how to write a medical research article for publication

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Primacy of the research question, structure of the paper, writing a research article: advice to beginners.

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Thomas V. Perneger, Patricia M. Hudelson, Writing a research article: advice to beginners, International Journal for Quality in Health Care , Volume 16, Issue 3, June 2004, Pages 191–192, https://doi.org/10.1093/intqhc/mzh053

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Writing research papers does not come naturally to most of us. The typical research paper is a highly codified rhetorical form [ 1 , 2 ]. Knowledge of the rules—some explicit, others implied—goes a long way toward writing a paper that will get accepted in a peer-reviewed journal.

A good research paper addresses a specific research question. The research question—or study objective or main research hypothesis—is the central organizing principle of the paper. Whatever relates to the research question belongs in the paper; the rest doesn’t. This is perhaps obvious when the paper reports on a well planned research project. However, in applied domains such as quality improvement, some papers are written based on projects that were undertaken for operational reasons, and not with the primary aim of producing new knowledge. In such cases, authors should define the main research question a posteriori and design the paper around it.

Generally, only one main research question should be addressed in a paper (secondary but related questions are allowed). If a project allows you to explore several distinct research questions, write several papers. For instance, if you measured the impact of obtaining written consent on patient satisfaction at a specialized clinic using a newly developed questionnaire, you may want to write one paper on the questionnaire development and validation, and another on the impact of the intervention. The idea is not to split results into ‘least publishable units’, a practice that is rightly decried, but rather into ‘optimally publishable units’.

What is a good research question? The key attributes are: (i) specificity; (ii) originality or novelty; and (iii) general relevance to a broad scientific community. The research question should be precise and not merely identify a general area of inquiry. It can often (but not always) be expressed in terms of a possible association between X and Y in a population Z, for example ‘we examined whether providing patients about to be discharged from the hospital with written information about their medications would improve their compliance with the treatment 1 month later’. A study does not necessarily have to break completely new ground, but it should extend previous knowledge in a useful way, or alternatively refute existing knowledge. Finally, the question should be of interest to others who work in the same scientific area. The latter requirement is more challenging for those who work in applied science than for basic scientists. While it may safely be assumed that the human genome is the same worldwide, whether the results of a local quality improvement project have wider relevance requires careful consideration and argument.

Once the research question is clearly defined, writing the paper becomes considerably easier. The paper will ask the question, then answer it. The key to successful scientific writing is getting the structure of the paper right. The basic structure of a typical research paper is the sequence of Introduction, Methods, Results, and Discussion (sometimes abbreviated as IMRAD). Each section addresses a different objective. The authors state: (i) the problem they intend to address—in other terms, the research question—in the Introduction; (ii) what they did to answer the question in the Methods section; (iii) what they observed in the Results section; and (iv) what they think the results mean in the Discussion.

In turn, each basic section addresses several topics, and may be divided into subsections (Table 1 ). In the Introduction, the authors should explain the rationale and background to the study. What is the research question, and why is it important to ask it? While it is neither necessary nor desirable to provide a full-blown review of the literature as a prelude to the study, it is helpful to situate the study within some larger field of enquiry. The research question should always be spelled out, and not merely left for the reader to guess.

Typical structure of a research paper

The Methods section should provide the readers with sufficient detail about the study methods to be able to reproduce the study if so desired. Thus, this section should be specific, concrete, technical, and fairly detailed. The study setting, the sampling strategy used, instruments, data collection methods, and analysis strategies should be described. In the case of qualitative research studies, it is also useful to tell the reader which research tradition the study utilizes and to link the choice of methodological strategies with the research goals [ 3 ].

The Results section is typically fairly straightforward and factual. All results that relate to the research question should be given in detail, including simple counts and percentages. Resist the temptation to demonstrate analytic ability and the richness of the dataset by providing numerous tables of non-essential results.

The Discussion section allows the most freedom. This is why the Discussion is the most difficult to write, and is often the weakest part of a paper. Structured Discussion sections have been proposed by some journal editors [ 4 ]. While strict adherence to such rules may not be necessary, following a plan such as that proposed in Table 1 may help the novice writer stay on track.

References should be used wisely. Key assertions should be referenced, as well as the methods and instruments used. However, unless the paper is a comprehensive review of a topic, there is no need to be exhaustive. Also, references to unpublished work, to documents in the grey literature (technical reports), or to any source that the reader will have difficulty finding or understanding should be avoided.

Having the structure of the paper in place is a good start. However, there are many details that have to be attended to while writing. An obvious recommendation is to read, and follow, the instructions to authors published by the journal (typically found on the journal’s website). Another concerns non-native writers of English: do have a native speaker edit the manuscript. A paper usually goes through several drafts before it is submitted. When revising a paper, it is useful to keep an eye out for the most common mistakes (Table 2 ). If you avoid all those, your paper should be in good shape.

Common mistakes seen in manuscripts submitted to this journal

Huth EJ . How to Write and Publish Papers in the Medical Sciences , 2nd edition. Baltimore, MD: Williams & Wilkins, 1990 .

Browner WS . Publishing and Presenting Clinical Research . Baltimore, MD: Lippincott, Williams & Wilkins, 1999 .

Devers KJ , Frankel RM. Getting qualitative research published. Educ Health 2001 ; 14 : 109 –117.

Docherty M , Smith R. The case for structuring the discussion of scientific papers. Br Med J 1999 ; 318 : 1224 –1225.

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Guide to writing and publishing a scientific manuscript: Part 1—The structure

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• Published: 21 December 2021
• Volume 24 , pages 117–119, ( 2022 )

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• Ian G. Stiell   ORCID: orcid.org/0000-0002-2583-6408 1 , 2

For the Canadian EM Writing Group

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Avoid common mistakes on your manuscript.

Introduction

Writing a scientific manuscript for a peer-reviewed medical journal can be a frustrating but ultimately very satisfying process. Benefits for the authors include the ability to share the results of their project with a large audience and the opportunity to change practice, the satisfaction of completing a challenging scholarly endeavor, and the recognition of your institution in terms of advancement and/or compensation. Those who have not yet written a scientific manuscript may not appreciate how long and intensive the journey can be. The goal of this guide is to offer tried and true, step by step, recommendations on how to simplify the writing process and increase the chances of successful publication. Variations on these tips have been presented nationally and internationally and have been the basis for authoring or co-authoring hundreds of papers as well as for mentoring many learners in the Canadian emergency medicine community. Part 1 will address the structure or anatomy of a manuscript and Part 2 will look at the process of writing and dealing with journals.

Specific sections

Example manuscript.

See online appendix.

Tables and figures

Generally, these should be finalized before writing the Results and Discussion sections.

These should be presented sequentially as cited in the text, first the Tables then Figures, at the end of the manuscript or in a separate document. See online appendix

The typesetter will determine their actual position in the published paper.

Titles should be short but self-explanatory, such that the Tables and Figures stand alone without the reader having to go back to the text.

For clinical journals, we suggest making the Tables and Figures easy to read :

round to one decimal where possible.

give only percentages without counts when there are multiple columns .

keep headings brief and use footnotes to explain terms and abbreviations.

Avoid use of p-values except for the primary outcomes; focus on differences and CIs.

When reporting on socio-demographic characteristics, use terms that are inclusive, describe diversity, and considerate of marginalized populations.

Most journals limit the number of Tables and Figures such that some may have to be moved to the online appendix.

Figures or graphs should be specifically prepared with simple lines for publication; do not use 3-D or PowerPoint slides.

Title should only give design if strong, e.g., randomized trial, systematic review, meta-analysis; avoid “retrospective” or “chart review” as these terms may devalue your paper.

A few journals may insist on giving the design in the title

Author Information , names, affiliations.

Disclaimers, e.g., findings represent the work of the authors and not their institution.

Sources of Support , grants, other funding.

Word count , text only excluding abstract and tables.

Keywords , 3–5 commonly used terms.

Other sections may be placed elsewhere in the manuscript:

Disclosures of conflicts and relationships, usually given on the ICJME form.

Acknowledgements of non-authors: research staff, clinicians.

Author contributions .

Adhere to the structured format and word count required by the specific journal.

Common subheadings are: Introduction, Methods, Results, Conclusion.

Use only standard abbreviations in the abstract and main text; non-standard abbreviations can be confusing to readers and reviewers.

Standard abbreviations should be introduced at the first use.

Examples of standard abbreviations are ED, CPR, CT, ECG.

Examples of non-standard abbreviations to be avoided include: LOS, SRS, IND, CCLS, RCSA.

ICMJE recommends placing clinical trial registration number at the end of the abstract.

Should be brief and no more than 3 paragraphs .

Paragraph 1: definition, epidemiology, and importance of the health-care problem .

Paragraph 2: key studies and knowledge gap to be addressed.

Paragraph 3: Goal and specific objectives of the paper and how the gap will be addressed.

For educational articles , the approach should be grounded in or framed within educational theory or principles

Authors should be aware of and generally follow accepted reporting guidelines , based upon the study type whether clinical trial, systematic review, observational study, etc.

These are well presented on the EQUATOR website [ 1 ].

A few journals require completion and submission of the relevant checklist.

Use standard subheadings : Study Design, Study Setting, Participants, Interventions (if any), Outcome Measures, Data Collection, Data Analysis and Sample Size.

Use “Research Questions” in Qualitative research .

“Health records review” is preferable to “retrospective chart review.”

Indicate Research Ethics Board approval or waiver, usually at end of Study Participants.

Educational research often involves one of many different quantitative, qualitative, or synthesis research approaches.

Generally, one paragraph for each Table and Figure.

Aim for brevity by reporting only important or interesting findings; do not repeat everything from the Tables.

In the text, give percentages and the number from which the percentage was calculated.

e.g., “12.1% of 410 participants…”

Avoid starting a sentence with a number.

e.g., use “Of all subjects, 3.1% were…”; not “3.1% of subjects were….”

We suggest using words for spelling out numerals 1–10 (e.g., “three”) and numerals above that.

This is the section that many authors struggle with ; we strongly recommend using the paragraphs described below.

We also encourage use of subheadings which will aid reviewers and readers, even though most journals do not require them.

All subheadings are usually one paragraph maximum except Previous Studies.

1. Interpretation. Highlight the main findings without repeating numbers and present the take home messages.

2. Previous Studies. Discuss how your findings compare to prior studies, trying to emphasize what is unique.

3. Strengths and Limitations. Discuss methodological strengths and weaknesses, trying to mitigate limitations.

4. Clinical Implications. Be explicit in how your findings can impact and improve care, either at the patient or the system level.

5. Research Implications. Suggest future directions of enquiry and knowledge gaps.

6. Conclusion. Highlight your unique findings in this important section; state explicitly how your study can improve care; align with Abstract conclusion.

Conclusions must not reach beyond the study findings.

Never, ever conclude by saying “future research required” as that immediately tells reviewers and readers that your findings are not meaningful.

Educational papers typically link interpretation and the existing literature together (rather than as separate paragraphs).

Always use reference software such as EndNote, Mendeley, or others.

Most medical journals use the Vancouver style , citing references with Arabic numbers in the text and providing a list at the end [ 2 ].

