AMA Research Challenge: How to get published

. 43 MIN READ

Watch the AMA Research Challenge video "How to get published," for tips on publishing medical research. This video first aired on Oct. 22, 2022.  

 

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Jessica Li speaks with Charles Lopresto, DO, about tips and lessons learned about the process of publishing medical research.  

Speaker

  • Charles Lopresto, DO, Department of Internal Medicine, New York Presbyterian-Queens/Weill Cornell Medicine

Host

  • Jessica Li, MD-PhD candidate, University of Pennsylvania, chair, AMA Medical Student Section Committee on Scientific Issues

Li: Good afternoon, everyone and welcome to the 2022 AMA Research Challenge on "How to get published" forum. My name is Jess, and I'm currently an MD-PhD candidate at the University of Pennsylvania, and I've been involved in the AMA as the chair of the AMA Medical Student Section's Committee on Scientific Issues, as well as the chair of the UPenn AMA chapter and the medical student representative to the Women's Physician Section in the Pennsylvania Medical Society. And I'll be serving as your moderator this afternoon.

As our forum is getting started I want to remind everyone of our commitment to be courteous, respectful and collegial in the conduct of AMA events. This event is governed by the AMA Code of Conduct and any claims of harassment and conflicts of interest are taken seriously here. And any violations of the code of conduct may be recorded confidentially via phone or web to our partner, Lighthouse Services. So thank you for your attention and ensuring this is a safe, welcoming and professional meeting.

Before we get underway with the forum, I'd just like to provide a general orientation to our event platform. So if you guys want to ask a question, please use the Q&A feature or raise your hand. You can find both of these features in your toolbar. And we'll take questions from participants in advance but we want this to be interactive and a fireside chat format, so please feel free to submit your questions on Q&A or raise your hand.

And now I want to introduce our speaker this afternoon, Dr. Charles Lopresto. Dr. Lopresto is a hospitalist in the Department of Internal Medicine at New York Presbyterian-Queens and Weill Cornell Medicine. He is the president-elect at the Medical Society of the County of Queens and secretary-treasurer of MSSNY, the young physicians section. So welcome. Thank you so much for being here. Our audience here includes medical students, residents, fellows and IMGs as well. So I'm so thrilled to have your expertise available to guide us through this very important topic. Thank you so much again for your time and we're so excited to have you join us this afternoon.

Dr. Lopresto: Thanks, Jess. I appreciate the introduction. And I want to first give a thank you to the American Medical Association for having me and to the staff here for making this possible. This is really a great event, I look forward to it every year. And this is just going to be a chat, some tips and lessons learned and also opportunities for question and answer regarding all things about how to get published.

So I'm going to mainly have some comments for people who maybe have not published before and are looking for some general advice and guidance about why we should be publishing and those types of topics. But if there's anybody out there who has more experience or has some more advanced questions we're happy to take those as well.

I'll say a little bit about myself. So I am a hospitalist as Jess introduced me. I'm also the former chair of the Resident and Fellow Section for the AMA Committee on Scientific Research. Before that I was involved in the Student Osteopathic Medical Association. I was their national research director for two years and in that role I had a chance to serve on the editorial board of The Journal of the American Osteopathic Association.

I was a section editor for the resident and fellow section and medical student section of their journal. So I had some experience in the behind-the-scenes of journals and how the publishing works and how the review process works. So I'm happy to share what I've learned from that time and answer any questions as they come.

Why do you want to publish?

I wanted to start first with the very basic question of why? When you're going to publish something you should ask yourself, why do I want to publish something? The answer to this question will really determine how much time and energy and ultimately satisfaction you're going to get from your project.

Are you genuinely interested in this topic? Are you doing this to help others? Patients? Society as a whole? Knowledge? To help yourself? To advance your career? Is this an academic requirement?

There's all sorts of reasons why people get involved in an academic pursuit that leads to a publication. And in my experience, I think it's very clear from a reviewer's perspective and also in the context of this research challenge and poster presentation, you can see which people who work on research projects are genuinely interested and which people are saying, OK, this is part of my career advancement to help me to get into residency or to get a job or fellowship or whatever their next step might be.

There's nothing wrong with all those different reasons. You just have to be honest with yourself and that will set up the appropriate expectations that you may have and how much satisfaction, again, you're going to get from working on something―which is hard work―that’s just research and getting a publication together.

