The next portion of our workshop is Rene Perea from Columbia. He'll be presenting from abstract to manuscript. Again, I'll just remind you to put forward your questions for the Q&A section, and we'll answer that at the end of his talk. So Dr. Perea, please begin when you're ready. Thank you, Dr. Farah. I'd first like to thank IGCS and its education department for giving me this opportunity. Also, I'd like to thank to the speakers, the fellows, and of course, almost 200 people connected from all over the world. I'd like to speak a little about from abstract to manuscript. It is always tough to speak after rock, but I'll try to do my best. I have no conflict of interest for speaking about this. And I would like to start saying that a modern teacher, a modern gynecologist, oncologist is basically a researcher. And research results have to be published because people have the right to know the facts that can change science or that can change practice. I'd like to consider what type of career do you want when finishing your training in gynecology and oncology? And academic research, including, of course, research and publishing. Just teaching, it is very common in Latin America. Our professors taught us how to see patients to operate, but not publishing because, unfortunately, in many parts of the world, we are not trained for publish. Just an attending physician, not teaching too much, just private practice. And if you go to private practice, forget about academics because you will not have enough time for other things than do your job. Social care focus, doctors going to very poor places in order to care those patients there, and basic research. Any of those is a good choice because they are personal choice. It's not a better doctor that publishes than one that doesn't publish. They're just life options. Regarding mentorship, we are going to talk about mentorship later, but one question you should make to yourself, which of your teachers do you want to be like? And the answer probably is a good option for a mentorship. And why publish? Why we publish? To improve my writing skills, of course, to upgrade my knowledge, to recognize my research, to assess my work quality, to help the society with my research. Those are reasons for publishing, but there are a few more. To be recognized in Latin America, to be famous. And we can talk later about fame to serve as an example. Ego-related reasons, and this is quite important because I'm looking for personal development, professional development. I like to accept challenges. Early morning, in the United States, there is an economical difference among being a assistant professor, associate professor, and full professor. And those categories depend on the number of publications and mostly the quality of the publications where your work has been published, to motivate other people and to help people, to help students, to help residents, fellows, to help patients. My preferred reason is to convince others that they can do it as well. This is the reason why I publish. The rationale for publishing is to try to impact science and to get some advance on the field. Outstanding science does not equal to definite publications. It depends from many other things. Personal anecdote means nothing, and the results are only believable if published. This is really common in medical meetings when a doctor stands up and says, according to my experience, I would like to remind you the pyramid of the evidence. And the lowest level of evidence is experts' opinion, but experts' opinion written, not spoken. You have to write. The priority in the journals for publication is new and original research. Of course, prospective randomized trial, but as Rob said, it's very difficult to run a prospective randomized trial. It's complicated. It's so expensive. Larger retrospective series of a topic of interest. This is appealing for journals. Data that contradicts previously established results, and a good example is lab trial. Reviews of relevant and current topics. Reviews are cited very, very well. So if you can write a very comprehensive review, systematic narrative, et cetera, probably will be accepted in a given journal. And videos or new or novel techniques. They are low priority publications, such as editorial commentaries, case report, et cetera. Case reports are important from the point of view of training. For training to medical students, training to residents. Case reports should be the first step when you are pursuing a publishing career. How to find an interesting topic? The first thing is to do a literature search to be sure that the issue hasn't been published yet. Review the current literature. Discuss with an expert in the field. Not a friend, not a peer, just an expert. It's important to be attentive to capture the missing element, the gap in the knowledge that you can provide with your research. It's important to visit abstract and posters in the meetings in order to get the addresses to make contacts with those people in order to establish a collaborative project. And additionally, discuss the proposal in group conference. This has been a kind of introduction. Now I'm going to talk about abstract and manuscript. And what is first? The abstract or the manuscript? Depends. If you have a project and you have already the results and you are planning to present it in a scientific meeting, such as SGO, ESGO, IGCS, you should write first the abstract because it's a requirement. And second, when you revise all the data and information, the abstract and the final abstract can change. Information can change. So for a scientific meeting, you should write first the abstract. Otherwise, you should write first the manuscript and then the abstract. Regarding abstract, the abstract must be appealing to readership. And unfortunately, but this is really true, is the only thing that most people will read about your article. Not the full manuscript, just the abstract. Please be concise in doing the abstract. There are different structures according to journal. One is a short background, methods, results, and conclusion. Another is just objective method, results, and