Secondary Logo

Journal Logo

From the Editor

Why Write?

Roberts, Laura Weiss MD, MA; Coverdale, John MD, MEd

Author Information
doi: 10.1097/ACM.0000000000003072
  • Free

If my doctor told me I only had six months to live, I wouldn’t brood. I’d type a little faster.

—Isaac Asimov1

The field of academic medicine is filled with extraordinary educators and brilliant clinicians. Many of these professionals are also gifted communicators who, seemingly with little effort, can share knowledge and inspire their students and patients. And, yet, many of these colleagues struggle when it comes to writing. They fret. They delay. They feel inadequate—even inauthentic. While these colleagues may view teaching and healing as natural capacities, they view writing as anything but.

The bright and dedicated researchers of academic medicine may also find writing to be the hardest part of their professional role. The highly complex activities of generating and pursuing questions of significance, assessing what has been done before, designing novel studies to advance understanding, gathering data, performing analyses—all forms of literacy in themselves—may seem easy in comparison to sitting down at a keyboard and facing a blank screen.

Stress associated with writing can become a serious problem in academic medicine because of the emphasis on publication in the development of one’s career.2,3 The pressure to “publish or perish” has led some who are in medicine along the path of discouragement, emotional exhaustion, and cynicism.4,5 Some investigators believe that the pressure to publish places a disproportionate cognitive burden on early career scientists,6 affects the credibility of science,4 and contributes to scientific misconduct.7 Publishing may be particularly distressing for individuals who feel secondary, marginalized, or nonmajority in academic medicine by virtue of their identities, life stories, early career status, or facility with the English language.8–11 Such individuals may feel that their hard work is less visible or less rewarded. Multiple studies2,3,12,13 have shown, for example, that women faculty hold fewer senior faculty positions than men, despite achieving similar publication rates to those of men.

Given these adversities, why write? Why does, and should, writing have so much weight in academic medicine? Having found little discussion of this specific question in our journal and in the broader literature,14,15 we offer some reflections that focus not only on the importance of writing for academic publication but also on the motivation for doing so. We address 2 principal and somewhat overlapping domains of consideration: scholarly contribution and professional growth. Our own academic careers have been greatly enriched by writing, and yet writing has not always come easily. For this reason, we hope our reflections will inform, activate, and encourage our dear readers.

Scholarly Contribution

An important motivation for writing in academic medicine is to promote the advancement of knowledge. Stated differently, not publishing novel scientific work withholds valuable information, which is antithetical to the physician’s role. Seeking and sharing new knowledge represent one means for physicians to meet their fiduciary obligations to patients, peers, and the population at large. Narrative writing about individual patients, for example, helps the clinician to achieve a state of attentive affiliation with a patient, register what is mysterious or unclear, and generate and test hypotheses about the patient’s situation.16 Through writing, authors are able to offer their observations and analyses to the world, invite feedback, and, hopefully, deepen understanding of a topic or set of issues. Even scholarship that reveals the limits or the hidden complexities or contradictions of a subject can lead to further clarity and comprehension.

A desire to influence the narrative or transform meaning in one’s field is yet another compelling reason to write. Writing for Academic Medicine, for instance, gives voice, attention, and illumination to a range of challenges in the field. Among these challenges are threats to the National Institutes of Health budget and the physician–scientist pipeline, barriers to addressing disease burden and disability, health disparities, inadequacies in the clinical workforce for the future, insufficient resources for education and educational research, the problem of student debt, and serious concerns related to diversity and the potential for discrimination that permeate health systems and health education, to name a few. Scholarly work in Academic Medicine also brings the experiences, research, wisdom, values, and creative ideas of underrepresented members of the profession to the fore. Writing for Academic Medicine elevates innovative work and reveals the culture and ideals of the field.

