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\begin{document}

\title{Publishing your work: An editor's perspective}



\author[1]{Mathew Mercuri  }%
\affil[1]{Mcmaster University}%


\vspace{-1em}



  
  \date{June 17, 2024}


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Academic journal publication is the currency of University faculty. It
can go without saying that publications play an important role in
securing an academic appointment and research grants, achieving
promotion within the University, and more importantly, advancing
knowledge, which is to me the primary purpose of any academic pursuit.
Despite its importance, academics seem to receive little or no formal
training in how to prepare a manuscript for publication or how to
respond to reviewer criticism\textsuperscript{1}. Quite often, such
skills are acquired through mentorship during graduate training.
Unfortunately, it is often the case that graduate students do not
produce enough manuscripts during their training to develop expertise in
how to translate completed research or scholarship into a published
report. As an editor, I often see manuscripts that are diminished by how
they are written, which often causes confusion in the reviewer,
resulting in a recommendation for rejection. I do not profess to be an
expert on writing for an academic audience. I have no idea exactly how I
learned to get my work published (I assume it was through practice and
good mentorship), nor do I have any idea if I am skilled at it -- I am
left to assume my level of expertise from my successes and failures.
However, from reading several manuscripts each day, I have picked up on
some common errors and have developed an appreciation for what editors
and reviewers expect in a published manuscript. In what follows, I
present a bit of what I have learned in my, albeit it short, time as an
editor.\textsuperscript{2}

\textbf{Adherence to Author Guidelines}

Some errors may seem trivial. Unfortunately, such errors are all too
common and impact the suitability (perceived or real) of a manuscript
for publication in a particular journal. For example, manuscripts are
often rejected because of a failure to understand or follow the Author
Guidelines. I often reject manuscript simply because its subject does
not fit the journal's mandate. Consider the Journal of Evaluation in
Clinical Practice (JECP), which caters primarily to a health services
research readership. Manuscripts that present a clinical case study or a
clinical issue that informs only to a very specialized group of
clinicians are often rejected, as are reports regarding laboratory
studies and/or animal research, because they are not appropriate for the
JECP audience. It is likely that if the editor considers those
manuscripts further the author will not get a high quality review (which
may result in not catching important errors prior to publication), and
the work will have a reduced chance of reaching the community that can
most benefit from the research. One strategy I find that helps in
choosing which journal to submit my work is looking at where the
literature I am citing is published -- journals that have a track record
of publishing on the subject are more likely to have the appropriate
readership and reviewer base. Another reason a manuscript is rejected
outright is that it has not been formatted according to the journal's
instructions or does not fit one of the listed manuscript categories.
Manuscripts not formatted according to the journal's requirements give
the editor the impression that the author does not care about the
quality of the work, and/or that the work has been rejected from another
journal, the latter of which raises a red flag as to what is the problem
that led to the rejection. It seems to me a bad idea to prime the reader
to assume there is an important flaw in the submitted work. Likewise,
submitting a commentary to a journal that states in the author
guidelines that such is reserved for invited authors, or substantially
exceeding the stated maximum length give the impression that the author
lacks attention to detail; some might consider attention to detail a
virtue of a competent scientist and good scholarship.

\textbf{The message is not clear}

One criticism I often see from reviewers is the manuscript does not
clearly articulate its contribution to advancing knowledge. A simple
statement of purpose is often not enough to convey that contribution to
the reader. The manuscript should provide the reader with information
about 1) context; i.e. what is the general issue and what is already
known about the topic that is being examined, 2) the knowledge gap; i.e.
what is not known about the topic, and 3) how the proposed study relates
to that knowledge gap. Such information is best presented in the
introduction. I have read introductions to manuscripts that list a
series of facts on a topic, but do not relate that information to the
knowledge gap or the purpose of the study. Listing ``everything you
know'' about a topic can be a distraction for the reader -- one should
only provide information that is needed to understand why the study was
developed and executed or to follow the argument presented. Linking the
findings of the study back to that knowledge gap and relating those
findings to what is already known is also helpful in articulating the
contribution of the work to advancing knowledge. Reviewers of healthcare
research journals have come to expect the first paragraph of the
discussion section will present a review of the major findings of the
study. It is also common practice that subsequent paragraphs will be
used to contextualize the findings within the previous literature. I
will address what counts as a contribution in a later section.

