The Recipe, A Practical Guide to Scholarly Activity (Editors: Rutherford, Lennon, Seehusen), describes scholarship as “a component of practice-based learning” and suggests that the “motivation to pursue scholarly activity comes from an understanding that such pursuits enhance life-long learning, provide a greater understanding of the changing landscape of medicine, and enable an environment of curiosity in the practice of medicine.” The Recipe is a tremendous resource that was created by military family physicians, and many of its chapters are referenced throughout the resources provided here.
CREATE YOUR RESEARCH QUESTION
The first, and sometimes most difficult, step in the research process is to develop a clear research question on a topic of interest to you and refine it to the point where it can be answered. We have provided two frameworks for creating your questions below.
PICO (Population, Intervention, Comparison, and Outcome) is an evidence-based process for framing and answering a research question. The PICO process can help identify the important parts and key concepts of a well-built foreground clinical question and develop a research strategy to effectively answer the question. PICO is one of the foundational concepts in Evidence Based Medicine (EBM) and is the starting point for most scholarly activity that is not investigator-initiated.
FINER (Feasible, Interesting, Novel, Ethical and Relevant) is another framework used to formulate and further define a research question. This often is used with investigator-initiated or original research.
PERFORM A LITERATURE REVIEW
Once you have created a clear and defined research question, it is critical to determine what is already known on the topic and where the gaps in knowledge are. A methodological literature search will help identify what has previously been discovered and how they discovered it (research methods). Chapter 3 of The Recipe offers valuable information on how to perform a literature search.
A comprehensive literature review can 1) help refine your research question (through study conclusions and/or recommendations of future studies); 2) build your research plan and methods; and 3) create a list of journals that publish similar work (and are more likely to publish yours). Keywords and Medical Subject Headings (MeSH), which represent your primary concepts, should be used to ensure that your literature search results are as specific as possible.
The Uniformed Services University Learning Resource Center (LRC) offers several resources to help with your literature review. A good place to begin is a video on PubMed Basics, which provides instructional tips on how to best search the database. Several searching guides, both general guidelines and specific Google Scholar guidelines, can provide direction on how to best use keywords, key phrases, and controlled vocabulary to refine your search. Additionally, there is an available guide to creating saved searches and automatic email alerts based on your search criteria.
CRITICAL APPRAISAL OF THE LITERATURE
It is important to determine the validity of your resources. Validity is one of the many ways to rate the evidence that you are reviewing, and determining validity is part of the process known as critical appraisal. Essentially, you are saying “Does this matter to me? Does this matter to my patients? Does this change my practice?”. The more valid or higher the evidence level, the more likely it is to provide a good answer and increase your chances of publication.
Strength of evidence includes discussion of sources and their designation. Primary source articles include double-blind, randomized controlled trials. Systematic reviews and meta-analyses are also considered primary source materials and are at the top of the evidence hierarchy.
Many journals, such as American Family Physician, use rating systems to grade the evidence or strength of articles and reviews found during a literature search, such as Strength of Recommendation Taxonomy (SORT) or the Duke FRISBE Validity Guide for evidence-based resources. Another common reporting/rating system for the strength of evidence is GRADE (Grading of Recommendations Assessment, Development and Evaluation).
Listed below is an additional resource to help you perform a literature search and determine the validity of your search results. Please see the next section for several literature search engines.
- Keeping Up with the Medical Literature: How to Set Up a System by Shaughnessy A.
LITERATURE REVIEW SEARCH ENGINES
The list below contains the more commonly used general literature databases. In some cases, specialty-area specific databases may be useful. As some databases may require a subscription to access full content, check with your institution or department to determine if a subscription is already licenced.
- The Cochrane Library
- EMBASE (requires login/registration)
- Google Scholar
- Medical Subject Headings
- Essential Evidence Plus (requires a subscription to access full content)
- Dynamed Plus (requires a subscription to access full content)
To continue with the PICO concept, please consider using PubMed4HH (Pubmed for Handhelds) as a starting point. This is both a website and an app available for your phone. See iTunes store or Google play store (PubMed4HH).