For all of these reasons, authors should ask themselves how a manuscript will address an issue of importance. That is, how prevalent or serious is the issue of interest and how likely will the results or conclusions or insights be of benefit?17 Benefit may include contributing to a less-than-well-studied topic or reassessing the conclusions about more well-studied topics. In empirical work, benefit includes the potential of the methods or study design to improve prior designs and the confidence attributable to the findings. The unprecedented permanency, accessibility, and international availability of the published record can extend a manuscript’s potential influence. It is helpful, if humbling, in this process to recognize that knowledge grows by accretion. Since very few authors publish landmark papers, incremental gains are to be celebrated. Replication studies, which can be combined in systematic reviews and meta-analyses, are potentially valuable in confirming or reversing prior findings, especially given concerns about the reproducibility of scientific results.18 Authors may hope for a large readership, but influencing just a few readers can be enough.

Professional Growth

Academic writing is a systematic and disciplined process that advances learning and has other salutary effects on authors’ professional growth. Writing toward publication or to secure research grants requires authors to develop, test, and sharpen their thinking. Putting thoughts into precise, meaningful phrases that foster shared understanding with others helps to refine academic skills. Effective academic writing entails understanding and pursuit of a question of genuine importance. Placing this question in context entails robust knowledge of existing scholarship and broader discussions within the profession and across society. Writing with care requires reading with care and even listening with care. The task of writing is a task of learning that is characterized by increasingly refined thinking, more exact and expressive communication, growing expertise, and more extensive reading and listening.

Good writing tells a story. Strong academic papers have a logical progression and structure that support the proffered conclusions and recommendations. Good academic writing, moreover, exhibits the values of academia. Writing the methods, for example, is central to promoting the integrity of science and requires an assiduous attention to detail, plain and adequate communication about what was done, and the delineation of possible biasing factors in the conduct of the research.19 In telling their stories, academic writers will ideally engage in honest self-observation, recognize and reckon with their blind spots, and make efforts to remedy potential distorting influences on their scholarship. Professional growth is supported through such work.

Narrative writing may in particular foster reflection and self-improvement.16,20,21 In one example, teachers on the faculty of the College of Physicians and Surgeons at Columbia University used a narrative pedagogy to equip learners and faculty with the capacity to tell and to listen to stories as a prerequisite to providing attentive, empathic clinical care.16,20 A systematic review22 and more recently published papers on the quantitative aspects of reflective writing on learners23,24 suggest that writing has a positive impact on empathy, a quality important to all missions of academic medicine.

Scholarly writing also serves to connect authors to the wider academic community and may foster a sense of belonging. Writing is indeed a collaborative exercise: few published papers are single-authored, and the processes of peer and editorial review engage many colleagues. One of us (L.W.R.)25 has described collaborative writing as among the most heartening professional experiences in academic medicine and, along with others,26 maintains that collaborative writing gives rise to more richly informed and higher-quality scholarship and grantsmanship. More immediately, writing can be helpful personally; expressing one’s views on an issue can be worthwhile, even when one’s writing does not directly or instantly contribute to the resolution of the identified problem.

As a consequence, instead of causing greater stress, writing can inspire greater purpose and meaning. Writing can serve as an antidote to isolation, exhaustion, and feelings of ineffectiveness. Having close and sincere relationships with colleagues has been identified as a key source of satisfaction and retention in academic medicine.27,28 Writing can play a role in nurturing collaborative work and in inducing shared successes.29 Collaboration engenders respect for others, promotion of one another’s work, and improved quality of scholarship26 and also supports excellence by optimizing communication, striving, and leadership within teams.30 Personal engagement with a collaborative team and utilization of a mentoring approach to writing also serve to build enduring relationships, lasting beyond career timelines.29 Sponsorship relationships, in particular, may help to further the recognition of writers whose contributions may otherwise be overlooked, such as women and authors who identify as belonging to underrepresented minorities groups.31,32 Because authors are responsible in the eyes of their peers and the public for all aspects of their work, including its integrity and accuracy,33,34 their accountability and success bring recognition and belongingness in the academic community. Such personal rewards are surely great motivating factors.

