The Writing Retreat: A High-Yield Clinical Faculty Development Opportunity in Academic Writing

Abstract

Background

The need for consistent academic productivity challenges junior clinician-scholars, who often lack the aptitude to ensure efficient production of manuscripts.

Intervention

To solve this problem, an academic division of a major medical center developed an off-site writing retreat. The purpose of the retreat was not to teach writing skills, but to offer senior mentor assistance with a focus on the elements of manuscript writing.

Methods

The retreat paired senior faculty members with junior staff. Senior faculty identified manuscript topics and provided real-time writing and editing supervision. Team-building exercises, midcourse corrections, and debriefing interviews were built into the retreat. The number of manuscripts and grant proposals generated during the 2008–2011 retreats was recorded, and the program was evaluated by using unstructured debriefing interviews.

Results

An average of 6 to 7 faculty members and fellows participated in each retreat. During the past 4 years, participants produced an average of 3 grant proposals and 7 manuscripts per retreat. After the writing retreat, each fellow and junior faculty member produced an average of 4 scholarly products per year, compared to fewer than 2 for prior years' retreats. Participant feedback indicated the success of the retreat resulted from protected time, direct mentorship by the scholars involved, and pairing of authors, which allows for rapid production of manuscripts and accelerated the editing process. More than 80% of mentors returned each year to participate.

Conclusions

The writing retreat is a feasible, effective strategy to increase scholarship among faculty, acceptable to mentees and mentors, and sustainable over time.

What was known

Fellows and junior faculty in academic settings are expected to engage in scholarly pursuits, but lack of time and mentors appear to be formidable challenges.

What is new

A writing retreat pairing fellows and junior faculty with senior mentors is a practical, sustainable strategy for increasing scholarly output.

Limitations

Single-site, small sample study may limit generalizability; cost of the retreat may be a barrier for some programs and institutions.

Bottom line

The writing retreat is an innovative approach for increasing scholarly activity in an environment in which scholars must balance academic and clinical productivity.

Introduction

Publication of manuscripts in peer-reviewed journals remains a key component for academic promotion, despite the opportunity for clinician scholars to report their work via nontraditional mechanisms, including e-learning products, open source journals, and participation in educational missions.^1,2 Publication in the peer-reviewed literature remains the “gold standard” that satisfies Boyer's 3 criteria for scholarship³ as seen by Shulman⁴: public access, subjection to critique, and the ability to serve as a foundation for the work of others. Promotion and tenure committees therefore emphasize the number and quality of publications in their deliberations.¹

Junior academic medical faculty face 2 primary barriers to publication: time and aptitude. Competition for time in an academic physician's work day is well recognized.⁵ Multiple and often concurrent roles of clinical care, teaching, administrative duties, and collegial interaction all require concerted effort and dedicated time. Writing requires time and practice. If time is lacking, then a faculty member must lean on aptitude developed during earlier years. A recent report on undergraduate education revealed that half of college undergraduates had not been asked to write more than 20 pages in the previous semester.⁶ Neither the Liaison Committee on Medical Education nor the Accreditation Council for Graduate Medical Education requirements include standards for the quantity of scientific writing for undergraduate or graduate medical education learners. Several articles have described writing workshops and writing groups as effective means to help junior faculty build skills as writers.^7,8 However, groups and workshops typically occur in time carved from the work week at the home institution.

In response to these issues, the faculty of the University of Massachusetts Medical School Division of Medical Toxicology created an off-campus writing retreat to provide protected time dedicated to manuscript production, with immediate mentorship and feedback from senior scholars. The division and fellowship director recruited senior fellows and junior and senior faculty. Each was offered the opportunity to advance team cohesion, participate in mentorship, and produce work suitable for publication. While residential writing retreats have been previously described in undergraduate liberal arts^9,10 and nursing education,¹¹ this appears to be the first time a writing retreat has been described in the medical literature. The purpose of this article is to describe the results of an educational innovation carried out at a US medical school that could easily be replicated in other settings.

Methods

Setting

Each January from 2008–2011, the Division of Medical Toxicology within the University of Massachusetts Medical School's Emergency Medicine Department conducted a writing retreat at a bed and breakfast in a seaside New England town. January was chosen as significant discounts were available for Monday through Friday rental of the facility.

