*Lloyd Lewis, PhD, emeritus professor of the Medical College of Georgia, participated in early meetings of the Task Force and contributed to the earliest draft of this section.
* The introduction builds a logical case and context for the problem statement.
* The problem statement is clear and well articulated.
* The conceptual (theoretical) framework is explicit and justified.
* The research question (research hypothesis where applicable) is clear, concise, and complete.
* The variables being investigated are clearly identified and presented.
ISSUES AND EXAMPLES RELATED TO THE CRITERIA
A scholarly manuscript starts with an Introduction that tells a story. The Introduction orients the reader to the topic of the report, moving from broad concepts to more specific ideas.1 The Introduction should convince the reader, and all the more the reviewer, that the author has thought the topic through and has developed a tight, “researchable” problem. The Introduction should move logically from the known to the unknown. The actual components of an Introduction (including its length, complexity, and organization) will vary with the type of study being reported, the traditions of the research community or discipline in which it is based, and the style and tradition of the journal receiving the manuscript. It is helpful for the reviewer to evaluate the Introduction by thinking about its overall purpose and its individual components: problem statement, conceptual framework, and research question. Two related articles, “Reference to the Literature” and “Relevance,” follow the present article.
The Introduction to a research manuscript articulates a problem statement. This essential element conveys the issues and context that gave rise to the study. Two examples of problem statements are: “With the national trend toward more patient care in outpatient settings, the numbers of patients on inpatient wards have declined in many hospitals, contributing to the inadequacy of inpatient wards as the primary setting for teaching students,”2 and “The process of professional socialization, regardless of the philosophical approach of the educational program, can be stressful … few studies have explored the unique stressors associated with PBL in professional education.”3 These statements help readers anticipate the goals of each study. In the case of the second example, the Introduction ended with the following statement: “The purpose of this qualitative study was to identify stressors perceived by physiotherapy students during their initial unit of study in a problem-based program.” In laying out the issues and context, the Introduction should not contain broad generalizations or sweeping claims that will not be backed up in the paper's literature review. (See the next article.)
Most research reports cast the problem statement within the context of a conceptual or theoretical framework.4 A description of this framework contributes to a research report in at least two ways because it (1) identifies research variables, and (2) clarifies relationships among the variables. Linked to the problem statement, the conceptual framework “sets the stage” for presentation of the specific research question that drives the investigation being reported. For example, the conceptual framework and research question would be different for a formative evaluation study than for a summative study, even though their variables might be similar.
Scholars argue that a conceptual or theoretical framework always underlies a research study, even if the framework is not articulated.5 This may seem incongruous, because many research problems originate from practical educational or clinical activities. Questions often arise such as “I wonder why such an event did not [or did] happen?” For example, why didn't the residents' test-interpretation skills improve after they were given feedback? There are also occasions when a study is undertaken simply to report or describe an event, e.g., pass rates for women versus men on high-stakes examinations such as the United States Medical Licensing Examination (USMLE) Step 1. Nevertheless, it is usually possible to construct at least a brief theoretical rationale for the study. The rationale in the USMLE example may be, for instance, about gender equity and bias and why these are important issues. Frameworks are usually more elaborate and detailed when the topics that are being studied have long scholarly histories (e.g., cognition, psychometrics) where active researchers traditionally embed their empirical work in well-established theories.
A more precise and detailed expression of the problem statement cast as a specific research question is usually stated at the end of the Introduction. To illustrate, a recent research report states, “The research addressed three questions. First, do students” pulmonary physiology concept structures change from random patterns before instruction to coherent, interpretable structures after a focused block of instruction? Second, can an MDS [multidimensional scaling] solution account for a meaningful proportion of variance in medical and veterinary students' concept structures? Third, do individual differences in the ways in which medical and veterinary students intellectually organize the pulmonary physiology concepts as captured by MDS correlate with course examination achievement?6
In experimental research, the logic revealed in the Introduction might result in explicitly stated hypotheses that would include specification of dependent and independent variables.7 By contrast, much of the research in medical education is not experimental. In such cases it is more typical to state general research questions. For example, “In this [book] section, the meaning of medical competence in the worlds of practicing clinicians is considered through the lens of an ethnographic story. The story is about the evolution of relationships among obstetrical providers and transformations in obstetrical practice in one rural town in California, which I will call ‘Coast Community,’ over the course of a decade.”8
For some journals, the main study variables (e.g., medical competence) will be defined in the Introduction. Other journals will place this in the Methods section. Whether specific hypotheses or more general research questions are stated, the reviewer (reader) should be able to anticipate what will be revealed in the Methods.
The purpose of the Introduction is to construct a logical “story” that will educate the reader about the study that follows. The order of the components may vary, with the problem statement sometimes coming after the conceptual framework, while in other reports the problem statement may appear in the first paragraph to orient the reader about what to expect. However, in all cases the Introduction will engage, educate, and encourage the reader to finish the manuscript.
1. Zeiger M. Essentials of Writing Biomedical Research Papers. 2nd Ed. London, U.K.: McGraw-Hill, 1999.
2. Fincher RME, Case SM, Ripkey DR, Swanson DB. Comparison of ambulatory knowledge of third-year students who learned in ambulatory settings with that of students who learned in inpatient settings. Acad Med. 1997;72(10 suppl):S130–S132.
3. Soloman P, Finch E. A qualitative study identifying stressors associated with adapting to problem-based learning. Teach Learn Med. 1998;10:58–64.
4. Chalmers AF. What is This Thing Called Science? St. Lucia, Qld., Australia: University of Queensland Press, 1982.
5. Hammond KR. Introduction to Brunswikian theory and methods. In: Hammond KR, Wascoe NE (eds). New Directions for Methodology of Social and Behavioral Sciences, No. 3: Realizations of Brunswik's Representative Design. San Francisco, CA: Jossey-Bass, 1980.
6. McGaghie WC, McCrimmon DR, Thompson JA, Ravitch MM, Mitchell G. Medical and veterinary students' structural knowledge of pulmonary physiology concepts. Acad Med. 2000;75:362–8.
7. Fraenkel JR, Wallen NE. How to Design and Evaluate Research in Education. 4th ed. New York: McGraw-Hill, 2000.
8. DelVecchio Good M-J. American Medicine: The Quest for Competence. Berkeley, CA: University of California Press, 1995.
American Psychological Association. Publication Manual of the American Psychological Association. 4th ed. Washington, DC: APA, 1994:11–2.
Creswell JW. Research Design: Qualitative and Quantitative Approaches. Thousand Oaks, CA: Sage Publications, 1994:1–16.
Day RA. How to Write and Publish a Scientific Paper. 5th ed. Phoenix, AZ: Oryx Press, 1998:33–35.
Erlandson DA, Harris EL, Skipper BL, Allen SD. Doing Naturalistic Inquiry: A Guide to Methods. Newbury Park, CA: Sage Publications, 1993: 42–65.
Glesne C, Peshkin A. Becoming Qualitative Researchers: An Introduction. White Plains, NY: Longman Publishing Group, 1992:13–37.
Review Criteria for Research Manuscripts
Joint Task Force of Academic Medicine and the GEA-RIME Committee