https://orcid.org/0000-0001-6023-2063
Figures
Abstract
Proficiency in medical writing is crucial for disseminating reports of medical studies. The impact of workshops in this regard on participants’ confidence is a subject of debate. We assessed the impact of a hands-on workshop on participants’ confidence in medical writing. Participants of a 2-day “learning-by-doing” workshop held at McMaster University participated in this before-after study. We used a unique, reliable, and valid tool comprising two domains of confidence in medical writing and using English language before and after receiving the educational intervention. Of 25 participants, 21 completed the instrument before and after the workshop. Typical participants were female, and students in their 30s, who had not attended a prior workshop. The mean (95% CI) increase in the participants’ confidence for domain 1 was 15.3 (10.5, 20.1), for domain 2 was 16.8 (9.8, 23.8), and for the total score was 32.1 (20.9, 43.2) (all P<0.001). Between-subgroup analyses showed the score increase was significantly higher in participants with less than 5 years of experience in medical research. The workshop had a positive impact on enhancing participants’ confidence in writing skills, including using active verbs, crafting short sentences, summarizing main findings, and adhering to checklists like CONSORT. Hands-on medical writing workshops can boost participants’ confidence in writing medical articles and using optimal English language. Targeting junior researchers and graduate students could result in a better outcome. Emphasizing the writing areas where participants achieved higher score changes might yield better outcomes for such workshops.
Citation: Astaneh B, Raeisi Shahraki H, Astaneh V, Guyatt G (2024) Effective hands-on teaching strategy on participants’ confidence in medical writing and publishing: A before-after study. PLoS ONE 19(7): e0307681. https://doi.org/10.1371/journal.pone.0307681
Editor: Somayeh Delavari, Iran University of Medical Sciences, ISLAMIC REPUBLIC OF IRAN
Received: February 24, 2024; Accepted: July 10, 2024; Published: July 26, 2024
Copyright: © 2024 Astaneh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: Data are available from https://lifesciences.datastations.nl/dataset.xhtml?persistentId=doi:10.17026/LS/7PDEF0
Funding: The author(s) received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
Introduction
Proficiency in medical writing and a thorough understanding of international standards for medical publishing are crucial for disseminating reports of medical studies [1,2]. Publishing is the last stage of research, without which the whole process of conception, design, data gathering, analyses, and interpretations would be largely wasted [3]. Within the academic landscape of health sciences, attaining success in medical publishing not only establishes personal credibility but also serves as a pivotal criterion for academic promotion [4].
Acquiring knowledge about elements associated with medical writing and publishing, including the standard structure of medical articles [5], ethical issues related to publishing, including authorship criteria [6,7], knowing the recommended guidelines and required items that should be considered in different types of articles [8,9], how to deal with medical journals, and how to select a journal [10], are essential for medical researchers to feel confident in medical writing [11].
Currently, the English language is the lingua franca of academic medical publishing [12]. For non-native English users, writing medical articles in English presents a considerable challenge, contributing to barriers in publishing and diminished confidence compared to native users [13–15]. Cultural inaccuracies, manuscript structure, and issues with grammar and style present notable challenges [16]. Non-native English users often exhibit common patterns such as varied usage of prepositions and an overreliance on passive verbs in their writing [17].
While essential elements of medical writing and publishing, along with optimal English skills, could be incorporated into graduate health sciences programs, the absence of a formal course dedicated to medical writing and publishing in research-focused medical education curricula necessitates the provision of such skills through specialized workshops [18].
Confidence refers to “people’s sense of competence and skill, their perceived capability to deal effectively with various situations” [19]. So, in medical writing, confidence means feeling competent and skillful in writing a standard medical article. The impact of these workshops on participants’ confidence remains a subject of debate. Debate persists due first to variations in teaching strategies and secondly to the lack of a standardized measurement tool with approved validity and reliability to assess confidence in dealing with the challenges of medical writing and publishing. Consequently, our objective was to assess the impact of a hands-on medical writing and publishing workshop on participants’ confidence in medical writing and the use of optimal English for this purpose using a unique, reliable and valid measurement tool.
Methods
Study population
Participants of a 2-day workshop on medical writing and publishing held on 8–9 Nov 2023 at McMaster University, Hamilton, Ontario, Canada, were eligible to participate in the study. The target audience for our workshop was clinical researchers in the early or middle stages of their careers. Students in graduate programs, clinical researchers, post-doctoral fellows, and junior and mid-career faculty members were among the primary target group, although other participants, such as professionals from industry who felt the workshop could be of benefit to them, would also be welcome.
