Writing can be a challenge for any scholar: #TheStruggleIsReal. One need only look at the Twitter hashtag #AcWri to see a whole community that struggles openly together.
Remember that what you see in the end within fully published papers is not what comes out of a writer’s mind or fingertips. A published manuscript has been through multiple authors, reviewers, editors, copy editors, and layout artists.
In this chapter, we will review some practical strategies for getting started on your writing, and hopefully overcoming writer’s block.
By the end of this chapter the learner should be able to:
- Identify professional and personal barriers to writing
- Describe the strategy of joining the conversation
- Explore the costs and benefits of several habits of writing
“Wow, Samra… that was an amazing presentation today,” remarked Dr. Molly Anders-Wong. “I am so proud of you! You did a great job presenting on behalf of the team. I took a pile of pictures so you can pick the best one and we can send it out to everyone in an email.”
“Thanks doc!” Samra beamed. She had received really good feedback from the community of health professions educators who had been there to see her oral presentation. It felt good to have such a great reception for her team’s work. “One of the audience members was asking us if we were going to publish a paper sometime soon.”
“Yes! That was me!” yelled a voice from across the room. They looked over and saw Dr. Jaime Letourneau, a prominent scholar in their field and the Editor-in-Chief of one of the key journals within health professions education.
Molly looked a bit stunned as Dr. Letourneau approached them.
“Oh!” Molly muttered, as her face turned beet red. “Th…th…thank-you for inquiring Dr. Letourneau. Did you have any specific feedback that would be helpful to us?”
Dr. Letourneau went on to monologue about the pros and cons of the research work, stressing several important points she thought Molly and Samra could weave into the story of their paper. Molly was quickly jotting down notes as fast as she could write. It was not often that one of the most prominent scholars in your field spontaneously gave you advice on your manuscript. Samra smiled as she still found it very endearing that Dr. Anders-Wong seemed to constantly be shocked that others were excited about her work. ‘Imposter syndrome,’ Samra thought to herself, ‘… is certainly a real phenomenon if Dr. Anders-Wong feels it still!”
“Alright then,” Letourneau glanced at the clock, “I must jet to another session. My postdoc is presenting our work and I have to be in the audience to support him.”
“Thank… thank you so much for your feedback,” stuttered Molly as she bowed and waved, and nervously watched as Dr. Letourneau bolted quickly out of the room.
Samra looked at Molly. Molly looked back at Samra. This was an exciting turn of events. Quietly, Molly wondered to herself: ‘I wonder what it takes to write this paper up? I don’t even know where to start!’
A Deeper Dive into this Concept
The above vignette demonstrates the link between an abstract presentation at a conference and the realities of publishing. The link is tenuous at best, since many scholars fail to publish their conference abstracts as papers. If you are prepared like Samra and Molly were to take a conference presentation and parlay the feedback into your manuscript, then this can be very helpful!
Unfortunately, what Samra and Molly have done is certainly not the most common case. In fact, studies have reported that less than 50% of abstracts at clinical or health professions education conferences end up being published (1-5).
The Struggle is REAL
As we stated in the abstract, the struggle is real. Even the most prominent scholars in our field have historically found writing difficult. There are a number of tips and tricks, however, that we would like to share with you that may be helpful. First we review potential barriers to writing and guide you through some reflections that can help you identify which barriers are most relevant to you. Then we present some strategies for creating structure and productive habits in your writing process.
What barriers are in your way?
There are a number of barriers that can prevent authors from writing efficiently. Below are some exercises that can help you to explore your own writing habits and hang-ups.
Before we identify some common barriers, take some time to identify some factors that contribute to delays in your own writing. Think of how you would answer the following questions:
- Can you recall a manuscript that was very easy to write? Was there another that was very challenging? What do you think made the difference?
- Do you assign dedicated time to write? Are these times when your cognitive energy is lower? Or when you feel optimal?
- When you focus on writing, is the task too big? Are you always the sole author or are you ignoring the potential help from co-authors?
Take some time to write answers to these questions and revisit them, identifying potential solutions as you read through.
Writing is a skill like any other and requires practice and feedback. Some manuscripts, just like some aspects of a skill, will be far easier than others. This is normal – the ease of a manuscript can be facilitated by deadlines, while the difficulty of a manuscript can be heightened by the complexity of the topic. Writing also takes focus and cognitive effort – if you are only focusing on writing at the end of a long day you may be creating extra challenges for yourself. Maybe you are prone to dedicating an entire day to writing, potentially creating unreasonable expectations for yourself. With the appropriate structure, it is possible to take on writing in smaller pieces. Additionally, remember that the labour of writing should be distributed amongst all co-authors – they’re not just there for a final review of the paper prior to submission. The ICMJE guidelines dictate that eligible co-authors must contribute significantly to the concept of the paper and the writing (6). If you are convinced that you should always be first author, but are struggling to write, consider contributing smaller sections as a co-author and build momentum for your own work.