Equator Network Reporting Guidelines United Kingdom: UK EQUATOR Centre. https://www.equator-network.org/reporting-guidelines/ . Accessed 1 Nov 2021.

Vancouver Style Reference Guide Toronto: The Michner Institute of Education at UHN. https://michener.ca/students/library/referencing-writing-help/ . Accessed 1 Nov 2021.

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Acknowledgements

We thank Angela Marcantonio, Jennifer Brinkhurst, and Catherine Clement for assistance with preparation of the manuscript. For the Canadian EM Writing Group: Paul Atkinson, Peter Cameron, Alix Carter, Warren Cheung, Ryan Chuang, Kerstin de Wit, Quynh Doan, Ian Drennan, Debra Eagles, Andrew Hall, Ariel Hendin, Grant Innes, Eddy Lang, Patrick McLane, Andrew McRae, Catherine Patocka, Jeffrey J. Perry, Naveen Poonai, Venkatesh Thiruganasambandamoorthy, Daniel Ting, Christian Vaillancourt, Robert Woods, Krishan Yadav, Peter Zed.

There was no funding for this project. Dr. Stiell is the Editor-in-Chief of the Canadian Journal of Emergency Medicine and the contents of this manuscript reflect the opinions of the authors and not those of the Canadian Association of Emergency Physicians.

Author information

Authors and affiliations.

Department of Emergency Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada

Ian G. Stiell

Clinical Epidemiology Unit, F657, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada

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• Paul Atkinson
• , Peter Cameron
• , Alix Carter
• , Warren Cheung
• , Ryan Chuang
• , Kerstin Wit
• , Quynh Doan
• , Ian Drennan
• , Debra Eagles
• , Andrew Hall
• , Ariel Hendin
• , Grant Innes
• , Eddy Lang
• , Patrick McLane
• , Andrew McRae
• , Catherine Patocka
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• , Venkatesh Thiruganasambandamoorthy
• , Daniel Ting
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• , Robert Woods
• , Krishan Yadav
•  & Peter Zed

Corresponding author

Correspondence to Ian G. Stiell .

Additional information

The members of the Canadian EM Writing Group are listed in acknowledgements.

Supplementary Information

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Supplementary file1 (DOCX 130 KB)

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Stiell, I.G., For the Canadian EM Writing Group. Guide to writing and publishing a scientific manuscript: Part 1—The structure. Can J Emerg Med 24 , 117–119 (2022). https://doi.org/10.1007/s43678-021-00241-5

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Received : 17 November 2021

Accepted : 19 November 2021

Published : 21 December 2021

Issue Date : March 2022

DOI : https://doi.org/10.1007/s43678-021-00241-5

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Guidance for new authors

The BMJ offers many opportunities for first-time authors and newly qualified doctors to get published. If you are stuck thinking about how to get started this guidance will help.

Medical students and doctors within two years of qualifying should also read how you can contribute to our Student section .

Why publish?

Newly qualified doctors are encouraged to get publications. Besides improving your CV, there are many motives and reasons for newly qualified doctors to publish their work. Getting published gives you the opportunity to say something important, provoke debate, share your experiences, educate others, change practice, and occasionally make some extra money.

What to write about

Unless you have a track record as an author, it is unusual for a journal to give you an idea to write about, or to commission an article. Usually it is down to newly qualified doctors to come up with an idea.

As a newly qualified doctor, you are likely to spend a lot of time with patients. Why not start by keeping an eye out for interesting cases, images, or situations where you have learned a lot?

One of these could prompt you to write a case report, based on an unusual case or to remind others of an important message. Alternatively you might have an idea for an education article – these are usually based on more common or typical situations and presentations. If you have not written before, consider working with a peer or senior colleague who is familiar with how to write this type of article.

You may come across a medical issue or a new development that you would like to write about. Or you might form an opinion, see, or read something that others may be interested in too. This could form the basis of an opinion or review article.

Some medical journals are developing online communities. You could build your confidence in writing by starting or joining a discussion. Post on a medical forum, or submit a Rapid Response to an article that has spurred your attention. Or you could write a blog for the BMJ Opinion site . To do this, contact Juliet Dobson at [email protected]

Audit and research

Newly qualified doctors are often involved in audit, and sometimes in research, which specific journals may be interested in. If you get involved in such projects make sure you negotiate how your work will be acknowledged. Will you be named as a contributor or as an author?

Developing your idea

Before you commit time to writing an article, consider your idea and all the options available to you. Talk to colleagues. Take a look online, perhaps on a general search engine such as Google , or medical search engine such as Pubmed and get an idea about what has already been written on the topic you hope to write about. This might help you gauge how original, well documented, or topical the subject is.

Editors are after the best content for their readers so consider how relevant your article will be to the readers of the journal that you plan to submit to. It is worth considering if your article is relevant to specialists, or to a wider audience, to doctors in a specific area of the country, nationally, or internationally.

To browse BMJ Journals follow this link . To look at the content of a specific journal, choose from the dropdown list on the right hand side, and select “go”. This will take you to the homepage. You will be able to look at recent content and think about how your idea might fit in.

From most of the BMJ Journals’ home page, you can select the link “About the journal” on the navigation bar - for example, the Emergency Medicine Journal . This will bring up a section on the remit of the journal. On a further navigation bar that appears beneath “About the journal” you can also click on and read “Instructions for authors” from this screen.

“Instructions for authors” will give you guidance about the types of articles they accept and instructions on how to present and format your article. Following these instructions will show editors that you have carefully considered the article.

What are editors looking for?

When editors are reading an article they may be looking for important topics for their readers, originality, and potential to improve patient care. They are also looking for clear and honest writing.

You are likely to improve your chances of publication if you choose the right journal, follow its advice to authors and submit it with the correct information, such as competing interest statements or patient consent. A cover letter can outline the importance of your article to the journal’s readers.

Pitching your idea

Before you commit time to writing you could consider contacting the relevant editor to discuss your submission. Contact details can be found on journal websites. It is best to keep this brief. Outline your idea, the type of article you want to write, what you qualifications have (and those that any co-authors may have), and how you can be contacted.

It is unusual for a journal to make a commitment to publish an article without seeing the finished product, and it is common for ideas to be rejected. Do not be put off. You may be able to present your idea to another journal, and you are likely to learn something from this process.

Top BMJ articles for newly qualified doctors to write

Tips for writing, what happens once your article has been submitted.

First your article will be read by one of the editors. If they think the article is promising it may be sent to another editor for a second opinion, or out for external peer review depending on the article type. This means that other clinicians will be asked how suitable they think the article it is for publication. Their comments should be constructive. If the editors decide to pursue your article they may ask you to make some alterations. If the article is accepted you will be contacted at a later date to make minor alterations and clarifications as the article is prepared by the production staff for publication.

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Professional Medical Writing & Editing Services

The Ultimate Guide for Medical Manuscript Writing

Medical Manuscript writing can be overwhelming, but there are some tried-and-true techniques and creative tips that can dramatically simplify the process.

We mined the literature for strategies plus revealed some tricks from our seasoned writers to help you get your manuscript written and published.

In this document, we focused our attention on manuscripts since they are one of the most common types of medical writing . However, these are techniques that can be useful for any medical writing project.

What is good medical manuscript writing?

When you’re writing for a scientific audience it’s important to write with three C’s in mind:

• Clear: Don’t be ambiguous or leave anything to the imagination.
• Concise: Use brief, simple language and avoid repetition/redundancy.
• Correct: Be accurate, and don’t overstate the significance of your results.

Good medical writing is never more complicated than it needs to be.

Make it easy for your audience by keeping your language clear and simple.

How is medical writing different?

Many people want to know how writing healthcare blog topics is different from other types of writing. The answer is simple: it isn’t.

Good writing has a goal and a target audience and they will influence how you write, regardless of what you’re writing. A good manuscript is rooted in a good story.

Even data-driven medical texts can be delivered in an engaging way. Most of us can think of examples of stand-out papers in our field of expertise.

At their best these papers are entertaining and thought-provoking even while they deliver complicated, data-heavy material.

Make an Outline for your Manuscript

Before you start writing you need to have a clear understanding of the type and scope of your writing.

For example, consider exactly what you are writing. Is it a case study, textbook chapter , or literature review? These distinctions have important implications for how you craft and present your material.

An outline should be an obvious place to start, but you’d be surprised at how often this step is skipped.

How to structure your medial manuscript outline

When possible, before you start your outline you should understand the formatting requirements for your targeted publisher.

Many publishers specify abstract headings and have specific requirements for what can (and can’t) be included in the body of your text.

Use the outline as a way to narrow down the research you’ll need to do as you write.

It is an unfortunate fact of life: the abstract is often the only portion of a paper that ever gets read. For this reason, your abstract needs to convey the most important points from your paper in 300 words or less. Note what these points are in your abstract.

Make sure you know what your publisher expects from your abstract. Some journals limit you to 150 words or require that you arrange your abstract using specific headers.

You may need to include an objective or a statement of impact as well.

Most publishers ask authors to provide some keywords. Think about the keywords you’d use to search for your paper and write them down.

Keywords that are more general will increase the number of search results your paper will appear in. For example, use “spinal cord stimulation” instead of “neuromodulation.”

Define your goal

Is your goal to present new research data or to provide a meta-analysis of existing data? By clarifying the goal of your manuscript you can streamline preparation and writing.

Defining the goal is one of the secrets of successful grants and manuscripts of top biomedical PIs . Having a well-defined goal will also help you find the most appropriate publisher.

Keep your target audience in mind as you define your goal.

Introduction/background

The outline for your intro should note the current state of the field and identify knowledge gaps.

A good way to understand how to arrange your intro is by looking at similar papers that have been published by your target journal.

A standard approach to an intro can be broken down as follows:

• First paragraph: Current knowledge and foundational referencesYou’re paving the way for your readers to understand your objective
• Second paragraph: Introduce your specific topic and identify knowledge gaps
• Third paragraph: Clearly identify your aim

Key references and identifying your hypothesis and aim(s).

Methods Briefly list your methods and timeframe, but don’t get too detailed. This is just an outline.

Results The results section can be the most challenging to organize.

To simplify the writing process, state your overall question and create subsections for each dataset.

List the experiments you did and your results.

In your outline, identify data that should be presented in a figure or table. Save any subjective interpretations for the discussion section.

Discussion Your outline for the discussion should pick up where the introduction left off.

For example, if your intro ends with an aim, your discussion should start by restating your aim and reminding your readers of the knowledge gap(s) that you are addressing.

Your discussion needs to address each set of experiments and your interpretation, but don’t simply restate your results section.

Timeline Make a timeline for your manuscript and specify a submission date to help keep you on track.

Questions to consider when making your discussion outline include:

• How do your data relate to your original question?
• Do they support your hypothesis?
• Are your results consistent with what other researchers have found?
• If you had unexpected results, is there an explanation for them?
• Consider your data from the perspective of a competitor. Can you punch holes in your argument?
• Address potential concerns about your data head on. Don’t try to hide them or gloss over them.
• If you weren’t able to fully address your question(s) or aim(s), what else do you need to do?
• How do your data fit into the big picture?