The next question about why is, if you're choosing to do an original project that is answering a question that you're interested in, I always say that we are each our own best principal investigators. We get medical training. We are the expert in our own patient cohorts more so than anybody else. We each have a unique lens in which we see the world through, and it's up to us with our medical training and research training that everybody gets as a graduate of medical school to look at our patients and ask the questions and say, what's unique about these patients? What am I missing here? What has somebody else missed here? And come up with your own questions.

In my opinion, these are the best and most interesting research topics that come. Of course, there's clinical-side research. There's obviously bench research and other types of research where it takes perhaps your own experience and personal view is not as relevant, but if you're going to be doing clinical research, I think that touching and seeing your own patient population, it can really inspire you to ask some profound questions.

Is your research question a good question?

The next tip is really to make sure you ask a good question. This may seem obvious, but that's the main crux of making sure that you get published, is that, is your question a good question? Some things you want to consider: has this question been asked before? Has it been answered before? Are there other next questions that others have asked? Oftentimes when you read an article at the end in the discussion or conclusion section, an author might say, more work is needed in this topic and these are the next questions that come next. Are you answering those questions? Is it a similar question?

So I encourage everybody, when you're formulating your questions and make sure you have a quote-unquote, "good question," review the literature in-depth. Build your introduction and discussion before you actually have your results. That's an important step of designing and writing a good paper. Your goal is always to contextualize your findings and prove to the reviewer why your findings are important.

Where to start

So let's say you've come to say that OK, I have a question, I want to answer a question, but I've never done research before, where do I start? So your first project is probably not going to be a randomized double-blind clinical controlled trial with NIH funding. So don't get overwhelmed. That's something that I see a lot from people or questions from medical students. “Oh, I want to do research, I have to do research, how am I going to get into residency or this specialty or on and on if I don't do research? But I'm so intimidated. I read JAMA, it comes to my doorstep, and you know, how am I ever going to do something like that?”

Take a breath. Not all research has to be at that high level. There's plenty of opportunities for research at every step in your career. The first step is to find a mentor if you've never done any research before. Look to your institution, look to your professors, look to your attendants. Look them up on PubMed. Visit their websites. See who is publishing in the field that you're interested in. I guarantee you that any PI, any principal investigator who does a large volume of publications every year will always need another set of hands and be eager to put you on a project.

You may not wind up being a first author, and that's OK. If it's your first publication, you, again, cannot expect to start at the top, you have to work your way up. Maybe you'll contribute to a literature review or maybe you'll help collect the data. You may develop a years-long relationship and be able to advance your career for years to come and continue publishing with them. So having a mentor and finding a mentor is really key.

If you, for whatever reason, perhaps don't have anybody accessible or would like to do some work on your own, another option is to consider writing a literature review on a topic you're passionate about or a case report. You can also partner with more senior people for that. They're likely always busier than you and will offer to review your work and partner with you, but a lot of times they're not really interested in writing a first draft, so that's where you'll come into play in terms of putting in your work and getting your feet wet with some writing.

Where do I submit my research?

So let's say you were successful and you wrote something and you have a project. Now the question comes, what do you do with it? So of course, you submit it somewhere. But where? So when I was doing research back in college actually I got some very good advice from my mentor at the time. He said you have to take a look at the journals in your field and rank them in a list. And so you would rank them by something that's called an impact factor. If you're not familiar with what an impact factor is, that's a way to measure, quote-unquote, "how important" a journal is.

It's actually a mathematical formula that divides the number of citations generated by that journal by the number of publications that it has made in the last two years, I believe. So that says, OK, we're publishing a lot of stuff and it's being cited, so this stuff is important.

So if you make a list of journals in your field and you sort of rank it by impact factor, maybe start one-third the way down the list and start there and say, this is where I should submit first. And then if it doesn't get accepted there, then work your way down the list and you can go on and on.

But you should be asking yourself and your peers, how impactful is your work? Maybe you read a copy or two of these journals that you're considering submitting to and see if it belongs alongside the other publications that they're including. You don't have to start at Nature or the New England Journal as your first point of submission. Again, keep that idea of a list in mind and work your way through it.

