Writing a Letter to the Editor: Guidance From the Editors

Letters to the Editor in Academic Medicine provide a platform for briefly sharing, in 400 words or fewer, fresh perspectives and insights inviting dialogue in academic medicine and across the health professions community. ¹ Letters can be standalone communications about issues of importance, responses to articles or letters in the journal, or replies to formal calls for Letters to the Editor from the journal. As noted by one of us (L.W.R.) in the January 2020 editorial, ²

Academic Medicine is a platform for fair, thoughtful, and rigorous scholarship as well as creative, discerning observations that enrich our perspectives and approaches.

Letters to the Editor thus represent one integral part of the mission of the journal, “square[d] with an ideal of democratic discussion.” ³

A Letter to the Editor offers a means to communicate with a broad audience and foster conversations about important and timely topics. In this editorial, we reflect on Letters to the Editor and provide guidance about them.

Why Write a Letter to the Editor?

Letters to the Editor are characterized by “relevance, brevity, entertainment, and authority” ³ and are often very popular with a journal’s readers. As noted with levity by Bradley-Springer, ⁴ “Where else can you complain, correct, criticize, contribute, support, praise, and ask for information without being interrupted?”

A Letter to the Editor ideally presents a novel or distinct viewpoint about an important question within the scope of academic medicine. We will comment here on 3 types of Letters to the Editor: letters submitted spontaneously as standalone communications, letters prompted by a published article or letter in the journal, and letters submitted in response to a formal call by the journal.

Standalone letters are submitted de novo to the journal. These letters have importance because they help the field to recognize topics that may be neglected or may have received insufficient attention in the published literature. Authors are able to express an argument or make an assertion without the same level of substantiation needed in a full Article, Research Report, or Review, but the position should be reasoned, careful, and consonant with what is known or theorized.

When Letters to the Editor are written in response to a published journal article or a published letter, they may discuss methodological concerns, seek clarification about certain aspects of a published study or its results, or provide a different interpretation of the findings. Letters ought to engage with published content in an original way, moving the content forward in a novel direction. A Letter to the Editor can prompt readers to return to an article or to explore one they may have missed, while simultaneously engaging them in a conversation about an issue salient to the field.

A Letter to the Editor can act as a wonderful venue for trainees and early-career faculty to gain experience in submitting manuscripts for publication and working with an editor on an accepted manuscript. Since 2016, Academic Medicine has hosted annual calls for Trainee-Authored Letters to the Editor, inviting medical students, residents, fellows, and other trainees in the health professions to submit letters on a given topic. Letters submitted in response to this annual call are reviewed and selected separately from our regular Letter to the Editor submissions, but it is important to note that trainees may submit regular letters as well. In 2019, the journal received over 400 submissions in response to its call on “Firsts,” and in 2020, the journal received over 560 submissions in response to its call on “Courage, Connection, and COVID-19.” The journal received 479 submissions for its 2021 call, “Trainees as Agents of Change in Academic Medicine and the Health Professions.” The letters submitted under these topics were rigorously reviewed by peers, experts, and editors. Many received recognition (honorable mentions), and a small subset were selected for publication. The 60 accepted Trainee-Authored Letters for 2021 will be published in the June, July, and August print issues and can be found on our website at https://journals.lww.com/academicmedicine/pages/collectiondetails.aspx?TopicalCollectionId=78.

Letters to the Editor differ from other features in our journal. For instance, Letters to the Editor are structured and written in a manner that is different from that used in Teaching and Learning Moments, which are true first-person narrative essays about an experience related to teaching, learning, or practicing medicine. In comparison, while a letter may have narrative components, the focus rests on a certain issue of importance to the topic discussed in the letter. Innovation Reports are much longer than Letters to the Editor; they are described in more detail in a prior editorial. ⁵ The AM Last Page is a visual feature that explores a topic in a 1-page graphic. Letters to the Editor in our journal do not include tables or figures of any kind, differentiating this feature from Articles, Research Reports, Innovation Reports, Scholarly Perspectives, Reviews, and the AM Last Page. One refreshing feature of Letters to the Editor is that because their authors take a particular position, they can speak more plainly and directly than would often be the case in a Research Report or other type of article, where statements are typically focused on findings and their interpretation.

