Presentation on theme: "Study skills and medical writing"— Presentation transcript:
1 Study skills and medical writing Professor B. J. Bain Department of Haematology
2 DeclarationThe lecturer has no conflict of interest to declare
3 Study Skills and Medical Writing Some of your teaching is didacticSome of it requires you to seek out information for yourself or generate data by research and synthesize it into your own workThis lecture deals mainly with the latterIt also deals with medical writingEssaysPracticalsScientific articles
4 Study SkillsScience and the Patient starts your preparation for the BSc courseThe BSc is different from the rest of the undergraduate medical courseIt is more scientificIt is less clinicalLearning is more self-directedScience and the Patient introduces you to self-directed learning skills
5 Study SkillsThese skills are relevant to writing up your 2nd year practical (and to essay writing in year 4)Some study skills are crucial for you whole medical careerIndependent learningCritical abilityThis includes the ability to find information for yourself and assess its validityYou need to think for yourself and question what you are told
7 Study SkillsYou need to be able to find information in the scientific literature; you should be using original scientific articlesNot just text books and lecturers’ handouts or Power Point PresentationsTo a lesser extent, you need to be able to find and assess the validity of information in alternative electronic sources
8 Study Skills So how do you do all this? The ability to write clear concise and accurate English is essential for your whole medical careerIt is time to start practicingSo 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 knowledgeWhen you have done that, search by topic on PubMed or using a search engine to find further up-to date informationGoogle, Yahoo etc give you a shortcut to relevant articlesPubMed 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 WikipediaWikipedia often gives high quality informationAn 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 sourceThe primary source is the original scientific articlePrimary sources can be right up-to-date; textbooks are always out of dateYou 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 abstractIf the abstract suggests it is relevant, read the articleIt 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 resultsSometimes authors misinterpret their own results so read what they actually did and see if you agree with their conclusionsFor 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 haveWhen you find a relevant article in PubMed you will notice that there is also a link to related articlesYou 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 foundFor 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 translationIt 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 yourselfWhat have the authors discovered?Is it important – scientifically or clinically?Statistical significance does not necessarily equate to scientific or clinical significanceAsk yourself if it matters and if so why
18 Other skillsYou need to understand and be able to use standard statistical testsYou need to be able to use a word processing packageYou 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 informationStart with a BRIEF introductionSet out your essay in paragraphs so that there is a logical flowStart 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 synopsisCount the wordsShorten if necessaryAlways give a list of cited referencesIf you have drawn heavily on a single source or a few sources, put it or them in a bibliography
21 Writing an essayIf 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 electronicallyIf you think a table is needed, compose your ownIf 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 itDon’t cite anyone you haven’t read
23 Writing an essay What is plagiarism? Plagiarise, plagiariseLet no-one’s work evade your eyesThat’s why the Good Lord made your eyesSo don’t shade your eyesBut plagiarise, plagiarise, plagiarise…...Remember always to call it researchNikolai Ivanovich Lobachevsky, a song by Tom Lehrer
24 Writing an essay What is plagiarism? “The act of presenting another’s work or ideas as your own”
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.
32 An Example of Plagiarism 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……………..
33 An Example of Plagiarism 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 toThe 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 experimentsThe 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 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."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."
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”
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 referencesNext 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 referencesNext establish the factsThen 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 referencesNext establish the factsThen put it in your own wordsThen indicate your sources
44 Writing an essayYou 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 al2 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 essayYou 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 electronicallyWhat do you do?
47 Writing an essayYou 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 electronicallyWhat do you do?You have at least 4 choices
48 Writing an essaySend for both references on interlibrary loan and hope one of them has the information you are looking forDo a literature search for hepatitis C + transfusion + Italy and see if anything useful turns upLeave it outCite the person who cited it (in this case Weatherall DJ and Clegg JB, The Thalassaemia Syndromes, Blackwell Science, Oxford, p. 309)
49 Writing an essayIf 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 wordsUse 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 correctErrors in spelling and grammar irritate the reader and distract him or her from what you are sayingThey make the reader think you might also be careless with scientific dataUse an electronic ‘Spellcheck’ but don’t rely on it entirely
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 apostrophesThe 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 childrenCoomb’s testA group of hereditary haemolytic anaemia’sAn 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.
58 How to write an essay—spelling, grammar and punctuation Does punctuation matter?Here is a story that suggests that it doesA 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.
63 How to write an essay—setting out references Follow a standard format from a journalIf you invent your own format then at least make sure it conforms to common practicesFor journal articles you need, at a minimumthe surnames and initials of at least the first 3 authorsthe journal namethe volumethe first page
64 How to write an essay—setting out references Usually you need the title of the articleDepending on the journal, you might need the last page as well as the firstFor journal articles you usually do not needThe issue number or monthThe first names of the authorsThe qualifications or titles of the authors
65 How to write an essay—setting out references Here are examples of acceptable formatsMarcelin 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, 6th 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 booksClinical Medicine - Kumar and ClarkHoward, Martin R; Hamilton, Peter J (1997) Haematology An Illustrated Colour Text, 1st 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 exampleLewis 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 URLTest the URL to make sure that it is correctHere 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 handwritingSticks to the topicHas a clear, logical sequence (headings are OK)Shows evidence of both study of the literature and independent thoughtPreferably has some reasonably original ideas or has discovered something the marker did not know
73 Writing a Scientific Article There is an organised structureTitleAbstract or summaryIntroduction – 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 PracticalYou can use the same structure as for an articleTitleAbstract or summaryIntroductionMethodsResultsDiscussionReferences
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 conclusionsIt does not matter if you use fewer words EXCEPT you may leave out something that could usefully have been includedIt 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 succinctThe article has to be worth writingYou need to consider which journal might publish it and how to reach your target audienceYou need to consider ethical aspectsDon’t irritate the editor or reviewers by carelessness
77 Ethics of Writing a Scientific Article (i) An article must be honestPrior work of others must be acknowledgedDiffering results published by others must not be ignoredConflicts of interest must be declaredThe article must not be ghost writtenIt 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 authorsPeople who have not contributed should not be authors (‘guest authors’)Ethical Committee approval may be neededPatient consent may be needed
79 A final bit of advice….Use an practical write-up or an essay as a learning experienceMake sure you understand the subject thoroughly and then it will be easier to write about itUse the essay to clarify your own ideas on the subjectWrite it so well that it will be useful to you for revision
80 Further readingBarbour 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)
82 Some exercises 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 …………..
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 futureBeware of erroneous apostrophe’s.
88 This lecture is sponsored by the Apostrophe Protection Society Not really