Tag Archives: science

How to Do a Peer Review: Part Two

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

The Title 
The title of a manuscript is the first area that we expect reviewers to evaluate.  Many people use catchy titles to capture readers’ attention in their papers.  However, because many readers only look at the title when deciding whether to read a paper, we suggest that the title should describe the paper’s content and, if applicable, the study’s results.  For example, if a paper uses medical student focus groups to evaluate a lecture, that is what the title should say. If the curriculum is about social media, the title could be something like “Follow me,” which doesn’t really describe what the paper discusses but is somewhat catchy.  So, you could suggest, “Follow me: an evaluation of an undergraduate course about social media.” Or, “Follow me: medical student focus groups rate social media course.” You can also comment if the title is too long.  Many people like to use colons in their titles, but if the title is too long, it is easy to lose track of what it says. The title is often the only part of the paper that is read. If it doesn’t catch the reader’s attention, they won’t look up the abstract. When possible, highlight the main finding in the title.  Instead of “An evaluation of a novel teaching method,” you could say, “Novel teaching method associated with higher resident satisfaction” or something like that.

Abstract  
If the title is catchy or describes a topic that the reader is interested in, they will go on to the abstract.  For many people, the abstract is the only thing they read. So, an abstract must be clear, well-written, and accurately describe what the paper is going to say. Abstracts, by their nature, are short, usually 150-250 words, and are structured with four sections:  background/objectives, methods, results, and discussion.  A strong abstract makes a brief case for the gap this study aims to fill, then describes how the authors addressed the research question.  We want reviewers to comment on whether the abstract is well written, clear, and accurately describes the study. We also want reviewers to let us know if the main findings are captured in the abstract.

Introduction
Often, when you are chosen as a reviewer, you are a content expert and know the literature on a given topic.  In that case, you will know if an author leaves out essential papers.   It is common for authors to write introductions that are too long because they don’t want to leave anything out.  It is your job as a reviewer to evaluate whether important background articles are included, but the author doesn’t make any detours (i.e., start talking about a peripheral topic).  Writing experts coach authors to start broad in the introduction and narrow the focus, so that the last sentence presents the paper’s research aims and explains how it fills a gap in the literature.  As a rule, the introduction should be about the same length as the other sections of the paper. An excellent guide to writing introductions is this paper by HG Welch: https://cancer.dartmouth.edu/sites/default/files/2019-05/papertrail.pdf. When new authors struggle with writing the introduction, we will often refer them to this paper. Essentially, it outlines how to write a three-paragraph introduction using the questions:

1. What is the global problem?
2. What is the specific issue?
3. How does this paper help?

Methods 
The methods section of a research paper should clearly describe the “how” of the study.  What did the researchers do?  We want enough detail so that someone at a different institution could replicate the study if needed.  If you did pre- and post-evaluations of an educational intervention, what questions did you use, when did you administer the surveys, etc.?  Reviewers want to see a statistical assessment and a justification for the researchers’ choice of statistical methodology.   Reviewers do not want to see any results in the methods section.  Does the methodology of this study make sense to answer the stated research question? Is the methodology based on any theoretical models?  The methods section must describe how the authors got the information that will be shared later in the results section of the paper. Everything in the methods section should map out well to the results section. If the authors do not say how they got the data in this section, they should not report it in the next section. This is also true for the abstract.

A note about statistics: most reviewers will not be expert statisticians (the editors may choose a reviewer who is if the paper needs it).   Most quantitative studies will include basic statistics.  If the authors use some statistical test that you have never heard of, they will need to explain why in the methods section.  All methods sections should have a detailed description of how the data was analyzed (whether quantitative or qualitative).

Results
While the methods section describes what you did, the results section describes what you found.  One common mistake that reviewers often see is the lack of specifics around surveys.  How many people received the survey?  How many people responded?  What is the response rate?  Do you know anything about the people who didn’t respond  (i.e. demographics)?  Findings from the research should be described either in text (in the results section) or in a table.  Some people use the text in the results section to give a high-level overview of the results and highlight key findings, then put the actual data into a table.  Tables traditionally do not count toward a word limit, so they are a great way to add more content without using many words. Reviewers should comment on whether the methods described can produce the results reported. Look for areas where the results are not reflected in the methods and vice versa. The Welch article listed above can be very helpful in crafting methods and results sections as well.