Be wary of predatory journals

Another concept here is to really be aware of predatory journals. You can do this more traditional route of, again, ranking the journals by the impact factor. We all know what are the, quote-unquote, "important" or "prestigious" journals in our field, but there are going to be other opportunities for you to publish in other places.

There are a lot of journals out there, believe it or that, are called, quote-unquote, "predatory journals." These are journals that have limited to no peer review and they might even charge a significant fee for publishing your work.

These journals then basically own your intellectual property, all the hard work that you put into something. Sure, you've got a publication, but I don't know if anybody's going to see it or anybody is going to really respect it. These are questions you might want to ask yourself before just publishing for the sake of publishing.

With this being said, there's also an expanding platform of publish ahead of print and other opportunities, open network journals, that are new and up-and-coming and maybe we can have a chat about that a little bit later with Jess; I know she had some thoughts about that.

Prepare your work for publication

So once you figured out where you want to publish, the next step is really to prepare your work for publication. And you may say, “oh well, I already wrote my paper and I just have to submit it.” That's really not the case. As somebody who's been an editor and a reviewer on a journal, I can tell you that a surefire way to get rejected easily or have multiple rounds of revision is just not following the basic guidelines that that journal has set out.

So I encourage everyone to read carefully the guidelines from that specific journal that you're submitting to. Pay attention to all the details that they want, the formatting. Do they use AMA style guidelines or some other style guidelines? The citation order, that is a pet peeve of mine, actually. Make sure that the first thing that you cite is citation number 1 and it of course points to the correct citation in your citation list.

Sometimes that's hard to keep track of as we have multiple citations and the order of our sentences while we write might get changed and flipped around, but there's tools to help you with that as well, so keep track of that. The design and formatting of your figures and data presentation, et cetera. Go through all the guidelines and make sure that it fits with the journal that you're submitting to.

Also have a second or third set of eyes review your paper for grammar, style, flow, basic stuff that you may have been sitting with this paper for a long time, months maybe, trying to write it, and it may make a lot of sense to you because you've been looking at it for so long, but have somebody else take a read and say, does this make sense? Can you understand what I'm trying to get across here?

Again, the reviewers and the editors are usually voluntary, and they're dedicating their free time to review your article because they are passionate about research. Don't make their lives difficult or give them an easy reason to reject you because you didn't follow these guidelines. You came this far. Put a bow on it, make it pretty, send it out and you'll do a lot better that way.

Causes for rejection

So the last thing that I wanted to talk about was some things along this line, things that will for sure get you rejected. So it may seem obvious, but poor study design due to bias. These are things that if you're a newer researcher or you haven't done too much study design, it may be difficult for you to pick up on if you're working more independently, so that's why it's more important to again, try to find a mentor, try to find somebody else with experience in the field to review your work first before submitting. It goes back to thinking carefully before you even start writing. It's when you're designing your project, are you asking the next question? Did you have complete data and a complete cohort? Envision the final paper from the beginning and plan accordingly. I always recommend you should overcollect data. It's better to be able to report a negative finding than have your paper rejected because you didn't ask a complete question.

And oftentimes it's very unfortunate but it's too late for people to fix things if they did if they had a poor study design from the beginning. They put all this work in and the reviewer may just look at it and say, well, this is nice, you did a lot of work, but why didn't you ask this question or why didn't you collect this data or why didn't you contextualize it this way? So again, think carefully before you start and try to overcollect some data.

The other thing that might get you rejected is incomplete context of your findings. So you may do a fantastic research and a fantastic study that proves something, but if people can't understand what it's proving or why it's important, then they may not be interested in it. So you should focus your literature on your literature review and place your study in the appropriate context of why this question is being asked and how it will impact your field.

The last thing is be cautious of overstating your findings and your conclusions. I think this is one of the most important things that we do in research is actually to write a conclusion of some new information that we’ve birthed into the world. So you should really be thinking carefully about what information are you sharing. Does your data actually support your conclusion? Just because you wanted to ask a certain question and expected a certain answer does not mean that your data always justify the conclusion that you wanted. I encourage everyone to be humble, write conservatively, and again don't overstate your findings.

So with all that being said, those are some of the tips and tricks and lessons learned that I've had over time. I wanted to also make this again interactive, so I will entertain questions from the chat. I see we have some people logged in. So this is a time for you folks. So anything you have to ask, any advice you might need, please submit your questions to the chat.