Participants

An average of 6 to 7 faculty members and fellows participated in each retreat. A total of 16 different scholars attended writing retreats over a 4-year period. Fellows or junior faculty (<6 years in practice) comprised 83% of the participants.

Institutional Review Board approval was obtained from the University of Massachusetts.

Description of Intervention

Junior faculty and fellows were paired with a senior faculty mentor before the retreat. Two months before the retreat, these writing pairs met to determine which work was ready for manuscript preparation or grant proposal submission. Previous presentations at national meetings were frequently chosen to advance to the manuscript stage. Two weeks before the retreat, the junior members of each pair had completed literature reviews and data analyses. All necessary supplies for manuscript production were secured 1 week before the retreat and clinical coverage was finalized at the home institutions.

The first evening of the retreat was dedicated to team-building exercises. These efforts enhanced group cohesion and served as a mechanism to reiterate the goal-oriented purpose of the retreat. The remaining days focused on manuscript preparation. Cell phone contact, e-mail, and nonscholarly Internet access were restricted during the writing sessions. A nightly group dinner provided all participants with a forum to review progress on each manuscript and to discuss modifications to the original concept and organization. On the last morning of the retreat, a debriefing session focused on continuous improvement of the writing retreat for future participants.

Data concerning participant attitudes were obtained from debriefing sessions and from postevent surveys. Quantitative data concerning workshop participation and productivity are presented, as well as narrative comments from participants.

Results

Impact on Scholarly Productivity

An average of 8 manuscripts and 3 National Institutes of Health grant proposals were produced per event. Of these, approximately 7 manuscripts and 3 proposals were submitted per year. In the 3 years before initiation of the writing retreat, fellows and junior faculty averaged fewer than 2 publications per year. After the writing retreat, each fellow and junior faculty member produced an average of 4 scholarly products per year. With 1 exception, all members of the division authored at least 1 manuscript that was generated during the retreat; the sole individual not achieving author status withdrew from fellowship training.

Although a formal, qualitative analysis was not conducted, several general themes emerged after analyzing survey responses from 7 participants: the nature and value of protected time, the value of proximity to mentors and feedback, and the importance of a definable product.

The Nature and Value of Protected Time

The concept of protected time is not new in academic practice, yet several participants noted that participation in the writing retreat was the first time that they experienced the ideal. Participants felt the off-campus location of the retreat and lack of distractions were key to the success of the event. Four days' duration was comparable to most academic meetings and participants found the personal and professional time away to be acceptable. Sample responses are as follows:

• “The opportunity for writers to congregate together intensely for a prolonged period of time without interruption from outside distracters allows for a more concentrated effort to produce results.” —Mentee

• “It's akin, in my mind, to locking yourself in the closet with your computer; however, you have an entire group of specialists, writers, and colleagues at your disposal.” —Mentee

• “This retreat would NOT be nearly the same if it was held at [our conference center]. (Imagine looking out the window only to see the hospital? No thanks…)” —Mentor

• “It is imperative that these retreats be located away from the primary academic site (as well as from where people live). That's the definition of a retreat.” —Mentor

Value of Proximity to Mentors and Feedback

Junior faculty members appreciated the attention of a writing mentor and the value of nightly group discussion. Senior faculty also benefited from group editing and feedback. Senior faculty felt mentorship was more efficient in this setting, and there was a greater than 80% return rate of mentors from year to year. Sample responses are as follows:

• “For the junior faculty and fellows the benefits are obvious. Being able to be around mentors and educators 24 hours per day for a week without interruption is like hitting the academic jackpot. Imagine if you could have lived with your professors in college or grad school while studying for an exam or writing a paper—the upsides are obvious.” —Mentee

• “The setting allows for much quicker ‘back and forth’ on a paper. Normally you're bouncing e-mails off each other over a few days.” —Mentor

• “Senior faculty benefit from having individuals further removed from their projects to bounce ideas off of and to give them fresh perspectives on their topics. Additionally, any intensive opportunity to teach individuals makes the teacher a better educator.” —Mentor