So, Why Write?

Success in writing is important in enhancing the growth of the scientific and scholarly foundations of the medical and health care professions. Writing and publishing are transformative processes that privilege authors and their subject matter. Embracing the imperative to write may offer sustenance and foster resiliency over the course of an academic career. Writing creates leverage across areas of academic work, and it creates opportunities. Very pragmatically, writing helps in getting, keeping, and succeeding in all types of positions across the field of medicine.

Beyond these personal considerations, the validity of the broad conversations across the health professions is strengthened when including the voices of those who understand, with depth and immediacy, the experiences, needs, and challenges of the people we in academic medicine serve, whether learners or patients. Very importantly, our fundamental aim of improving human health is enhanced by the critical work of reaching beyond individual encounters with students or patients to better inform practices throughout academic medicine.

So, why write? Write for a desire to make a small difference in the world, driven by compassion and commitment, bringing something rigorous and valuable to contribute. Write to meet the fiduciary obligations of medicine. Write to give voice to experiences, concerns, or achievements. Write for fulfillment. Write to learn or to promote knowledge, strengthen your skills, and refine your thinking and listening. Write to develop collegial relationships, to be engaged in our wider community. Write to learn. Write to influence. Write to be heard. Write to belong. Write to help others. Write to serve the aims of academic medicine.