conclusions. And you have to say this in just 200 or 300 words. And please avoid discussion elements in abstract because you won't have space for doing anything different than the requirement. Some recommendation is construct the title and abstract from keywords from all section of the main text. Use important keywords at the beginning of the title. No abbreviation or passive voice. It is important to state the objective and start the results sections with the objective of the research. Give the sample size if you were reporting percentages. And present effect size with confidence intervals and rubsets and isolated value means nothing. They're useless. Always a P should need an interval. You should consider the four W's. What is known and why is this study needed? What did you do in methods? What did you find in results? And what does it mean in discussion? From my point of view, the most difficult part of writing a manuscript is discussion because in discussion, you have to think how to sell your idea or how to offer your proposal. Check the answer can be read independently from the main text. One thing, one more important thing is every time you check the manuscript or revise the manuscript or revise the data or the results, you should check the abstract because as a reviewer, it is very disappointing when you read the abstract and authors are presenting some information. And when you read the results sections are completely different. So you should check the abstract every time you revise the manuscript. When writing the manuscript, you have to be concise and go to the point. A lot of words does not equal to a good story. And this is particularly important from Latin American people and Spanish speaking people because we use a lot of words. We love words. And in English, you have an economy of 30% compared to Spanish. English is too sharp and you have to be very precise and try to use scientific language. And for non-native English speakers, it is highly recommended to include one English native speaker in the team because the way to write is completely different. Please try to avoid non-scientific language. We perform this approach in the easiest manner. The blood loss was less than expected. The approach was done as routine. You have to explain. This vague terminology is not appropriate for a manuscript. And also language that can be misinterpreted. The length of stay was very short. What does mean very short? Three hours, three days. In China, 21 days. Who knows? The rate of sentinel load detection was outstanding. You should avoid adjectives all the time when writing a manuscript. Complication rates were minimal. What does mean minimal? You have to provide data. You have to provide numbers. Never split the tables or figures in the middle of the manuscript. In fact, the managing editor will get back the manuscript to you if find tables included in the body of the manuscript. There is a right place to put those in the platform. Please use real English speaking editors. Some examples, hysterectomy, appendicectomy. Similar to appendicectomy in Espanol, but it's appendectomy. They're very, very common mistakes in manuscript. Don't use Google Translate. This is, as a reviewer, I can notice this easily. And Google Translation looks really, really bad in a manuscript. Please try to find a native English speaking person revising the manuscript. I think this is fundamental. And some journals offer English edition, but this can be costly, $2,000, $3,000. In the introduction, you have to provide the reader essential information in order to understand why this study is being conducted and informing about the research question. The introduction must allow readers to understand the biological, clinical, or methodological rationale for your study. The most important thing is a good introduction will sell the study to the editors, reviewers, and reviewers are the key element. I'll speak a little later. Readers and sometimes the media. The introduction doesn't have a number of words, but typically should be about 10, 15% of the full length of the manuscript. And the introduction is the first part of the story that you are trying to tell. Every story has a start, a medium part, and a final part. Introduction is the initial part. The middle part are methods and results. And the final part is the discussion. In introduction, you should not exceed three, four paragraphs. In the first paragraph, very brief background information. Second paragraph, why this is important. And third paragraph, what is the gap in the knowledge that you're trying to fill with your manuscript. And additionally, in the final part of the introduction, you should state the aim of your study. Please don't use more than eight or 10 reference. It is really tiring to see an introduction with 30 references. That does not make any sense. If results is the final aspect of the meal, methods are the ingredients and the recipe. So methods are important because they will help to readers to understand how the study was conducted. IRB approval always. It is very difficult to publish a paper in a manuscript in a top journal without IRB approval statement, even for retrospective studies. What kind of data was collected? It is common to find this statement. This is a retrospective review of prospectively collected data. That means nothing. Don't say prospectively, if not. For same prospective study, you have to provide an IRB statement and a registry clarifying that is a prospective study. Who are the study group? From where, when were recruited or included? Provide details for each replication, the methods for statistical analysis. And this can be written with the help of a statistician. The consent process for subject, it is a prospective study. Give some details on the process of randomization. And if prospective, don't forget to explain how the sample size was calculated. Include basic information on the design of the study, setting and subject, data collection, data analysis and ethical approval always. Refer to previous publication from the same large research project such as study protocol for additional