Barriers to focusing on the practice of writing can arise from personal or professional factors. Personal factors may include a healthy dose of imposter syndrome (like Molly in the vignette!), perfectionist tendencies, and hang ups you have about your own writing. For instance, if you don’t think your writing is any good, it makes it more difficult to engage in the skill. As with any skill it helps to seek out coaching or feedback from colleagues. Try to seek advice from co-authors and mentors as you practice this skill.
Professional barriers in writing include competing interests and jobs. For many educators, we must juggle our students, administrative meetings, teaching, and marking! For those who are clinicians as well, then you may need to fold in your clinical schedule as well. Consider also if you protect your writing time: the unpredictability of schedules, the drama of last-minute deadlines for grants, the emails that are urgent-to-them-but-not-to-you… all of these interrupt our writing time and make it difficult to become immersed in a story. All academic writing is a story, and like any good story there are key and required elements that will contribute to the success of the story. Attending to these elements can create structure on a previously blank page and can help overcome some of the personal barriers identified above.
The table (3.1.1) below offers solutions to commonly reported writing challenges. Try out one solution at a time and commit to sticking with it for a few weeks. After some time, consider either trying another strategy or adding another one. Over time you will discover the strategies that work best for you.
|’I don’t have enough time’||First set some expectations around how much writing is possible.||Get in the habit of using your calendar to your advantage – put in writing time slots. Assign priority and deadlines to writing tasks so that you’re not focusing on too many at once.||Create structure by seeking out grants and career awards that can offer motivation to write to a deadline. For clinicians, these can also help support dedicated time to focus on scholarship.|
|’Everything around me needs to be just right’||Face your tendencies for perfection and identify small, achievable goals||If there are kids at home, create home routines that let everyone know that independent homework time is also your writing time.||Create structure using a quiet space that is ideal for writing, with a comfortable chair and desk. Create a dedicated writing space at the office or at home; create an understanding with kids (if old enough), define your own expectations around how much writing you can do. Consider the timing of the day – some people report being more creative and productive in the morning while for others the best time is the afternoon. Timing may not be relevant to you, but it is worth figuring out.|
|’I cannot write alone’||Maybe this really means you cannot write when it’s too quiet? Experiment with writing alone accompanied by background music.
Reach out to people in your network – others struggle with writing too.
|Use social media to connect with like-minded individuals.||Create structure and accountability buy booking time to connect (or even Zoom) & write with a colleague.|
|’I am not a good writer’||Writing is a skill like any other and requires constant practice – if you’re feeling the sting of reviewers’ recent comments or rejection, try to focus on the constructive side and integrate their feedback into your next paper.||Employ the assistance of a writing coach or mentor – some objective feedback may help change your perspective. Keep a notebook nearby to capture ideas and researchable questions that can build your literature review.||Create a positive outlook by celebrating your writing successes and remind yourself of your writing strengths. This is the one time you may want to be completely unstructured and write freely – knowing it is your worst, first draft. You will review and edit it yourself at a later date – but at least it won’t be a blank page.|
Strategies for creating structure on a ‘blank page’
The following are hard-learned tips for getting started on your writing for your paper.
Don’t just imagine joining a conversation – have one!
We are big fans of Dr. Lingard’s concept: the problem-gap-hook heuristic (7-8), but booking time to discuss your study findings with your advisor or co-authors can be very helpful for getting your writing started. If you are using Zoom, you can even turn on auto-transcription and then actually record your conversation (and then have it magically transcribed) so you can use the transcript as a starting point for your draft.
Create a storyboard for your paper
Just like animators at Disney or Pixar studios, it can be useful to assemble your notes into an outline via a “storyboard”. Afterall, in these animated features, usually thousands of artists come together to make a singular story flow. As such, having a clear outline with your arguments laid out, and the story arc defined, can help your authorship team to create a shared mental model of your paper. Engaging in this process first can make it more transparent how authors can be involved in shaping the story line, give feedback, add citations, and then bring their intellectual contributions to the table. Ultimately, having processes can allow for more equity in authorship and involvement of more thoughts and voices.
How to storyboard:
We have three key steps that may help you create a storyboard.
- Brainstorm: Write down your key ideas and make them separate lines or objects (You can do this linearly in a share document, or if you are more visually oriented, you can use real stickie notes or with virtual tools like miro.com or Google Jamboard)
- Sequencing: Arrange your key ideas into a logical sequencing that tells a singular story. Sometimes you may have so much data that there can be more than one storylines that appear during this process. At this point, you and your team should consider whether you have more than one paper in reality. Turn this set of logical statements into a shared document for all in the team to review. Remember, this is an OUTLINE – do not write sentences – just express your ideas and concepts enough so that others can follow your logic.
- Refinement: Have your team all take turns vetting the story as a first pass. Use interactive tools like comment boxes to leave notes to each other Let them add their ideas and thoughts to the outline. Then have your team take another pass to add their citations and address questions ideas.
