This is a summary of the advice I’ve been giving to medical students for years. However, the advice is quite generic and it may be helpful for anyone writing an article on a particular medical subject area where you have to synthesise evidence into a coherent report.
It assumes that there is a general topic area and the writer has the freedom to fine tune the aim and exact niche they want to cover. If you have been given an assignment with a very specific pre-cooked title and aim then much of this advice won’t fly. Non-student writers may not need to state the aim so explicitly but I’d still recommend having one in mind to ensure your writing sparkles. Nothing kills off the impact of an article or report as quickly as rambling digressions.
1. Choose your topic well – niche down
One of the best ways to confuse the hell out of yourself is to pick an enormous topic where there are thousands of papers. Yes, the intro will start with a big topic but you have to focus.
There are several ways to reduce a topic down to sensible proportions. You can concentrate on a sub-group – women, or women over 60, or women over 60 from BME groups, or women over 60 from BME groups with an ‘r’ in their name. You get the idea. Another option is to concentrate on a single intervention. Intervention-based essays and reports can work very well as they can have laser-like focus. There is no temptation to stray into other areas.
More than anything, one of the best strategies I’ve found for students is that they need to get to the bottom of the literature and start dredging there. What I mean is that you need to get all the way down to the original studies, the nuggets of research on which the wider reviews and the guidelines are then built. If you write about a topic which is too broad then you’ll end up trying to critique systematic reviews, narrative reviews, and meta-analyses. That is incredibly hard to do as the full-time academics who have spent their life immersed in the topic will be much better at it than you. That way leads to stress, anxiety and overwhelm.
If you get down to the original literature then you will be able to flex your critical appraisal muscles. All papers, even the very best ones, have flaws in some shape or form. There is no perfect research. Handily, most papers kindly point out their own flaws in the Discussion section.
If you can narrow your niche down to the original research where there are just 5-10 papers with all the knowledge on that topic then you are well on your way.
2. Get the structure of the introduction sorted
Now, there are several different options for how you start an introduction but I’ll describe here the most basic one – the general overview. A well-written general overview is a gem. Some of the best papers have wonderfully succinct summaries of the most important and relevant evidence in the topic area and, regardless of the rest of the content of the paper, could stand alone as brilliant articles.
Think of the intro as funnel or upturned triangle with a number of sections. If each section is a paragraph then you will know exactly what to write. Start with the very big picture, the global, then the next paragraph will be the national, and then get into the specifics of the niche you are looking at. You may need a paragraph on the intervention and sub-group. Finally, the final sentence or two should bring it all together in the pointy bit of the triangle – a description of the aim. The aim should by then feel completely logical and you’ve set the reader up for the findings of your report.
3. Work hard at the aim – and keep working it
The aim is the cornerstone of your report. Don’t just dash one off and abandon it. Re-write it, work it over. It is the formal written expression of the purpose of your report, its raison d’être. Spend some time to get it right and it will make writing your report a lot easier. It is a common flaw in reports that the title and the aim don’t match – make sure they do. More worryingly, it’s common in the poorer reports for the content of the report not to match either the title or the aim. These are the ones where the student has wandered around the research literature, bewildered and disorientated, latching onto occasional snippets.
It is OK to adjust and tweak the aim as you go – it may be too specific and need to be widened. This is not a research project so it is OK to adjust the aim. It’s a written report and if you get to choose the topic then you also should be able to shift the aim. It’s not cheating and it’s not ethically wrong. It is essential if you want the report to have some coherence. Remember, nobody will read your early drafts so you are free to develop the work.
You might be lucky and get it spot on first time. More commonly, as you get into a subject and get to know the papers, it often becomes apparent that it’s too narrow and confined or, more commonly, it’s still too big. Recognise that there is only so much you can squeeze into 2000, 3000, or 4000 words. Tailor your aim to suit.
4. Make sure the report itself answers the aim
Gee, now this might seem obvious, but it is a surprisingly common problem that I regularly see as an editor as well as from students. People get enticed by shiny baubles. Beware interesting tangents and fascinating digressions. Make sure that everything you right about in the report or article can be linked back to the aim.
Look at everything you write (and this might be more of a task for the editing phase) and ask yourself: does it address the report’s aim? If not, it probably needs to be binned. Alternatively, if you are convinced of its importance then you might need to tweak the aim: see #3.
5. Get your notekeeping sorted
Do this right and your report or article will practically write itself. Get it wrong and you will end up in horrible confusion. Make sure, particularly in the early phases of literature searching, you keep detailed notes on the search strategies.
When it comes to reading, start making short brief notes in your own words on each of the papers (carefully referenced) rather than simply underlining and highlighting. This will help enormously when it comes to the drafting stage. Do not think you will just remember and don’t copy and paste from papers. You will forget and, worse, if you then use that pasted text in your essay you will be plagiarising. Don’t go there.
A good notekeeping system will help you make sense of your reading and make connections between themes in the research you read. This is a whole subject area in its own right but if you want to read more then pick up a copy of Sönke Ahrens’ How to Take Smart Notes.° I also spoke to him on the Blokeology podcast.°
6. Write the first draft fast
Don’t linger on the first draft. Get it down and then re-write. Procrastination is the enemy here. Get comfortable with the fact that your first draft will be rubbish. That’s entirely normal. This is where you will find that those notes, written in your own words, are incredibly helpful. You can paste these in the appropriate areas – they are your words right? So, no problem. With these you’ll quickly build the basic building blocks of your report.
7. Writing is re-writing, so, give yourself time to edit
You can only expect to turn that rubbish first draft into quality work if you give it enough time to re-write it. I often find that I have three, four or five passes at a piece of work before I start to feel it’s coming together. Sometimes, it’s longer, but I have learned to trust the process and that if I keep working at it then the quality will improve and I get to a stage where I am satisfied. It is hard to put aside your anxiety in those initial drafts but try to be patient and keep moving forward. Of course, this is all dependent on making sure you have enough time. So, you have to work backwards from the submission date and allow that leeway. The most important thing is to get the first draft down quickly and then you’ve got something to work with.
9. Follow the formatting guidance and don’t throw marks away with sloppy presentation
This is just one of those very basic things. Don’t forget to follow the formatting guidelines for the submitted report. Check the student handbook. I don’t care if you hate Calibri (I’m not a fan myself), if that’s the font they want, then use it. Otherwise you are throwing away marks.
Getting rid of typos is not the only thing you need to do. The overall readability of the report is usually considered here. You need to present a coherent report. Sub-headings are strongly recommended to help the reader follow the logical flow. You may know what a given paragraph is about – make it easy for the half-wit reader (me) to follow that too. Walk around and read it out aloud. If you stumble over it then it needs a rewrite.
9. Write the abstract last
This should be written at the end. It’s a summary of the overall report – how can you do that until you finish the full report? Don’t be coy and offer teasers. It’s not some ad copy. You are not trying to avoid giving the findings here – spoilers are expected! It is a mini version of your report. Write a couple of sentences summarising each section and then put it all together. Think of it as the 280 character version or Instagram post of your report. It will take more time than you think.