How the material within the manuscript is organized also impacts how it
will be received by the reviewer (which again, impacts the probability
of success). There is little chance the manuscript will be published if
the reviewers and editor cannot follow the argument. I have too often
received manuscripts that (as discussed in the previous paragraph) have
no clear statement of purpose, offer substantial (and often distracting)
editorial content in the introduction, present some of the methods in
the results section, present information that is pertinent to the
analysis or important findings in the discussion section (or fail to
present that at all, as I will discuss in the next section), etc.
Conventional approaches to the organization of reporting empirical
research findings have primed experienced scientific audiences to expect
specific kinds of information in specific sections. Such conventions
also help orient the reader who may not have deep familiarity with some
aspects of the research. Misplaced information can confuse the reviewer
and may lead to a misinterpretation of the intended message. Anyone who
has a large volume of publications has experienced receiving a review
from someone who appears to completely miss the point of the manuscript.
Often that is a problem with how the information was presented and the
message communicated and not with some characteristic of the reviewer.

Clear communication of the message is often blurred by poor use of
language and grammar. When submitting a manuscript, the author is
confident that the writing is sufficient to communicate to the reader
the intended message. If not, why would the author be under any
impression that it is appropriate for publication?\textsuperscript{3}
Proofreading one's own work to ensure the message is being conveyed in a
clear manner cannot be relied upon because the author is already
familiar with what the manuscript is about, as are the co-authors. In
some cases, the message is lost simply because the prose is poor. It may
be that the paper is full of jargon, several acronyms that are not
intuitive, or terms that are vague in meaning or are unfamiliar to the
reader. In his essay ``How I write'', Bertrand Russell offers some
simple advice, acquired through his brother-in-law, on how to
communicate effectively in academic contexts. His maxims are: 1) ``never
use a long word if a short word will do'', 2) ``if you want to make a
statement with a great many qualifications, put some of the
qualifications in separate sentences'', and 3) ``do not let the
beginning of your sentence lead the reader to an expectation which is
contradicted by the end'' {[}1; p.65{]}. In many cases, the use of
complex terms and nuanced language cannot be avoided. However, the use
of complicated language as an affectation (i.e. using difficult language
so as to give the impression that you know what you are talking about)
is unhelpful in getting a point across to the editor and reviewers --
making the reader work hard to understand what the manuscript was
written to communicate is counterproductive.

\textbf{The manuscript is not comprehensive in its presentation of
methods and results}

When Robert Boyle was performing experiments with the air pump in the
17\textsuperscript{th} Century, his discoveries were communicated to
other ``natural philosophers''\textsuperscript{4} using live
demonstration. Where that was not possible, scientific findings and
discourse were generally communicated through personal letters. When the
scientific paper became popular, its purpose was to give readers the
impression that they were there with the author in witnessing the
experiment. Detail was important. Today, we are often taught that the
purpose of a report is not just to communicate the findings, but also to
provide the reader with the information needed to repeat the study. In
my experience as an editor (and reviewer), I have reviewed several
manuscripts that inadequately describe the methods of study or omit
important information required to adequately interpret the presented
results, much less repeat the study. It may be unclear as to how
participants were selected, how the data acquired, the experimental
procedures (e.g. randomization and blinding), and the validity and
reliability of the approach to measurement. Statistical analyses are
often poorly described. It is not enough to say which test were used --
one must also state what is being compared and how. In addition,
important metrics related to the quality of the analyses are often not
reported (e.g. what are the assumptions of the statistical tests used
and were those assumptions met). Likewise, the results might not include
important information (e.g. characteristics of study participants,
number who dropped out, statistical data, including standard errors and
confidence intervals, etc.). I suspect that much of the under-reporting
on methods and results is due to concern about maximum word count. If
so, it is recommended that the author prioritize the justification for
the study, and the methods and results over discussion of findings and
editorializing.

