So, You Want to Publish Your Medical Education Paper in Academic Medicine - The @AcadMedJournal Editors Share Their Tips

So, You Want to Publish Your Medical Education Paper in Academic Medicine - The @AcadMedJournal Editors Share Their Tips

By Bruce H. Campbell, MD FACS

Dr. Campbell, who curates the blog, shares highlights of a recent podcast moderated by Toni Gallo, the Academic Medicine staff editor, with practical tips that will smooth your way into publishing in the journal ...

Happy New Year! Maybe one of your resolutions this year is to publish a MedEd article in a top-tier journal. You can do it!

To make it more likely, the editors of Academic Medicine created an Academic Medicine Podcast (12/19/2022) where the people who help decide what will get into print offer a peak behind the curtain. The episode is entitled “Writing Effectively and Navigating the Publication Process."

First of all, here are links to online medical writing resources: 

• Fostering Scholarship in Medical Education: Resources for Authors and Reviewers
• The Conducting Research in Health Professions Education: From Idea to Publication eBook
• The Writer’s Craft section in the journal Perspectives on Medical Education  
• Review Criteria for Research Manuscripts
• Scholarly Publishing Webinar Series

Below are tips and suggestions that each editor offers. As you prepare your manuscript, remember that folks like these editors will eventually be reading it. 

Colin West, MD, PhD (Deputy Editor, Professor of Medicine, Medical Education, and Biostatistics, Mayo Clinic) 

Three things to think about when preparing a manuscript:

• Be clear on how a practical application of your work bridges the gap from theory to practice without overstating your findings
• Be clear about the paper’s place in the field of study
• Be honest and thoughtful about the paper’s limitations

Jonathan Michael Amiel, MD (Assistant Editor, Professor of Psychiatry and Senior Associate Dean for Innovation in Health Professions Education, Columbia University)

Things he hopes to see when reviewing a submission:

• A clear demonstration of how the work helps make medical education better
• The paper doesn’t overreach; rather it takes a “small bite” and rigorously addresses the problem

Laura E. Hirschfield, PhD (Assistant Editor, Associate Professor of Medical Education and Sociology, University of Illinois-Chicago) 

Things she looks for when reviewing a submission:

• A clear demonstration that the authors have engaged with the foundational papers and authors in relevant fields, even if outside the traditional MedEd disciplines. 
• A well-demonstrated link between the research question or topic and the research design 

Gustavo Patino, MD, PhD (Assistant Editor, Associate Professor of Neuroscience, Oakland University William Beaumont School of Medicine) 

Questions he asks as a reviewer:

• Do the authors clearly articulate the research question?
• Have they described the knowledge gap? 
• What was the genesis of the idea? 
• Why is it important that this question be answered? 
• Are the research methods and study design appropriate to answer the question? 
• In the Discussion, are the claims and takeaway points consistent with the Methods and Results? 

Dan Schumacher, MD, PhD, Med (Assistant Editor, Associate Professor, University of Cincinnati)

His advice to authors:

• Pay attention to Lorelei Lingard’s idea of “It’s a Story, Not a Study.” Tell the reader why it’s important, what you found, and why what you found is important.
• Rely on well-crafted research questions and matching methodologies. 
• Write with clarity.

John H. Coverdale, MD (Associate Editor, Professor of Psychiatry and Behavioral Sciences, Baylor College of Medicine)

His advice to authors:

• For both qualitative and quantitative research, make the Methods section crystal clear.  Explain how the design relates to the research question or hypothesis, including how it is appropriate to the question.

Mary Beth DeVilbiss (Managing editor)

What she likes to see in the visuals:

• Exhibits, tables, figures, charts should have a clear purpose and add value.
• Visuals that enhance and illuminate the text, but never repeat it. 

Teresa Chan, MD, MHPE (Associate editor)

How she describes the Academic Medicine "Innovation Reports": 

• They are a first stab at a new way of doing things that builds on previous literature but then tweaks it in a novel way. Outline the problem, outline the approach, and always provide a reflective component.