Delivery of the workshop
The 2-day workshop marked a pioneering initiative at McMaster University, led by five faculty members from the Health Research Methods, Evidence, and Impact (HEI) Department, alongside three editors from the Canadian Medical Association Journal (CMAJ). These facilitators brought extensive expertise in medical writing and publication, with two of them having a track record of successfully leading similar workshops in the past.
The mode of delivery of the workshop was “learning-by-doing,” in which the participants had the opportunity to offer a draft of a manuscript at hand at the time of participation for discussion and feedback. During the workshop and in the related breakout rooms, we anticipated that discussion and feedback conducted under the supervision of facilitators and using the workshop content would improve these articles, ideally to be ready for submission to a reputable peer-reviewed journal.
The workshop curriculum aimed to comprehensively cover the fundamentals and essential aspects of manuscript development, encompassing various topics related to standards and ethical publication (Table 1). Sessions addressed the standard structure of medical articles, including the Introduction, Methods, Results, and Discussion (IMRaD) sections. Additionally, the workshop addressed aspects of publication ethics, authorship criteria, insights into medical journal operations, and guidelines for reporting different article types (e.g., CONSORT, STROBE, PRISMA). Preceptors offered practical advice on responding to peer reviewers, understanding scholarly metrics, and selecting journals. The workshop dedicated specific attention to the optimal use of English in medical article writing, illustrating key points with examples from published articles.
Measurements
We informed the participants of the workshop about the aims of the study and asked them to participate. We included those who signed written informed consent forms. We gathered data about participants’ demographic characteristics and administered an instrument evaluating their confidence in their medical writing and publishing skills. After the workshops, we assessed the participants’ confidence again with the same tool.
Measurement instrument
We had previously created a measuring tool by creating an item pool after a comprehensive literature search. After rating and ranking the items by a team of professionals, a tool was created whose psychometric properties were checked in a sample of previous workshop applicants by using standard statistical analysis [20]. The instrument has 36 items comprising two domains. Domain 1 is “confidence in choosing the appropriate contents for different parts of a standard medical article based on the international guidelines” (18 items), and domain 2 is “confidence in the use of appropriate academic English language required for publishing articles in peer-reviewed medical journals” (18 items). We prepared a Google form with the response options with a 5-point Likert scale ranging from 1 (showing no confidence) to 5 (extremely confident) (S1 File). So, the range of scores in each domain was from 18 to 90. Higher scores show higher confidence.
The total content validity index of the tool was 0.75. The internal consistency of the tool was greater than 0.90 for both domains. Temporal stability was checked using test-retest reliability with r = 0.92.
Sample size
The sample size was determined first by feasibility issues, including the institutional resources to hold the workshop and ultimately by the number who proved interested and enrolled.
Outcome measures
The primary outcome was considered to be an increase in confidence scores in both domains and in total after the educational intervention. The secondary outcome was an increase in the score of individual items after the intervention. An increase in mean scores greater than 1 for individual items was considered a more pronounced impact of the educational intervention.
Ethics board approval
This study was reviewed by the Hamilton Integrated Research Ethics Board (HIREB) and approved with the code 2023-14916-GRA.
Analysis of data
We reported demographic variables descriptively using mean±SD or proportion as required. For between-group analysis, we used the independent t test and one-way analysis of variance (ANOVA) followed by the LSD post hoc test. Analyses addressed the pre-post changes in the confidence scores in both domains of the measurement instrument using a paired t test. The software for statistical analysis was SPSS version 23.
Results
In total, 31 applicants registered for the workshop. Two applicants changed their decision to participate because of schedule conflicts. We sent an email to the remaining 29 applicants, informing them of the aims and procedure of the before-after study, and asked for their consent to participate in the study; 25 consented. We emailed the Google form containing the measurement tool addressing their confidence to them 2 days before the workshop and asked them to fill out the form prior to the start of the workshop. We sent two reminder emails to those who had not filled out the forms before the workshop.
Of the 25 participants, 21 completed the instrument before starting the workshop. Two had forgotten to fill out the form before the first day, and the remaining two filled out the form after starting the workshop on day one, so we excluded them from the study.
After the workshop, the same form was emailed to the 21 participants who were included in the study. All returned the filled form within a few days of receipt.
