Young GI angle: How to publish in high‐impact journals as young fellows?

INTRODUCTION

Being listed as an author or co‐author in a published study is always a rewarding experience. From the thrill of publishing one's first paper as a trainee or fellow to a more seasoned approach for early career researchers, the joy of seeing one's work reach fruition is a testament of the hard work and thought put into academic pursuits. Although we are hardly experts, we have been very fortunate to have mentors and teachers who have provided us with constant support and guidance along the way, for which we are forever indebted. They have led by example, showing us that meticulous planning, teamwork, encouragement and perseverance are essential in creating an environment conducive for research. Here, we would like to share some of our thoughts on how to successfully (co‐)author papers in high‐impact journals, largely reflecting what we have observed from our mentors. Our discussion will be divided into three main parts: brainstorming, execution and the listing of some examples.

BRAINSTORMING

This is arguably the most important part of the whole process. It gives birth to the soul of a study and a well‐thought‐through framework could already lead you half‐way through to success. The conception of a research idea is like building a house, from theming and styling to consolidating the structure with current scientific evidence and finally polishing through idea exchanges with peers (Figure 1).

FIGURE 1.

Brainstorming of the clinical question

Theme

To start up a research project, one should be able to ask a good question that should be answered at the end of a study. The simplest way is to keep track of the hottest topics and advances in the field and identify knowledge gaps. Through routine clinical practice one should also pay attention to under‐developed clinical aspects, and sometimes even patients themselves ask important questions which we do not have answers for and many of these are worthy of further study. As a beginner, one may also make use of their institutional edge as the starting point as this would make it easier to gain support from seniors and mentors. Prior Young gastrointestinal (GI) angle articles have explored on how to choose a good mentor, ¹ and how to utilize international research fellowships as a good initial step to establish research activities if there is a lack of relevant expertise locally ² and are also excellent resources for the budding researcher. Always keep your curiosity and be inquisitive! As Albert Einstein once said, ‘The important thing is not to stop questioning’. Every day we are surrounded by freely flowing ideas in clinical practice, one just needs to catch them!

Enrichment

After having a brief research idea in mind, it is time to conduct a literature search to enrich the framework. You can do extensive browsing of published literature to learn from renowned scholars on how to design a good study. Getting familiar with online repositories of clinical trials to get a grasp of ongoing academic work to avoid duplication is crucial. In the era of internet conferencing and webinars, one should not forget to keep up‐to‐date by just switching on smartphones or laptops anywhere around the globe to participate. A key to truly getting the most out of these conferences is to remember that it's not just listening to the lectures, many a time inspirations come from staying behind for the discussion part, actively participating in the question and answers (Q&A) session, and trying your best to interact with the experts in the field. With the blossoming of social media in medical training and development, platforms such as Twitter can also facilitate discussions and idea exchange, and in some cases lead to multicentre studies and bonafide publications.

Refinement

Brainstorming is incomplete without the word ‘storm’. Coming up with a novel idea is great, but afterwards, it is essential to have someone provide constructive criticism to further polish your ideas. Never feel ashamed or defeated towards negative opinions as confronting these in the early stages of planning before really initiating a study will make life much easier later on. Generously share your plans with peers, mentors and supervisors, even Twitter friends and just anyone that's willing to listen to broaden your vision and refine your research framework from different angles. Having a detailed meeting with your statisticians in the early stages is also essential to identify potential hurdles in subsequent execution of the project. Having a great idea which is impossible to execute due to a lack of cases as reflected by overly ambitious sample size estimates would mean back to the drawing board. Someone who has the experience and knowledge to play the role of a devil's advocate can point out potential pitfalls to a study idea, and through the formulation of ways to overcome these problems can one conclude that the brainstorming process is complete.

EXECUTION

Before the study

The adage 'Rome wasn't built in a day' certainly rings true with clinical studies. To kick start with a complex study from scratch, good planning beforehand to lay a solid foundation is essential. After brainstorming the hypothesis and ideas, one can assign the relevant tasks to teammates for action in parallel. Identifying appropriate candidates to delegate tasks that they are experienced or interested in is also an important step. An outstanding statistician would also help to manage the large amount of data in retrospective studies or to estimate the optimal sample size in prospective trials. Effective teamwork would save a research team plenty of time and effort.

It is essential to familiarize oneself with different study designs and methodologies so as to opt for the best way forward. In the course of topic browsing, one will get to explore more about the feasibility and potential limitations of a research topic. It will facilitate the brainstorming process and refine the research scope. Always start with the easier study designs. For example, a retrospective cohort study may be a better choice for beginners. Nevertheless, it may generate important preliminary data for future randomized controlled trials. After gaining more experience, one may adopt a stepwise approach to carry on with prospective studies.

When a preliminary research outline has been formulated, it is time to consider preparing for a grant application. Establishing a concrete and feasible study protocol would convince the selection panel on why that particular proposal should be chosen. Details of the research proposal should be substantially elaborated and quantified as far as possible to justify the amount of the grant. A reminder here that time management is of the essence. Don't miss the deadlines and do allow some buffer time for revisions!