Bridget O’Brien, PhD (Deputy editor, Adjunct Professor of Medicine, UCSF)

Things she suggests to authors before they submit a manuscript: 

• Read through the manuscript three times before submitting. 
• Read as an author. Make certain arguments flow and that essential details are covered. 
• Read as a reviewer. Try to apply the manuscript review criteria you use to your own work. 
• Read as a reader. Is it interesting? Do you skip sections? Does it make sense?
• Then ask others to read your manuscript from these perspectives, as well. 

Tony Artino, PhD (Assistant Editor for Last Pages, Professor at the George Washington School of Medicine and Health Sciences)

Reactions he suggests you have if you are asked to “revise and resubmit”:

• A revision request is a win, right? Don’t be discouraged! It is better to get it right before publication than after.
• Revisions always result in a better paper. 
• (Tongue-in-cheek) Editors and reviewers are always right. Realize that arguing only delays getting your manuscript into print. 
• Remember that medical and health professions education is a very small world. Your work might end up in the hands of the same reviewers if you re-submit to another journal. So, be gracious.

That should get you started. Happy writing!

Bruce H. Campbell, MD, FACS, is a Professor in the Department of Otolaryngology and Communication Sciences and in the Institute for Health and Equity (Bioethics and Medical Humanities) at MCW. He is on the editorial board of the Transformational Times and a member of the Faculty Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. He has published two Innovation Reports in Academic Medicine and still learned some stuff listening to and summarizing this podcast. 

Diagnostic Reasoning – A Call for Faculty Engagement

From the August 12, 2022 issue of the Transformational Times newsletter

Diagnostic Reasoning – A Call for Faculty Engagement 

  

By Jayshil J. Patel, MD - Director of MCW's curriculum "Critical Thinking in Medicine" thread

  

Dr. Patel shares, in earnest, this call to interested clinical faculty to engage in the diagnostic reasoning curriculum.  In many ways, our patients and posterity depend on it ... 

 

As many of you know, threads will be woven into the new medical school curriculum.  The Critical Thinking in Medicine thread will be a synergistic marriage between diagnostic reasoning and evidence-based medicine which, I think, are the key constituents for deliberately practicing medicine in today’s clinical environments and setting learners on paths towards diagnostic expertise.  Over the past few years, components of the curriculum have been tried and tested in various venues throughout undergraduate and graduate medical education and many learners have embraced and incorporated the language of the diagnostic process into their medical lexicon. Some have left training equipped with skills to metacognate.   

I am thrilled the curriculum will become a staple of undergraduate medical education at the Medical College of Wisconsin, but the initial implementation and sustainability of any curriculum, let alone ours, relies on an acceptance and participation from learners and faculty.  Thus, faculty development will be crucial.    

If, at this point, you’re asking, “Well, how are you going to do that?” Don’t fret. I share your line of questioning.  My honest answer is that I don’t know.   Or rather, I haven’t figured it out yet.   

But before embarking on a journey to capacitate and train the trainers, I would like to share why I think clinical faculty members would benefit from engagement, including becoming fluent in the semantics, scientific underpinnings, and metacognitive strategies related to the diagnostic process.  Here, I outline the impact (and really benefit) for three key stakeholders. 

For the sake of patients: Reducing medical errors by teaching how to arrive at a correct diagnosis 

Clearly, the goal for many front-line specialties is to get an accurate and timely diagnosis.  Without it, management is ineffective, wasteful, and potentially harmful.  With an accurate diagnosis, management and prognosis are guided.   

A diagnostic error is defined as a “failure to develop an accurate explanation for a patient’s health problem and/or failure to communicate that explanation,” and studies of autopsies, secondary reviews, and voluntary reports suggest diagnostic errors occur in up to 15% of cases, culminating in adverse events in up to 90% of cases.  It turns out cognitive errors are by far the most common cause of diagnostic error. An analysis of 583 physician-reported diagnostic errors suggested a failure/delay in considering diagnosis, suboptimal weighing of information, or too much emphasis placed on competing diagnoses were the most common reasons for “what went wrong.”  