Include a discussion subsection for each of your results subsections where you can subjectively interpret your data. Your outline should include the points you want to make in each subsection as well as your overall goal.

Conclude your discussion with a one sentence summary of your conclusion and its relevance to the field.

Again, don’t forget to write to your target audience!

Additional Resources for Medical Writing

Templates for Building a Perfect Writing Plan:

• Scope of work guide
• 30 Scope of work templates
• Medical cover letter + Templates
• Detailed guide of medical manuscript Scope of Work
• Short guide of scope of work for a medical journal

Know the Literature Before You Write Anything

An effective medical or scientific manuscript provides compelling information that builds on the existing literature and advances what is currently known.

This means you need to have a thorough understanding of the relevant literature!

Your goal is to collect all relevant references into a structured document. Make note of the aim and conclusion of each reference. Use this as a foundation to refer back to when you’re writing your paper.

Organize your research into buckets.

When you find a relevant source, ask yourself:

• Are the data consistent with what’s already known?
• If not: why are they different and how do they affect what’s known?
• Do your data support or refute the data presented in the source?
• You’ll need to explicitly address inconsistencies and identify potential resolutions.

Find Scholarly Sources

If you are writing an original research article , how do your data fit into the broader topic?

Google searches don’t usually produce scholarly resources unless you know where to look.

There are numerous FREE and Paid online resources available to find the right sources.

Top Scholarly Databases for journals, news, and articles

These tools can be used to find all the reputable sources needed to flesh out quality medical writing.

PubMed (MEDLINE):

PUBMED is an extremely popular and free search engine hosted by the NIH (National institutes of Health and U.S. National Library of Medicine. It can be used to access a vast index of peer-reviewed biological and medical research.

EMBASE is a database of literature intended to aid in organizational adherence to prescription drug regulations. Whereas it does contain some references that are not returned by PUBMED, there is a subscription fee associated with EMBASE.

Cochrane Library

The Cochrane Library is a curated database of medical research reviews, protocols, and editorials. While a subscription is required, the Cochrane is a critical resource for evidence-based medicine.

Web of Science

The Web of Science is another subscription service similar to those that have already been mentioned, albeit with an expanded range of academic disciplines including the arts, social sciences, and others.

Google Scholar

Google Scholar leverages Google’s powerful search engine to retrieve published literature from the whole internet (rather than just biomedical journals). This means you’ll get textbooks, theses, conference proceedings, and other publications that won’t show up in PubMed or EMBASE searches. Google Scholar is a powerful tool but it lacks the curation of other search tools, so a careful vetting of any information from this source is important.

Other databases:

Faculty of 1000 (F1000) offers Faculty Opinions and F1000Research. Faculty Opinions are links to recommended life-science articles, while F1000Research is a database of open-source research papers and results.

EBSCO is an online library providing a wide range of services, including its research databases that allow powerful searches of journals in a variety of academic disciplines.

iSEEK Education:

iSeek Education is a search engine geared specifically for academics. The resources from iSeek are meant to be dependable and from reliable sources, such as government agencies and universities.

RefSeek is another popular option for academically oriented search engines. RefSeek is designed to pull results from a large number of sources but not commercial links. 

Virtual LRC:

The Virtual Learning Resources Center is a modified Google search of academic information websites. Its index of websites has been chosen by qualified curators.

More journal databases for medical research

• 100+ journal databases
• Top Academic Search Engines
• 101 Free Journal and Research Databases
• List of Global scholarly sources 

Organize Your References:

One other point on knowing the literature: find a strategy that helps you keep references organized. 

If you’ve ever written a paper and couldn’t remember where on earth you saw that one, perfect reference you know how important this is! 

Rather than putting things into a long word document start with a research template.

RESOURCE: Use our FREE research template to collect sources for your manuscript

You can also download free basic software to organize references.

5 Reference Organization Tools and Software

EndNote is the most popular reference organization tool for medical writers. 

A basic version of EndNote is available for free, but paid subscriptions offer more options.

EndNote features include:

• Import, annotate, and search PDFs
• Ability to store reference libraries online, so you can access them from anywhere
• Collaboration is easy with shared libraries
• EndNote provides the most comprehensive citation style database, or you can create custom citation styles
• Easy to import/export references from databases using RIS, BibTex, and many other standard data schemes 

One potential drawback of EndNote is that it’s not compatible with Linux.

Zotero Zotero is a free, open-source reference management and citation tool. 

Features of Zotero include:

• Save screenshots and annotate them within your citation library
• Import and export references in many formats, including RIS, BibTeX and BibLateX, EndNote, RefWorks, and more
• Supports over 30 languages
• Zotero’s online bibliography tool ZoteroBib lets you generate bibliographies without installing Zotero or creating an account
• Drag-and-drop interface
• Linux compatible

Mendeley Mendeley is Elsevier’s “freemium” referencing software, meaning the basic package is available for free but more sophisticated versions require a paid subscription. 

Features of Mendeley include:

• Extract metadata from PDFs
• Create private, shareable libraries

A free online reference tool, Citefast allows users to quickly generate a library in APA 6 or 7, MLA 7 or 8, or Chicago styles. 

Citefast doesn’t require you to make an account, but if you don’t create one your references will be lost after 4 days of inactivity.

Another free online resource, BibMe lets you import references and offers MLA, APA, Chicago, and Turabian formatting styles.

BibMe can also check your spelling and grammar, as well as look for plagiarism.

List of MORE Online Software Tools for Academic and Medical Research

30+ research tools to make your life easier

5 best tools for academic research

31 Best Online Tools for Research

10 great tools for online research

Know your audience

It’s important to know your audience before you start writing. This will help you define your goals and create an outline.  

For example, if you’re preparing a case study for specialists your manuscript will be different than one for a multidisciplinary audience. 

Ask yourself what your message is and find out how it aligns with the goals of your readers to maximize your paper’s impact.

Formatting requirements

Whenever possible, find out the formatting requirements you’ll need to follow before you start writing. They will explicitly state the layout, word limits, figure/table formatting, use of abbreviations, and which reference style to use.

If you’re writing for a journal their website will have a Guide for Authors that specifies formatting. If you’re not sure what the requirements are, you should contact the editor or publisher and ask them. 

Types of medical manuscripts

Knowing what kind of manuscript you’re writing will help you organize your material and identify which information you should present. In addition, many publishers have different formatting requirements for different types of articles.

Although each publisher has their own guidelines for authors, many journals encourage authors to follow reporting guidelines from the EQUATOR Network (Enhancing the QUAlity and Transparency Of health Research). 

Original research

The goal of an original research article is to convey your research findings to an audience. These articles typically follow the same structure:

• Introduction 

Methods & Materials

Examples of great original medical research manuscripts:

• Nowacki J, Wingenfeld K, Kaczmarczyk M, et al. Steroid hormone secretion after stimulation of mineralocorticoid and NMDA receptors and cardiovascular risk in patients with depression . Transl Psychiatry . 2020 Apr 20;10(1):109.
• Pfitzer A, Maly C, Tappis H, et al. Characteristics of successful integrated family planning and maternal and child health services: Findings from a mixed-method, descriptive evaluation . F1000Res . 2019 Feb 28;8:229. 
• Yi X, Liu M, Luo Q, et al. Toxic effects of dimethyl sulfoxide on red blood cells, platelets, and vascular endothelial cells in vitro . FEBS Open Bio . 2017 Feb 20;7(4):485-494. 
• Karsan N, Goadsby PJ. Imaging the Premonitory Phase of Migraine . Front Neurol . 2020 Mar 25;11:140. 
• Chan SS, Chappel AR, Maddox KEJ, et al. Pre-exposure prophylaxis for preventing acquisition of HIV: A cross-sectional study of patients, prescribers, uptake, and spending in the United States, 2015-2016 . PLoS Med . 2020 Apr 10;17(4):e1003072.

Examples of great medical journal publications from The Med Writers :

Rapid communications

Rapid (or brief) communications are aimed at publishing highly impactful preliminary findings. 

They are shorter than original research articles and focus on one specific result. 

Many journals prioritize rapid communications, since they can provide paradigm-shifts in how we understand a particular topic.

5 Examples of Rapid Communications

• Rose D, Ashwood P. Plasma Interleukin-35 in Children with Autism . Brain Sci . 2019 Jun 27;9(7).
• Nash K, Johansson A, Yogeeswaran K. Social Media Approval Reduces Emotional Arousal for People High in Narcissism: Electrophysiological Evidence . Front Hum Neurosci . 2019 Sep 20;13:292.
• Su Q, Bouteau A, Cardenas J, et al. Long-term absence of Langerhans cells alters the gene expression profile of keratinocytes and dendritic epidermal T cells . PLoS One . 2020 Jan 10;15(1):e0223397.
• Nilsson I, Palmer J, Apostolou E, et al. Metabolic Dysfunction in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Not Due to Anti-mitochondrial Antibodies . Front Med . 2020 Mar 31;7:108.
• Rabiei S, Sedaghat F, Rastmanesh R. Is the hedonic hunger score associated with obesity in women? A brief communication . BMC Res Notes. 2019 Jun 10;12(1):330. 

Case reports

Case reports detail interesting clinical cases that provide new insight into an area of research. 

These are brief reports that chronicle a case, from initial presentation to prognosis (if known). 

Importantly, when writing a case report, you need to clearly identify what makes your case unique and why it’s important. 5 Examples of Great Case Studies

• Scoles D, Ammar MJ, Carroll SE, et al. Cytomegalovirus retinitis in an immunocompetent host after complicated cataract surgery . Am J Ophthalmol Case Rep . 2020 Apr 6;18:100702.
• Yanagimoto Y, Ishizaki Y, Kaneko K. Iron deficiency anemia, stunted growth, and developmental delay due to avoidant/restrictive food intake disorder by restricted eating in autism spectrum disorder . Biopsychosoc Med . 2020 Apr 10;14:8.
• Pringle S, van der Vegt B, Wang X, et al. Lack of Conventional Acinar Cells in Parotid Salivary Gland of Patient Taking an Anti-PD-L1 Immune Checkpoint Inhibitor . Front Oncol . 2020 Apr 2;10:420.
• Crivelli P, Ledda RE, Carboni M, et al. Erdheim-Chester disease presenting with cough, abdominal pain, and headache . Radiol Case Rep . 2020 Apr 10;15(6):745-748.
• Tsai AL, Agustines D. The Coexistence of Oculocutaneous Albinism with Schizophrenia . Cureus . 2020 Jan 9;12(1):e6617.

Literature review

A good literature review provides a comprehensive overview of current literature in a new way. There are four basic types of literature review:

Traditional: Also known as narrative reviews, these reviews deliver a thorough synopsis of a body of literature. They may be used to highlight unanswered questions or knowledge gaps.

Li X, Geng M, Peng Y, Meng L, Lu S. Molecular immune pathogenesis and diagnosis of COVID-19 . J Pharm Anal . 2020 Mar 5. 

Wardhan R, Kantamneni S. The Challenges of Ultrasound-guided Thoracic Paravertebral Blocks in Rib Fracture Patients . Cureus . 2020 Apr 10;12(4):e7626.

