Tag Archives: creative-writing

Growing Your Writing Practice

by Sarina Schrager, MD, MS, Family Medicine Editor-in-Chief, and Jose Rodriguez, MD, FAAFP

“It’s none of their business that you have to learn how to write. Let them think you were born that way.”

—Ernest Hemingway

Writing is hard; there are no two ways about it. Starting a paper or narrative can be daunting. How should I start? What if it is not good? Will anyone want to read it? These questions arise even for accomplished writers. The best writers still work very hard at writing. In this blog, I share lessons I have learned during more than 30 years of writing in academic family medicine, along with resources I have found helpful. I encourage you to read these suggestions and share what works for you.

Find Time to Write and Block Your Schedule

It may seem like an oversimplification to say, “Just find the time to write.” We all know it can be difficult to fit writing into busy schedules filled with clinical, teaching, and administrative responsibilities. However, if you do not block time on your calendar to write, writing will continually be pushed to the bottom of your to-do list. You have to make the time to write.

In his 2009 article, “Tuesdays to Write,” Lowenstein describes restructuring his schedule so that his academic work occurred on Tuesdays, allowing him to carve out dedicated writing time each week.1 Some people write best early in the morning, whereas others are most productive late at night. For example, I write best early in the morning, whereas a colleague does their best writing at night. After 4 PM, my writing brain simply does not work.

Similarly, some people can write productively during a spontaneous 30-minute opening in their schedule, whereas others need at least a 2-hour block. Consider scheduling dedicated “writing time” on your calendar so other meetings are less likely to replace it.

Plan to Revise

“Almost all good writing begins with terrible first efforts. You need to start somewhere.”

—Anne Lamott, Bird by Bird

Becoming a good writer—or producing good writing—takes time, effort, and multiple revisions. In Draft No. 4, John McPhee describes routinely writing at least 4 drafts of every manuscript.2 By the fourth draft, the manuscript has usually become coherent enough to share with others. His process can be summarized as follows:

  • Draft 1: Get something on the page.
  • Draft 2: Develop your argument.
  • Draft 3: Refine word choice and improve the flow of your argument.
  • Draft 4: Polish the writing, use a thesaurus if needed, and read the manuscript aloud.

Ask for Feedback

Once you reach Draft 4, you are ready to seek feedback. Many authors submit manuscripts without asking colleagues or friends to review them first. Although the peer-review process provides valuable suggestions, colleagues often identify many of the same opportunities for improvement before submission.

There are several low-stress ways to receive feedback. An accountability partner or writing partner (eg, Prolific Partners) can be helpful. Writing groups are another excellent option because everyone shares their work, reducing the self-consciousness that often accompanies sharing your writing.

Reflect on Your Writing Process

Everyone writes differently, so there is no single perfect list of writing tips. Think about the times when you are most productive. Where were you? What time of day was it? What aspects of the setting contributed to your productivity?

Before I begin writing, I spend time thinking about how I want to structure the piece and how I want to begin. I create an outline, although it often resembles a stream of consciousness. Draft 1 is the hardest part for me because getting started is difficult. Once I have something on the page, revision becomes much easier.

Others find drafting easy but struggle with editing, searching endlessly for the “perfect” word. Still others never reach Draft 4 because they continually discover new ways to improve a sentence. Every writer is different.

Other strategies may also improve writing productivity. Consider working on 2 projects simultaneously. Pairing a small project with a larger one—or a challenging project with one you enjoy—allows you to switch between them and maintain momentum. Joining a writing challenge can also provide encouragement and accountability. Writing challenges vary in length, lasting anywhere from 1 week to 1 month, but they all encourage participants to write consistently each day.

The STFM community is filled with prolific, talented writers. What strategies have helped you develop your writing practice?


References

  1. McPhee J. Draft No. 4. Farrar, Straus and Giroux; 2017.
  2. Lowenstein SR. Tuesdays to Write: A Guide to Time Management in Academic Emergency Medicine. Acad Emerg Med. 2009.

Crafting Narratives for Publication

By Sara Shields, MD
associate editor
,
Family Medicine

You’ve had a defining clinical, teaching, or learning experience in your role as a family physician educator, clinician or student.  Someone suggests that you write about it. Here are some pearls for crafting your reflective piece in hopes of publication in a journal like Family Medicine that accepts such narrative work.

