Abstract
Within the Department of Medicine (DOM) in a large tertiary academic health care facility in midwestern United States, we have developed an educational offering that incorporates an academic writing program (AWP) blending the approaches of a writing accountability work group, a writing workshop, and didactic writing courses. The purpose of this AWP was to assist healthcare professionals (HCP) with their manuscript writing skills to enhance academic productivity. We report our evolving journey and experiences with this AWP. To date, it has been offered 3 times to 25 HCP over the course of 3 years. Among those responding to a post program follow up survey (N = 11), 8 (73%) indicated that they completed the project that they were working on during the AWP and went on to publish the manuscript (N = 5) or were in the process of submission (N = 2). Some indicated they has also gone on to present posters (N = 2) or were in the process of presenting posters (N = 2) or had received grants (N = 1) or were awaiting grant notice (N = 1). A number of attendees have continued to use and share the tools presented during the AWP. Based on input from attendees and increased requests for this AWP, this educational program has been deemed a success and expansion of this program is currently underway.
Keywords
Background
The development of academic writing skills is often assumed to be part of the training for many doctoral and post-graduate programs, when in fact they are not included.1 -4 Despite this assumption, publishing productivity has become a measure of faculty performance, annual evaluations, promotions, and tenure. 5 Due to this disconnect between training and academic reality, individual groups and institutions have made a concerted effort to address this deficit by providing additional training to professionals in academic writing skills. Programs focused on writing skills vary from writing accountability groups (WAGS), writing workshops, writing retreats, writing courses, to writing centers. All vary in the administration of the skill training, but all are similar in that these programs attempt to address the self-reported barriers to writing such as: getting started, time management, difficulty finishing due to lack of deadlines, competing priorities with clinical practice, and personal/family commitments.3,5 -7
WAGs3,5,8 usually include groups of people who are encouraged to schedule and protect time dedicated to writing. WAGs usually assume that the people enrolled know how to write but just need the dedicated time to write. In most WAGs, a facilitator will lay out the rules of the meeting in the first session of the group, and the participants spend the session, and subsequent session, writing, with no interruptions (cell phones, e-mail, and electronic health records) allowed. WAGs can be formal or informal and in-person or virtual. Individual WAG sessions are usually between 1 and 2 h each for an average of 6 sessions. WAGs can be composed of individuals with similar backgrounds (education/jobs) or interests (field of study). The number of attendees can also vary—some can be as small as 6 or as large as 50.5,9 Most WAGs report measure of success by the increase of time spent in writing. Skarupski et al, recently reported on the results from WAG groups held during orientation at a large Medical Institution. 10 When comparing writing habits from pre-WAG experience to post-WAG experience, they were able to demonstrate pre WAG, 36% reported writing once a week and 17% reported writing almost every day; while post WAG, 68% reported writing every day and 23% reported writing once a week. In addition, qualitatively, when asked to describe their WAG experience, participants consistently used descriptors such as “accountability,” “habit-formation,” and “social support.”
Writing Workshops can vary from a 1-day workshop 2 to workshops which are of shorter duration over several days (for, eg, 6 sessions of 2.5 h each over several days 6 ). The number of attendees in these workshops can also vary from 50 11 to 126. 6 When measuring success, Goyal et al 2 did a comparison of writing knowledge pre-post workshop experience and found that 20% to 70% of the clients had deficits in the principals of writing prior to attending the writing workshop; but post workshop, 88.3% found it to be very useful and 50% to 75% walked away with high awareness of how to publish.
An additional option is a Writing Retreat 7 which can function as a hybrid between a WAG and a workshop. Bell and Murray 7 described an example in which nurses attended an all-day retreat structured to focus solely on uninterrupted writing. This again assumes that the attendee has the skill to write but just needs the time to write.
We also have the standard approach of Narrative Writing Courses 12 or Systematic Teaching on writing 4 which consists of writing assignments and exchanging of papers to critique and read aloud to enhance clarity. This approach can be a combination of classroom instruction and writing workshop whereby the attendee receives coaching and mentoring to promote self-awareness and improve writing competencies. These sessions resulted in 83% with high satisfaction overall, 61% high satisfaction writing confidence, and 56% high satisfaction with writing skills. The key, as indicated by Remein et al 12 is to build and foster skills, and provide time, space and sense of peer support/community engagement.
The addition of a Writing Center 13 has been utilized when a professional writer/editor experienced in science and medical publications provides one-on-one consultation on a drop-in basis to faculty members. This was initially developed to provide individual consultations by a professional writer/editor with experience in science and medical publications. Among the clients, 54% were faculty members, and 95% of the clients indicated it helped them achieve their writing goals, with 99% indicating they would definitely recommend it to others. 13
Program Design and Implementation
This commentary is focused on the development and implementation of an Academic Writing Program (AWP) within a Destination Medical Center (DMC). A DMC refers to a specialized healthcare facility or network designed to attract patients from across the country or around the world for its exceptional medical care. These centers offer advanced treatments, cutting-edge technology, and highly specialized medical expertise in various fields. Patients often travel to these centers for complex surgeries, rare conditions, or advanced treatment options unavailable in their local hospitals. Within the Department of Internal Medicine (DOM) in this DMC in midwestern United States, we have developed an educational offering which blends the WAG, writing workshop and didactic (ie, classroom) elements referred to asthe AWP. Within this manuscript we report our evolving journey and experience with this AWP. To date, it has been offered 3 times to 25 healthcare professionals over 3 with continued requests for more sessions.