The mean (± SD) age of the participants in the study was 35.4 (± 8.6) years (range: 17–52). 14 (66.7%) were female, and 14 (66.7%) were students. Two (9.5%) were faculty members, and nine (42.9%) had doctoral education. Typical participants were students in their 30s, who had not attended a prior similar workshop. Table 2 shows the participants’ demographic characteristics and the number of publications as the first author and workshops attended.
We encountered a few instances of missing data from two participants, resulting in the sum of frequencies for some variables not rounding to 21.
Table 3 shows that mean pre-test scores in both domains and total scores of the measurement tool increased substantially after the workshop.
To find possible differences between different subgroups, we did between subgroups analyses, which showed that the mean score changes were statistically significant exclusively among the three groups with different years of experience in medical research (P = 0.04 for domain 1 and = 0.03 for domain 2). We then did the post hoc analysis, which revealed that the score increase was significantly higher in participants with less than 5 years of experience compared with the participants with 6–10 years of working in medical research for both domains (Table 4). Table 4 also shows score changes within different subgroups.
Figs 1 and 2 show the score increase for each question in both domains. The workshop had a positive impact on enhancing participants’ confidence in various writing skills. This included utilizing figures in the Results section (item 9 in Fig 1), composing the Acknowledgment section (item 11 in Fig 1), summarizing the main findings (item 12 in Fig 1), crafting the conclusion (item 17 in Fig 1), and adhering to checklists such as CONSORT (item 18 in Fig 1). Additionally, participants reported increased confidence in effectively using active verbs (item 19 in Fig 2), crafting short sentences (item 22 in Fig 2), employing simple words (item 23 in Fig 2), incorporating subordinate clauses (item 34 in Fig 2), utilizing fewer words (item 31 in Fig 2), and distinguishing between while and although (item 33 in Fig 2).
Discussion
We found that the 2-day hands-on workshop at McMaster University effectively enhanced participants’ confidence in writing various sections of a standard medical article and using optimal English language for this purpose. Post-test total scores as well as post-test scores in both domains, substantially increased after the workshop. We found no significant between-subgroups differences except for the participants with varying years of experience in working in medical research. Notably, the mean score changes were significantly more pronounced in participants with less than 5 years of experience compared with those with 6–10 years of experience in medical research for both domains. The reason for this difference could be that those who worked less than five years in the research field had a lower base of knowledge and experience in writing a standard medical article. Therefore, when they received the educational intervention, their scores increased more significantly compared to those with more years of experience in research. As a result, the difference between pre- and post-intervention scores was statistically significant. The non-significant difference in other groups might be related to the lower number of participants in those groups, as there were only 6 participants with 6–10 years of experience.
Strengths and limitations
This workshop on medical writing and publishing marks a significant milestone as the first to employ a standard, valid, and reliable measurement tool for evaluating participants’ confidence in writing medical articles and using optimal English language.
Another notable strength of this study is the detailed reporting of confidence score changes for each individual question. This level of granularity in reporting, which is unique to our study, has not been observed in similar research endeavours in this field.
The composition of our diverse facilitation team is another strength of this study. Our team included different stakeholders, including world-class researchers, editors from one of the most reputable Canadian medical journals, and facilitators with extensive experience in conducting numerous workshops of this nature.
The diversity of participants, encompassing students from various fields of study, individuals with diverse academic careers, and participants with varying numbers of previous publications, attendance at similar workshops, and years of experience working in medical research is another strength. This diversity can add to the generalizability of the findings.
However, this study has its limitation, notably the small sample size. This is a common constraint in face-to-face, hands-on workshops, primarily due to budget limitations and logistical challenges. In certain subgroups, there were only two participants, which may account for statistically non-significant findings, potentially reflecting the limited statistical power rather than an actual absence of an effect.
Relation to prior work
In a comparable workshop designed for post-doctoral fellows, the program spanned three weeks and included three 6-hour modules. Facilitators focused on teaching participants techniques for writing with clear and cohesive language. Confidence self-assessments were conducted before and after the workshop, revealing an increase in confidence levels from 1.12 to 1.44 points on a 5-point Likert scale [21]. However, unlike our study, the authors did not furnish details about the content of the confidence tool, and it remained unclear whether the researchers evaluated the psychometric properties of the measurement tool.
In another study aimed at enhancing writing skills for publications, the authors employed remote teleconferencing to teach writing standards to Australian employees within the public hospital system. Utilizing a self-reported 5-point Likert scale questionnaire, with a response rate of 26%, participants noted an increase in their confidence in facing challenges related to writing for publication. However, in contrast to our methodology, the study did not utilize a valid and reliable tool to assess confidence, and there was no report on the content of the questionnaire [22].