How to find a mentor

Li: Well, while people are typing, we've got some really good points that I wouldn't have thought of going so far before the actual publication process. I think you're so right, finding a good question to ask and finding a good mentor to help teach you what those questions may be and how to go about doing that is so important. But how do you think someone might go about finding a research mentor if they're just getting into the world of research?

Dr. Lopresto: Right. So this is a challenge sometimes. People come from all different institutions. I was very fortunate in college and undergraduate. I had a great premed advisor who would send us out emails all the time about, hey, this principal investigator, this researcher is looking for somebody to help in their lab or helping this or that. So I was fortunate in that I had an opportunity given to me. I had to meet with that person and present my CV. There wasn't much on it at that time, and they had to look at me in the eye and say, is this somebody that I'm going to trust and work with?

And even though you may not have a lot of experience, I think making those meetings, putting your neck out on the line, and trying to find mentors when you don't have much research experience, it's really an important first step. Don't be intimidated by it. If you're so passionate about something you can send out blind emails. If you've made it this far in your career, if you're a medical student, if you're a resident, a fellow, an IMG, whatever your categorization is, if you've made it this far, I want to remind everyone, we are in the top 1% of educated people in the world.

It may not feel like that sometimes. Sometimes you get down on ourselves and we think, oh well, everything's so hard, I don't know everything, and my scores aren't as competitive, on and on. But remember, you're a professional or a professional student, you've made it this far. You have an email address that's associated with an institution. You can send an email out to somebody who's a thought leader in their field, somebody who publishes a lot, who may be not at your institution, but in close proximity. Or even these days with the world of Zoom and everybody communicating digitally even not nearby to you, you can send out a blind email and say, hey, I'm passionate about this, I love your work, I've read your work, I want to get involved in your lab or with some trials. Do you need an extra set of hands, can we set up a call? And you'd be surprised.

You might not get responses from everybody, but if you email enough people, I bet you one person might be interested in you. So that's one way to go about it. And as I mentioned before, really look I think first at your own institution and look at who the people who are making the applications. If you have an advisor, if you're still a student, they might be a good resource, or a dean. Or if you're in a hospital system, again, sort of go through the department list and see who's working on what. And again, visit their website, see what they're publishing. Does anything interest you?

Li: So I had a wide range of mentors in the past. Some of them, I think, for my first paper I ever tried to publish, and we had done some studies and it was about that time. We had answers to some interesting questions. We wanted to get that worked out there. And my PI said, OK, go write the paper, and I've never written a paper before. I had only written essays and college projects.

So what resources should people look to to start writing a manuscript?

Writing a manuscript: how to begin

Dr. Lopresto: Right, absolutely. So I have a bunch of resources here. Jess, actually it might be easier for you to get them on the screen than it might be for me. You have them, correct?

Li: Sure.

Dr. Lopresto: Yeah, so I made a list of resources for exactly this question for templates. Because scientific writing is a different type of writing for sure. So if you've never done scientific writing before, I have a list of templates that are here. Jess is going to share them in the chat momentarily. And it's for all different types of things. For original articles, review articles, brief reports, case reports. So you name it, there will be a template there for you.

And these are actually all organized by the former journal that I was on the editorial board, The Journal of Osteopathic Medicine. So a good place to start is to look at a template. The other thing to remember just in general is scientific writing is the type of idea that every sentence you write really should have a meaning. It's really a technical type of writing.

It's not your opinion, it's not a time to be necessarily flowery with language. I've been told many times in my writing career or scientific writing career that I write too much and I speak too much. So the idea is to be more concise, and every sentence that you write, you should really have a reason why it's included in the paper. Are you citing something else that happened in the past? Are you contextualizing what you're going to be presenting in terms of your data? And there's a very specific format, again, for each of these journals, how they would want you to organize your writing in general, whether it's having an abstract verse and then an introduction, a method section, your data or findings, your discussion and then conclusion, and then references that's in a typical format. But using some of these templates is a good place to start.

While Jess is posting these links in the chat, I wanted to remind everyone that we do have a Q&A feature here. That's another way to submit questions. And Jess, I believe you're monitoring that as well. We have one here I think.

Li: Yeah.

Dr. Lopresto: Or a couple.

Case report, poster presentation or publication?

