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Study skills and medical writing Professor B. J. Bain Department of Haematology.

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1 Study skills and medical writing Professor B. J. Bain Department of Haematology

2 Declaration The lecturer has no conflict of interest to declare

3 Study Skills and Medical Writing Some of your teaching is didactic Some of it requires you to seek out information for yourself or generate data by research and synthesize it into your own work This lecture deals mainly with the latter It also deals with medical writing Essays Practicals Scientific articles

4 Study Skills Science and the Patient starts your preparation for the BSc course The BSc is different from the rest of the undergraduate medical course It is more scientific It is less clinical Learning is more self-directed Science and the Patient introduces you to self-directed learning skills

5 Study Skills These skills are relevant to writing up your 2 nd year practical (and to essay writing in year 4) Some study skills are crucial for you whole medical career Independent learning Critical ability This includes the ability to find information for yourself and assess its validity You need to think for yourself and question what you are told

6 Wall of British Library Photography K. Bain

7 Study Skills You need to be able to find information in the scientific literature; you should be using original scientific articles Not just text books and lecturers’ handouts or Power Point Presentations To a lesser extent, you need to be able to find and assess the validity of information in alternative electronic sources

8 Study Skills The ability to write clear concise and accurate English is essential for your whole medical career It is time to start practicing So how do you do all this?

9 How to find relevant sources of information Start with recommended text books and lecture handouts to make sure you have the necessary basic knowledge When you have done that, search by topic on PubMed or using a search engine to find further up-to date information Google, Yahoo etc give you a shortcut to relevant articles PubMed gives you are more exhaustive list

10 Beware! Beware of websites for patients (sometimes they are very good but their quality is variable) Be cautious with Wikipedia Wikipedia often gives high quality information An article in Nature in 2005 found 162 errors in Wikipedia and 123 in Encyclopaedia Britannica (quoted in Wilkinson N, ‘Tis all in pieces, The Author, Spring 2010, p15) Original articles are the most reliable source

11 How to find relevant sources of information Textbooks are a secondary source The primary source is the original scientific article Primary sources can be right up-to-date; textbooks are always out of date You need to learn how to read and assess an original article

12 How to find relevant sources of information When you have found an article that looks relevant, read the abstract If the abstract suggests it is relevant, read the article It is sometimes useful to read the abstract, the introduction and the discussion first since that tells you what the authors think they have discovered

13 How to find relevant sources of information Once you have done that, read the methods and the results Sometimes authors misinterpret their own results so read what they actually did and see if you agree with their conclusions For example, have they claimed to have established something when the results are not statistically significant?

14 How to find relevant sources of information You may need to go back to earlier articles that are referred to if the authors have assumed knowledge that you do not have When you find a relevant article in PubMed you will notice that there is also a link to related articles You may also want to check for published corrections or later letters relating to the article

15 How to find relevant sources of information You may also want to look at other articles that have cited the article you have found For essays, don’t bother looking at articles in languages other than English (unless you happen to speak them) However, for serious research you should try to read anything relevant, despite language problems—read the English abstract and if it seems relevant get some help

16 How to find relevant sources of information You may be able to make sense of something by using an automatic translation It will not be good English but it might be intelligible

17 How to find relevant sources of information In critically reviewing an article there are two important questions to ask yourself What have the authors discovered? Is it important – scientifically or clinically? Statistical significance does not necessarily equate to scientific or clinical significance Ask yourself if it matters and if so why

18 Other skills You need to understand and be able to use standard statistical tests You need to be able to use a word processing package You need to learn to write accurately, clearly and concisely, using appropriate scientific language

19 Writing an essay Read the title carefully Answer the question Draw up an outline based on what you know and then seek relevant extra information Start with a BRIEF introduction Set out your essay in paragraphs so that there is a logical flow Start by outlining briefly what you are going to do

20 Writing an essay Then do what you said you were going to do Finally end with a conclusion or synopsis Count the words Shorten if necessary Always give a list of cited references If you have drawn heavily on a single source or a few sources, put it or them in a bibliography