How to Write a Successful Letter to the Editor

Much has been written about how to write a successful Letter to the Editor. ^3,4,6–9 Letters to the Editor in response to an article should be submitted soon after the original publication, when the information is still timely and relevant. The letter should cite the original publication, and the critique should be made in a point-by-point fashion, with reference to specific claims or methodological features of the article in question, and with compelling evidence to support any agreements or disagreements. A full summary of the original article is not needed, as readers can refer to it directly. Letters can raise controversial issues but must not be combative or disparaging, given that the purpose is to invite further dialogue. ⁶ In fact, in one study ¹⁰ of Letters to the Editor in otorhinolaryngology journals, more Letters to the Editor were found to agree with rather than criticize the results and conclusions of the articles they were responding to.

Individuals submitting a Letter to the Editor in response to a published article must provide a full citation for the article they are commenting on. If the letter is accepted, the author of the original article is typically invited to respond. The letter and the article author’s reply to the letter are published in the same issue of the journal to more easily stimulate debate and discussion. Sometimes, further rounds of responses (letters replying to previous replies) are received and published. Occasionally, an article—usually on a controversial topic—will stimulate several readers to write excellent letters in response. When those letters, and the reply from the article’s author to the letters as a group, are published together, readers are presented an overview of current, key issues of the article’s topic in just a few pages.

Letters should have an engaging title that gives a sense of the main viewpoint expressed in the letter. Replies are published under the same title as the letter or letters to which they reply, to present the conversation as a unit for readers. All Letters to the Editor should open with a paragraph that clearly lays out the author’s reason for writing the letter, which should be a thoughtful and timely statement that offers guidance to the field being discussed. Letters to the Editor for Academic Medicine (except for replies) are addressed “To the Editor.” The body of the letter should focus on 1 or 2 well-developed ideas; explain the context in a brief and compelling way; and add to the iterative, advancing conversation on a topic. Letters to the Editor can use personal experience to illustrate a point, but the purpose of the letter should be to communicate a broader issue or idea.

The closing paragraph of a Letter to the Editor should provide a concise summary with actionable recommendations that may contribute to the advancement of the particular topic discussed in the letter. In sum, a successful Letter to the Editor often will have a clear statement of significance or of a problem; a brief discussion or analysis; and then forward-looking recommendations, steps, or guidance.

Citations are welcome in a Letter to the Editor, but are included in the final word count. Letters to the Editor do not require abstracts. Prospective authors can review the journal’s full instructions for authors on the journal website. ¹

What Is the Editorial Decision-Making Process for Letters to the Editor?

Every Letter to the Editor considered for publication by our journal is reviewed at this time by one of the assistant editors and the editor-in-chief of Academic Medicine. As with all submissions to the journal, a Letter to the Editor may be accepted, declined, or returned for revisions based on specific recommendations. As with all submissions to the journal, publication is not guaranteed. Although a Letter to the Editor is a short communication, the same standards of quality that are used for all journal submissions apply. Publication decisions are based on content, relevance, timeliness, quality of writing, and, ultimately, contribution to academic medicine.

The number of Letters to the Editor that the journal receives has increased in recent years. In 2018, we received 166 Letter to the Editor submissions, and in 2021, we received 287. Our journal has page constraints, so we limit the total number of published Letters to the Editor. Our acceptance rate for Letters to the Editor has for these reasons dropped from 57% in 2018 to 38% in 2021.

In 2022, we inaugurated the role of assistant editor for the Letters to the Editor feature. One of us (I.A.) has been invited to fulfill this new role, working closely with the editorial staff and the editor-in-chief. Appointing an assistant editor and expanding our calls for Trainee-Authored Letters to the Editors together will, we hope, continue to elevate this feature of the journal.

Looking Forward

In our review of the literature on Letters to the Editor, we came across an important adage. Sometimes the act of writing a letter has inherent value, even if it is not published. The exercise of writing itself reflects the spirit of scientific discourse and communication and allows us to clarify and organize our thoughts. ⁴ Reflecting on a Letter to the Editor that he had forgotten to drop into the mail in the mid-1980s, one author states, “It was an exercise worth writing, but my failure to mail it was an unintended kindness….” ⁹

We would like to express our deep gratitude to all of the authors who have written Letters to the Editor for Academic Medicine over the years and helped us to cultivate a forum for ideas, reasoned positions, and strategies to address the challenges facing the academic medicine community. Letters to the Editor serve an important role in fulfilling our journal’s mission, and we look forward to reading your thoughts when you do remember to send them to us.