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Effective communication is essential in most careers, including academic medicine. Results of scientific studies are typically disseminated through publication in scientific journals. As editors of two biomedical titles published by the American Society for Clinical Pathology (ASCP) and Oxford University Press, we read hundreds of submitted manuscripts every year and select a fraction for publication in our journals. How do we decide which papers to accept and which to reject? For most scientific journals such as ours, it is a process that involves several steps and includes review by experts in the subject area the paper falls within.

In brief, when a manuscript is received by AJCP or Laboratory Medicine, it is first screened for plagiarism by a proprietary software product. Then an additional screen is applied to detect certain irregularities that are associated with fraudulent publishing. The paper is then reviewed by the editor for relevance to the journal’s focus, grammar, study design, and overall likelihood of interest to the scientific community. But editors are, in general, experts only in their specific field of specialization, so we depend on our board of editors and external reviewers to provide the expertise necessary to assess the quality of the research. The reviewers may find the paper unsuitable for publication due to errors in the experimental design or in the conclusions reached, or simply because the paper does not add anything substantial to the existing literature. If the paper has promise, however, the reviewers often will make constructive suggestions for revisions, and the paper will be returned to the authors with those suggestions. If the authors heed the suggestions and make the requested changes, the paper is usually accepted for publication.

We will share some helpful tips for giving your paper the best chance at acceptance. A caution, though: our tips will be useful only if the science you describe in your manuscript is sound, interesting, and at least somewhat novel. Assuming your manuscript meets those three criteria, here are some things you should do to help improve the overall quality of your paper and maximize its chances of being accepted for publication.

Dr. Bertholf’s Tips (Editor in Chief, Laboratory Medicine)

1. The abstract

There is a very good possibility that a majority of people who encounter your published paper will only read its abstract, so you should give it attention that is disproportionate to its size. The abstract summarizes all the pertinent information in the entire manuscript, including why the study was done, how the study was done, what the results of the study were, and what conclusions you reached from those results. There is usually a limit to the size of the abstract, so you must choose very carefully what you want to include in it. The language should be clear, efficient, and concise so you can convey as much information as possible with the number of words allowed. An additional consideration is that invitations to reviewers typically include only the abstract, so a potential reviewer’s decision to review the entire manuscript is often based on the abstract alone. Some authors prefer to write the abstract first, believing that once the abstract is written, the rest of the paper elaborates on the abstract. Others maintain that the abstract should be written last so that all the pertinent information has already been fleshed out before distilling it down to an abstract. Both approaches make sense to some degree, and it comes down to personal preference. But my advice is, don’t treat the abstract as an afterthought because it probably is the most important text in your entire manuscript.

2. The title

Consider the title of your paper as your own personal advertisement for your manuscript. It will be the first thing anyone who looks at your paper sees. Any literature search via PubMed, Google Scholar, or other search engine will likely display only the title of your paper and perhaps the first few authors, so the title should accurately reflect the results of your study. Vague or ambiguous titles, such as “Variations in Transfusion Practices” or “Liver Enzymes in the Diagnosis of Cirrhosis,” are not helpful to anyone conducting a literature search on a specific topic. Another relatively common practice that I find unnecessary is the inclusion of a reference to the location of the study in the title, such as: “Incidence of Beta Streptococcal Infections at a Major Medical Center in Mumbai, India.” A title such as this implies that the data are only relevant to that city, and if that is the case, it is of limited interest to anyone outside of that area. If the results of a study are only relevant to the area in which it was conducted, then they probably don’t belong in the biomedical literature, which has a global audience. As a personal preference, I like simple declarative titles, such as “Plasma Renin Activity Predicts Hypertensive Crisis in Primary Aldosteronism,” as opposed to passive voice, but other editors may prefer the latter.

3. Select the appropriate journal

Scientific publishing has evolved over the past few decades from exclusively printed journals to primarily electronic publishing. Although many printed titles critical values | volume 16 | issue 2 April 2023 | critical values 7 still exist, access to the published papers is increasingly online through various search engines. As a result, the specific journal in which a paper is published matters less than it once did, when the journal’s circulation would determine the breadth of exposure the paper would receive. It could be argued that in the current publishing environment, the actual journal is irrelevant since the paper will be accessed by key words in the title and text. However, it would be a mistake to ignore the relevance of the paper you want to publish to the focus of the journal for several reasons.

First, the editorial board of a journal typically includes experts in the field that is the journal’s primary focus, such as laboratory medicine or clinical pathology. Papers that are outside those disciplines are not likely to be considered for publication simply because the editorial board needs more expertise to give them a fair review.

Second, printed journals still exist and are often a benefit of professional society membership, such as AJCP and Laboratory Medicine. Members who receive official society publications will ordinarily peruse its contents for papers relevant to their specific practice, so the papers published in the journal should reflect the interests of its readers.