References

1. Miner M, Rawson H. The Oxford Dictionary of American Quotations. 2006.2nd ed. New York, NY: Oxford University Press.
2. Diamond SJ, Thomas CR Jr, Desai S, et al. Gender differences in publication productivity, academic rank, and career duration among U.S. academic gastroenterology faculty. Acad Med. 2016;91:1158–1163.
3. Reed DA, Enders F, Lindor R, McClees M, Lindor KD. Gender differences in academic productivity and leadership appointments of physicians throughout academic careers. Acad Med. 2011;86:43–47.
4. Haven TL, Bouter LM, Smulders YM, Tijdink JK. Perceived publication pressure in Amsterdam: Survey of all disciplinary fields and academic ranks. PLoS One. 2019;14:e0217931.
5. Tijdink JK, Vergouwen AC, Smulders YM. Publication pressure and burn out among Dutch medical professors: A nationwide survey. PLoS One. 2013;8:e73381.
6. Jatin S, Anand S, Ricardo P. Scientific writing of novice researchers: What difficulties and encouragements do they encounter? Acad Med. 2009;84:511–516.
7. Tijdink JK, Verbeke R, Smulders YM. Publication pressure and scientific misconduct in medical scientists. J Empir Res Hum Res Ethics. 2014;9:64–71.
8. Bowles AO, Kevorkian CG, Rintala DH. Gender differences regarding career issues and promotion in academic physical medicine and rehabilitation. Am J Phys Med Rehabil. 2007;86:918–925.
9. Macaluso B, Larivière V, Sugimoto T, Sugimoto CR. Is science built on the shoulders of women? A study of gender differences in contributorship. Acad Med. 2016;91:1136–1142.
10. Kaplan SE, Gunn CM, Kulukulualani AK, Raj A, Freund KM, Carr PL. Challenges in recruiting, retaining and promoting racially and ethnically diverse faculty. J Natl Med Assoc. 2018;110:58–64.
11. Cameron C, Deming SP, Notzon B, Cantor SB, Broglio KR, Pagel W. Scientific writing training for academic physicians of diverse language backgrounds. Acad Med. 2009;84:505–510.
12. Holliday EB, Jagsi R, Wilson LD, Choi M, Thomas CR Jr, Fuller CD. Gender differences in publication productivity, academic position, career duration, and funding among U.S. academic radiation oncology faculty. Acad Med. 2014;89:767–773.
13. Carr PL, Raj A, Kaplan SE, Terrin N, Breeze JL, Freund KM. Gender differences in academic medicine: Retention, rank, and leadership comparisons from the national faculty survey. Acad Med. 2018;93:1694–1699.
14. Anstey A. Why write? Br J Dermatol. 2013;169:1173–1174.
15. Goodney PP. Why do we write? J Vasc Surg. 2019;69:1566.
16. Charon R, Hermann N, Devlin MJ. Close reading and creative writing in clinical education: Teaching attention, representation, and affiliation. Acad Med. 2016;91:345–350.
17. Coverdale JH, Roberts LW, Balon R, Beresin EV. Writing for academia: Getting your research into print: AMEE guide no. 74. Med Teach. 2013;35:e926–e934.
18. Open Science Collaboration. Estimating the reproducibility of psychological science. Science. 2015;349:aac4716.
19. Coverdale J, Roberts L, Louie A, Beresin E. Writing the methods. Acad Psychiatry. 2006;30:361–364.
20. Charon R, Hermann N. Commentary: A sense of story, or why teach reflective writing? Acad Med. 2012;87:5–7.
21. Whitmore CA, Sakai J, Mikulich-Gilbertson SK, Davies RD. A four-week reflective writing program in the psychiatry clerkship: Testing effects on reflective capacity. Acad Psychiatry. 2019;43:171–174.
22. Chen I, Forbes C. Reflective writing and its impact on empathy in medical education: Systematic review. J Educ Eval Health Prof. 2014;11:20.
23. Wellbery C, Saunders PA, Kureshi S, Visconti A. Medical students’ empathy for vulnerable groups: Results from a survey and reflective writing assignment. Acad Med. 2017;92:1709–1714.
24. Lemay M, Encandela J, Sanders L, Reisman A. Writing well: The long-term effect on empathy, observation, and physician writing through a residency writers’ workshop. J Grad Med Educ. 2017;9:357–360.
25. Roberts LW. Addressing authorship issues prospectively: A heuristic approach. Acad Med. 2017;92:143–146.
26. Johnson MO, Neilands TB, Kegeles SM, Gaffney S, Lightfoot MA. The architecture of an internal, scientific, presubmission review program designed to increase the impact and success of grant proposals and manuscripts. Acad Med. 2020;95:200–206.
27. Pololi LH, Krupat E, Civian JT, Ash AS, Brennan RT. Why are a quarter of faculty considering leaving academic medicine? A study of their perceptions of institutional culture and intentions to leave at 26 representative U.S. medical schools. Acad Med. 2012;87:859–869.
28. Wai PY, Dandar V, Radosevich DM, Brubaker L, Kuo PC. Engagement, workplace satisfaction, and retention of surgical specialists in academic medicine in the United States. J Am Coll Surg. 2014;219:31–42.
29. Abramson EL, Naifeh MM, Stevenson MD, Li ST. Scholarly collaboration, mentorship and friendship: A new model for success in academic medicine. Acad Pediatr. 2019;19:860–864.
30. Coverdale JH. Virtues-based advice for beginning medical students. Obstet Gynecol. 2008;111(2 Pt 1):427–430.
31. Gottlieb AS, Travis EL. Rationale and models for career advancement sponsorship in academic medicine: The time is here; the time is now. Acad Med. 2018;93:1620–1623.
32. Travis EL, Doty L, Helitzer DL. Sponsorship: A path to the academic medicine C-suite for women faculty? Acad Med. 2013;88:1414–1417.
33. Rennie D, Yank V, Emanuel L. When authorship fails. A proposal to make contributors accountable. JAMA. 1997;278:579–585.
34. International Committee of Medical Journal Editors. Defining the role of authors and contributors. 2019. http://www.icmje.org/recommendations/browse/roles-and-responsibilities/defining-the-role-of-authors-and-contributors.html. Accessed October 17, 2019.
Copyright © 2019 by the Association of American Medical Colleges