Lakhan, S.E., Vieira, K.F. Nutritional therapies for mental disorders . Nutr J 7, 2 (2008). https://doi.org/10.1186/1475-2891-7-2

A minireview is similar to a review, but confines itself to a specific subtopic:

Marra A, Viale G, Curigliano G. Recent advances in triple negative breast cancer: the immunotherapy era . BMC Med . 2019 May 9;17(1):90.

  Systematic : These are rigorous, highly structured reviews that are often used to shed light on a specific research question. They are often combined with a meta-analysis or meta-synthesis. 

Asadi-Pooya AA, Simani L. Central nervous system manifestations of COVID-19: A systematic review . J Neurol Sci . 2020 Apr 11;413:116832.

Katsanos K, Spiliopoulos S, Kitrou P, Krokidis M, Karnabatidis D. Risk of Death Following Application of Paclitaxel-Coated Balloons and Stents in the Femoropopliteal Artery of the Leg: A Systematic Review and Meta-Analysis of Randomized Controlled Trials . J Am Heart Assoc . 2018 Dec 18;7(24):e011245.

Meta-analysis: A meta-analysis analyzes data from multiple published studies using a standardized statistical approach. These reviews can help identify trends, patterns, and new conclusions.

Zhang J, Zhang X, Meng Y, Chen Y. Contrast-enhanced ultrasound for the differential diagnosis of thyroid nodules: An updated meta-analysis with comprehensive heterogeneity analysis . PLoS One . 2020 Apr 20;15(4):e0231775.  

  Meta-synthesis: A meta-synthesis is a qualitative (non-statistical) way to evaluate and analyze findings from several published studies.

Stuart R, Akther SF, Machin K, et al. Carers’ experiences of involuntary admission under mental health legislation: systematic review and qualitative meta-synthesis . BJPsych Open . 2020 Feb 11;6(2):e19. 

At this point you’ve established three things for your manuscript:

• Your goal : Is your goal to convey the latest research? You should find a way to describe what you want to accomplish with this article. 
• Your target audience : The most effective medical writing is done with a specific audience in mind. 
• Type of manuscript : The type of article you’re writing will influence the format of the document you are writing.

You probably have a target journal or publisher in mind and you should have checked out their formatting requirements. Now it’s time to start writing!

Notably, many seasoned authors don’t write their articles from beginning to end. For example, if you’re preparing an original research manuscript they suggest writing the methods section first, followed by the results, discussion, introduction, and, lastly, the abstract. This will help you stay within the scope of the article.

Generally, the title for a medical document should be as succinct as possible while conveying the purpose of the article. 

If you’re writing an original research article your title should convey your main finding as simply as possible. 

Avoid using unnecessary jargon and ambiguity.

Some authors recommend including keywords that will help people find your writing in the title.

Your publisher may have a specific abstract format for you to follow. There are three general types of abstract:

• Indicative (descriptive) abstracts provide a clear overview of the topics covered. They are common in review articles and conference reports.
• Informative abstracts summarize the article based on structure (e.g. problem, methods, case studies/results, conclusions) but without headings.
• Structured abstracts use headings as specified by the publisher.

Good abstracts are clear, honest, brief, and specific. They also need to hook readers or your article will never be read (no pressure!).

Many publishers will ask you to come up with some keywords for your article. Make sure they’re specific and clearly represent the topic of your article. 

If you’re not sure about your keywords the National Library of Medicine’s Medical Subject Headings ( MeSH ) website can help. Just type in a term and it will bring up associated subject headings and definitions.

Introduction

The goal of the introduction is to briefly provide context for your work and convince readers that it’s important. It is not a history lesson or a place to wax poetic about your love of medicine (unless you’re writing about history or your love of medicine). Everything in your introduction needs to be directly relevant to the overall goal of your manuscript.

Introductions vary in length and style between the different types of manuscript. The best way to understand what your publisher is looking for in an introduction is to read several examples from articles that are stylistically similar to yours.

Broadly speaking, an introduction needs to clearly identify the topic and the scope of the article. For an original research article this means you explicitly state the question you’re addressing and your proposed solution. For a literature review, the topic and its parameters should be stated.

Importantly, don’t mix the introduction with other sections. Methods and results don’t belong in the introduction.

Abbreviations

If you use terms that are abbreviated, some journals will ask you to include a section after the introduction where you define them. Consult the authors guide to learn how you should handle abbreviations. Also check to see if they have standard abbreviations that you don’t need to define in your manuscript.

A couple of tips for abbreviations:

·        Terms that are only used once or twice should be spelled out, not abbreviated

·        Don’t capitalize each word in an acronym unless it’s a proper noun (e.g. ubiquitin proteasome system (UPS), not Ubiquitin Proteasome System (UPS))

A good methods section will contain enough information that another researcher could reproduce the work. Clearly state your experimental design, what you did in chronological order, including equipment model numbers and specific settings you used. Make sure to include all equipment, materials, and products you used as they could account for future variability. Describe any statistical analyses.

The methods section should describe the following:

·        Population and sampling methods

·        Equipment and materials

·        Procedures

·        Time frame (if relevant)

·        Analysis plan

·        Approaches to ensure reliability/validity

·        Any assumptions you used

·        Scope and limitations

If you are using methods that have been described before you can refer to that publication or include them in your supplementary material, rather than re-writing them in the body of your text.

The results section is where your findings are objectively presented (save your interpretation of the results for the discussion section). Figure out which data are important for your story before you write the results section. For each important data set provide the results (preferably in a table or graph) and include a sentence or two that summarizes the results.

It’s easy to lose sight of the goal of the paper when you’re relaying numbers through the lens of statistics. Make sure to tie your results back to the biological aspects of your paper.

The discussion section is where you sell your interpretation of the data. Your discussion section needs to tie your introduction and your results sections together. A common strategy for the discussion section is to reiterate your main findings in light of the knowledge gaps you outlined in your introduction. How do your findings move the field forward?

Consider each of your results with respect to your original question and hypothesis. If there are multiple ways to interpret your data, discuss each of them. If your findings were not in line with your hypothesis, state this and provide possible explanations.

If your data are inconsistent with other published literature it’s important to consider technical and experimental differences before concluding that you’ve stumbled onto a groundbreaking medical discovery. Discuss all potential reasons for the divergent data.

Key points to include in your discussion section:

·        What your results mean

·        Whether your methods were successful

·        How findings relate to other studies

·        Limitations of your study

·        How your work advances the field

·        Applications

·        Future directions

Don’t draw grand conclusions that aren’t supported by your data; some speculating is okay but don’t exaggerate the importance of your findings.

It’s important to remind your reader of your overall question and hypothesis throughout the discussion section, while you are providing your interpretation of the results. This will ensure that you stay on track while you’re writing and that your readers will understand exactly how your findings are relevant.

This is your final chance to convince your readers that your work is important. 

Start your conclusion by restating your question and identify whether your findings support (or fail to support) your hypothesis. 

Summarize your findings and discuss whether they agree with those of other researchers. 

Finally, identify how your data advances the field and propose new or expanded ways of thinking about the question.

It’s important to avoid making unsupported claims or over-emphasize the impact of your findings. Even if you think your findings will revolutionize medicine as we know it, refrain from making that claim until you have the evidence to back it up.

Figures/Tables

Many readers will get the bulk of their information from your figures so make sure they are clear and informative. Your readers should be able to identify your key findings from figures alone.

Tips for figures and tables:

·        Don’t repeat data in tables, figures and in the text

·        Captions should sufficiently describe the figure so the reader could understand it even if the figure was absent

·        Keep graphs simple! If a basic table will work there’s no need for a multi-colored graph

Acknowledgements

Use the acknowledgments section to identify people who made your manuscript possible. Include advisors, proofreaders, and financial backers. In addition, identify funding sources including grant or reference numbers.

Make sure to use the reference style specified by your target journal or publisher. Avoid too many references, redundant references, excessive self-referencing, and referencing for the sake of referencing. Personal communications, unpublished observations, and submitted, unaccepted manuscripts should generally be avoided.

It should go without saying that you need to be ethical when preparing medical manuscripts. Fabricating or falsifying data is never acceptable, and you put your career at risk. It’s not worth it.

Plagiarism is not a viable strategy for getting works published. Any indication that you’ve plagiarized will be investigated, and if you’re found to have plagiarized your career and scientific reputation are at stake. Any time you refer to published work you need to reference it, even if it was your own publication. Be very careful about self-plagiarizing!

To learn more about ethical writing take a look at the U.S. Department of Health and Human Services guide: Avoiding Plagiarism, Self-plagiarism, and Other Questionable Writing Practices: A Guide to Ethical Writing , by Dr. Miguel Roig.

Ethics standards require that you submit your manuscript to only one publisher at a time. If you’re caught submitting to multiple editors none of them will publish your work.

Traps to avoid

Seasoned writers told us some of the pitfalls they’ve learned how to watch out for:

Writing versus editing

Writing and editing are not the same. Get comfortable writing , that is, pouring out all of your ideas without editing yourself. Then go back and edit.

Lack of editing

One of the toughest parts of writing is opening yourself up to critique. As hard as it can be, the best way to get a polished and meaningful manuscript is to have other people read it. As writers we can get attached to particular phrases or styles that may not read as well to other people.

Scientific manuscript editing is the toughest of any manuscript editing but if you keep patience and edit honestly it will get easier over time. Imagine that you’re editing someone else’s document to help give you fresh eyes. If possible give yourself a couple of days without looking at the manuscript, then go back and read it.

Being unfamiliar with the literature

It’s important to be familiar with the current literature on the topic you’re writing about. A fatal flaw of any research manuscript is proposing a hypothesis that has already been tested or posing questions that have already been answered.

Not formatting properly

If your manuscript is not formatted properly, it is less likely to be accepted. Make sure your font and line spacing are correct, that you’ve adhered to word and figure limits, and that your references are in the correct style.

Useful tips

Here are some helpful tips that you can use to improve your writing:

Framing your manuscript

A common trope in outlining manuscripts is the inverted triangle approach, which starts generally and ends specifically. A more useful method is to consider an hourglass-shaped outline, which starts generally, specifically addresses your contribution to the field, then ties your contribution back to current knowledge and unanswered questions.

Passive and active voice

Medical writing has long used passive voice to communicate and, while this is still the status quo for many journals, don’t be afraid to get out of that mire. As journals begin to recognize that active voice is not only more economical but can also be more readable they are becoming more comfortable publishing articles that include active voice.

Don’t edit while you write

Get a first draft onto paper as quickly as possible and then edit. Don’t waste time trying to get a paragraph perfect the first time you write it.

Ask someone else to edit

Medical writing does have some unique challenges associated with it. Your audience may not be experts on the material you are delivering, so an ability to communicate complicated information in an accessible manner is very helpful. Improve on your skills by asking people outside of your field to provide constructive criticism on writing samples.

It can be a very useful practice to edit some manuscripts that other people have written. This will help you understand what editors are paying attention to.