As a result, patients may be subject to unnecessary testing and incorrect therapies, which may subsequently lead to psychologic/physical harm, toxicity, prolonged hospitalization, financial distress, and even death. Therefore, if the primary goal during an initial undifferentiated patient encounter is to arrive at a diagnosis, shouldn’t medical education, for the sake of patient care, strive to teach learners how to arrive at a diagnosis by explicating the diagnostic process into discrete teachable components to be deliberately practiced? And in doing so, is it possible to reduce diagnostic errors?   

While I can’t cite literature, and even if the answer is “no,” I opine, from a philosophical standpoint, that there’s intrinsic value, for doctoring and the doctor-patient relationship, in better understanding the diagnostic process.  

For the sake of learners: Giving them tools to build their diagnostic expertise 

It is not uncommon for novice learners to be “full of facts.”  However, they may have a difficult time “putting it all together.”  In fact, the diagnostic process is often considered a “black box” where learners can see what goes in (the data) and what comes out (the eventual diagnosis) but may not be able to articulate (in written or verbal communication) the intermediate steps.  And in some cases, the diagnoses are often drawn from a grab bag of differential diagnoses, which are verbalized using reflexive and biologically unlinked thinking.   

Instead of just creating competent graduates, what if we aim to set learners on a path towards diagnostic expertise?  After all, and as stated earlier, nothing good happens without an accurate diagnosis.  And so, what if the learner could: 

(a) Recognize how to appropriately utilize and toggle between different systems of thinking 

(b) Recognize when their cognitive load is high 

(c) Utilize different approaches to problems (e.g., hypothetical-deductive versus inductive approach) 

(d) Acquire a template for knowledge storage, expansion, and retrieval 

(e) Learn to conduct a cognitive autopsy and scan their environment for cognitive pitfalls 

(f) Learn to calibrate their thinking for future similar but not identical cases 

It is not a stretch of the imagination, and in fact, when we launched this curriculum in the internal medicine residency program, these components were exactly what learners desired out of their training.  For learners to grasp and deliberately practice these components, they’ll need their faculty counterparts to share their understanding of the diagnostic process (or at minimum, speak the same language). 

For the sake of faculty: Creating a culture where they can share their skills 

A few years ago, before delineating the components of a diagnostic reasoning curriculum, I began with the end in mind.  Assuming resources abound, I envisioned a Center for Diagnostic Reasoning (and Evidence-Based Medicine). It would be a place where educators would encourage learners to think aloud, deliberately dissect clinical cases into aliquots, and expound systematic approaches. They would approach problems embedded in a patient context and within a consciousness of the scientific underpinnings of decision-making and evidence-based medicine, all the while reflecting and calibrating their thinking.  The Center would be magnetic, attracting educators into the logos of diagnostic reasoning, creating sustainability.   

To me, that is aspirational and exciting.  Here’s why.  Sure, for young learners, the acquired skillsets are meant to promote lifelong learning and equip them to stay on the path towards diagnostic expertise.  But for clinical faculty, the acquired skillsets provide an opportunity to illuminate their thinking and provide a window (for learners) into their mind, within a culture of democratized rounds where both learners and faculty are encouraged to say, “I don’t know,” without the worry of perceived failure.   

Faculty might be overwhelmed and say, “I just don’t have time to do this.”  I will submit to you that you (faculty) are already, some in an extemporaneous manner, reasoning; however, the addition of semantic and scientific structure may provide greater clarity for learners (and yourself).   

Importantly, such a culture would enable the expression of virtues such as courage, prudence, empathy, grace, and humility.  For example, it takes courage and humility to say, “I don’t know.”  The manifestation of these virtues is central for the success of the hidden curriculum, which has far-reaching implications, perhaps more than the exposed curriculum.  And an explicated awareness of an individual’s thinking may be the key in accruing tacit knowledge.   

After all, it was Aristotle who said, Knowing yourself is the beginning of all wisdom. 

