Writing for publication in medical education: The benefits of a faculty development workshop and peer writing group

Abstract

Background: Although educational innovations in medical education are increasing in number, many educators do not submit their ideas for publication.

Aims: The goal of this initiative was to assist faculty members write about their educational innovations.

Method: Twenty-four faculty members participated in this intervention, which consisted of a half-day workshop, three peer writing groups, and independent study. We assessed the impact of this intervention through post-workshop evaluations, a one-year follow-up questionnaire, tracking of manuscript submissions, and an analysis of curriculum vitae.

Results: The workshop evaluations and one-year follow-up demonstrated that participants valued the workshop small groups, self-instructional workbook, and peer support and feedback provided by the peer writing groups. One year later, nine participants submitted a total of 14 manuscripts, 11 of which were accepted for publication. In addition, 10 participants presented a total of 38 abstracts at educational meetings. Five years later, we reviewed the curriculum vitae of all participants who had published or presented their educational innovation. Although the total number of publications remained the same, the number of educationally-related publications and presentations at scientific meetings increased considerably.

Conclusions: A faculty development workshop and peer writing group can facilitate writing productivity and presentations of scholarly work in medical education.

Introduction

A well-known American sportswriter has said, ‘Writing is easy. All you have to do is sit down at a typewriter and open a vein’ (Smith 1980). Many medical educators will identify with the pain of writing implied in this quote. Although innovations in medical education are increasing in number, as are the venues in which they can be described and disseminated (Prideaux 1999), many educators are not submitting their educational innovations for publication, and many good ideas are not being shared. As Simpson et al. (2000) have observed: ‘although writing continues to be one of the main ways in which we share our innovations in medical education, the majority of medical educators are reluctant to write’. Possible explanations for this reluctance include a lack of time, a lack of self-confidence, difficulty writing, or trouble selecting a topic of wide appeal (Boice & Jones 1984; Huston 1998).

Recognizing that many colleagues in our local medical education community are reluctant to put pen to paper to publish the results of their educational endeavors, we embarked upon a formal initiative designed to encourage clinical teachers and program directors to write about their educational innovations. This intervention consisted of three components: a half-day workshop on writing for publication in medical education; a series of three follow-up peer writing groups, for all workshop participants; and independent study time, guided by a self-instructional workbook. We regarded curriculum design and reform, new methods of teaching and learning, and novel approaches to evaluation as educational innovations worthy of publication.

Table

Practice points
•Writing groups, designed to support and assist the writing process, may help to overcome writer's block and increase writing productivity.
•A faculty development workshop on Writing for Publication followed by three peer writing groups was valued by participants and helped them to publish and present their educational innovations.
•Research on writing productivity should examine the relationship between faculty development interventions, individual attitudes towards writing, and systems factors.
•Educators should look at ways of modifying environmental conditions to enhance writing productivity.

Although writing workshops and seminars have been described in the educational literature, few such initiatives have been designed for health care professionals (Hekelman et al. 1995). Moreover, the workshops that have been described focus primarily on principles of effective writing (Bordage 1989; Cormack 1994) and not on writing about innovations in health care education. It has also been noted that workshops alone may not bring about the desired change, and the added value of writing groups, designed to support and assist the writing process, has been highlighted by Fassinger et al. (1992) and Bryan (1996). However, only one such initiative has been described in the medical literature (Grzybowski et al. 2003). We therefore chose to combine a workshop with peer writing groups, and to assess the impact and viability of this approach to increasing writing productivity.

Methods

Faculty development intervention

Faculty development workshop

We conducted a faculty development workshop, entitled ‘From Innovation to Publication’, in November 2002, as part of our ongoing faculty development program. Workshop faculty included the former editor of a major journal in medical education and faculty members from our institution who regularly publish in medical education journals.

The workshop began with a plenary session that focused on general principles of effective writing for publication in medical education as well as common venues for writing about innovations. Following the plenary, participants worked in small groups to: (1) identify educational innovations appropriate for publication; (2) review the steps required to write up an educational innovation; and (3) develop a plan to prepare a manuscript. This plan included areas for further work (e.g. literature review; evaluations of the innovation) and the draft of an abstract. We also gave participants a workbook, based on a self-instructional primer, Get It Published, (Marks & Jabbour 1999) to guide the writing of their innovation, as well as a number of additional resource materials (e.g. Bordage & Dawson 2003) and assistance with literature searches. At the end of the small group, we encouraged participants to complete an ‘action plan’ (reproduced in Figure 1) that was designed to facilitate the writing process.