information if applicable and in supplementary material. Consider providing detailed information on the methods as well as web-only supplementary materials. And the question you have to to be asked to yourself is would a researcher be able to reproduce the study with the information I provided in this paper? This is quite important in systematic literature use. The results should reflect that what's collected in the methods always begin with the number of patients included, provide chronological sequence of the data, make sure that numbers match abstract and table. This is one of the most common mistake when one check for making reviews for of papers. Make sure that all numbers are up, provide data that will be of interest of the reader and do not interpret the data in a result, just give the facts. And in discussion please start with a single statement of your main findings, do not repeat results, place in context of previously published literature and be sure to include comparison of major articles. So we found this and other authors have found that and please provide comparisons between the information you have obtained from others. Please include strengths and weaknesses, this is very important and this is a missing element in most papers that we receive for peer review process. Provide future directions, provide details as to why this is contributing to literature and please don't make editorial statement, just a discussion. This is the checklist, there is a very good publication in Journal of Clinical Epidemiology in 2013 where all of those aspects are highlighted and very well explained. References, please use the format that the journal are recommending to, double check spelling as a specific for every citation, keep reference to irrelevant and important, really important, think about including reference of work of previous work from people you are selecting for reviewer. This is just politics but it's important. In Latin America there is a very heavy discussion about who should be the author. The authorship can be discussed before starting writing the manuscript, before, not after, before. So an author according to the International Committee of Medical Journal Editors is the person who substantially contribute to the conception and design or acquisition of data, analysis and interpretation. Draft the article or revise it critically for important intellectual content and give their approval of the final full version to be published. All three conditions must be fulfilled to be an author. Sadly in Latin America it is not rare to write the manuscript and when you present to the boss, to the chief of department, the chief can ask to yes put me first because you work here because of me and there are our patients or the patients of our clinic so put me first. So you should discuss this seriously before starting the manuscript and if you want to be the first author you should state and you will write the whole manuscript by you. Before regarding selection of the journal we are trying to to submit your work. You should consider basic versus clinical research journal, a general versus specially focused. We have in gynecology, oncology of course, International Journal of Gynecological Cancer, Gynecological Oncology, Journal Gynecological Oncology and European Journal Gynecological Oncology and other journals on the topic and the generalists can be the Green Journal, Great Journal, Lancet Oncology, JAMA Oncology etc. Traditional journals versus electronic journals, most of the journals have moved to electronic versions. If there is a subscription journal versus open access and if it is an open access you have to be aware that you will have to pay. You have to balance the desire to publish in top quality journals with the need of rapid publication. Consider but not be fooled by impact factors. Impact factors is not the only important thing you should think in the audience you are looking for. Draw up a prioritized list to three to five journals in case your manuscript were rejected from your first choice then go to second and third and importantly be realistic. If you have a retrospective series on vaginal trachelectomy please don't send it to New England Journal of Medicine, don't send it to gynecological oncology because that's a common issue. So try to find the right journal for the kind of manuscript you have. I like this image because publishing is always a frustrating process but it can be the opposite, it can be very satisfying but you will need some requirements. Finally I would like to share with you some take-home messages from my experience writing manuscripts. The first is find a mentor or at least try to be found by one. According to my point of view it is more easy for a mentor to find the right mentee than the opposite but the mentor needs some characteristics and we will discuss later on the right mentor and the right mentee. It is better to be realistic than too optimistic and this will avoid some early frustration in your career. If you are a non-native English speaker please include one in your team. This is one of the most important recommendations today. If you do small steps and you accept progressive challenges you will get sequential achievement. So if you are starting your career in publishing, publish case report, then small case series, then larger, then collaborative series and look for journal with modest impact factors because higher the impact factor, higher the more difficult the possibility to get accepted for publication. After a submission anything responds other than reject is a success and celebrated because reviewers and editors are giving you the opportunity to improve your manuscript, to put in a better shape your manuscript, so be grateful with them. They are not trying to piss off your life, they are trying to have a better manuscript in their journal. This is important for Latin American people. Do not write motivated by fame or looking for immortality. You should write for reviewers. When you are preparing a manuscript you always have to think as a reviewer. What things would you ask if you were the reviewer of that paper? It