  • What story are you trying to tell? Just as with any written piece, consider first your content. What are your key themes (keeping in mind that any word limit may mean focusing on just one theme)?  Consider the readership of the journal—how would a medical student on a family medicine rotation respond to your story? How would a seasoned family medicine faculty member?
  • Avoid judgment–In general, an effective narrative piece is a personal story that shares a particular learning point, but does so without editorializing or requiring references.  How can your writing avoid judgment even as you elucidate and emphasize what you hope the reader will learn with you in your story?
  • Focus on the writing–In narratives, the “methods” of your writing enrich your themes and help them resonate for your readers.  The term “methods” refers to the craft of the writing—how are you using language to move your meaning along?  While avoiding redundancies or complicated phrasing is important, your writing may “sing” more to your readers with careful use of specific literary devices such as metaphor, alliteration, rhythm, or repetition of key words.  No matter whether you are choosing prose or poetry, remember the adage “show, don’t tell” –how can you describe people or events in ways that invoke the reader’s sensory or emotional response rather than simply stating what happened?
  • Every word matters–Especially for formats with strict word counts such as 6 word stories or 55 word essays, every word needs to move your story along. 
  • Circle back to the meaning—When looking at every word,do not lose sight of the totality of the essay.  Does this piece make sense overall?  Does it still say what you want it to say?
  • Do your homework–If your themes seem like they are common in narrative work (e.g. a physician’s experience of their own illness), you may want to look for similar pieces and think about how your story offers new angles or reflections compared to other similar work.  What can you contribute that may be new or surprising for readers?
  • Ask a friend or colleague to read your story–Consider asking someone to read your work before submitting it, to help assess both the content/themes and your storytelling style.  Do these readers resonate with your language?  Your themes?
  • You may need permission__If you describe a patient or learner scenario with enough detail, you may need to get their permission to submit your story for possible publication.
  • Don’t lose yourself–Be authentic; challenge yourself to dig deeply into both personal and professional lessons from your story.   How can you help the reader to consider multiple perspectives?

Reference: Walling A, Shapiro J, Ast T. What Makes a Good Reflective Paper? Fam Med 2012;45(1):7-12.

Behind the Curtain: What Really Happens After You Submit a Paper to a Journal

By Sarina Schrager, MD, MS, 
Family Medicine editor-in-chief

Many people express confusion about the process of submitting a paper to a journal, receiving peer reviews, and ultimately getting published. This post attempts to answer your questions. Editors do not want their activity to be opaque. We want everyone to know what really happens when you submit a paper. The team at Family Medicine may do things a little differently than other journals, but the major steps will be the same.

You hit “submit”, then what? Once you submit your paper into the electronic portal (we use ScholarOne) the paper will be evaluated by our editorial assistant. S/he will determine if your paper conforms to our author instructions (please read before submitting) for formatting and whether you have IRB approval, if needed. The assistant will unsubmit your paper if it is too long, has too many references, or if the references are not in the proper format.

First review by the editor in chief: At Family Medicine, I read each submitted paper carefully before assigning it to an associate editor. I will occasionally reject a paper at this stage if it is not in scope for our journal (ie, we do not publish clinical papers) or if I think it is in the wrong category. For example, papers describing educational studies in one residency or one medical school fit in our Brief Report category, but probably not in Original Research. I will send those papers back to the authors if they are submitted in the Original Research category and ask the author(s) to shorten them. Another common mistake I often see is papers submitted as a narrative essay when they are really a commentary or an editorial. Narratives are personal stories about an experience you have with patient care, teaching, or your career.

Assigning papers to the associate editors: We have a team of fabulous associate editors at
Family Medicine. Papers that are both in scope and of interest our readers go on to the next step. I assign these papers to one of our associate editors who carefully reads the paper again, and either advises me they don’t think the paper is appropriate for our journal, or, more commonly, sends the paper for peer review.

Requesting peer reviewers: We have hundreds of peer reviewers who volunteer their time and expertise to help us publish the best papers we can. The associate editors aim to get 2-3 reviewers to evaluate each paper before sending it back to me with a recommendation. The associate editor sends requests to 4-6 people. Sometimes these invited reviewers don’t respond, and sometimes they respond but decline the invitation. It will occasionally require upwards of 10 invitations to find the 2-3 reviewers needed for a thorough review of each paper. We give all peer reviewers 3 weeks to return the review. Sometimes a
paper will be caught in this step for a few months. Family Medicine designates 4 potential
outcomes for a paper after peer review: accept (it’s very unusual to accept after initial peer review),
minor revision, major revision, and reject.

Revisions: The vast majority of authors will be asked to revise their paper. This is a good thing.
It means that the editorial team believes that the paper will be an important addition to the literature when revised. We expect authors to respond to every reviewer comment and explain how they addressed each comment. After the revised manuscript is submitted, I will review it again and then send back to the associate editor. In some cases, if there were many revisions, the associate editor will send the revision back to the reviewers to assure that all comments were addressed. After those reviews come back, the associate editor indicates an outcome. It is not unusual for a paper to be revised a second (and occasionally a third) time. It is important for authors to remember at this point that these further reviews are designed to improve your paper.

Recommendations for publication: Even great papers can be improved, and this is always the goal of peer review. Our peer reviewers and our associate editors provide feedback to authors to help make
their papers better. A minor revision decision signifies that a paper needs only small changes before it is appropriate to publish. A major revision decision signifies that the peer reviewers and the associate editor like the paper and think it has potential to be a meaningful addition to the scholarly literature, but has some weaknesses. We do not ask people to revise a paper if we do not think it will be interesting to our readers and contribute to the literature. Those papers are denied further review.

Acceptance: Once the associate editor believes that the authors have addressed all revision
requests, they send it to me with a recommendation for publication: Yay! Our production
team has worked hard to decrease the time from acceptance to online publication. You may expect your paper to be published online about 6 weeks after you get your acceptance notice. It will be available on the journal’s ‘Recently Published’ page before being assigned to a monthly issue. As you can see, there are a lot of steps in the process! However, they all aim to support authors through optimizing their paper’s impact.