Keep track of references

Make sure to keep detailed notes of where you got your references so that you can easily and accurately cite the literature you used. There’s nothing more frustrating than not being able to remember where you saw a really great reference.

Before you submit your manuscript

Ideally, you’ve left yourself plenty of time to proofread and have other people edit your document. At the very least make sure you budget some hours to carefully proofread. Triple check that your paper adheres to formatting requirements. You can learn how to proofread scientific manuscripts before submitting them for publication.

Cover letters

If you’re submitting an article for consideration you’ll need to write a cover letter. Take the time to find out who the editor is and address your letter to him or her. This is your chance to communicate with the editor! A generic “To whom it may concern” won’t impress anyone.

Your cover letter should be brief, but it needs to convey the value of your paper to the journal. Describe your main findings and their significance and why they’re a great fit for your publication of interest. 

If you have conflicts of interest, disclose them in your cover letter. Also, if your paper has already been rejected, let them know. Include the reason (if known) and reviewer comments, as well as discussing changes you’ve made to improve the paper.

You can also suggest peer-reviewers or people who shouldn’t review your paper. Be cautious when suggesting reviewers! Some of the most critical reviews come from suggested reviewers.

Your cover letter is an excellent opportunity to prove that you know what the goals of the journal are and that your article furthers them. Don’t waste it!

Reviewer comments/Revisions

If the publisher asks you to address reviewer comments, take the time to do this seriously and thoughtfully. Understand reviewer comments and address them objectively and scientifically (be polite!). If you disagree with a comment, state why and include supporting references. When more experiments or computations are requested, do them. It will make your paper stronger.

When you resubmit your manuscript make sure to identify page/line numbers where changes were made.

What if you’re rejected?

Don’t despair! Rejection happens to every writer. Try to understand why your manuscript was rejected. Evaluate your manuscript honestly and take the opportunity to learn from your mistakes.

A rejected paper isn’t a dead paper. You’ll need to make some substantial revisions and may need to change your formatting before resubmitting to a new journal or publisher. In the cover letter to the new editor you’ll need to state that your manuscript was rejected. Include any information you got about why your manuscript was rejected and all reviewer comments. Identify changes you made to the paper and explain why you chose to submit to the new journal.

Medical writing can be very rewarding but it’s important that writers have a clear understanding of what publishers are looking for. High-quality, original works that advance the medical field are much more likely to be published than papers that are not original or that have little medical or scientific interest.

Quality medical writing should have clarity, economy of language, and a consistent theme. It’s important to always state the question or topic you’re addressing early and refer to it often. This will help you stay focused and within the scope of your article during the writing process and it will help your readers understand your intentions. Using an outline is a very helpful way to make sure your article is consistently on-topic.

Following the tips and techniques provided here will definitely improve your writing skills, but the most effective way to get better at medical writing is to do it. There is no single best way to prepare a medical manuscript and even professional writers are continuously tweaking their writing strategies.

Hopefully these tips have helped you create a great manuscript. If you’re feeling overwhelmed and want some help with your medical writing or editing, we at The Med Writers can help. Contact us to learn more about our writing and editing services. 

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How to Write a Medical Abstract for Publication

Preparing Your Study, Review, or Article for Publication in Medical Journals

The majority of social, behavioral, biological, and clinical journals follow the conventional structured abstract form with the following four major headings (or variations of these headings):

OBJECTIVE   (Purpose; Aim; Goal) : Tells reader the purpose of your research and the questions it intends to answer

METHODS   (Setting; Study Design; Participants) : Explains the methods and process so that other researchers can assess, review, and replicate your study.

RESULTS (Findings; Outcomes) : Summarizes the most important findings of your study

CONCLUSIONS   (Discussion; Implications; Further Recommendations) : Summarizes the interpretation and implications of these results and presents recommendations for further research

Sample Health/Medical Abstract

Structured Abstracts Guidelines *

• Total Word Count: ~200-300 words (depending on the journal)
• Content: The abstract should reflect only the contents of the original paper (no cited work)

*   Always follow the formatting guidelines of the journal to which you are submitting your paper.

Useful Terms and Phrases by Abstract Section

Objective:  state your precise research purpose or question (1-2 sentences).

• Begin with “To”: “We aimed to…” or “The objective of this study was to…” using a verb that accurately captures the action of your study.
• Connect the verb to an object phrase to capture the central elements and purpose of the study, hypothesis , or research problem . Include details about the setting, demographics, and the problem or intervention you are investigating.

METHODS : Explain the tools and steps of your research (1-3 sentences)

• Use the past tense if the study has been conducted; use the present tense if the study is in progress.
• Include details about the study design, sample groups and sizes, variables, procedures, outcome measures, controls, and methods of analysis.

  RESULTS : Summarize the data you obtained (3-6 sentences)

• Use the past tense when describing the actions or outcomes of the research.
• Include results that answer the research question and that were derived from the stated methods; examine data by qualitative or quantitative means.
• State whether the research question or hypothesis was proven or disproven.

CONCLUSIONS : Describe the key findings (2-5 sentences)

• Use the present tense to discuss the findings and implications of the study results.
• Explain the implications of these results for medicine, science, or society.
• Discuss any major limitations of the study and suggest further actions or research that should be undertaken.

Before submitting your abstract to medical journals, be sure to receive proofreading services from Wordvice, including journal manuscript editing and paper proofreading , to enhance your writing impact and fix any remaining errors.

Related Resources

• 40 Useful Words and Phrases for Top-Notch Essays  (Oxford Royale Academy)
• 100+ Strong Verbs That Will Make Your Research Writing Amazing  (Wordvice)
• Essential Academic Writing Words and Phrases  (My English Teacher.eu)
• Academic Vocabulary, Useful Phrases for Academic Writing and Research Paper Writing  (Research Gate)
• How to Compose a Journal Submission Cover Letter  (Wordvice/YouTube)
• How to Write the Best Journal Submission Cover Letter  (Wordvice)

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How to Write a Medical Research Paper

Last Updated: August 12, 2024 Approved

This article was co-authored by Chris M. Matsko, MD . Dr. Chris M. Matsko is a retired physician based in Pittsburgh, Pennsylvania. With over 25 years of medical research experience, Dr. Matsko was awarded the Pittsburgh Cornell University Leadership Award for Excellence. He holds a BS in Nutritional Science from Cornell University and an MD from the Temple University School of Medicine in 2007. Dr. Matsko earned a Research Writing Certification from the American Medical Writers Association (AMWA) in 2016 and a Medical Writing & Editing Certification from the University of Chicago in 2017. wikiHow marks an article as reader-approved once it receives enough positive feedback. In this case, 89% of readers who voted found the article helpful, earning it our reader-approved status. This article has been viewed 205,825 times.

Writing a medical research paper is similar to writing other research papers in that you want to use reliable sources, write in a clear and organized style, and offer a strong argument for all conclusions you present. In some cases the research you discuss will be data you have actually collected to answer your research questions. Understanding proper formatting, citations, and style will help you write and informative and respected paper.

Researching Your Paper

• Pick something that really interests you to make the research more fun.
• Choose a topic that has unanswered questions and propose solutions.

• Quantitative studies consist of original research performed by the writer. These research papers will need to include sections like Hypothesis (or Research Question), Previous Findings, Method, Limitations, Results, Discussion, and Application.
• Synthesis papers review the research already published and analyze it. They find weaknesses and strengths in the research, apply it to a specific situation, and then indicate a direction for future research.

• Keep track of your sources. Write down all publication information necessary for citation: author, title of article, title of book or journal, publisher, edition, date published, volume number, issue number, page number, and anything else pertaining to your source. A program like Endnote can help you keep track of your sources.
• Take detailed notes as you read. Paraphrase information in your own words or if you copy directly from the article or book, indicate that these are direct quotes by using quotation marks to prevent plagiarism.
• Be sure to keep all of your notes with the correct source.
• Your professor and librarians can also help you find good resources.

• Keep all of your notes in a physical folder or in a digitized form on the computer.
• Start to form the basic outline of your paper using the notes you have collected.

Writing Your Paper

• Start with bullet points and then add in notes you've taken from references that support your ideas. [1] X Trustworthy Source PubMed Central Journal archive from the U.S. National Institutes of Health Go to source
• A common way to format research papers is to follow the IMRAD format. This dictates the structure of your paper in the following order: I ntroduction, M ethods, R esults, a nd D iscussion. [2] X Research source
• The outline is just the basic structure of your paper. Don't worry if you have to rearrange a few times to get it right.
• Ask others to look over your outline and get feedback on the organization.
• Know the audience you are writing for and adjust your style accordingly. [3] X Research source

• Use a standard font type and size, such as Times New Roman 12 point font.
• Double-space your paper.
• If necessary, create a cover page. Most schools require a cover page of some sort. Include your main title, running title (often a shortened version of your main title), author's name, course name, and semester.

• Break up information into sections and subsections and address one main point per section.
• Include any figures or data tables that support your main ideas.
• For a quantitative study, state the methods used to obtain results.

• Clearly state and summarize the main points of your research paper.
• Discuss how this research contributes to the field and why it is important. [4] X Research source
• Highlight potential applications of the theory if appropriate.
• Propose future directions that build upon the research you have presented. [5] X Research source
• Keep the introduction and discussion short, and spend more time explaining the methods and results.

• State why the problem is important to address.
• Discuss what is currently known and what is lacking in the field.
• State the objective of your paper.
• Keep the introduction short.

• Highlight the purpose of the paper and the main conclusions.
• State why your conclusions are important.
• Be concise in your summary of the paper.
• Show that you have a solid study design and a high-quality data set.
• Abstracts are usually one paragraph and between 250 – 500 words.

• Unless otherwise directed, use the American Medical Association (AMA) style guide to properly format citations.
• Add citations at end of a sentence to indicate that you are using someone else's idea. Use these throughout your research paper as needed. They include the author's last name, year of publication, and page number.
• Compile your reference list and add it to the end of your paper.
• Use a citation program if you have access to one to simplify the process.

• Continually revise your paper to make sure it is structured in a logical way.
• Proofread your paper for spelling and grammatical errors.
• Make sure you are following the proper formatting guidelines provided for the paper.
• Have others read your paper to proofread and check for clarity. Revise as needed.

Expert Q&A

• Ask your professor for help if you are stuck or confused about any part of your research paper. They are familiar with the style and structure of papers and can provide you with more resources. Thanks Helpful 0 Not Helpful 0
• Refer to your professor's specific guidelines. Some instructors modify parts of a research paper to better fit their assignment. Others may request supplementary details, such as a synopsis for your research project . Thanks Helpful 0 Not Helpful 0
• Set aside blocks of time specifically for writing each day. Thanks Helpful 0 Not Helpful 0

• Do not plagiarize. Plagiarism is using someone else's work, words, or ideas and presenting them as your own. It is important to cite all sources in your research paper, both through internal citations and on your reference page. Thanks Helpful 4 Not Helpful 2

You Might Also Like

• ↑ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3178846/
• ↑ http://owl.excelsior.edu/research-and-citations/outlining/outlining-imrad/
• ↑ http://china.elsevier.com/ElsevierDNN/Portals/7/How%20to%20write%20a%20world-class%20paper.pdf
• ↑ http://intqhc.oxfordjournals.org/content/16/3/191
• ↑ http://www.ruf.rice.edu/~bioslabs/tools/report/reportform.html#form

About This Article

To write a medical research paper, research your topic thoroughly and compile your data. Next, organize your notes and create a strong outline that breaks up the information into sections and subsections, addressing one main point per section. Write the results and discussion sections first to go over your findings, then write the introduction to state your objective and provide background information. Finally, write the abstract, which concisely summarizes the article by highlighting the main points. For tips on formatting and using citations, read on! Did this summary help you? Yes No

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How to write an article: An introduction to basic scientific medical writing

Affiliation.