Li: So we have someone who is a PGY1 in family medicine with no experience in publishing so far. And at the institution, these reports are not considered research, but instead considered just scholarly activity. And this person has identified a case of a rare disease in the U.S. And so do you think writing up a case report would be a good start? Or perhaps a poster or presentation, or is it better to publish something in a journal?

Dr. Lopresto: So this is a great question. First of all, congratulations, PGY1. You are still a new PGY1. I hope that you are doing OK and you found out where all the bathrooms are and the nurses aren't paging you too much and all that type of stuff, so good luck.

If you have found a rare case, the first question is really ask yourself is this a rare case? Is this just something that you've seen for the first time or is it actually rare? That's something that I see as a problem sometimes where people will see something for the first time in their career and it's actually not as rare as they think and they get very excited about it and say, oh well, I'm going to write a case report about it. And maybe it's not actually as interesting as you see.

So if you have something, don't lose hope right away. I would say a good first place to start is to review the literature a bit about what your case is and see how many case reports have been published on this. See if you write another case report on this, is it actually going to add to the literature? Is it going to be useful to have another case report on this that has a unique perspective or a unique treatment modality or a unique presentation, a unique diagnostic course? If that's the case, then absolutely you should pursue this case report.

In terms of the question of going through publication versus poster presentation, if it's your first time I would recommend starting actually with a poster presentation. Unless you're very ambitious and you want to go straight to publication, you can take that route. I encourage the poster presentation for a number of reasons. One, because we're actually part of the AMA Research Symposium right now. So next year, you should definitely submit. Just a little plug there, obviously.

But also you can submit to the American Academy of Family Practice or any other local state medical society meetings. There's a lot of opportunities that may come from submitting a case report at a presentation where you'll get a chance to network with people and you'll get a chance to get feedback in-person while people review your presentation that you might not get from submitting for publication right away.

If you submit for publication right away, you might get rejected or you might have a lengthy process and you might lose interest, whereas if you have the poster presentation first, again, it's a little bit easier, the stakes are a little bit lower, you get to present it, you get to get the feedback. You also get that line on your CV which everybody is looking for when they do publications or presentations. And then if you get some positive feedback and people who are more senior in the field have looked at it and said, wow, this is great, thank you for presenting this, this was rare, I learned something from this, then I think those are some green flags to go ahead and consider turning that presentation into a publication. So I think it's safe to start with a presentation. But again, good luck. I hope it's an interesting case, and I hope you go and present it someplace.

Managing time for research

Li: So how do you recommend balancing going to conferences and presenting posters or giving talks? Do you have any suggestions on how to balance that with taking time to write up a manuscript and publish? What do you think is more valuable?

Dr. Lopresto: Hmm. That's a good question. I think it depends on what your goals are. Again, I go back to the first point that I made, and for those of you who are joining a little bit later, one of the first points that I made was, ask yourself why am I publishing? Why are you publishing? Are you publishing because it's an academic requirement? Are you publishing because you're genuinely interested in something? Are you publishing to advance your own career? Are you publishing to help society and add to the knowledge pool of the scientific community?

These are all different answers and they will guide you to the appropriate amount of time and energy and satisfaction that you're going to get from pursuing all of these things. I can tell you that if you're going to spend a lot of time on writing a lengthy manuscript and going through the publication process and you're not that interested in it, it's going to be a hard time. You're not going to be fulfilled at the end of the day. You might even quit halfway through and it's going to add to your stress and your burnout and all those issues.

So what I would say is, again, ask yourself what are you interested in? Why are you looking to publish? Why are you looking to participate in an academic pursuit like this? And that will best guide you as how to balance these types of things. And let me tell you, it's still going to be hard. Let's not lie to ourselves―academic pursuits are challenging. Not everybody is a principal investigator who gets a pay structure for them to sit in their office for a certain percentage of their week and think and review literature. As students or residents, we are busy, we have other things to focus on―exams and clinicals and taking care of patients and everything else, our life, our family, on and on. When we choose to put something else like a publication or an academic pursuit on our plate, we have to be careful about why we're doing that, how we're going to do that and how we're going to balance those things. So my general advice is, make sure it's something you're passionate about, make sure it's something you're actually going to enjoy because those extra hours that you're going to spend on it, which are going to take away from your personal time for yourself, they have to be worth it in your own eyes.