21 Writing an essay If you think your essay needs illustrations, it is better to draw them yourself rather than use anyone else’s—you can scan them in or compose them electronically If you think a table is needed, compose your own If you do use someone else’s tables or figures this MUST be acknowledged—otherwise it is plagiarism

22 Writing an essay Don’t plagiarise Do cite anyone when you are quoting their ideas or using precise information they have given—if you say ‘53% of British adult males drink more than the advised number of units of alcohol per week’ they reader wants to know your source—cite it Don’t cite anyone you haven’t read

23 Writing an essay Plagiarise, plagiarise Let no-one’s work evade your eyes That’s why the Good Lord made your eyes So don’t shade your eyes But plagiarise, plagiarise, plagiarise…... Remember always to call it research Nikolai Ivanovich Lobachevsky, a song by Tom Lehrer What is plagiarism?

24 Writing an essay What is plagiarism? “The act of presenting another’s work or ideas as your own”

25 Writing an essay What is plagiarism?

26 Writing an essay What is plagiarism?

27 Writing an essay What is plagiarism?

28 Writing an essay What is plagiarism?

29 Writing an essay Source: Roger Beale, FT Magazine, April 1/ Don’t ‘Cut and Paste’

30 Writing an essay What is plagiarism?

31 An Example of Plagiarism (from a previously respected popular medical writer) 'He took paragraphs from my work, word for word' - psychiatrist faces plagiarism charge · Journal retracts article after US scholar complains · Raj Persaud says credits 'inadvertently omitted' Helen Pidd Monday November 7, 2005 The Guardian Britain's most ubiquitous psychiatrist was yesterday at the centre of a plagiarism row after it emerged that substantial portions of an article he had written for a medical journal were copied from the work of an American academic. The Guardian

32 The article written by Raj Persaud in the February edition of Progress in Neurology and Psychiatry was withdrawn and a retraction printed, but it went unnoticed outside the mental health community. One of the youngest doctors to become a consultant at the highly respected Maudsley teaching hospital in London, and boasting eight degrees, Dr Persaud writes on mental health matters in a string of publications and has presented the Radio 4 psychology programme All in the Mind. The alleged plagiarism came to light when Thomas Blass, professor of psychology at the University of Maryland, happened upon Dr Persaud's article. He said he was shocked by the similarity between Dr Persaud's piece and his work…………….. An Example of Plagiarism

33 Why the Media Refuses to Obey, by Raj Persaud, Progress in Neurology and Psychiatry, Vol 9, issue 2. "Milgram's study demonstrated with brutal clarity that ordinary individuals could be induced to act destructively even in the absence of physical coercion, and humans need not be innately evil or aberrant to The Man Who Shocked the World, by Professor Thomas Blass PhD, University of Maryland, in Psychology Today (March 2002) "[The study] demonstrated with jarring clarity that ordinary individuals could be induced to act destructively even in the absence of physical coercion, and humans need not be innately evil or aberrant to

34 An Example of Plagiarism Why the Media Refuses to Obey, by Raj Persaud, Progress in Neurology and Psychiatry, Vol 9, issue 2. act in ways that are reprehensible and inhumane. While we would like to believe that when confronted with a moral dilemma we will act as our conscience dictates, Milgram's obedience experiments The Man Who Shocked the World, by Professor Thomas Blass PhD, University of Maryland, in Psychology Today (March 2002) act in ways that are reprehensible and inhumane. While we would like to believe that when confronted with a moral dilemma we will act as our conscience dictates, Milgram's obedience experiments

35 An Example of Plagiarism Why the Media Refuses to Obey, by Raj Persaud, Progress in Neurology and Psychiatry, Vol 9, issue 2. teach us that in a concrete situation with powerful social constraints, our moral sense can be all too easily overwhelmed." The Man Who Shocked the World, by Professor Thomas Blass PhD, University of Maryland, in Psychology Today (March 2002) teach us that in a concrete situation with powerful social constraints, our moral sense can easily be trampled."