CITATIONS AND BIBLIOGRAPHY
Certain common styles are widely used for citing sources in medical research. Individual journals usually require specific formatting for citations; therefore, please check the Author Instructions on the specific journal site for specific guidance. NLM stands for National Library of Medicine.
American Medical Association (AMA) format:
Author(s). Article Title. Abbreviated NLM Journal title. Year;Vol(Issue):pp-pp.
Example: Shaughnessy A. Keeping Up with the Medical Literature: How to Set Up a System. Am Fam Physician. 2009;79(1):25-26.
American Psychological Association (APA) format:
Author, A. (Publication Year). Article title. Periodical Title, Volume(Issue), pp-pp.
Example: Shaughnessy A. (2009). Keeping Up with the Medical Literature: How to Set Up a System. Am Fam Physician, 79(1), 25-26.
Guidelines on Style for Scientific Writing available on The Uniformed Services University Learning Resource Center (LRC) website discusses scientific writing in the APA style.
Citation managers, which help you organize and cite your research and create bibliographies as you write, may be very helpful. There are many choices, including free, on-line versions such as Zotero.
SELECT YOUR FINAL PRODUCT
Poster presentations provide an opportunity to present finished or ongoing work, and can be presented at numerous conferences, thus increasing the exposure of your work and the potential for feedback and networking. A poster can also be used to present work from other final products, such as Case Reports and Photo Quizzes. Thus learning how to create a successful poster and improving your presentation skills can be invaluable assets. The resources below, including Chapter 6 of The Recipe are intended to help you in this endeavor. Examples of posters that have been presented at local and national meetings can be found on The Uniformed Services University Learning Resource Center (LRC) poster repository.
- USAFP “Every Doc Can Do a Poster” Workbook
- Ten Simple Rules for a Good Poster Presentation by Erren et al.
- Preparing and presenting effective research posters by Miller JE.
A poster (or paper) abstract is a critical first step in creating a successful poster. The abstract is both an outline and a summary of your poster, and is primarily what will draw interest in your presentation. An abstract is also often required when submitting your paper for publication. Several resources, provided below, can help you in creating a well-written abstract.
- USAFP How to Write a Good Abstract
- STFM Tips to Improve Your Abstract
- IMRaD Abstract Cheat Sheet
- Poster template
A Case Report is a brief clinical report that accomplishes one of two objectives. The first potential objective is the “Grand Rounds-style” case report, which focuses on an unusual or novel occurrence of symptoms, signs, diagnosis and/or therapies. Think of that crazy case that was presented at your last Grand Rounds discussion.
The second potential objective of a case report uses a clinical case as a “vehicle” to educate, hypothesize or innovate. Think of someone who wants to propose a new research study, areas for quality or process improvement or patient safety innovations. Chapter 4 of The Recipe offers some guidance on how to write a Case Report. Provided below are some useful resources and articles on writing a case report:
- USAFP “Every Doc Can Do a Case Report” Workbook
- USAFP Writing a Case Report Abstract
- American College of Physicians (ACP) Case Report Abstract Checklist
- How to Write a Case Report by McCarthy et al.
- Tips for writing a case report for the novice author by Sun Z.
Clinical Review articles (or updates) are evidence-based articles that broadly discuss a topic by examining the medical literature, reviewing the relevant information and providing a comprehensive overview of what is known on the topic. The authors are tasked with reviewing the available evidence (literature search and critical appraisal of the literature) and then synthesizing and interpreting that research into a coherent summary. Clinical Reviews are considered secondary sources, and are extremely useful for background information and often for point-of-care medical decision-making. Examples include the main articles in American Family Physician and every article on UptoDate®.
- How to Write an Evidence-Based Clinical Review Article by Siwek et al.
Book Chapters are generally requested by editors from experienced authors who have made significant contributions to the literature on specific topics. However, you may have the opportunity to collaborate with a colleague who has been invited to submit a book chapter. As an example, Essential Evidence Plus solicits book chapter authors on its webpage. Book chapters are version of clinical reviews, usually in a very specified format.
- How to write a medical book chapter? By Kendirci M.