Jayshil J. Patel, MD, is an Associate Professor of Medicine in the Department of Medicine at MCW.  He is on the Learning Environment Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and the Critical Thinking in Medicine Thread Director at MCW. 

Medical Education Matters podcast

Medical Education Matters podcast

Join Kern Institute hosts Michael Braun, Anita Bublik-Anderson, Jeff Amundson, and Herodotos Ellinas as they explore MedEd topics with innovative and distinguished thought-leaders.

Listen on Boomplay, Amazon Music, Apple Podcasts, or wherever you find and stream your podcasts.

Sit Down, Get Paged, Repeat

From the December 23, 2022 issue of the Transformational Times 

 

Sit Down, Get Paged, Repeat

 

By Laura Slykhouse, MD

 

At this time of year, we celebrate and thank our hard-working residents and hospital staff that work through the nights, weekends, and holidays. Dr. Slykhouse, a resident in Internal Medicine, recounts a call night that was also her birthday. She shares some moments which are specific to being in the hospital overnight… 

 

Birthdays have a way of getting less and less exciting each year. Yes, there are some milestone birthdays we celebrate as we get older; but, as the years march on, enthusiasm lacks compared to a sweet sixteenth or a twenty-first birthday. This year, I see my schedule for June and of course, I’ll be celebrating my birthday at Froedtert at the end of a twenty-eight-hour shift. 

I readjust my expectations and wish for a calm night, good cross-cover, no ICU transfers, and friends to make the time go faster. The night is off to a good start when my favorite co-resident is pulled in to cover the night portion of the shift with me. I was obviously more excited than she was, but the night was looking promising.  

We get sign-out, nothing exciting. Then we start brainstorming our evening – what kind of food are we going to order, which movies do we hope to watch in the team room and what music should we listen to. We’re not even five minutes into our planning when two pages come through – it’s the admitting medical officer (AMO) with two outside hospital transfers who are already on the floor: one with metastatic lesions to the brain and concern for increased intracranial pressure, the other one for AMS (altered mental status) in an elderly woman. This would be the last quiet moment of the evening.  

We decide to see the patient with concern for increased intracranial pressure first. He does not appear as sick as his labs and imaging have detailed. This is one of those times in residency where I feel the sense that a patient could decompensate quickly, but next steps are not clear. I feel uneasy about this patient. We call the neurosurgical team, and they also share our concerns and take over care of the patient in the Neuro ICU. The patient and his wife are very grateful for our small contribution to his care.  

Then the cross-cover begins. Two stroke calls, status epilepticus, a transfer to the Neuro ICU and Medical ICU. This is not the night I had planned when the shift started. However, time is passing quickly as we try to triage the patients and deal with one situation at a time.  

It’s now midnight, and I’m happy there are still a few options left on Door Dash, as I have been craving Mexican food the whole night. This would not be a night for a movie. The chaos continues throughout the night, page after page, almost comical with the timing – sit down, page, sit down, page. The food delivery has been there for hours, but something about a lukewarm burrito at 4:00 AM is less appetizing.  

The last crisis of the night is the elderly woman admitted for AMS. She has dementia and hypercalcemia. We give IV calcitonin and a bisphosphonate which causes diffuse body aches. She speaks both German and English intermittently. I find myself drawn to her. I’m not sure if it’s because she reminds me of my grandma or because I feel guilty that our treatment has caused her pain. I hold her hand for a while, and she seems to feel some relief from the IV pain medication. Just this small point of contact makes the night seem less frenetic. It reminds me why I enjoy what I’m doing, even during the difficult nights, the missed holidays and celebrations.  

It’s 6:00 AM and we re-group in the team room. The window for sleeping has passed, and it’s evident I’ll need a significant amount of coffee to make it through rounds. We debrief quickly, cold burritos are half-eaten and abandoned next to the computers, and I feel proud. I learned a lot, we gave the best care that we could, and another call shift is over.  

 

Laura Slykhouse, MD, is a PGY3 Internal Medicine resident at MCW who is planning to start her career in hospital medicine.