• 1 Department of Minimal Access, Metabolic and Bariatric Surgery, Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Healthcare Institute Ltd., Saket, New Delhi, India.
• PMID: 29974882
• PMCID: PMC6561072
• DOI: 10.4103/jmas.JMAS_91_18

An original scientific article published in a peer-reviewed professional journal of repute provides great personal satisfaction, adds stature and endows professional respectability to contributing authors. Various types of surgical publications that exist nowadays are case report, cohort study, case-control study, randomised controlled trial narrative review, systematic review, Cochrane review, meta-analysis, editorials and leading articles. A study/research protocol is a standardised document, common to all research projects that typically comprise study objectives, study design, selection of participants, study intervention, study evaluations, safety assessments, statistics and participant rights committees. Once the study protocol is completed and reviewed, it is submitted to the local Institutional Review Board/Institutional Ethics Committee for approval. An outline of the levels of evidence and grades of recommendation is available from the Centre for evidence-based medicine at the University of Oxford. A standardised, structured template exists for scientific presentations in the field of medicine which is also followed in medical writing and publications Introduction Methods Results And Discussion (IMRAD). Instructions to authors would normally include reference to International Committee of Medical Journal Editors and Committee on Publication Ethics guidelines for good and ethical publication practice. It is strongly advised to follow the recommended guidelines appropriate for the published study.

Keywords: Evidence-based medicine; IMRAD; manuscript types; reporting guidelines; study protocol.

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Citing journal articles.

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APA: Citing Journal Articles  from  Lawrence W. Tyree Library  on  Vimeo . View a transcript  here.

In this tutorial, you will learn the basics for citing journal articles with and without a DOI and how to cite open access journal articles.

Every APA reference needs four parts:  author, date, title,  and  source . As you go through these examples, you will learn how to identify these four parts and how to place and format them into a proper APA reference.

Example 1: A Journal Article with a DOI

For the first example, you will learn how to cite a journal article with a DOI. Often, you will find journal articles online using the library's databases or other online resources. 

The first step is to identify the  author  of the article. The author of this article is Brittanie Atteberry-Ash,

To list an author, write the  last name , a  comma , and the  first and middle initials .

Example: Atteberry-Ash.

Next, identify when this article was published. For journal articles, you typically only need the  year . In this case, this article was published in 2022. You can usually find the date at the top of the article, the cover of the journal, or, for online articles, the article's record.

List the  date  after the author(s), in  parentheses , followed by a  period .

Example: Atteberry-Ash, B. (2022).

Now, identify the  title of the article . The title will usually be at the very top of the article, in a larger size font.

List the  title  of the article after the date. Make sure you only capitalize the  first word of the title ,  the first word of the subtitle , which comes after a colon, and any  proper nouns . End with a period. In this title, only the words Social  and  A  are capitalized.

Example: Atteberry-Ash, B. (2022). Social work and social justice: A conceptual review.

For the last component, you need the  source . For an article, this is the  title of the journal, volume, issue , which is sometimes called  number , and  page numbers  of the article. Usually this information can be found on the cover of the journal, on the table of contents, or at the top of the article. For the page numbers, you should look at the first and last pages of the article. For online articles, this information is usually found in the article's record.

Type the  journal title , in  italics , capitalizing all major words, a comma, the  volume , also in  italics , the  number or issue  in parentheses, a comma, and then the  page numbers  of the article.

Example:  Atteberry-Ash, B. (2022). Social work and social justice: A conceptual review.  Social Work,   68  (1), 38-46.

The last element of the  source  is the  DOI , which stands for Digital Object Identifier. A DOI can be found in the article’s record or on the first page of the article.

Type the  DOI , using the prefix  https://doi.org/ . There is no period after the DOI.

Example:  Atteberry-Ash, B. (2022). Social work and social justice: A conceptual review.  Social Work,   68  (1), 38-46. https://doi.org/10.1093/sw/swac042

If you refer to a work in your paper, either by directly quoting, paraphrasing, or by referring to main ideas, you will need to include an in-text parenthetical citation. There are a number of ways to do this. In this example, a  signal phrase  is used to introduce a direct quote. The  author's name  is given in the text, and the  publication date  and  page number(s)  are enclosed in parentheses at the beginning and end of the sentence.

Example: Atteberry-Ash (2022) notes "social workers are called on to practice socially just values and to address the consequences of oppression, specifically lost opportunity, social disenfranchisement, and isolation" (p. 38).

Example 2: Multiple Authors and No DOI

In this example, most of the components needed for the reference can be found in the article’s record. This article, however, has multiple authors and does not have a DOI listed in its record or in the article itself.

Format all the citation components of this journal article like the first example. For multiple authors, list the authors in the order they are listed in the article. Use a  comma  to separate each author and an  ampersand (&)  should be placed before the last author’s name. This applies for articles with up to twenty authors. Since there is no DOI listed for this article, simply omit that element. The reference will conclude after the page numbers.  

Example: Penprase, B., Mileto, L., Bittinger, A., Hranchook, A. M., Atchley, J. A., Bergakker, S., Eimers, T., & Franson, H. (2012). The use of high-fidelity simulation in the admissions process: One nurse anesthesia program’s experience.  AANA Journal, 80 (1), 43–48.

If you refer to a work in your paper that has three or more authors, the in-text citation will include the first author's name only, followed by  et al.  which means "and all the rest."

Example: Penprase et al. (2012) states that "Admission into nurse anesthesia programs is known to be a competitive process among a diverse pool of candidates" (p. 43).

Example 3: An Open Access Journal Article

This article was found in  PLOS One  which is an open access journal. Open access journal articles are articles with the full text freely available online and do not require logging in.

You will need all of the same information from the previous examples to cite an open access article. In this example, most of this information can be found at the top of the article.

In this example, the article's volume, issue, and the  article number  are found in the citation provided by the journal. Article numbers are used in place of page numbers in some online journals.

The format for open access journals is the same as the other examples. In this example, an article number is used in place of the page numbers. After the issue number, type  Article  and then the article number. If an open access journal does not provide a DOI, you may provide the URL of the article instead. Only include the URL if it directly brings you to the full text of the article without logging in.

Example: Francis, H. M., Stevenson, R. J., Chambers, J. R., Gupta, D., Newey, B., & Lim, C. K. (2019). A brief diet intervention can reduce symptoms of depression in young adults – A randomised controlled trial.  PLOS ONE, 14 (1), Article e0222768. https://doi.org/10.1371/journal.pone.0222768

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Writing for publication in a medical journal

R. grant steen.

Medical Communications Consultants, LLC, 103 Van Doren Place, Chapel Hill, NC, USA

The essence of writing for publication in the medical field is distilled into a dozen precepts to guide the anxious author. These precepts focus on the attitude of the writer, rather than the mechanics of writing. A medical author must strive to be the following: Original, honest, innovative, organized, careful, clear, modest, fair-minded, frank, persistent, rigorous, and realistic. These attributes are essential because there is a new climate of skepticism among the lay public as to the validity of scientific and medical claims. This climate has encouraged journal editors to be demanding of authors and to be especially vigilant about plagiarism; originality of all contributions is therefore essential.

I NTRODUCTION

There is always a danger in writing about writing. The effort can look presumptuous, in that few writers are truly in a position to tender advice; more medical writers are workmanlike than inspired. Writing a paper about writing a paper can also seem futile because guidelines have to be so broad as to be vague. Practical advice about writing a research report is necessarily different from advice about writing a systematic review or a case report.

Still, there can be no doubt that scientists writing their first paper need guidance, and such guidance can be hard to find. With full awareness that this effort may seem both presumptuous and futile, the lessons of a career in writing are distilled into a few precepts to guide the anxious author. These precepts focus on the attitude of the writer, and leave practical advice as to the mechanics of writing to other authors.[ 1 ]

B E O RIGINAL

Lack of originality is the cardinal sin in a creative field. Using the words or thoughts of someone else without adequately crediting that person is plagiarism.[ 2 ] Lack of originality can include plagiarism of words, of ideas, or of one's own already published work. Plagiarism can have serious consequences, including retraction of papers, suspension or firing of authors, and other legal actions.[ 2 ] In fact, up to 29% of all papers retracted were faulted for some form of plagiarism,[ 3 ] and authors in India have been responsible for about 6% of retractions worldwide.[ 4 ] Some believe that India cannot emerge as a global player in science and medicine until plagiarism is reduced, so a “National Plan of Action” has been proposed.[ 5 ]

A distinction has been made between theft of words and theft of data.[ 3 ] Theft of words is clearly plagiarism, but theft of data is a more serious crime that has been called data fabrication. Theft of words can happen inadvertently, whereas theft of data is always a calculated act. As scientists, our first duty is to defend the authenticity of data; the originality of words is more a concern of writers and publishers, which many scientists do not aspire to be. Though this viewpoint is controversial, plagiarism of words could be considered error, whereas plagiarism of data must be considered fraud.[ 3 ]

The essence of plagiarism is that the writer claims something as his own when it is not his to claim.[ 6 ] Failing to give credit where credit is due amounts to theft from the owner of that material. Such theft may not be a material loss to the owner since in academic circles, no exchange of money is usually involved. Yet, it is certainly a material gain to the person who appropriates such material, making the plagiarist seem more creative or more diligent or more intelligent than is warranted.[ 6 ]

Plagiarism can be hard to avoid, especially when writing in English for the first time.[ 7 ] Authors often have difficulty expressing their ideas or using the idiom of science. Some authors believe it is a form of flattery to use the words of a mentor, or that there is little harm in borrowing phrases that may describe findings better than more original words. Yet, the attitude in science is that recycling of words without attribution is a crime.[ 7 ] Interestingly, when plagiarism-detection software was used to assess all submissions to a single journal, 11% of manuscripts were found to have some degree of plagiarism, with the average extent of theft in plagiarized manuscripts amounting to about 25% of the text.[ 8 ] Generally, the extent of plagiarism was highest in the Materials and Methods section,[ 8 ] confirming that plagiarism is most likely in describing experimental methods.