Figure 1. Workshop ‘action plan’.

Peer writing groups

Following the workshop, we invited participants to attend a series of three two-hour peer writing groups, over a six-month time period. In our experience, workshop attendees often leave an educational activity keen to try something new, but when confronted by the reality of their work situation, they are unable to follow through with their intentions. The goals of our peer-writing groups, modeled after a similar experience in the Department of Family Medicine at the University of British Columbia (Grzybowski et al. 2003), were to help participants maintain their interest, work on specific sections of their manuscripts, with peer support and feedback, and discuss appropriate journals for publication. We structured the peer writing groups with the hope of helping participants overcome the challenges of working alone. As Huston (1998) has remarked: ‘educators can easily become discouraged or ‘blocked’ in the process of writing’. A solitary pursuit of publication heightens the risk of writer's block.

Independent study

In addition to requiring participation in the workshop and peer-writing groups, we encouraged participants to engage in independent study, using the self-instructional workbook and additional resource materials to guide their writing process. The workbook was designed to help individuals choose an educational innovation for publication and describe the initiative by responding to seven key questions: What did you do? Why did you do what you did? What have others done? In what ways was your program innovative? How was your program evaluated? What did you find? What lessons did you learn?

Subjects

We invited all undergraduate and postgraduate program directors and course coordinators, all of whom were responsible for implementing educational programs in the Faculty of Medicine, to participate in this activity. Twenty-four faculty members, representing eight different disciplines (Geriatrics; Internal Medicine, Pediatrics, Physical Therapy, Psychiatry, Obstetrics and Gynecology, Occupational Therapy, and Surgery) registered for the workshop. Of these twenty-four, twenty participated in the peer writing groups; three chose not to participate because of competing priorities and one withdrew because of illness.

Program evaluation

We assessed the impact of this intervention in several ways. Prior to the workshop, participants completed a brief, open-ended questionnaire describing their previous writing experiences as well as their goals for this faculty development activity. Immediately after the workshop, they completed a written evaluation that assessed their perceptions of the workshop's format and usefulness. In particular, we asked participants to numerically rate each workshop component, provide narrative comments on each component, describe what was ‘most’ and ‘least’ helpful about the workshop, and indicate whether they would recommend the workshop to their colleagues. We also invited them to submit their detailed action plan, for follow-up and monitoring purposes. One year later, we asked all participants to complete an open-ended questionnaire to assess their perceptions of the usefulness of each component of the intervention (i.e. the workshop, the peer-writing group, the independent workbook, the literature searches) and to report on what they had accomplished as a result of this initiative. Five years later, we asked all participants who had published or presented their educational innovation to submit their curriculum vitae for review. To document group process and progress, the workshop facilitators kept field notes during the workshop and peer writing groups.

Results

Participant profile

Responses to the pre-workshop questionnaire indicated that all 24 participants had had some experience in writing, albeit mostly in the clinical and basic science literature, and all came to the workshop with a particular writing goal in mind. Fifty percent of the participants came to the workshop with the express purpose of writing an article for publication, 20% wanted to develop an educational project, and 30% wanted to prepare an abstract for an educational meeting. Other important goals included: learning what journal editors look for; identifying venues for publication; and structuring an educational article. Participants also reported that their main barriers to writing (prior to the workshop) included a lack of experience in writing about educational topics, a lack of time to write, and discomfort with the writing process.

Immediate post-workshop evaluation

The immediate post-workshop evaluation showed that the workshop was highly rated (an average of 4.4 on a 5-point scale), and that participants appreciated both the plenary and the small group discussions. In particular, they valued the opportunity to discuss venues for publication, the workbook that outlined the key features of a manuscript, and the ‘action plan’ that guided their writing process.

One-year follow-up

Assessment of the workshop

One year after the workshop, participants once again rated the workshop as very helpful (4.2 on a 5-point scale) and commented on the value of the small groups, the workbook that guided the writing process, and the ‘action plan’. Moreover, many reported that they had used the workbook as a guide for preparing a manuscript as well as a research grant submission, abstract, or other education-related publication. The value of the small groups was also highlighted, as exemplified in the following comment.

The most helpful part of the faculty development workshop was that it brought together a group of experts who instilled zest and enthusiasm towards writing projects.