Make sure to read Part 3 of this blog series where we will discuss what to look for in the discussion section, in tables and figures, and in references.

The Joy (and Jostling) of Team-Based Care

Barry J. Jacobs, PsyD

In the early 1990s, at the outset of my career as a psychologist in medical settings, I spent 5 years at a physical medicine rehabilitation hospital on what I was sure was a team of perennial all-stars. During our weekly clinical meetings, daily curbside dialogues in the hallways and cafeteria, and co-care in the PT gym and patients’ rooms, I always marveled at the competence, youthful confidence, and innumerable skills of the doggedly optimistic physical and occupational therapists, canny speech therapists, hardy nurses, and street-smart social workers on my assigned squad. At the head of this team was usually a gray-haired, white-coated physiatrist, wizened and patient, offering subtle guidance to team members but generally allowing us to practice our crafts. Not that harmony always reigned. We would have table-pounding debates about treatment plans. Rivalries simmered about who best evaluated cognition or ambulatory status.  But the team worked proudly and effectively and patients usually thrived.

I’ve been waxing nostalgic recently about those years because of family medicine’s ostensible move toward team-based care. The patient-centered medical home (PCMH) is intended to be a collaborative, integrated, multidisciplinary place where family physicians work shoulder to shoulder with behaviorists, pharmacists, case managers, social workers, medical assistants, and administrators to deliver improved, cost-effective, chronic disease management. But the culture of family medicine, in my opinion, is not yet team driven. What is second nature in physical medicine rehab is of necessity first nature for us—a new set of spiffy dress-up clothes without the well-worn comfort of habitual garb. I think there is much we can learn from rehab medicine’s decades-long experience with teams:

Multidisciplinary isn’t interdisciplinary. An oft-cited truism in the field of  integrating behavioral health services into primary care is that “co-location isn’t integration”—that is, proximity by itself doesn’t lead diverse clinicians to work in tandem toward better patient outcomes. I think this truism extends to team-based care in general. A multidisciplinary PCMH just connotes different disciplines under the same roof, which are working on their own respective and possibly divergent goals. Rehab was distinctly interdisciplinary—different disciplines working on commonly agreed upon goals. I believe that the PCMH likewise needs to be interdisciplinary to best blend the talents and skills of multiple specialists striving together. That means, like rehab, there needs to be processes in place for ongoing team communication and decision making. (An EHR alone won’t suffice.)  That means somehow creating team meeting times out of the hectic primary care work flow.

Continue reading

Aligning Our Efforts to Transform the System

Robert Cushman, MD

As a longtime member of the Society of Teachers of Family Medicine (STFM) and the incoming president of the Collaborative Family Healthcare Association (CFHA), I am both excited and a bit anxious about taking on this role at this time, because we are truly at a critical juncture. As health care providers and educators, we offer clinical services in a “system” that is about to either continue making important strides forward toward becoming a true system achieving meaningful outcomes or to slip backward into the free-for-all chaos that has complicated delivering good, patient-centered care for decades. We need to work together as members of STFM and CFHA to navigate through these twists and turns, or plow through some obstacles, so that we, our trainees, and our patients and communities, come out in better shape on the far end.

I want to share one of the “clinical pearls” I learned in my residency, which has served me well as a “compass,” and which I have quoted (with attribution!) many times to my own trainees as I precept them in the hospital and the office. I offer it now because it is applicable beyond the direct patient care process. I can still hear Tom Campbell saying, “When you’re stuck, expand the system.” He of course meant to explore more into the patient’s family and community context, gathering the perspective of some of those folks that make up that social network or enlisting their assistance in changing parts of that context to achieve change for the patient. He also meant to ask for input and additional, new, and different perspectives and suggestions from one’s professional colleagues, both diagnostically and for interventions. This approach has proved hugely valuable to me, repeatedly. And I think the current emphasis on team-based care is a result of a collective recognition that this systemic approach is valuable and more effective than “going it alone.”

I want to challenge us all to continue to “expand the system” in three ways. I want us to expand our concept of teams, to expand our measurements of what we’re doing, and to expand our reach. Let me elaborate briefly on each of these.

Continue reading