\textbf{Overstated findings and overreaching conclusions}

Very few studies provide definitive findings. Hence the clich\selectlanguage{ngerman}é ``more
studies are needed''. I have found that authors tend to position their
findings as definitively solving an issue or closing the book on a line
of inquiry. I suspect that is a rhetorical device aimed at conveying the
importance of publishing the manuscript. Unfortunately, from an editor
and reviewer's point of view, that is a bad strategy. Overstated
findings or drawing conclusions that are beyond the scope of the data or
analysis give the impression of arrogance and/or ignorance. Very few
studies by themselves provide information that will (or even should)
revolutionize clinical practice or the organization and/or provision of
healthcare services (or even have an immediate impact on any aspect of
healthcare). That is the rule in science, not the exception. A recent
report by the International Association of Scientific, Technical and
Medical Publishers notes approximately 2.5 million articles published in
academic and scientific journals in 2018 (as per Scopus) {[}2{]}. A
substantial proportion of those articles are in areas related to
medicine and healthcare. The United States National Library of Medicine
notes nine hundred thousand citations added to MEDLINE in
2018\textsuperscript{5}. Despite these impressive numbers, clinical
practice and the organization/provision of healthcare services seems to
change little from year-to-year. One might blame poor knowledge
translation, but a more reasonable explanation is that very few of those
studies provide more than preliminary findings or something that can be
generalized across patient populations. Given that it is unlikely that a
study will revolutionize practice, it seems odd to make any claim about
how practice ought to change when stating the manuscript's conclusion.
Such statements should be reserved for studies with highly robust
findings (however that is defined by the community).

It is convention that authors explicitly acknowledge the limitations of
their studies. Despite that acknowledgement in the manuscript, there
seems to be a fondness among some authors for drawing conclusions from
the data as if those limitations were not present! Reviewers and editors
pick up on that and often ask the authors to temper their conclusions. I
suppose such enthusiasm for the findings is an attempt to elevate the
perception of the contribution of the manuscript to advancing knowledge.
I find that it can have the opposite effect -- academics are skeptical
people and are uncomfortable with hyperbole, or at least that has been
my experience.

Perhaps the reason for overstating findings and drawing conclusions that
go beyond what the data can support is the author does not have a clear
idea as to what counts as a contribution worth publishing. What matters
is that the manuscript presents information that has done something to
advance the community's understanding of a subject or phenomenon. The
strength of the contribution is contingent on the importance of what is
being examined (i.e. the question asked, or issue raised) and how good
the study or argument is in supporting that examination (i.e. answering
that question or addressing that issue). Thus, the emphasis in the
manuscript should be on carefully articulating the importance of what is
being examined and showing how the methods used and results obtained
address the concern raised by the author (e.g. the knowledge gap),
rather than the conclusion. A contribution can be more than identifying
a causal mechanism or showing an intervention is effective. Examining a
previously described relationship or finding in a new context can count
as a contribution, although the author should communicate in the
manuscript what it is about that context that raised concern as to why
the previous finding was potentially not applicable (this is a common
criticism I see among reviewers). An interesting interpretation of the
current knowledge base or a critical analysis of an issue, body of
literature, or specific study may also be a contribution, provided it
adds something new to the community's understanding of the subject of
inquiry.

\textbf{Responding to peer review}

Peer review is perceived as the gate keeper in publishing work. While
that is not entirely true (editors have the final say and sometimes
disagree with reviewers), it is a good idea to take seriously their
concerns. Again, in some cases, the concern raised by the reviewer is
not in fact a flaw with the study, but is due to poor communication by
the author -- everyone who has submitted a manuscript for publication
has experienced (or will likely at some point) a moment of ``but I
showed that! The reviewer obviously does not understand my work'' when
reading a review, and yet it is too often assumed the issue is with the
reviewer and not what was submitted. As I stated earlier, the author
should not assume the reviewer was provided with enough information to
understand what was done by the author and why or can follow the
argument as presented. In my experience, reviewers are often trying to
be constructive in providing advice on how the manuscript can be
improved.11I say ``often'' because I do believe there is collegiality in
the community. That has been my experience. It is true that in some
cases, the reviewer offers no advice on how the manuscript can be
improved and only provides negative feedback. Sometimes that is due to
an intractable difference of opinion regarding theory or method,
sometimes it is because the reviewer is a contemptibly obnoxious person,
and in some cases, the manuscript is just not very good.