36 An Example of Plagiarism Why the Media Refuses to Obey, by Raj Persaud, Progress in Neurology and Psychiatry, Vol 9, issue 2. Milgram's interest in the study of obedience partly emerged out of a deep concern with the suffering of fellow Jews at the hands of the Nazis and an attempt to fathom how the Holocaust could have happened. The Man Who Shocked the World, by Professor Thomas Blass PhD, University of Maryland, in Psychology Today (March 2002) Milgram's interest in the study of obedience also emerged out of a continuing identification with the suffering of fellow Jews at the hands of the Nazis and an attempt to fathom how the Holocaust could have happened.

37 Writing an essay What is plagiarism? What would you think if you read the following in a student essay: “Following the identification of hepatitis C virus it became apparent that this infection is widespread and presents a serious risk to patients with transfusion-dependent thalassaemia. The prevalence of anti-HCV antibodies varies in different parts of the world from 11.7% in Turkish Cypriots to 75% in Italians”

38 Writing an essay You might suspect plagiarism

39 Writing an essay You might suspect plagiarism If you want to convey this information how do you deal with it?

40 Writing an essay You might suspect plagiarism If you want to convey this information how do you deal with it? First find the original references

41 Writing an essay You might suspect plagiarism If you want to convey this information how do you deal with it? First find the original references Next establish the facts

42 Writing an essay You might suspect plagiarism If you want to convey this information how do you deal with it? First find the original references Next establish the facts Then put it in your own words

43 Writing an essay You might suspect plagiarism If you want to convey this information how do you deal with it? First find the original references Next establish the facts Then put it in your own words Then indicate your sources

44 Writing an essay You might end up with something like this “Since hepatitis C can be transmitted by blood transfusion it is a serious risk to patients, such as those with thalassaemia major, who need regular blood transfusion. This was particularly so in the past before there was adequate testing of donor blood. Wonke et al in reported that a quarter of 73 thalassaemia major patients had anti- HCV antibodies. The prevalence was…

45 Writing an essay … 12% in those transfused only in the UK and 44% in those who had been transfused elsewhere. Lau et al 2 found a higher prevalence of seropositivity in Hong Kong, 34 of 99 patients having anti-HCV. Both these studies observed a correlation between seropositivity and impaired liver function” However, at this stage you run into a problem

46 Writing an essay You would like to give the information about the even higher prevalence reported in Italy (which was mentioned in the textbook from which the extract was taken) but neither of the references with Italian names are available electronically What do you do?

47 Writing an essay You would like to give the information about the even higher prevalence reported in Italy (which was mentioned in the textbook from which the extract was taken) but neither of the references with Italian names are available electronically What do you do? You have at least 4 choices

48 Writing an essay Send for both references on interlibrary loan and hope one of them has the information you are looking for Do a literature search for hepatitis C + transfusion + Italy and see if anything useful turns up Leave it out Cite the person who cited it (in this case Weatherall DJ and Clegg JB, The Thalassaemia Syndromes, Blackwell Science, Oxford, p. 309)

49 Writing an essay If you were sure which reference the information came from it would be best to put it in the form: Cancado RD, Guerra LGM, Rosenfeld MOJA, et al. (1993) Prevalence of hepatitis C virus antibody in beta thalassaemia patients, Fifth International Conference on Thalassaemia, p. 176, Nicosia, Cyprus, cited by Weatherall DJ and Clegg JB, The Thalassaemia Syndromes, Blackwell Science, Oxford, p. 309.