Integrate templates into your writing
For many authors, staring at a blinking cursor on a blank screen is one of the least inspiring things in the world. Talk about a recipe for writer’s block! The solution that we have developed has been to simply create templates for the types of writing you should do – so that you never have to start with a truly blank page!
Most papers will follow a similar structure so use those structured headings to your advantage – go so far as to identify the target journal and use their required headings to structure your paper. If you would like to develop templates, here is a paper template that one of our MERIT postdoctoral fellows created.
Generally speaking, there are four core documents that all scientists can consider creating as a template.
- The Study Protocol template – This helps you to scaffold your initial study design plan and should contain all the headings and material that your research ethics board or institutional review board will need when they review your study.
- The Research Manuscript template – Template for basic research article with the IMRAD formatting can be very helpful in this way.
- A template for non-research article (e.g. commentary) – These articles tend to avoid standard headings, but still can benefit from some structure.
- Cover letter (with all the niceties)
- One for original submission
- One for R&R with revision table
- Optionally, you could consider creating a visual abstract template – for you to generate some buzz around your published paper, have a template that gets you to consider creating a 3-panel infographic (i.e. visual abstract) that will help people understand your study at a glance and want to review more (See the following website: https://www.surgeryredesign.com/resources )
As many journals have inconsistent requirements for submission, it may also be prudent to have multiple versions of the aforementioned templates – one for each journal that you tend to submit to most often!
Read more to write better
There are a number of peer-reviewed publications that offer tips for effective writing, such as this open-access paper by Gottlieb et al. (2018) (9).
As Dr. Lara Varpio (Adjunct MERIT scientist) highlights in a HPER podcast with Dr. Teresa Chan, reading is very important for helping you to improve your writing. By reading the articles of a similar type (or “genre”) within your favourite journals, you will get a sense of what the journal editors prefer. We suggest you profile several papers from the TYPE of article you’d like to write and then consider using one that you really liked to reverse engineer your paper a bit. Bonus point: If you eventually find yourself able to engage in peer reviewing and editing others’ work, this will improve your writing even more. Learning what works and doesn’t work by reviewing the work of others is far easier than suffering the slings and arrows via your own reviews!
In summary if you struggle to get started on your writing, take time to:
- Rethink your mindset – You will get better, but you’ll always struggle to get better. Reflect on the potential barriers to your writing – maybe you are hanging on to old assumptions and old habits
- Create new habits – Just as you have created habits for teaching, leading a meeting or answering emails, spend time to create a habit to write. Habits can take time to form, so keep at it.
- Build a structure – Create opportunities for writing, timelines to create accountability and new attitudes to encourage your motivation.
Molly stared for a while at Samra, who smiled and waved at Molly to nudge her out of her trance.
“Earth to Molly!” Samra chuckled. “Penny for your thoughts?”
“Oh… I was… Well… I just was thinking that maybe… this means we should write the project up?” asked Molly, still a bit starstruck by the whole encounter.
“Yes, good thing I’m 90% done. I’ve been writing all along the way! That chapter in the HPER was very helpful to get me started. I’ll just add the finer points you just took down from our conversation with Dr. Letourneau…”
- Macmillan CD, Moore AK, Cook RJ, et al. Abstract-to-publication ratio for papers presented at scientific meetings: a quality marker for UK emergency medicine research. Emerg Med J. 2007;24(6):425–6.
- Kalkan A, Kose O, Bilir O, et al. Publication rate of abstracts presented at the emergency medicine congresses held by the European Society for Emergency Medicine (EUSEM) in 2011 and 2012. Emerg Med J. 2015;32(9):728–32.
- Papp KK, Baker EA, Dyrbye LN, et al. Analysis and publication rates of Clerkship Directors in Internal Medicine (CDIM) annual meeting abstracts 1995–2005. Teach Learn Med. 2011;23(4):342–6.
- Walsh CM, Fung M, Ginsburg S. Publication of results of abstracts presented at medical education conferences. JAMA. 2013;310(21):2307–9.
- Sawatsky AP, Beckman TJ, Edakkanambeth Varayil J, et al. Association between study quality and publication rates of medical education abstracts presented at the Society of General Internal Medicine Annual Meeting. J Gen Intern Med. 2015;30(8):1172–7.
- International Committee of Medical Journal Editors (ICJME) Authorship Guidelines. Link here: http://www.icmje.org/recommendations/browse/roles-and-responsibilities/defining-the-role-of-authors-and-contributors.html
- Lingard L. Joining a conversation: the problem/gap/hook heuristic. Perspectives on Medical education. 2015 Oct;4(5):252-3. https://doi.org/10.1007/s40037-015-0211-y
- Lingard L, Watling C. Problem/Gap/Hook Introductions. InStory, Not Study: 30 Brief Lessons to Inspire Health Researchers as Writers 2021 (pp. 7-14). Springer, Cham.
- Gottlieb M, Dehon E, Jordan J, et al. Getting Published in Medical Education: Overcoming Barriers to Scholarly Production. West J Emerg Med. 2018;19(1):1-6. doi: 10.5811/westjem.2017.11.35253