Finally, the specific journal in which your work is published may be important when your scholarly activity is evaluated for employment or promotion in academia. Publishing in high-impact journals is favorable. The most common measure of the prestige of a scientific journal is its Impact Factor, which is based on how often papers published in the journal are cited in other published papers. Newer measures of a journal’s impact include Altmetrics, which reflect how often papers published in the journal are mentioned in any media, including social media. So carefully select the most appropriate and most prestigious journal for your paper. A caution: highly prestigious journals also receive the most submissions and therefore are the most selective. Although there are no penalties for trying to publish in a top journal and having your paper rejected, the process takes time and it is usually preferable to choose a journal that is more likely to accept your manuscript.

Dr. Kroft’s Tips (Editor in Chief, AJCP)

4. The quality of the writing matters

No matter how great your experiment is, your paper will fall short or fail if it is not well-written. This applies both to adherence to basic elements of scientific writing and to using concise, clear, and logical prose.

Each section of a traditionally organized scientific manuscript serves a specific purpose, and authors are welladvised to keep these purposes in mind when building a paper. The main purpose of the introduction is to explain the rationale for performing the study and clearly state its objectives. The introduction should include exactly no more and no less background literature information to make the case that your research was worth doing. Extensive literature reviews don’t belong in this section. If by the end of the introduction, a reader doesn’t know why you did the study and what you hoped to achieve by doing it, you’ve already lost the battle.

The methods section needs to clearly explain everything you did in detail to conduct your experiment(s). Reproducibility of findings is an enormous problem in scientific literature. If you haven’t provided sufficient information to allow someone in another institution to reproduce your findings, or for an expert to assess the quality and robustness of your methods, you are not providing a meaningful contribution to the body of knowledge on your subject.

The results should consist of exactly that: your results. Results sections are often contaminated with stray pieces of introduction, methods, or discussion. Get that stuff out. Just the facts, please, in as clear, organized, and concise a fashion as possible. And the results should show a one-to-one correspondence with your methods: no method without a corresponding result, and vice versa.

Finally, the discussion summarizes and interprets your results and puts them into the literature context. The discussion is the place for the detailed literature review but take care not to go overboard. Your review should be appropriate to the scope of the research. Discussion no-nos include rehashing all of your results, which produces unnecessary clutter, and also can appear to readers as an attempt to fill space as compensation for lack of interesting results. The worst discussion no-no is to draw conclusions that don’t follow from your results. For a skilled reviewer, authors coloring outside the lines can be the kiss of death for a manuscript.

With respect to prose, grammar, syntax, and concision, they all matter. Don’t use big words when small words will do. Don’t use three sentences when an idea can be expressed in one sentence. Avoid fluff words that don’t add anything substantive to the thought you are trying to convey. And pay attention to pesky little details like subject-verb agreement, consistent tense, properly deployed commas and semicolons, and spelling. A sloppily written paper will bias a reviewer against you out of the gate. A poorly written paper that forces a reader to work hard to understand what you are saying may be fatal, no matter how great your data is.

Ultimately, except for a few writing prodigies out there, writing is hard. Really hard. A good paper requires many rounds of editing and rewriting. One little pearl I have picked up over the years is to read your paper out loud with co-authors in the room. Things that sound funny when you say them out loud probably need to be rewritten. Put in the effort, and it will be rewarded.

5. Be scrupulous with your statistical methods

Most investigators know just enough about biostatistics to be dangerous. Many of us like to fire up the statistical software and just start running tests. But, applying inappropriate statistics or not understanding how to interpret the results of statistical tests may produce “results” that are overtly misleading. Even some of the simplest and most common statistical tests are often misapplied and misinterpreted. Take the time to get your statistics reviewed by someone who knows what they are doing. While bad stats often make it through review (because the reviewers also often lack the knowledge to assess your statistical methods), publishing a paper with poor statistics doesn’t do you or the world any favors (unless you want to be vivisected in absentia at journal clubs). And one very specific pearl: never, ever say, “These results lacked statistical significance, likely because of small sample size.” Say this, and you are telling a reader that either 1) you have a fundamental lack of understanding of statistics, or 2) you are being deliberately misleading. Either possibility could result in a summary rejection. Increasing sample size is as likely to cause your P-value to get worse as to get better.

6. A picture is only worth a thousand words if it is a good picture, and it is necessary for presentation of the results

As you are creating your manuscript, consider whether a particular set of results is best explained in prose in the results or in a graph or table. Sometimes a long paragraph of results can be easily and clearly explained in a well-designed figure. However, emphasis is placed in the last sentence on “well-designed.” A poorly constructed figure or table may do more harm than good. And generally, you should choose one mode or the other. If you have an informative graph or table, you should be content to provide just a high-level summary of the data in the prose section of your results. Redundancy does not constitute good manuscript composition. Photographic images or schematics should be easy to understand and pleasing to the eye. An image that is so low power that nobody can actually see what it is illustrating is a waste of journal space. Illustrations should not be so complex that they constitute an assault on the senses. Finally, don’t cram your paper with figures just because they are pretty, and you want to show them off. Each figure or illustration should serve a specific purpose for the reader to enable complete understanding of the results. Leave it out if you can’t articulate why you are including a particular picture.

Publishing in biomedical literature is a requirement in most academic medicine careers. While the quality of your research, review, or case report is the most important determinate in whether it will be published, we hope this practical guidance will improve your chances of having your paper accepted in the journal of your choice.