50 Writing an essay If you use someone else’s words use quotation marks However it is very irritating to the reader if there are a lot of direct quotes—use your own words Use direct quotes only if the actual words matter: “I have a dream”

51 How to write an essay—spelling, grammar and punctuation Your essay should be spelt and punctuated correctly and grammar should be correct Errors in spelling and grammar irritate the reader and distract him or her from what you are saying They make the reader think you might also be careless with scientific data Use an electronic ‘Spellcheck’ but don’t rely on it entirely

52 A test Find the error, its impossible:

53 A test–there is a missing apostrophe Find the error, its impossible:

54 How to write an essay—spelling, grammar and punctuation Beware of erroneous apostrophes The Guardian

55 How to write an essay—spelling, grammar and punctuation Beware of erroneous apostrophes—here are four direct quotes from student essays: Two third’s of children Coomb’s test A group of hereditary haemolytic anaemia’s An agent acts on the red cell leading to it’s destruction

56 How to write an essay—spelling, grammar and punctuation “The confusion of the possessive “its” (no apostrophe with the contractive “it’s” (apostrophe) is an unequivocal sign of illiteracy.” Truss L, Eats, Shoots and Leaves, Profile Books, London, 2003, p 43.

57 The Apostrophe Protection Society

58 How to write an essay—spelling, grammar and punctuation Does punctuation matter? Here is a story that suggests that it does A panda walks into a cafe. He orders a sandwich, eats it, then draws a gun and fires two shots into the air. “Why?” asks the confused waiter. The panda produces a badly punctuated wildlife manual and tosses it over his shoulder. “I’m a panda,” he says, at the door “Look it up”.

59 How to write an essay—spelling, grammar and punctuation The waiter turns to the relevant entry and, sure enough, finds an explanation. “Panda. Large black-and-white bear-like mammal, native to China. Eats, shoots and leaves.” Truss L, Eats, Shoots and Leaves, Profile Books, London, 2003.

60 How to Write an Essay—Does Punctuation Matter?

61 Apparently Yes

62 How to Write an Essay—Does Punctuation Matter?

63 How to write an essay—setting out references Follow a standard format from a journal If you invent your own format then at least make sure it conforms to common practices For journal articles you need, at a minimum the surnames and initials of at least the first 3 authors the journal name the volume the first page

64 How to write an essay—setting out references Usually you need the title of the article Depending on the journal, you might need the last page as well as the first For journal articles you usually do not need The issue number or month The first names of the authors The qualifications or titles of the authors

65 How to write an essay—setting out references Here are examples of acceptable formats Marcelin A-G, Aaron C, Mateus E, et al. Rituximab therapy for HIV-associated Castleman disease, Blood 2003;102: Marcelin, A.-G., Aaron, C., Mateus, E., Gyan, G., Gorin, I., Viard, J.-P., Calvez, B. & Dupin, N. (2003) Rituximab therapy for HIV-associated Castleman disease. British Journal of Haematology, 102,

66 How to write an essay—setting out references Here are examples of how not to set out references (copied exactly from student essays) -Hematologically Important Mutations: Spectrin and Ankyrin Variants in Hereditary Spherocytosis – P.G. Gallagher and B.G. Forget – Blood cells, Molecules and diseases (1998) 24(23) Dec 15:

67 How to write an essay—setting out references Here are examples of how not to set out references (copied exactly from student essays) Bolton-Maggs PHB, (2000) The Diagnosis and Management of Hereditary Sperocytosis. Balliere’s Clinical Haematology, Vol. 13, No. 3, A. Iolascon, S. Perotta, G.W.stewart, Red blood cell membrane defects, Vol

68 How to write an essay—setting out references For books, all authors or editors are usually given and you must give the publisher, city and year. This is an acceptable format: Hughes Jones NC and Wickramasinghe SN, Lecture Notes in Haematology, 6 th Edn, Blackwell Science, Oxford, 1996, pp

69 How to write an essay—setting out references These are some genuine examples from student essays of unacceptable formats for citing books Clinical Medicine - Kumar and Clark Howard, Martin R; Hamilton, Peter J (1997) Haematology An Illustrated Colour Text, 1 st Edition, Churchill Livingston, NY, 1997 pp 28-35

70 How to write an essay—setting out references In quoting a chapter from a multiauthor book it is even more complex; here is an acceptable example Lewis SM and Roper D, Laboratory methods used in the investigation of the haemolytic anaemias, In Lewis SM, Bain BJ and Bates I (Eds) Dacie and Lewis Practical Haematology, Churchill Livingstone, Edinburgh, 2001, pp