Self-plagiarism, the act of extensively borrowing words from one's own published work, is strongly discouraged.[ 9 ] Some people dismiss this practice by saying that it is impossible to steal anything from oneself, and that self-plagiarism is no worse than laziness. But the net result of repeated self-plagiarism is that the productivity of a researcher is artificially elevated. Thus, a degree of deception is involved in self-plagiarism.[ 9 ] Because professional advancement and scientific reputation depend upon research productivity, self-plagiarism is a form of theft from the scientific establishment. As a practical matter, some journals use a guideline that up to 30% of the words in a paper can be recycled by an author from a previous paper, but no data, whatsoever, can be recycled.[ 10 ]

B E H ONEST

Writers must be scrupulously, unrelentingly, and totally honest in their work because any dishonesty will eventually be discovered and fabricated or falsified data is judged harshly.[ 3 , 4 , 11 – 13 ]

Science is generally thought to be self-correcting; scientists are eager to criticize new work and to fault established wisdom. For example, there has been an ongoing debate as to whether the results presented a century ago by Gregor Mendel, the father of modern genetics, are too good to be true.[ 14 ] Mendel bred pea plants together in various combinations to understand how individual plant traits are expressed through the generations. His work was eventually accepted as the first physical evidence of genes. However, R. A. Fischer, the father of modern statistics, did a detailed statistical analysis and concluded that Mendel's data were too close to the ideal expected if experiments had involved a larger sample size. This suggests that Mendel may have “edited” his data after collecting it,[ 14 ] a transgression that would now be called data falsification.[ 3 ] The point is not that Mendel was dishonest; we cannot know this with certainty. Yet, we do know that his results are still being examined and questioned more than a century after the fact.

B E I NNOVATIVE

Attacking the same problems with the same tools will often yield the same results; it can be useful to approach an old problem in a new way. For example, personalized medicine has caused a paradigm shift in oncology; the idea that each patient should be treated in a way individually tailored to the genes unique to their tumor has caused a great deal of excitement. Yet, it is only recently that the idea of personalized medicine has come to diabetology.

For many years, the goal of treatment of type II diabetes mellitus (T2DM) has been to lower glycemic levels as close to normal as is safely possible.[ 15 ] Tight glycemic control is known to reduce complications of the disease that affect the eye, kidney, and nerve. Although T2DM is heterogeneous – in terms of presentation and pathogenesis – patients tend to be treated in similar ways. Hence, it cannot be surprising that current T2DM therapies often fail to achieve glycemic control, particularly over the long term. Somewhat more than half of all diabetics achieve the goal of glycosylated hemoglobin (HbA1c) <7%, so patients are at risk of eventual diabetic complications.[ 15 ] Insight into the genetic variability that probably underlies the heterogeneity in clinical presentation is an innovative clinical strategy. Identification of the Kir6.2 mutations as potentially responsible for several forms of maturity-onset diabetes, as well as a better understanding of the polygenic nature of T2DM, suggests that personalized medicine may enable better glycemic control in patients.[ 15 ]

B E O RGANIZED

There is a specific structure to a science paper, as formal and as circumscribed as haiku poetry (see http://www.ijem.in/contributors.asp ). If writers do not use that structure, they are unlikely to get published. This may seem a trivial point in that a good idea badly argued is more easily fixed than a bad idea well argued. But people are busy; if an author does not organize his writing, why would anyone read it?

The key thing in writing science papers is to first finalize the data. All tables and figures should be put in final form before anything else is attempted. Then throw out your preconceptions and look at the data with a fresh eye; what story do the data tell? Jot down conclusions looking at the data as a new reader would, without thinking about what you were trying to prove. Sometimes the story that emerges is not the story you intended to tell, but as long as the story is driven by data, the story is worth telling in a paper.

B E C AREFUL

It is often little details that trip up big ideas. Recently, Einstein's theory of relativity seemed at risk, because European physicists had detected subatomic particles known as neutrinos that seemed to be moving faster than the speed of light.[ 16 ] Yet, newer evidence suggests that the excess speed of neutrinos may really have been excess zeal of the neutrino-detecting scientists.[ 17 ] When the apparatus used to make the measurement was carefully examined, a loose wire was found that made neutrinos appear to move faster than they were actually going.[ 17 ]

A misplaced decimal point, a cut-and-paste error in a table, a crucial typo, a tiny miscalculation – each of these minor errors has sunk many papers. Check every number two or three times, then put the paper aside, come back to it with fresh eyes, and check it again. The accuracy of the data is the first concern; you cannot have good science without reliable numbers.

The ideas in science are so complex that the words used to describe those ideas should be simple. Verbal excess and flowery language must be avoided; prose should be clear and direct. Acronyms never add clarity, though they can sometimes help with economy of words; nevertheless, acronyms do more harm than good.

Clarity is especially important in the Results section, the beating heart of a paper.[ 1 ] Writers should lead readers through the results with clear, direct sentences. Writing should convey competence and professional authority and that is often accomplished by writing in first person and using the active voice. Active voice emphasizes the agent of an action; passive voice emphasizes the result of an action. “We analyzed the results” is clearer than “The results were analyzed,” because the latter formulation leaves open the question of who performed the action.

In a paper, as in a mathematical formula, less is more. Clarity can only be achieved by direct thinking, which is associated with direct writing. Precision of thought is important, and concision of words is a useful marker for it. It is easier to generate confusion with many words than with few. If concision reveals a paucity of ideas, then do not write more; think more. The most important biology paper of the last century was extremely short – Watson and Crick's description of the structure of DNA in Nature [ 18 ] was scarcely a page long – yet, it revolutionized biology.

B E M ODEST

It is a major mistake to claim too much credit, whether for the strength of your data or for the originality of your ideas. Science is an iterative process by which we approach the truth in tiny steps. None of us would be where we are without people before us who blazed a trail; none of us could have followed that trail without mentors and colleagues. Modesty is not merely appealing; it is essential.

A model of scientific modesty is provided by the penultimate paragraph of Watson and Crick's famous paper on DNA:[ 18 ] “It has not escaped our notice that the specific pairing we have postulated immediately suggests a possible copying mechanism for the genetic material.”

B E F AIR -M INDED

Do not misrepresent an argument merely to demolish it as this is intellectually dishonest.[ 19 ] You cannot be certain you are right, so you cannot know that others are wrong. In science, we struggle to illuminate the darkness of ignorance and darkness always resists light.

One way to be sure you are fair-minded is to circulate your manuscript among colleagues. This is particularly valuable if you have a colleague with whom you have disagreed. A disagreement about a paper prior to submission can result in a stronger paper; a disagreement about a paper after publication can harm a career. You should also offer to review your colleague's papers prior to submission.

Flaws and weaknesses are present in every paper; be open about the blemishes in your paper. This does not diminish your work; it builds credibility for you as an investigator and opens a door for others to follow you. For example, India was estimated to have 51 million people with diabetes.[ 20 ] But this estimate was based on small, often under-powered studies done in various parts of the country, and methods were heterogeneous between studies. Component studies were weakened by differing diagnostic criteria, unconfirmed preliminary diagnoses, local, regional, and ethnic differences, poor characterization of measurement error, and spotty coverage in rural areas.[ 20 ] It may seem an error to confess such weaknesses openly in the literature, but it creates a spectacular research opportunity. Because these various weaknesses were known, a national study on the prevalence of diabetes in India was proposed.[ 20 ] When the national study was done, it was found that there are actually about 62 million people with diabetes in India,[ 21 ] 11 million more than had been predicted.[ 20 ]

B E P ERSISTENT

Your work may not be recognized as worthy of publication the first time it is submitted to a journal. This is the normal course of events; most journals will not accept a paper on first submission even from a prominent author, so the novice writer should not be discouraged.

Your paper may require a rewrite; after all, which paper cannot be improved? But it may also be true that the journal was not a good fit for your paper. The best course of action is to put the review of your manuscript in a drawer and leave it there until the sting of rebuke wears off. Then, being as dispassionate as possible, go through your manuscript with the comments in hand and see which of those comments are helpful.

If the referees enable you to see something which you did not see before, or if the referees have made an error that you can persuasively counter, then it may be possible to resubmit your manuscript to the original journal. If you cannot respond to all of the comments by either altering your manuscript or rebutting the criticism, then it may be time to pick another journal for submission. Often a clue as to which journal provides the best fit for your paper is to look at the references cited. There can be an alignment between what a journal has published in the past and what that journal is likely to publish in the future.

Many papers go through an odyssey of submission and rejection before they finally achieve publication and some papers are finally published in a journal more prestigious than the original journal of submission. Writing and submitting papers requires a thick skin and a resilient nature.

B E R IGOROUS

You can never “prove” a hypothesis; you can only fail to disprove it.[ 22 ] Of 276 studies published in Indian journals in 2009, roughly 5% claimed that an insignificant P value proved the null hypothesis. This is incorrect; if a study is inadequately powered, it likely will fail to identify a difference between treatment groups.[ 22 ]

Careful analysis of the medical literature has revealed that statistics are misused in a great many papers and in a variety of creative ways.[ 23 ] Many statistical errors have been identified, which break down into five broad categories: Flaws in study design, in data analysis, in documentation of statistical methods used, in presentation of data, and in interpretation of findings.[ 23 ] Statistical software is widely available, yet such software requires knowledge of the assumptions inherent to the statistical tests and of their limitations. Statistical errors in published papers are so common that a statistician should be involved at study inception, to minimize damaging errors.

B E R EALISTIC

If something is statistically significant, that does not mean that it is clinically significant, and clinical significance is far more important.[ 24 ] A study that enrolls a great many people and finds a tiny difference upon treatment may achieve statistical significance and still mean nothing for a patient. Reality is strained when clinical trials use composite endpoints that make the trial more likely to obtain a positive result because such endpoints also make it harder to determine if a new patient will benefit from treatment.[ 24 ] For example, the JUPITER trial[ 25 ] enrolled 17,802 apparently healthy men and women and treated them with rosuvastatin for 1.9 years. The primary outcome measure was, “the occurrence of a first major cardiovascular event, defined as nonfatal myocardial infarction, nonfatal stroke, hospitalization for unstable angina, an arterial revascularization procedure, or confirmed death from cardiovascular causes.”

This composite endpoint conflates medical events that vary greatly in severity.[ 26 ] A nonfatal stroke may not impinge much on the patient, whereas death is hard to ignore. This compound endpoint may have falsely inflated the odds that medication would be deemed helpful. The JUPITER trial may have been unrealistic in other ways as well. Cardiovascular mortality was surprisingly low, since healthy people were enrolled and the trial was prematurely terminated. Because few primary endpoints were observed, results are more prone to statistical fluke than if there had been many cardiovascular deaths over a long follow-up period. Thus, JUPITER may not present a realistic picture of the potential benefits of statins in healthy people.[ 26 ]

C ONCLUSION

I cannot promise that if all these precepts are followed, publication will follow; talent, energy, and luck are also required. I cannot promise that publication will get easier over time; each new paper presents unique difficulties. I cannot promise that every paper will garner praise and honors, once it is written up; writing is just the last step in research and strong writing cannot compensate for a weak experiment. But I can promise that seeing the first publication – or even the hundredth publication – will be a thrill.