So the other advice in general in terms of balancing and presenting and traveling and those types of things, I think it's very helpful to try to develop a positive relationship with whoever it is who's your superior who's going to allow you this time to do this. There's unfortunately a lot of places and a lot of institutions who maybe don't value academic activities, don't value your traveling to a conference or things like that. And that's unfortunate.

And perhaps if you sort of win somebody's hearts and minds and show them the value of what you're doing and how it's important to you, it's important to your career advancement, it's important to the institution, important to the scientific community at large, you might be able to convince them, hey, could you allow me this time off? Can you allow me this time to build into my schedule or our schedule to allow me to pursue some of these things? So I wish you all luck with finding that balance.

Li: Just a quick reminder, everyone. Feel free to chime in with questions in the Q&A feature and we'll make sure we get to them.

How important is it to publish?

And another question, while we're on this “why publish” question, how important is it to publish? And is the quality of the journal, the impact factor of the journal more important? Or is it better to have 30 publications? How is that valued at each stage of training and residency applications or job applications, fellowships, things like that?

Dr. Lopresto: Right. So this is a great question. And it's a question that people like Jess and I think about a lot because we're sort of representing the research interest of our cohorts at the American Medical Association. And we ask ourselves these questions all the time. We want to promote research activity and academic excellence and all these things, but at what extent or for what reason, really?

So what I would say is, again, you have to ask yourself why you're doing this. If your goal is to be a orthopedic surgeon or a neurosurgeon in a very competitive, quote-unquote, "traditionally competitive" residency field and you look at the published results of the match from year to year, you will find a clear pattern that says, this is how many publications successful applicants had and this is how many publications that the non-successful applicants had.

So unfortunately―or maybe fortunately, depends how you look at it―we live in a system that values academic activity in a certain way in order for you to have certain lines on your CV, in order for you to be accepted to certain types of fields or certain types of specialties. That being said, it's going to be up to you how you fulfill those requirements.

I know a lot of people who fulfill those requirements, and again, to me, it's very obvious when I see it, that they're just publishing to publish, they're publishing maybe not that great quality work or presentations, and they're just doing it because they have to or because they want to fulfill some other goal, but they're not actually interested in the work that they are producing.

And if that's the way that you approach it and that's going to allow you to achieve your dream and achieve your goal, then kudos to you and I wish you good luck with it. Personally, I find that the best work and the most impactful research is done by people who are actually interested in the work that they're doing and they have a genuine question that they want to ask that sort of burns in their soul, so to speak, that keeps them up at night, that they're academically interested in.

Sometimes these questions … it might not be the right time in your career to publish them. It may not be the right time in your career to ask these questions. That's OK, too. Keep those on the back burner. Keep a list of research questions that bother you or interest you, and maybe you don't have the resources or time to devote to these things right now, but maybe you will soon.

So in terms of where to publish and what's prestigious or not, I think that really depends on, again, what's your goal here? If your goal is to just have some lines on your CV, then the prestige of the journal may not matter. If your goal is to become an academic physician and you want to become a professor in a medical school or a professor or a clinical professor and advance your career in that way, then the prestige of the journal may matter a bit more.

If you're looking to build a career where you're going to be citing yourself and you want other people to cite you, then the impact of your work and the impact factor of that journal is for sure going to be important. So again, ask yourself what your overall goal is and where you are in your career and what type of work you're publishing and I think that will best answer how to publish and where to publish.

Additional reasons why your manuscript may be rejected

Li: Let me ask a perhaps more selfish question. Sometimes when you submit a journal―your manuscript to a journal―they don't even look at it. You get a desk rejection. Or even after multiple rounds of reviews, you might not get accepted by that particular journal. And what I’ve been told and what I tell myself and my friends is that there are so many reasons that a paper will not accept your work. Perhaps you could elaborate on what some of those reasons might be.

Dr. Lopresto: So this is sort of tough. Everyone thinks there's some sort of secret sauce or magical element to the reviewers. They’re like, what are they thinking and why are they rejecting? And to be perfectly frank, I don't think there's anything that's that secret behind it. All of us as reviewers are individuals and we all have our own approach to the review process. I think that depending on the journal there may or may not be very strict guidelines that they have for reviewing. I think that has something to do with it.