71 How to write an essay—setting out references If citing a website, give the date you accessed the site as well as the URL Test the URL to make sure that it is correct Here are some satisfactory examples (accessed 21/11/04) (accessed 21/11/04)

72 What makes a good essay? Written on a word processor or very clear handwriting Sticks to the topic Has a clear, logical sequence (headings are OK) Shows evidence of both study of the literature and independent thought Preferably has some reasonably original ideas or has discovered something the marker did not know

73 Writing a Scientific Article There is an organised structure Title Abstract or summary Introduction – why? Methods – how? Results – what was found? Discussion – what does it mean? References – what have other people said that has contributed to your introduction, methods and discussion?

74 Writing up a Practical You can use the same structure as for an article Title Abstract or summary Introduction Methods Results Discussion References

75 Writing up a Practical Use your full word allocation but no more Those setting the practical will have considered the number of words you are likely to need to explain what you did and discuss your conclusions It does not matter if you use fewer words EXCEPT you may leave out something that could usefully have been included It does matter if you go over your word allocation

76 How Does a Scientific Article Differ From a Practical Write-Up? An article must be succinct The article has to be worth writing You need to consider which journal might publish it and how to reach your target audience You need to consider ethical aspects Don’t irritate the editor or reviewers by carelessness

77 Ethics of Writing a Scientific Article (i) An article must be honest Prior work of others must be acknowledged Differing results published by others must not be ignored Conflicts of interest must be declared The article must not be ghost written It may be important to publish negative results

78 Ethics of Writing a Scientific Article (ii) People on whose work the article is based must be authors People who have not contributed should not be authors (‘guest authors’) Ethical Committee approval may be needed Patient consent may be needed

79 A final bit of advice…. Use an practical write-up or an essay as a learning experience Make sure you understand the subject thoroughly and then it will be easier to write about it Use the essay to clarify your own ideas on the subject Write it so well that it will be useful to you for revision

80 Further reading Barbour V (2010) How ghost-writing threatens the credibility of medical knowledge and medical journals. Haematologica, 95, 1. Hall PA (2010) Getting your paper published: an editor’s perspective. Ann Saudi Med, 31, 72. (www.saudiannals.net)www.saudiannals.net

81 Anything else we should discuss?

82 There was no difference between either method. There were 28 male children and 23 female children in the study. The patients complained of breathlessness and ankle swelling. She was noted to be pale. The full blood count revealed anaemia. A 67 year old gentleman was admitted with ………….. Some exercises

83 With regard to weight, the women were heavier. The fetus was found, on ultrasound, to be hydropic. Foetal blood sampling led to a diagnosis of haemoglobin Bart’s’ hydrops fetalis. The treatment group showed improved survival but, because of the small numbers, the difference was not statistically significant. The platelets were 323.

84 There were 15 patients in the study, who were assigned randomly to treatment A (n = 7) or to treatment B (n = 8). The majority of patients responded to treatment A whereas only one patient responded to treatment B. If liver failure was to develop, a low protein diet should be given. The data is potentially misleading.

85 Neither an elevated bilirubin or and increased alkaline phosphatase provides certain evidence of liver disease. At this point in time…… Those who inherit the  S gene from one parent only enjoy a degree of protection from falciparum malaria. There is a superior therapeutic outcome with anti-viral treatment.

86 Graft-versus-host disease which may be fatal is a serious complication of transfusion from close relatives. Graft-versus-host disease which results from transfusion of blood from close relatives can be prevented by irradiation of the blood. The white cell count did not fall because folinic acid was given. The liver was firmer than normal. It’s edge was felt two finger-breadths below the costal margin.

87 We performed the biopsy utilizing a disposable Yamshidi needle. With respect to chelating therapy, it is within the realm of possibility that oral iron- chelating agents will be developed in the foreseeable future Beware of erroneous apostrophe’s.

88 This lecture is sponsored by the Apostrophe Protection Society Not really


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