Assessment of peer writing groups

Twelve of the 20 participants (60%) who participated in the peer writing groups attended at least two of the three sessions. Lack of time and competing responsibilities were cited as major reasons for non-participation. Those who regularly attended the meetings highly valued the process. In particular, they appreciated the peer support and feedback, the group dynamics and camaraderie, and the reinforcement of self-imposed deadlines, as illustrated by the following representative comments.

The workshop signaled me to publish in medical education. The peer writing group pushed me to re-develop my project in a much better way and I wish it would continue!

The peer writing group helped me to learn that I just need to write my ideas down.

I was scared to come if I did not have anything to show.

The facilitators’ field notes indicated that each peer writing group varied with respect to emphasis. In one group, the meetings were devoted to the process of writing. For the first meeting, members brought an abstract of their articles and spent most of their time reviewing the abstracts. The second and third meetings of that group focused on specific sections of the written manuscript and discussion of potential publication venues. The second group spent a significant portion of the time on the design and evaluation of an educational intervention, as most of the group members required help with research design. The facilitator's comments highlighted the value of articulating clear research questions, preparing an abstract early in the writing process, peer support, and externally imposed deadlines. The third group incorporated aspects of both other groups and noted the value of individual feedback, externally imposed deadlines, and peer support.

Overall program assessment

Figure 2 illustrates the participants’ assessments of each component of this faculty development intervention one year after the initial workshop. Twenty participants responded to the follow-up questionnaire; their responses indicated that they most valued the workshop small groups, the self-instructional workbook, and the individual support and consultation provided after the workshop and during the peer writing groups. All of the participants commented that their participation in the program was helpful in developing their manuscript.

Figure 2. One-year assessment of program components.

Unanticipated results

During the workshop and peer writing groups that followed, it became apparent that a number of participants needed help with the design and evaluation of their educational activities, and they valued the opportunity to hone their knowledge of research design in addition to developing their writing skills. As one small group facilitator noted:

We should re-name the peer writing group to a ‘peer design group’.

A participant reported a similar sentiment:

I thought I would learn about writing tips; instead, I am learning about research methods.

A second unexpected outcome was the number of requests we received for permission to circulate the workbook to participants’ colleagues, some of whom wanted to use it to prepare manuscripts and design research projects in medical education. Thirdly, we were asked to offer this workshop in different departments in the faculty of medicine and to deliver a similar workshop on designing research studies in medical education.

Manuscript status

The one-year follow-up questionnaires indicated that nine participants had submitted a total of 14 educational manuscripts, 11 of which had been accepted for publication; three individuals were working on a manuscript draft and one individual had successfully submitted a research grant proposal based on her work in the peer writing group. Ten participants had presented a total of 38 abstracts related to their innovation at a scientific meeting. Sample manuscript titles included: Mentoring: A Legacy for the Future; Games as Teaching Tools in Surgical Residency; Visual Spatial Perception and Residency Selection; Innovative Web-Based Learning for Pediatric Intensive Care; Integrating Online Lectures into the First-Year Curriculum. Overall, 16 participants (80%) had submitted either a manuscript for publication or an abstract for presentation.

Five-year follow-up

Publication and presentation success

Five years after the initial workshop, we requested curriculum vitae (CV) from the 16 individuals who had submitted a manuscript for publication or an abstract for presentation. We received 14 curriculum vitae (88%). To gauge the impact of this faculty development intervention, we arbitrarily concentrated on the reported publications and presentations, five years before and five years after the innovation, assuming that any impact would be reflected in the breakdown of publications and podium presentations. The results of this CV review, summarized in Table 1, suggest that our intervention had a positive impact. Although the 14 respondents published the same number of articles following the intervention, the post-intervention activity in educational publications and presentations at scientific meetings increased considerably.

Table 1.  CV analysis of publications and presentations before and after the intervention in 2002 (1997–2007)

	Publications		Presentations
	All publications	MED ED publications	All presentations	MED ED presentations
Pre-intervention	85	9 (9%)	111	14 (13%)
Post-intervention	85	26 (30%)	177	90 (50%)

Discussion

The results of this intervention suggest that a faculty development program, consisting of a workshop, a series of peer writing groups, and independent study, can help to promote scholarly writing among faculty members. One year after the intervention, more than half of the participants had either submitted a manuscript for publication or used the skills learned to develop an abstract for presentation at a scientific meeting. Five years later, there was a notable increase in educationally-related publications and presentations. In many ways, our goal of encouraging faculty members to disseminate their educational innovations was met.