Wajekar and colleagues conducted a medical writing workshop for post-graduate anesthesia students, focusing on teaching them how to write a case report. They reported using a validated questionnaire to assess participants’ confidence levels in academic writing skills post-workshop and noted a significant improvement in participants’ confidence levels after the workshop. However, a notable limitation is that they neither reported on the psychometric properties of the questionnaire nor cited a reference for the tool used [23].
A similar limitation is evident in the report of a protocol writing workshop conducted for general practitioners, where pre- and post-workshop questionnaires were administered to participants to gauge their improvement in writing protocols. Participants reported a significant increase in their confidence in writing a research protocol on a 6-point Likert scale. However, the authors did not provide an explanation of how they ensured the validity of the scale used and how the scores could be translated to an actual increase in confidence [24].
In a recent report, Harvey and colleagues detailed their series of three 90-minute face-to-face workshops conducted over an 8-month period for employees of public sector health services, focusing on how to write for publication [25]. Their before-and-after program surveys, comprising both quantitative and qualitative questions, indicated a 0.3 increase in the average confidence level in the ability to write a manuscript for publication on their 5-point Likert scale [25]. Even considering the difference between the number of questions in their questionnaire and our measurement tool, the mean increase in confidence in both domains of our tool in our study was significantly higher than theirs.
Other researchers planning to conduct educational interventions for academic writing and publishing have reported a common challenge: the absence of systematic or validated tools for evaluating such educational courses [15,26]. Sabouni and colleagues reported their intervention aimed at enhancing the level of knowledge and confidence in academic writing and publishing for Syrian participants in 2021. They mentioned using questions from a previous similar course with permission from the copyright holders but did not provide a citation to the previous work [26]. Regarding the impact of their workshop, they stated that the number of participants reporting confidence in writing an article increased from 55% to 83%. Despite acknowledging English as the preferred language for scientific articles, which could pose a challenge for non-native English language users, including their participants, the researchers neither focused on teaching optimal English language nor assessed the participants’ abilities in using optimal English language [26]. An important distinction in our study is the emphasis on teaching optimal English language use and evaluating how this instruction could enhance our participants’ confidence in utilizing the English language for medical writing.
In general, previous reports on similar workshops exhibit inconsistencies in providing comprehensive details about the educational activities, presentation methods, and curricula, often lacking completeness and varying widely across different workshops. Assessing the impact of such workshops on participants’ confidence in academic medical writing has frequently been limited by the absence of rigorous, standardized methods. Valid and reliable measurement tools for these assessments have been notably scarce. Our study distinguishes itself by employing a standard, valid, and reliable measurement tool. We further contribute by reporting mean score changes for individual questions, offering valuable insights for the planning of future workshops by researchers. Additionally, the sharing of the entire measurement tool through this article adds to the distinctiveness of our approach compared to previous reports.
Implications for practice and research
We presented the mean confidence score changes for individual questions, highlighting items that exhibited an increase in mean scores greater than 1. Such items may signify areas where the workshop could have a more pronounced impact. Notably, participants derived greater benefit from topics covering the appropriate use of figures in the Results section, summarizing main findings, and writing conclusions, as well as utilizing checklists like CONSORT, compared to other items on the measurement tool. Therefore, for future workshops, facilitators can, in addition to maintaining a focus on teaching these subjects, explore improved techniques such as providing some published articles and comparing the good examples with less satisfactory papers for teaching other items that our workshop did not demonstrate a clear impact. This approach aims to enhance the effectiveness of the workshop across a broader range of topics.
We observed that participants with less than 5 years of experience exhibited significantly greater mean score changes in both domains compared to other groups with different years of experience. So, these workshops might be more advisable to actively target junior researchers and graduate students for a more impactful outcome.
Conclusion
This workshop provided an opportunity to generate evidence related to optimizing the educational strategies of similar workshops and contributed to the literature on their evaluation. Hands-on medical writing and publishing workshops have the potential to boost participants’ confidence in writing various sections of a standard medical article while also improving their proficiency in using the optimal English language for this purpose. Specifically, targeting junior researchers and graduate students could result in a better outcome in participants’ writing abilities. Developing a pre-workshop curriculum emphasizing the writing areas where participants achieved higher score changes might yield better outcomes for such workshops.
Supporting information
S1 File. Final tool for confidence in medical writing.
https://doi.org/10.1371/journal.pone.0307681.s001
(PDF)
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