A prudent approach to dealing with reviews is to consider the comments
as advice on how to improve the manuscript. It is helpful that when
responding to the reviewers, the author provides a written response to
each comment and clearly outlines what changes were made to the
manuscript. It is not enough to respond with ``done'' or ``thank you for
the comment, changes were made'' (yes, I do receive such responses, and
far too often). Such responses do not help the editor in determining if
the manuscript has been adequately improved. Which changes were made?
How is the new manuscript different than what was previously
submitted''? Answering these questions will avoid confusion -- making
the editor work hard to understand what has been done to allay reviewer
concerns is counterproductive. I have heard several colleagues say they
approach their response to peer review with a ``the reviewer is always
correct'' attitude. I believe that is generally a healthy approach and
shows humility. However, one must be mindful that there is room for
scientific debate. The author is certainly within her rights as an
expert in the field to disagree with the reviewer. What matters is that
the author provides the editor with a defence for her position.

\textbf{Final comment}

Getting your work published can be both a stressful and rewarding
endeavour. I do not profess to be an expert in how to do that
efficiently. All I can do is provide the reader with what I observe in
my role as an editor. That role has given me an appreciation for the
various pitfalls in preparing a manuscript. It has also given me the
tools to reflect on some of the errors I have made in trying to get my
own work published. We all think our work is worthy of publication and
do not always appreciate that what our audience sees in our submitted
work may be different than what we intended to communicate. I hope that
what I express here will help authors close that gap.

\textbf{Footnotes}

1.~Incidentally, while writing this editorial I received an email from a
prominent medical school advertising a certificate program focused on
``Effective Writing for Health Care''. It would appear that I am not
alone in my impression that there is a gap in training related to
manuscript writing.

2.~What I discuss in this editorial stems from a series of invited
presentations I delivered over the past year in Canada and South Africa
on how to get your work published.

3.~I know of authors who take an ``it's good enough, let's deal with
(known or unknown) issues after review'', or a ``let's see what
happens'', or worse, a ``let's see what the community thinks before we
settle on a final manuscript (which we will then submit to the journal
that we really want it published in)'' attitude when submitting work.
Those authors seem to think of the peer review process as some sort of
proofreading service or feel it appropriate to distribute the effort of
scholarship to a community of colleagues who will not receive credit for
their contribution (e.g. providing input on how the data should be
analyzed and presented, how the argument should be framed, etc.).
Perhaps it is the ease by which manuscripts can be submitted and
processed that drives such behaviour (which adds significantly to the
labour of an already thinly stretched reviewer base). The first
manuscript I ever submitted to a journal was sent (via conventional mail
service) in a package that included 3 printed copies and high resolution
images on a compact disc. The receiving editor would mail one of the
printed copies to a potential reviewer. If that reviewer declined, the
manuscript would be sent back to the editor, who would then need to
write to another expert for review. Given the time a manuscript would be
in review, the cost and effort to prepare and mail the package to be
submitted, and a concern that my work would become outdated (or
``scooped'') if I was required to ``shop'' it around to several
journals, I was diligent to put my best work forward with the initial
submission (and only submit work that I felt would be received as a
contribution to advancing knowledge). I suspect that was a common
attitude prior to the proliferation of the internet.

4.~The term ``scientist'' was coined by William Whewell almost 300 years
after the start of the period often referred to as the ``Scientific
Revolution'', and almost two centuries after Boyle's investigations.

5.~\url{https://www.nlm.nih.gov/bsd/stats/cit\_added.html}, accessed on
December 5, 2019.

\textbf{References}

\begin{enumerate}
\tightlist
\item
  Russell B. How I write. In Russell B, The Basic Writings of Bertrand
  Russell. (pp.63-65). New York: Routledge, 1992.
\item
  Johnson R, Watkinson A, Mabe M. The STM Report: An overview of
  scientific and scholarly publishing. Fifth edition. The Hague:
  International Association of Scientific, Technical and Medical
  Publishers, 2018. Available at
  https://www.stm-assoc.org/2018\_10\_04\_STM\_Report\_2018.pdf.
  Accessed on December 5, 2019.
\end{enumerate}

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