The Importance of a Definable Product

Many participants commented on the value of having a product (manuscript or grant proposal) at the end of 1 week. For new participants, this often represented the first foray into academic writing. For senior and returning participants, it accelerated the production of peer-reviewed products. Sample responses are as follows:

• “How many times have I attended a conference with very little to show for it but a thick binder of notes that I may never reference again? To have a workable manuscript draft at the end of a week was amazing.” —Mentor

• “I sincerely believe that this dedicated time leads to the acceleration of publications (due to dedicated writing time, availability of mentors and other writers, etc).” —Mentee

• “Accelerated publications. In fact, more like ‘make possible.’ No retreat. . .probably no publications for me.” —Mentee

Discussion

The approach described in this article helps establish the career-critical behaviors of initiating, implementing, and completing a writing task. Physicians generally work effectively when confronted with deadlines, but untimed scholastic tasks—such as drafting a manuscript—are influenced by convenience and are often considered less of a priority than clinical workload or administrative demands. In contrast, the model described here defines preparatory timelines that culminate in a writing product.

Previous approaches described in the literature to assist junior faculty in the production of manuscripts have involved writing clubs or workshops, in which participants generate content for comment from a group, or the use of contracts that prescribe writing by an unsupported, inexperienced author for as little as 10 minutes per day.¹² Other articles have reported on the use of continuous quality improvement methods to bring discipline to the writing process by mapping expectations, scheduling realistic time to write, and encouraging team efforts.¹³ Writing retreats such as the one described here can accelerate advantages of these methods.

For inexperienced authors, public criticism of their writing efforts, commonplace in writing clubs or writing workshops, may engender a sense of insecurity or embarrassment rather than confidence. The approach described here of private mentoring by senior authors is designed to promote confidence in junior faculty. In addition, the immediate ability of senior faculty to answer organizational, semantic, and stylistic questions guided junior authors to a better understanding of the distinction between content and structure in a manuscript.¹⁴ The pairing of junior and senior authors clarified the goals of each paper, and mitigated the lack of focus that often plagues early manuscript drafts. The immediacy of editorial feedback in a writing retreat decreases turnaround time for drafts and accelerates manuscript production.

Most existing interventions to improve the writing efforts of clinicians are not designed to deter interference from routine work responsibilities.^7,8 A dedicated writing retreat overcomes procrastination, apprehension, anxiety, and perceived lack of time aptly described as “cognitive burden”¹⁴ by providing time and space to write. Lessons learned from participants in these venues validate our own approach to ensuring academic productivity.

Adequate clinical coverage was provided by members of the department who were not in the academic group. In larger departments, the development of scholarly collaborations with members from different divisions can ensure the group can retreat together without creating gaps in clinical coverage in 1 division. In smaller departments, potential gaps in coverage may prevent faculty from engaging in this type of scholarly retreat without support from departmental leadership.

Our approach has several potential limitations. One is the cost of a writing retreat, which may be a barrier at some institutions. Total cost to the University of Massachusetts Toxicology Division for each retreat involving 6 to 7 participants was approximately $3,500 for rental of a bed and breakfast for 4 weekdays during the off-season. Clinical time was considered educational leave rather than vacation. Each participant was required to cover the cost of personal transportation and 2 meals daily. One way to mitigate costs is to offer the retreat as a local continuing medical education course. Beyond clinical release time and rental of an off-site facility, the costs of this approach are relatively modest. Tuition to most continuing medical education events would more than cover expenses and could unlock reimbursement from medical schools or health systems. In addition, we did not evaluate the quality of manuscripts or grant proposals produced, though we are aware quality as well as quantity are relevant to promotion and tenure decisions.

Conclusion

An off-site academic writing retreat at the University of Massachusetts Medical School has been well received by junior and senior faculty participants and has increased production of peer-reviewed publications by junior faculty. We believe this approach can be implemented at other institutions where departments wish to address lack of time and enhance novice writing skills of their junior scholars. A writing retreat creates an intensified space that removes a group of academic clinicians from the daily distractions and obligations of the clinical environment. As faculty struggle to balance academic productivity with clinical duties, educational innovations such as this writing retreat can serve as a model for increasing faculty scholarly activity.