target journal. Many referees randomly check one or two references, but any errors in this section reect badly on the paper as a whole. In our experience, one easy way of editing references is by using EndNote to organize references, images, PDFs, and other les in a library and to transform the resulting text into the format required by the target journal.
Microsurgery DOI 10.1002/micr

Final step: Practice all the time

Chinese proverbs say Practice makes perfect and Diligence is the means by which you compensate for dullness. Writing is more skill than talent. Similar to training in surgical techniques, constant practice is required to improve your writing performance. Even the best writer devotes substantial time to honing her or his skills.22 As a novice writer of scientic papers, you must practice writing and thinking, and learn from the writing of others. You will see improvements in your own scientic writing as a result of repeated reading, writing, and critiquing the writing of others. Additionally, arrange for a medical (or scientic) editor to help improve the clarity and precision of your writing. A good medical editor agrees to provide feedback from the perspective of the readers, and to help express the content in the authors voice. An editor should be familiar with journal editors, possible reviewers, journal requirements for manuscripts, potential readers, and recent articles on similar topics.22 Editors can revise scientic language in the service of common usage, ow, and clarity, thus reducing the awkwardness of phrasing, the use of biased language, and the inclusion of jargon that is inappropriate for the audience.
CONCLUSION

Writing and publishing scientic papers is imperative for physicians and many benets accrue to those who publish. However, such an endeavor can represent a Mission: Impossible to physicians who are not native English speakers. Improvement of their writing skills contributes not only to the advancement of science but also to the comprehensiveness of medical data. On the basis of our experience, we have presented a series of steps as a way of teaching new writers (medical students, residents, young colleagues, and international fellows) how to write scientic papers and how to improve their writing skills. Remember these important steps: (1) get a mentor, (2) think, (3) conduct an accurate and adequate literature review before writing, (4) choose a target journal, (5) get a medical editor, and (6) practice constantly. Do not be afraid of failure. Consider the Chinese Proverb that says, Every failure is a stepping stone to success. Only by constantly writing and rewriting and checking and rechecking can you achieve success in your writing.
ACKNOWLEDGMENTS

The authors wish to thank to Dr. Kevin C Chung, Professor of Surgery, Michigan University Health System, Ann Arbor, MI, USA, for providing the guidance for this article.

A Guide to Write a Scientic Paper

PAO-YUAN LIN, M.D., and UR-REN KUO, M.D., Ph.D.* Division of Plastic and Reconstructive Surgery Department of Surgery Kaohsiung Chung Gung Memorial Hospital 123, Ta-Pei Road Niao-Sung District, Kaohsiung, 833, Taiwan

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REFERENCES
1. Day PA,Gastel B, editors. How to Write and Publish a Sientic Paper,6th ed. London: Greenwood Press; 2006. 2. Ebel H,Bliefert C,Russey W, editors. The Art of Scientic Writing: From Student Report to Professional Publications in Chemistry and Related Fields,2nd ed. Weinheim, Germany: Wiley-VCH; 2004. 3. Schein M, Farndon JR, Fingerhut A. Why should a surgeon publish? Br J Surg 2000;87:35. 4. Beneld JR, Howardb KM. The language of science. Eur J Cardiothorac Surg 2000;18:642648. 5. Kotsis SV, Chung KC. A guide for writing in the scientic forum. Plast Reconstr Surg 2010;126:17631771. 6. Chong SA. Mentoring: Are we doing it right? Ann Acad Med Singapore 2009;38:643646. 7. Singletary SE. Mentoring surgeons for the 21st century. Ann Surg Oncol 2005;12:848860. 8. Toledo-Pereyra LH. Mentoring surgeons. J Invest Surg 2009;22: 7781. 9. Carey EC, Weissman DE. Understanding and nding mentorship: A review for junior faculty. J Palliat Med 2010;13:13731379. 10. Straus SE, Chatur F, Taylor M. Issues in the mentormentee relationship in academic medicine: A qualitative study. Acad Med 2009;84:135139. 11. Orth CD, Wilkinson HE, Benfari RC. The managers role as coach and mentor. J Nurs Adm 1990;20:1115. 12. Goldreich O. How to write a paper. 2004;http://www.wisdom.weizmann.ac.il/oded/PS/re-writing.pdf. 13. Bordage G. Reasons reviewers reject and accept manuscripts: The strengths and weaknesses in medical education reports. Acad Med 2001;76:889896. 14. Babor TF,Stenius K,Savva S,OReilly J, editors. Publishing Addiction Science: A Guide for the Perplexed,2nd ed. Brentwood, UK: Multi-Science Publishing Company; 2008.

15. Alpers W. How to write a scientic paper.http://www.earthsystemschool.mpg.de/leadmin/user_upload/Documents/Alpers_How_to_write_a_scientic_paper.pdf. 16. Pierson DJ. The top 10 reasons why manuscripts are not accepted for publication. Respir Care 2004;49:12461252. 17. Happell B. Writing for publication: A practical guide. Nurs Stand 2008;22:3540. 18. Jenkins S. How to write a paper for a scientic journal. J Physiother 1995;41:285289. 19. Harley CDG, Hixon MA, Levin LA. Scientic writing and publishingA guide for students. Bull Ecol Soc Am 2004;85:7478. 20. Fahy K. Writing for publication: The basics. Women Birth 2008;21:8691. 21. Derish P, Eastwood S. A clasity clinic for surgical writing. J Surg Res 2008;147:5058. 22. Anaya-Prado R, Toledo AH, Toledo-Pereyra LH. The surgeon as a scientic writer. J Invest Surg 2006;19:335339. 23. Introduction ot Journal-Style Scientic Writing.http://abacus.bates.edu/ganderso/biology/resources/writing/HTWgeneral.html. 24. Fielden JS. What do you mean I cant write? J Nurs Adm 1981;11:4247. 25. Cunningham SJ. How to . . .. write a paper. J Orthodon 2004;31:4751. 26. Eriksson P, Altermann W, Charles-Sadron R, Catuneanu O. Some general advice for writing a scientic paper. J African Earth Sci 2005;41:285288. 27. Nadim A. How to write a scientic paper? ASJOG 2005;2:255258. 28. Kotur PF. How to write a scientic article for a medical journal? Indian J Anaesth 2002;46:2125. 29. Dixon N. Writing for publicationA guide for new authors. Int J Qual Health Care 2001;13:417421. 30. Stenchever MA. The editors dilemma: What do the readers want and need? Obstet Gynecol 2003;102:5,6. 31. Brown J. What readers want. 2007;www.clearest.co.uk/les/WhatReadersWant.pdf. 32. Steingraber S, Jolls C, Goldberg D. Guidelines for writing scientic papers. 1985;www.bms.bc.ca/resources/library/. . ./GuidelinesScienticPapers.pdf. 33. VanWay CW. Writing a scientic paper. Nutr Clin Pract 2007;22: 636640. 34. Maloy S. Guidelines for writing a scientic paper. 2010;http://www.sci. sdsu.edu/smaloy/MicrobialGenetics/topics/scientic-writing.pdf. 35. Davidoff F, Godlee F, Hoey J, Glass R, Overbeke J, Utiger R, Nicholls M G, Horton R, Nylenna M, Hojgaard L, and Kotzin S. Uniform requirements for manuscripts submitted to biomedical journals. J Am Osteopath Assoc 2003;103:137149. 36. Kallet RH. How to write the methods section of a research paper. Respir Care 2004;49:12291232. 37. Hess DR. How to write an effective discussion. Respir Care 2004; 49:12381241.

Microsurgery DOI 10.1002/micr