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
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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
- 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
- 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
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.