3-3 The Anatomy of a Discussion

Overview

The discussion section of the manuscript is the last chapter of your study’s story: a strong finish is essential.  The discussion section explores the “so what” of the story.

The discussion section requires attention to achieve its many goals. The content of a discussion section should extend beyond restating the findings of the study. It should relate findings to other literature, highlight practical and theoretical relevance of the findings and outline limitations.  The discussion also needs to be cohesive with the other sections of the manuscript- from vocabulary used to concepts described.

This chapter will introduce you to a few approaches to writing a discussion section, review what content readers will expect in a good discussion, and some processes to ensure the discussion meets its potential.

Vignette

Dakota has just received an email from his supervisor to schedule a time to plan the discussion section of his manuscript. His supervisor has asked him to think about how they will complete the story they started in the introduction. The email also emphasized how a common criticism from reviewers is that the findings are “underdiscussed” in the discussion. He isn’t sure how to prepare for this meeting… he hasn’t written a discussion for a manuscript intended for a health professions education audience before. Where should he begin? How does he tell a story in a scientific paper?

Deeper Dive into this Concept

Components of the discussion 

The expected components of a discussion section intended for a medical education audience include: summarizing results, comparing to prior literature, emphasizing practical or theoretical relevance, reflecting on limitations and highlighting future research. While there are recognized expected components, the discussion section should not take on a formulaic or tick-box type approach to including these components. Some practical tips are summarized below. When summarizing results, consider those that are most important for the reader to put your study in context. In comparing to other literature, consider explaining why your results are the same or different. Are there differences in the population studied or the methods applied?

The practical and theoretical relevance are important. Consider the potential types of readers and how it might be relevant to them: how would the findings relate to trainees, clinical teachers, educational researchers? Furthermore, reflect on your findings and their relevance to ensure that the findings are not overstated or applied too broadly. Consider taking a reflective stance when writing the limitations. While it is tempting to list limitations or dismiss them, the limitations section can be strengthened by reflecting how the limitations may have shaped your findings (1). For example, consider a survey-based study where participants were predominantly physicians working in academic institutions. Rather than stating that community-based physicians were underrepresented or dismissing the limitation (e.g. the topic is of less relevance to community based physicians), authors could explain how the underrepresentation of community based physicians could have changed the results. When highlighting future research, it goes without saying that further research is always needed! Providing specifics about the further studies can strengthen the impact of this component. For example, one might ask: What novel findings were identified that need further study? What populations could be further studied?

Styles of discussion sections

Discussions that go beyond summarizing results make more impact. But how can this be accomplished? Lorelei Lingard provides helpful strategies to improve how discussion sections are written (1). She emphasizes the importance of telling a story that links the introduction and discussion. Three potential storylines could evolve: coming full circle, deep exploration and surprise insights.

In a coming full circle storyline, no new concepts are presented in the discussion. This storyline is well suited for well defined research questions. No new keywords or references are expected in the discussion.

In a deep exploration storyline, the discussion focuses on a subset of ideas that were introduced in the introduction. New concepts may be incorporated to further explore the main ideas that are elaborated in the discussion.  New keywords and references will be present in the discussion. It aligns with broad research questions in health professions research. In a surprise insight storyline, there is a new concept introduced in the discussion that was not present in the introduction. Many new references will be expected in the discussion. Importantly, the surprise insight represents a new concept rather than a surprising result. If incorporating this storyline, the authors should consider deliberate signposting to orient the reader to this new concept, e.g. this unexpected or provocative explanation for our findings. Authors should also consider how the intended journal for submission will perceive this storyline, as it is not commonly used.

Writing processes to ensure the discussion meets it potential 

Writers should deliberately consider the storyline and concepts they plan to incorporate into their discussion prior to writing. Meeting with the research team prior to writing to develop an outline can be effective in deciding on the storyline and concepts that will be incorporated into the discussion. This team-thinking approach to test out storylines and concepts can strengthen the outline before significant time is invested in writing.

Another strategy is to present the preliminary outline to a larger research group as a work in progress to elicit feedback.

Vignette Conclusion

Dakota sees the invitation to meet with his supervisor about the discussion section as more than scheduling some time. He decides to reflect on the storyline he thinks would fit best with the study and the intended journal. Additionally, he drafts an outline of the expected content of the discussion to review with his supervisor. He deliberately focuses on a reflective stance for the limitations. He plans to ask his supervisor if they can present their intended storyline to the rest of the research group to vet the ideas.

References

1. Lingard, L. (2017). Does your discussion realize its potential?. Perspectives on medical education, 6(5), 344-346. https://link.springer.com/article/10.1007/s40037-017-0377-6

About the authors

name: Sarah Blissett

institution: Schulich School of Medicine & Dentistry, Western University

Sarah Blissett is an Assistant Professor, Department of Medicine (Division of Cardiology) at Western University. She is also a researcher within the Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University.

name: Matt Sibbald

institution: McMaster University

Matthew Sibbald is an Associate Professor of Medicine, McMaster University and Interventional Cardiologist at Hamilton Health Sciences and Niagara Health System. He is also the Associate Dean of the Michael G. DeGroote School of Medicine Undergraduate Medical Education Program.