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R EFERENCES

• Case report
• Open access
• Published: 16 September 2024

Spontaneous resolution of synovial lumbar cyst presented with severe symptoms: a case report

• Mostafa Hassan   ORCID: orcid.org/0009-0001-6034-3721 1 ,
• Iyas Salman 1 &
• Issam Salman 2  

Journal of Medical Case Reports volume  18 , Article number:  432 ( 2024 ) Cite this article

Metrics details

Introduction

Spinal cysts have traditionally been treated with surgery since it was first described in 1950. However, there have been rare instances where these cysts have resolved on their own without the need for surgical intervention. Here, we discuss the 27th reported case of such spontaneous resolution in the medical literature and delve into the details of this unique case.

Case presentation

This report details a rare case of a 58-year-old Middle Eastern female who suffered from severe radicular and lumbar pain. Radiological study showed the presence of a cyst in the lumbar column. Noninvasive treatment was chosen after ensuring that there were no other symptoms requiring surgery. The patient showed gradual improvement over the course of 12 months, after which the pain completely disappeared.

The surgical approach is currently the main treatment for spinal cysts, but spontaneous resolution, despite its rarity, may be worth considering as a preferred therapeutic approach in the future. This avenue has not been thoroughly explored or studied. Due to the etiology of these cysts and their location within mobile joints, a longer period of conservative management including rest and physical therapy may play a pivotal role in promoting natural resolution.

Conservative treatment of cysts should continue for at least 8 months, using painkillers and physical therapy without lumbar bracing. Surgery remains the most effective means of treatment to date. Further research is needed to validate and establish standardized treatment protocols.

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In 1877, Becker was the first to describe synovial cysts, initially identifying them as cysts located in the joints of the lower limb [ 1 ]. Later, it was found that they can occur in most of the body’s moving joints. Then, in 1950, Vossschulte and Borger [ 2 ] documented the first case of a synovial cyst in the lumbar spine.

Synovial cysts, or ganglion cysts, are fluid-filled sacs that develop in the facet joints of the spinal column as a result of external factors putting pressure on the movable joints in the spine, causing degenerative changes that can lead to the enlargement of the facet joints and the formation of these cysts [ 3 ].

Spinal cysts are mostly found in the lumbar and cervical regions, with limited evidence of their occurrence in the thoracic spine. The main treatment approach, as indicated by the majority of medical literature, involves surgical intervention by excising and decompressing [ 4 ]. In some cases, spinal fusion might be necessary to stabilize the spine following the removal of the cyst [ 5 ]. A recent study by Benito et al. [ 6 ] on 657 patients with synovial cysts, comparing the outcomes of different surgical methods, revealed that lumbar decompression and fusion (LDF) were associated with better outcomes, including reduced postoperative back pain and lower rates of cyst recurrence compared with lumbar posterior decompression (LPD).

Alternatively, treatment may include aspiration and steroid injections. Facet joint injections have demonstrated efficacy in offering short-term pain relief for spinal synovial cysts. Nonetheless, their effectiveness tends to diminish over time [ 7 ]. Additionally, the aspiration of cysts guided by computed tomography (CT) or fluoroscopy, along with subsequent steroid injection, has produced varying outcomes [ 8 , 9 ]. Certain studies have indicated increased recurrence or failure rates when employing this method compared with surgical alternatives [ 9 , 10 ].

In some rare cases, cysts may resolve spontaneously with the use of pain management, physical therapy, and lumbar bracing [ 11 ].

This report will elaborate on a unique case of a patient who achieved full recovery from a painful lumbar synovial cyst without the need for any interventional procedures, using only painkillers and physical therapy.

A 58-year-old Middle Eastern female from Syria presented to the neurosurgery department in the sixth month of 2021 with progressive left radicular pain extending to the hip and the lateral posterior side of the thigh and leg, reaching the lateral toes, and back pain in the lumbar region, scoring 10/10 on the numeric pain scale, that had been ongoing for 1 month. The patient had difficulty walking and denied any traumatic events. A review of the patient’s medical history revealed that she had chronic right radicular lumbar pain in 2018 with a normal lumbar magnetic resonance imaging (MRI), which was successfully treated with painkillers for 3 months. In 2020, the same pain recurred, and the MRI was again normal, and she recovered using painkillers once more.

Investigations

Physical examination revealed normal strength and tendon reflexes in the lower limbs, normal muscle tone in both lower limbs, and a highly positive Lasègue test. Lumbar MRI showed an extradural cystic lesion in the L5–S1 spinal canal, adjacent to the left internal facet joint, with hypointensity in T1-weighted images and slightly hyperintensity in T2-weighted images, consistent with a synovial cyst (Fig.  1 ).

A lumbar MRI revealed a cystic lesion depicted in ( A ) T2 Sagittal, ( B ) T2 axial, ( C ) T1 sagittal, and ( D ) T1 axial images. The red arrows indicate the cyst that appears hyperintense on T2 and hypointense on T1 sequences

Differential diagnosis

The primary differential diagnosis considered for the observed lesion was a spinal synovial cyst. The MRI findings showed a significant increase in synovial fluid within the articular facet, with a clear connection between the cyst and the articular facet.

In some cases, an extruded disc fragment may be considered when there is a disc herniation. Nonetheless, protruding disc fragments usually show signal intensity features that mirror those of the original disc and are commonly situated in front, rather than posterior and lateral to the thecal sac.

Meningioma is another differential diagnosis that may present with similar intensity to synovial cysts on MRI. However, meningiomas are typically intradural extramedullary and develop over a longer period. The earlier MRI results excluded this potential diagnosis.

The patient did not exhibit any clinical or radiological signs indicating the need for surgery. Therefore, a noninvasive approach was chosen, focusing on pain management with diclofenac potassium 50 mg twice daily and a proton pump inhibitor (PPI) once daily in the morning. Physical therapy was recommended, while orthopedic bracing was not deemed necessary. Clinical re-evaluation was scheduled every 3 months.

Follow-up and outcome

The patient reported gradual but significant improvement in pain over the next 3 months, but the pain remained severe, scoring 7/10 on the pain scale. After 6 months she stopped physical therapy sessions, with 5/10 on the pain scale, and we reduced the dose of pain relievers to once a day or when needed. A total of 9 months after the onset of symptoms, the patient reported a nearly complete absence of pain. A follow-up MRI performed 12 months later showed overgrowth of facets without canal stenosis at L5–S1. The previously observed cyst was nearly no longer present. Since then, the patient has been free of pain or any neurological symptoms (Fig.  2 ).

Lumbar MRI T2-weighted sequences: ( A ) sagittal and ( B ) axial views show the cyst shrinking visibly after 12 months from symptom onset, as indicated by the red arrow

Spinal cord cysts are often a result of degenerative changes in the spine or repeated minor trauma to the joint surfaces. These issues can cause a build-up of joint fluid and subsequent leakage, leading to the development of synovial cysts, which sometimes may present with severe symptoms indicating appropriate treatment. These cysts are frequently located near the joint surfaces and are particularly prevalent in the most mobile regions of the lumbar spine, such as at the L4–L5 level [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ]. In the patient’s medical history, she experienced intermittent lumbar pain attributed to external factors, which aligns with the degenerative etiology of these cysts.

Synovial cysts are consistently located posterolateral to the thecal sac and can cause central or lateral spinal stenosis. Symptoms may include radiculopathy, back pain, sensory deficit, motor deficit, neurogenic claudication, and cauda equine syndrome. These cysts can appear at any level in the spinal column, including the C1–C2 level, but 92% of cases occur in the lumbar spine. The cervical and thoracic spines are less frequently affected, with rates of 6.3% and 1.6%, respectively [ 12 ].

The available treatment options for these spinal cysts include interventional treatments, such as surgical procedures with or without spinal instrumental fusion, or aspiration of the cyst along with steroid injections. Noninterventional treatments, such as pain management, physical therapy, and lumbar bracing, may also be considered. Surgical intervention with cyst removal to relieve pressure on the spine is considered the most common procedure for treating these symptomatic cysts in medical literature, as it has shown lower recurrence rates than any other approaches [ 10 , 12 ]. The type of surgical procedure, whether it involves cyst removal or decompression with or without fusion, remains the best and in most cases the primary treatment for any symptomatic lumbar synovial cyst [ 13 , 14 ].

The spontaneous resolution of these cysts is very rare in the medical literature, with only 26 cases recorded. Adding our case brings the total number recorded to 27 to date. Chiarella et al. [ 11 ] collected data on the spontaneous resolution of spinal cysts, which they referred to as “ganglion cysts.” They suggested noninvasive treatment for at least 6 months including anti-inflammatory drugs and light unloading exercises to control pain and reduce intra-cystic fluid, rest, and lumbar bracing. But they did not mention any specific indication for conservative treatment, and most of the reviewed cases did not mention severe symptoms.

Considering the pathological mechanism of these cysts, as well as the absence of alternative causes for the patient’s pain in the clinical and radiological examinations, a conservative treatment plan was implemented. This involved the administration of painkillers and physical therapy over a period of 3 months. Following this initial treatment, the patient reported a reduction in pain from 10 out of 10 to 7 out of 10 on the pain scale, prompting an extension of the conservative treatment. After 10 months from the onset of symptoms, the patient reported intermittent pain at an intensity of 1 out of 10 on the pain scale. Subsequent MRI scans after 12 months demonstrated a 90% reduction in the size of the cyst, with decreased signal intensity at both T1 and T2. This case illustrates that physical therapy and long rest, which alleviated external pressures on joint surfaces and relieved spinal pressure, facilitated the gradual reabsorption and reduction in cyst size over time.

Lumber bracing is a controversial issue. While lumbar spine stabilizers may offer short-term benefits, they may also lead to muscle weakness in this area, potentially resulting in increased pain and subsequent complications.

Noninvasive treatment methods may hold significant promise for the future, with the potential to reduce the need for surgical intervention, thereby decreasing financial burdens and mitigating potential post-operative complications. However, this case, along with the other 26 cases of spontaneous resolution in the medical literature, does not provide sufficient evidence to consider it as the optimal method for managing spinal synovial cysts. Hopefully, the number of these cases will increase in the future so that a large study on this treatment method can be done.

Cysts are a rare cause of radicular pain, but they can manifest as severe pain, which may perplex the medical practitioner regarding treatment and diagnosis. Surgical treatment is approach the most often availed for treating these cysts. A longer period of conservative treatment can be given a chance, even with severe pain. We propose a conservative approach involving noninvasive therapies for a minimum of 8 months focusing on pain management and physical therapy. Further extensive studies are needed to validate the effectiveness of this method so it could be considered for treatment.

Availability of data and materials

Not applicable.

Abbreviations

Lumbar decompression and fusion

Lumbar posterior decompression

Computed tomography

Magnetic resonance imaging

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Mostafa Hassan contributed to writing, editing, data collection, data interpretation and analysis, drafting, and critical revision. Iyas Salman contributed to data collection and editing of the manuscript. Issam Salman was the supervisor and contributed to critical revision and final approval.

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Correspondence to Mostafa Hassan .

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Hassan, M., Salman, I. & Salman, I. Spontaneous resolution of synovial lumbar cyst presented with severe symptoms: a case report. J Med Case Reports 18 , 432 (2024). https://doi.org/10.1186/s13256-024-04762-2

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Received : 19 July 2024

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DOI : https://doi.org/10.1186/s13256-024-04762-2

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