If you're at a very prestigious journal there may be very strict guidelines that they have where the reviewers are literally checking boxes and making averages of scores and things like that where if you don't meet the criteria that they're looking for, then you're not going to meet a threshold and it's simply going to be a rejection, unfortunately.

At some lower or mid-tier journals, the reviewers might have a bit more flexibility in terms of how they're reviewing and what their values are. Everyone still probably has a template that they're working off of, but they may take their desires and experiences more into account.

The goal of the reviewer is to be impartial, but again, we all are individuals, and perhaps most of them are volunteering as well. So perhaps they didn't have the time or the energy or the headspace to give you a fair shake that time. Unfortunately, sometimes things like that happen. It doesn't mean that your work is not valuable. Doesn't mean that there's necessarily large problems with your work unless you have some specific feedback from the reviewers.

That's what I encourage you to do. If you have a rejection, is really to have a dialogue with the reviewers and the editor and to understand what was the reason that you were rejected, how could you improve this paper? Is it a matter of it not being impactful enough for that journal or is it the matter with some of the things that I mentioned before, are there just profound errors in your study design? Is it not contextualized? Is it not meeting the style guidelines or there's grammatical errors or other things like that?

So having the dialogue with the editors I think is most important rather than to focus on the rejection as much. Again, make a list of journals. Peck your way down the pecking order; you will get published someplace and be persistent.

Publishing work through non-traditional avenues

Li: Very encouraging, I would say. Well, so then there are all these different avenues of publishing your work without peer review these days and whether it's because someone is having trouble publishing the traditional route or because you're trying to get your research out faster. What are your thoughts on the sharing of your work in these open access preprint social media avenues?

Dr. Lopresto: Right, so this is a really interesting and developing topic in research. For years and years and years the only way to publish was to go through this very traditional rigorous peer review processing in traditional journals. And now journalists have taken a slightly different approach, I think originally with the publish ahead of print. And that idea, I think, was not necessary to skip peer review, but it was to disseminate findings a bit faster because people are using print and paper less, things are appearing online faster and they didn't want to have to consider holding on to something before it could be accessible to people.

Just to give you some context of that. When you're an editor for a journal, the traditional idea is to put together a physical book that makes sense to read, even though that we might not think of it that way, that's how editors tend to think of it. For instance, JAMA has issues that come out. I think there was one recently from September that was like the firearm/gun violence-type issue. And it was a bunch of studies that were all related and editorials and commentaries related to firearms and firearms research. So it makes sense from an editorial perspective, OK, let's wait to publish all of these so that the reader can be interested and consume all these things at the same time.

So since we're moving away from paper, publishers have started to offer options of publish ahead of print, which, again, the idea is just, let's get it online and get it published and get it accessible.

I think the publish ahead of print is a great option because it still goes to the traditional peer review and it's just as quote-unquote, "impactful" and "valuable" and all those types of things. It's just not in the traditional waiting for it to be in an issue.

In terms of the other options like open journals, open journals are a very interesting topic. If you're not familiar with an open journal, open journals are essentially an idea where the peer review process is a lot more limited. And people can just submit their research and say like, "hey, this is what I've been working on, here it is," and there's less review. There are a lot of prestigious journals that have open networks and open journals now.

I think that it's a good opportunity for people who want to share data, and there are certain fields of research where it's very important to get your findings out there for a number of different reasons. For whether it's going to advance a field in a certain way and you're in a very fast moving field, or for things like when we had a COVID pandemic and there wasn't time to wait for a lot of lengthy reviews and revisions and stuff, we wanted to get more new information into the world.

And then for other sometimes competitive reasons. You're working against other labs that may be working on similar types of projects and you want to get your findings out there first.

So there's a lot of benefits to having open networks and publications, but there also are some challenges as well. People might look at a publication, an open journal or open network and say, well, what is the value of this? Who reviewed this or can I trust this data? Can I trust these findings?

I think people's opinions are evolving regarding this. Academia is evolving regarding this. So it's an exciting time to see how these open journals and open networks are going to evolve and what their impact factors are going to be and if they're going to change their guidelines, how they're going to review things. So these are all exciting times to live in. Yeah, those are my thoughts about that.

Li: Wow, yeah. It's definitely an interesting direction that the academia fields are moving in. Yeah.

AMA resources

Well, what are some ways that students or residents or fellows can get involved in research through the AMA or in more broad topics?