is important to use a guideline according to the type of article we are writing. For randomized trial, a consort for observational studies, retrospective course, case control studies, stroke, systematic review, prisms, study protocol, etc. This is an example of the consort, the checklist and when you are writing your report you should check that every aspect is included in your manuscript. Same for retrospective areas, case control studies, cohort studies. This is the stroke for a cohort study. Check every aspect because frequently as a reviewer you use these guidelines in order to check that all the elements have been included in the manuscript. Probably the most important thing that I will say in my presentation is this. Become a reviewer. If you want to learn how to write papers, become a reviewer because as a reviewer you will have a huge exposition on how the authors write the manuscript, what styles they have to write, what they try to say when submitting your manuscript. As a reviewer you can say the opinion of the other reviewers and you will verify how authors respond to the reviewers queries and requests. So, strongly consider becoming a reviewer because being a reviewer will improve your writing skills heavily. Networking is crucial. If you see the manuscript, it is rare to see a manuscript signed by just one author. Always, this is a work of a team, not an individual. So, you have to find a network of collaborators inside your hospital, inside your city, into your country or in your continent. Try to build this kind of network which is really, really important. This will allow you to get involved in multi-centric collaborative projects. Please try not to pay to have your work published in some parts of the world, particularly again Latin America. One of the requisites to be graduated as a specialist is to have a manuscript published and many times this is paid. Try to get your work published due to its quality, not because you have the money to pay for publishing it. The name of this game is resilience. Resilience is the ability to recover from or adjust easily to misfortune or change. You will receive rejections, you will receive major changes and major changes can be three, four, ten pages of changes to your manuscript. So, be patient because every manuscript that you produce will be better than the other and will be better. Then, at the end, when you have published many manuscripts, the flow will be natural. They will be spontaneous and the quality will improve. As a final remark, I would like to say that for me, even today, seeing one of our manuscripts get accepted and published gives me a unique feeling of happiness. This is real. It reflects the satisfaction of a duty accomplished, a challenge accepted and I'm always proud and grateful for my work team that ultimately are responsible that the manuscript can be accepted and published. That's all. I'd like to finish with my editorial team at International Organic and Ecological Cancer. All of those people are trying to have better manuscripts, trying to improve your work. So, don't hate them, love them as I love them. Thank you very much. We thank you so much, Dr. Pereira. That was a fantastic talk. Again, some really invaluable information for our audience and we have some really good questions for you, if that's okay. The first question is from Sagar Chochki. He's from the US. He's a junior attending, intending to apply for the fellowship. He wants some advice on trying to publish a negative study, a negative study that still adds to the literature without significant findings. How do you get that published? Such a good question. There is a thing called publication bias on positive results because in science, reviewers and editors prefer positive results than negative ones. But if the paper is well written and the conclusions are well supported, definitely you can publish even negative results. Great. Another question that comes from Diaz Seywan. Diaz has asked, how do you choose or select articles to form part of your discussion? Is there any criteria? Can you choose to use any paper once it has a link with your study? Interesting question. For me, I'll try to include in my discussions, first, the pyramid of evidence. If we have prospective clinical trials, necessarily I need to put them in my discussion. Then, systematic reviews on the issue. And then, papers similar to my paper based on the number of patients included or the journal that the work has been published. Those are my criteria for choosing the elements of the papers for being included in discussion. Great. The third question is a technical question. It's related to reviewing papers. If you've written a paper, how do you have your co-authors review your manuscript sequentially or at the same time? I prefer at the same time. It is important. It should be one writer. Not, again, it is common. Please, you, George, you write the introduction. Anna, write the methods. You, Philip, write the results. And I will write the discussion. This is always noticed by reviewers and by editors. The author of the manuscript, the writer, should be just one. And then, all the co-authors have to provide their comments. But try to not include several hands, several brains in the same manuscript because the result will not be good. That's great advice. I think this will be the final question. And we can go through other questions later on our Q&A. What is the first and most important thing you look at when reviewing a paper, the first most important thing? Thanks for nice questions. The first thing to me is novelty. As a reviewer, I select the title and put it in PubMed and then play with words in order to find similar papers. If the paper is not novel, there is no value reason for getting published unless the paper could have a really, really new or relevant or contradictory message. But the most important thing is the novelty of the work. That's great, Rene. Look, thank you for your valuable insights today. Thank you.

Dr. Rene Perea

publishing research results

career paths

mentorship

writing skills

selecting the right journal

scientific articles