Participant feedback also suggested that the workshop small groups, peer writing group meetings, and workbook were the most helpful components of this intervention. In addition, both participant and facilitator feedback identified the value of peer support and feedback. Not surprisingly, time for writing was the major impediment to success.

Although time constraints were identified as the major impediment to success in both this intervention and that of Hekelman et al. (1995), a survey by Boice & Jones (1984) revealed that highly productive authors had no more free time than less productive authors, and that individual as well as systems factors are key. As Hekelman et al. (1995) have said, ‘writing consumes a great deal of time’. Future research on writing productivity should therefore examine the relationship between faculty development interventions such as this one and individual attitudes towards writing, writing behaviors, and systems factors (e.g. the role of ‘protected time; availability of peer coaches; administrative support; and sabbatical leaves). It would also be helpful to explore ways of modifying environmental conditions that can enhance faculty members’ writing productivity.

The value of a supportive environment has been noted by several authors (Fassinger et al. 1992; Bryan 1996; Grzybowski et al. 2003). It appears that peer writing groups and the motivation inherent to working with others can play an important role in helping faculty members to define a writing project, complete unfinished work, and find the most appropriate venue for publication. In our study, peer writing groups were used to help program directors and course coordinators to focus on the publication of their educational innovations. Similar groups could also be used to help faculty members write up their clinical and research studies.

This study has several limitations. Only a select group of faculty members attended both the workshop and the peer writing group meetings. Moreover, we did not have a control group and we do not know whether the participants would have been equally successful without this intervention. However, the participants’ publication ‘success’ matches that reported elsewhere (Bryan 1996; Grzybowski et al. 2003), and the increase in scholarly work in medical education was impressive.

In his seminal work on the diffusion of innovations, Rogers (1995) highlighted the need to examine unanticipated results or consequences. This observation is particularly relevant in our context as we had not expected that participants would value assistance with research design as highly as they did help with writing. We were also encouraged by the number of abstracts presented at medical education meetings, the perceived usefulness of the independent study guide, and the observation that participants were able to transfer ‘lessons learned’ to other contexts.

Given the importance of scholarship in medical education, and the role of writing in disseminating educational innovations and interventions, faculty development programs designed to enhance writing should be widely implemented and evaluated. This study was one of the first to critically examine and tease apart the components of a faculty development intervention in this area, to include both a workshop and peer writing group, and to emphasize the importance of publishing innovations in medical education.

Acknowledgements

We gratefully acknowledge the Royal College of Physicians and Surgeons of Canada for granting a Faculty Development Award to support this innovation. We would also like to acknowledge Meridith Marks and Mona Jabbour from the University of Ottawa for allowing us to adapt their self-instructional primer, Get It Published, to our setting, and Maureen Leaman for administrative support. Finally, this paper would not have been written without the input and productivity of the individuals who participated in this program.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Additional information

Notes on contributors

Yvonne Steinert

YVONNE STEINERT, PhD, clinical psychologist and Professor of Family Medicine, is Associate Dean for Faculty Development and Director of the Centre for Medical Education (at McGill University).

Peter J. McLeod

PETER MCLEOD, MD, Professor of Medicine and Pharmacology, is Core Faculty Member at the Centre for Medical Education.

Stephen Liben

STEPHEN LIBEN, MD, Associate Professor of Pediatrics, is Director of Pediatric Palliative Care and former member of the Centre for Medical Education.

Linda Snell

LINDA SNELL, MD, Professor of Medicine, is Core Faculty Member at the Centre for Medical Education.

Yvonne Steinert

YVONNE STEINERT, PhD, clinical psychologist and Professor of Family Medicine, is Associate Dean for Faculty Development and Director of the Centre for Medical Education (at McGill University).

Peter J. McLeod

PETER MCLEOD, MD, Professor of Medicine and Pharmacology, is Core Faculty Member at the Centre for Medical Education.

Stephen Liben

STEPHEN LIBEN, MD, Associate Professor of Pediatrics, is Director of Pediatric Palliative Care and former member of the Centre for Medical Education.

Linda Snell

LINDA SNELL, MD, Professor of Medicine, is Core Faculty Member at the Centre for Medical Education.