A photo quiz is a case-based educational tool which presents the audience with a clinical challenge based on a photograph and brief clinical scenario. Photo quizzes can also be easily translated into a poster for presentation at a conference. The American Family Physician journal offers examples in their AFP Photo Quiz department. A useful guide on creating a photo quiz can be found in Chapter 5 of The Recipe.
COCHRANE FOR CLINICIANS
This is a specific department of American Family Physician, where 1-2 clinicians interpret a larger Cochrane Review (see Cochrane Collaboration) to be able to answer a foreground clinical question (PICO format) pertinent to patient care. Cochrane reviews can be 50+ pages long, and are (usually) not useful at the point-of-care. Cochrane for Clinicians attempts to provide a brief answer to a clinical question from within the larger Cochrane Review.
LAY MEDICAL ARTICLE
As a physician, you may be asked to write a Lay article as part of your interactions with the community. They can appear in local papers, newsletters, blogs, etc. A Lay Medical article is intended to educate patients, family members and the media by providing evidence-based, accurate information about medical conditions or questions. Information presented needs to be in lay language, with readability at the 6th-8th grade reading level for general audiences. The readability level can be evaluated using online readability check tools. A guide for writing a lay medical article and an example can be found in Chapter 8 of The Recipe.
LETTER TO THE EDITOR
A Letter to the Editor is a way to communicate an opinion or insight, offer corrections or alternative ideas, and/or request clarification with the editor and the general medical community or original author of an article in a timely manner. They should be brief, focused on conveying the desired message or question, and referenced. Chapter 7 of The Recipe offers a guide to writing a Letter to the Editor.
SELECT A JOURNAL
The final product may be influenced by the journal you select, or you may have a nearly-finished final product and you want to find a journal for publication. Regardless, it is important to carefully choose an appropriate journal for publication by taking into account both the scope and the reputation of the journal.
To maximize your publication success, ensure that your paper fits within the scope of the journal. This can be easily accomplished by browsing the published content for relevance to your topic. Additionally, refer to the journal’s website for information about the journal’s Aims and Scope. This section will provide information about the journal’s target audience. After reading this section, ask yourself these questions:
- Who reads this journal?
- Will they be interested in my findings?
- Do I explain anything that this audience would already know? Ideally you would bring something new to the audience.
Importantly, pay careful attention to the journal’s instructions for authors and any services or tools they offer authors. One of the biggest pitfalls in submissions is NOT following the directions given by the journal.
While submitting a paper to more than one journal simultaneously is considered a breach of publishing ethics, you may submit your paper to a different journal if it is rejected. Often, the critiques you receive can help inform and improve your next submission.
Several publication tools can help you identify appropriate journals for your submission. Be aware of predatory or pseudo-journals. Emails soliciting articles for an apparent scholarly publication or journal may be a phishing attempt or a predatory journal that will accept exorbitantly high fees to “accept and publish” your work. Always verify a journal, and when in doubt, do not click on a link in an email.
- Journal/Author Name Estimator (JANE): This publication tools will compare your title or abstract to documents in PubMed to find the best matching journals, authors or articles
- The World Association of Medical Editors (WAME) offers advice to identify predatory or pseudo-journals
A list of common Primary Care journals to consider:
- American Family Physician | Information Sheet
- Journal of Family Practice | Information Sheet
- Journal of the American Board of Family Medicine | Information Sheet
- Annals of Family Medicine | Information Sheet
- Military Medicine | Information Sheet
- Family Medicine | Information Sheet
- Academic Medicine | Information Sheet
- PRiMER | Information Sheet
- Family Physicians Inquiries Network (individual or institutional membership required)
POSTER AND PUBLICATION ACKNOWLEDGMENT GUIDANCE
Whether you are presenting a poster or submitting a product for publication, it is imperative that you acknowledge any individuals or groups that were involved, such as collaborators, funders, and organizations. Additionally, the DoD has publication clearance and disclaimer processes that must be observed.
If MPCRN helped with your project, please make sure to include an appropriate acknowledgement. For example, “The Authors thank the Military Primary Care Research Network (MPCRN) for their assistance in…. (research design, research consultation, editorial review, etc.).”
Mandatory DoD/USU/Service Disclaimer (follow local processes and policies for all publication clearance and disclaimers)