During the study

During the early phase, one should prepare a comprehensive case report form to facilitate data collection. A well‐designed electronic database is essential for future data input and analysis. Don't forget about a proper informed consent form and procedures for all studies, and especially for randomized controlled trials involving medications or interventions. Ethics approval should be sought as soon as possible as the process can take quite some time. Wherever available, a dedicated research staff should be assigned to manage the logistics and databases (in the most ideal scenario, this should be covered by the aforementioned grant).

It is not uncommon that we do come across potential study cases every day, but they are often overlooked amidst our busy clinical schedule. Therefore, building up a ‘study mentality’ would be a positive habit to incorporate research into our daily routines. Always keep one's eyes open for opportunities!

It is important to bear in mind that conducting research is not all about excitement. It may take onemonths or even years to reach the endpoint. A lot of the time there may be long spells of rather dull documentation, recruitment and follow up of subjects but embracing these mundane tasks and executing them with clinical precision is the essence of a well‐run study. Problems and errors inevitably pop up and do embrace them proactively. Stay positive and enthusiastic at all times! Always feel free to discuss with your teammates and seniors for troubleshooting if problems arise.

After the study

Data analysis is the cornerstone of manuscript preparation. Be familiar with various statistical models and concepts. As mentioned before, conducting clinical studies is all about teamwork so don't be afraid to ask your mentors or friendly statisticians for advice. Try to formulate a plausible conclusion of your results before writing anything (Figure 2).

FIGURE 2.

Proposed schematic on the execution of a clinical study

One can consider submitting the preliminary results as an abstract in local or overseas conferences. Sharing your ideas through oral presentations and interacting with experts in the Q&A sessions would certainly widen your horizon. It's entirely possible that the questions asked by these experts would come up later in the review process when one submits a paper for publication so one should always take this opportunity to address important flaws and to enrich the content of your study. Be open‐minded to accept critiques and rejections. Failure is the mother of success!

Following that, one can consider starting to draft the manuscript. Subject to personal interest and scope of research, one can look out for calls from journals on ‘hot topics’. Matching your paper with a relevant high impact journal may be helpful for successful publication. Pay attention to the specific manuscript format and requirements of different journals during the submission process. If necessary, you may discuss with your mentor when preparing a cover letter and to suggest potential reviewers.

EXAMPLES

Listed here are several examples that highlight various aspects we have previously discussed on how to successfully publish in high impact journals. Having great mentors always makes life much easier for trainees and young fellows. The first example is a study that showed that positive hepatitis B core antibody was associated with cirrhosis and hepatocellular carcinoma in non‐alcoholic fatty liver disease and represents a more conventional approach to collaboration with a close and established partnership between two research institutes. ³ The following examples highlight the importance of choosing a hot and trending topic, namely COVID‐19, with one study trying to decipher the collateral effects of the infection on hospitalizations and clinical outcomes in GI and liver diseases ⁴ ; one reviewed the existing literature available at that time point to provide guidance for endoscopy during the pandemic ⁵ ; another was a research idea incubated and discussed on a social media platform, in this case, Twitter, which culminated in an international multicentre study on the impact of COVID‐19 on endoscopy trainees. ⁶ With the increasingly widespread use of social media in academia that can serve as forums for discussion and incubation of research ideas, these instances of #Twitter2Paper will likely become more commonplace in the near future. ⁷ Last but not the least, a more conventional form of participation in a randomized controlled trial at our combined endoscopy unit led by our chair professor of surgery, a world‐renowned expert in GI bleeding. As endoscopy fellows on the GI bleeding on call rota, we were tasked to assess, recruit and randomize suitable patients to urgent versus early endoscopy during our sleepless calls., ⁸ and it was very rewarding to see it being published in a high impact journal.

CONCLUSION

Initiating a study and hoping to see it published is always a daunting task. It is evident that teamwork is one of the main pillars to succeed in publishing in high‐impact journals. As a trainee, fellow or junior faculty, it is always important to learn the ropes of research methodology and conducting studies from mentors. Deliberately starting with simpler study designs such as retrospective case–control studies or using existing databases is one way to kick start clinical research, develop a research focus, and to get a grasp of the basics. However, sometimes even if all the boxes have been ticked, at the end of the day one's work may still get rejected but it is important to recognize that this is never the end of the road. A Chinese proverb says it best, ‘failure is the mother of success’. In the end, through perseverance, experience and developing a publication track record, one will progress through the levels of a research career: from being a beginner, to gaining competence and becoming an expert; exceptional individuals may even become champions for a cause and lead to a change in the way patients are managed, and ultimately become legends that inspire future generations of researchers. ⁹ To all the young fellows and budding researchers out there, good luck and good hunting!

CONFLICT OF INTERESTS

The authors have no conflicts of interest to declare.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.