Dr. Lopresto: Right. So in terms of the AMA resources, I encourage you to, and Jess, I might actually turn this back to you since you're the chair of the Scientific Research Committee for the Medical Student Section. But if you're interested in the American Medical Association and their systems approach to answering questions, just structurally speaking, the Medical Student Section has a Committee of Scientific Research, which I'm sure you'll elaborate on, and the Resident & Fellow Section also has another Committee on Scientific Research. I think the general idea of those groups is to promote academic activity and give people resources for conducting their own research and partnering with other people, and also finding mentors, things like that.

The other thing that the AMA does that I think is great is actually what we're doing right now, which is being involved in the AMA Research Challenge and the symposium. This is an opportunity, again, to submit your presentation―like we had a question from a PGY1 before, should I submit a presentation? Absolutely.

We here at the American Medical Association are proud to present what I think is one of the most important and most prestigious opportunities to present your research around the country. It's the most inclusive. We accept publications from all different fields and all different levels of training. And it gives you a really wide platform to share your findings with all the rest of not only the American Medical Association members but the reach of their network generally.

So I think that submitting your posters to the AMA Research Symposium is a great opportunity. And Jess, I'll give you a little bit of a platform to chat about the Committee on Scientific Research if you'd like and how medical students can be more involved.

Li: Sure. That was not intentional, believe it or not, but as a medical student, there are actually quite a few opportunities to get involved in research and research scientific writing as part of the AMA, including the standing committees within the Medical Student Section of the AMA. And so there are multiple committees that review different policies and concerns of medical students that are brought up at each Annual and Interim Meetings.

And as part of those committees, what you'll end up doing is researching topics and providing a review article policy brief on certain topics of interest and of concern to the population. And so there's committees which have a particular focus, and I'll try to include a link there below. And so things like bioethics and humanities, economics and quality in medicine, global and public health, health and information technologies. And so there are multiple areas of interest that one could participate in.

Conclusion

But yeah, I mean, Dr. Lopresto, do you have any overarching words of wisdom for all the researchers and potential published writers in the group?

Dr. Lopresto: Sure. I'll just have perhaps a few inspiring words if I can muster them. Publication is hard. Stay motivated, stay interested, stay curious and do the hard work. It's worth it. Not only for you, but remember why we're doing all of this. Making a publication, again, it's not supposed to be about just career advancement or fulfilling academic requirements. I know many people approach it that way, and if that's your only experience with research then I hope that you have other experiences with research down the road in your career.

But the whole point again is to really be asking the important questions, adding to the scientific literature, expanding our knowledge, expanding the practice of medicine, and creating a better world and more information that we can all rely on as a scientific community.

The last thing I'll say is that in a world now where information is being questioned in general and what is truth and what is alternative facts, and we've been living in a world like this for some years now, unfortunately, I think the value and the importance of scientific research and academic activity is more important than ever now. I think it's up to us actually to be the bastion of reason and the bastion of actual real information and expertise, to be the voice that challenges people who may not want to believe in real information. We have to hold our ground. We have to continue to put out the truth as we see it through our publications and stand by that and help promote it.

So remember, the things that you're doing are important, they do make a difference. And I encourage everyone to keep at it. Again, find your mentors. You're not in this alone. There's many people who have published for many years before you, so latch on to somebody else who has published a bunch and try to be their left hand or their right hand and you'll get there eventually.

Li: So that was quite inspiring, I would have to say. I feel better about the publication process for sure.

Well, thank you so much for taking the time to be here today and sharing your thoughts with us, and thanks to everyone who stayed with us throughout our conversations and for participating in tonight's forum.

AMA is really committed to providing medical students, residents, fellows and IMGs a best-in-class opportunity to build and showcase research and engage with the AMA beyond the traditional policy and advocacy opportunities that it provides.

And so participants, make sure to go visit the Research Challenge semi-finals hall to submit your scores for the research competition, which is an AMA member-exclusive opportunity. And the top five voted participants will advance in the finals that will be held on Dec. 7 for a chance to win a $10,000 grand prize sponsored by Laurel Road. And so if you guys didn't submit this year, also definitely submit an abstract poster for next year's competition.

If you guys have any further questions down the line, I think our contact information will be available to you. But thank you all so much and hope you enjoy the rest of your weekend.

Dr. Lopresto: Thanks, Jess.


Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.

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