The attendees were selected as part of an award process within the DOM and each of the sessions were limited to small groups (5-10 attendees per group). Groups 1 and 2 each had 10 attendees from the outpatient health service, all physicians who received a research award requiring a manuscript for the final project outcome. Group 3 had 5 health care professionals (4 physicians and 1 physician assistant) from hospital internal medicine who applied for and were selected to participate in a writing program. All attendees were granted time to participate in the AWP. The AWPs took place over the course of 3 years (Group 1 in 2020 (N = 10), Group 2 in 2022 (N = 10), and Group 3 in 2023 (N = 5)). In all 3 groups, each of the AWP attendees had the goal of writing a manuscript but were at different writing skill levels. The writing skill level was never formally assessed and attendance to the AWP was voluntary.
The 3 groups for the AWP each consisted of a mix of male and female healthcare professionals both in general and specialty medical practice within a range of 5 to 10 per group. Each program included 5 to 10 virtual sessions, (using a mix of Zoom and Microsoft Teams for Group 1 and Microsoft Teams for Groups 2 and 3). Each of the 3 programs had interactive didactic presentations by the facilitator and guest speakers as well as interactive oral presentation by the attendees. All 3 programs had the same facilitator (ITC), rotating guest speakers (dependent on the topics presented) and a similar approach to the training. The basic topics discussed in all 3 programs included: the anatomy of a manuscript; how to conduct a literature search and tools used for said search; an introduction to reference managers and how to use said reference managers; a virtual tour of the institutional library, institutional resource availability, as well as location of said resources. Other topics were included at the request of the participants. Table 1 provides details of an example curriculum.
Example Curriculum.
What makes this AWP program unique is that it is ever evolving, and the curriculum and topics covered changes based on the interests of the attendees. Examples of topic covered included: introduction to Qualitative Analysis; how to use Redcap; the basics of study designs; the basic steps to research—from concept to publication; and how to conduct systematic reviews. Finally, all participants were required to continue writing their paper and presenting a different section of their paper to the rest of the group. The group was also tasked with providing feedback to their peers. As discussed within the group, the exercise of providing and receiving feedback on the writing was to understand the role of a reviewer and know how to react to review comments. Participants were required to present at least 1 section of their paper, and some presented more than 1 section. At the end of each program, participants were invited to connect with the facilitator for individual support as they continued to write and submit their manuscript. This program’s overarching goal was to provide practical support to the participants.
Current Status of the AWP
At the conclusion of the first 3 AWP groups, requests for more writing programs increased. This was the midpoint where a decision was made to review the past process and determine if any changes should be made to the program in structure, format, and/or outcomes. Toward this goal, an internal brief survey was developed by the writing program team consisting of questions concerning satisfaction, outcomes, and open-ended questions of what they liked the most and what they would like to see improve. The survey was sent electronically (using Qualtrics® 2024) to all 25 past participants over a 14-day period; with a total of 11 (44%) responding.
Among the 11 responders, most reported that the program was worthwhile (N = 10, 91%), and valuable in advancing their writing skills (N = 9, 82%). The majority (N = 8, 73%) of responders indicated that they completed the projects they were working on during the writing program. The reported outcomes included manuscripts (published (n = 5)/submitted (n = 2)), posters (presented (n = 3)/submitted (n = 1)), and intramural/extramural grants (received (n = 1)/submitted (n = 2). While 3 responders indicated achieving their goal within 6 months of completing the writing program, 5 indicated they achieved their goal within 6 to 12 months of completing the program. Among the 3 who did not achieve their goal (specific reasons not disclosed in this report), they indicated that a delay caused a cascade effect, including loss of protected research time. All 3 noted that their writing efforts were continuing their individual projects. Finally, 1 of the 11 responders did indicate a meaningful research collaboration resulted from program participation.
When participants were asked what they liked about the writing program positive comments included: sharing of ideas, commitment, accountability, mastery of specific skills, helpful tips, meeting others, focus, and delivery of practical information. When asked for areas for improvement, participants reported needing breaks (group 3 had 2-h sessions, with suggestions that 1-h would be optimal), 1 participant had engaged in a WAG in the past and indicated that in comparison this program was more productive; another felt that a group of people with similar interests would have been better; and another felt that they needed more sessions (longer engagement).
Input from participants and requests for development of future program strongly suggest that this writing program is not only a success but a much-needed resource within our institution. We evaluated WAG and began with that approach in mind; believing that all our health professionals had the skills to write and just needed the protected time to do so. As the ground rules were being set by the facilitator during the first session of the first group—which was then called “WAG,” the facilitator took the initiative to ask the attendees for their input. Perhaps it was the tone set during this session, or it was how the question was worded, but regardless of how it happened, the participants were open and honest and asked for some basic instructions on manuscript writing. This allowed the WAG approach to evolve and morph into a unique writing program all on its own where the participants designated the writing needs of the group. The direction writing has evolved at our institution is the needs of the health care professional is focused onto the practical aspect of writing. In addition, each of our Writing Groups are unique into and onto themselves, making it difficult to compare them since each of the group had similarities but at the same time had differences related to the preferences and input from the individual attendees. In Group 1, the participants were focused more on the basics of manuscripts writing, and sharing their work; Group 2, were interested in a variety of topics including study designs and statistical approaches and sharing their writing; and Group 3 were more focused on literature searches, references manager utilization, and reviewing samples of cover letters and reviewer samples and responses, as well as sharing samples of their writing. For this program to continue to be successful the facilitator(s) need to be adaptable to the needs of the attendees. The concept of educational programs evolving as a response to students’ needs is nothing new. Another writing program reported the development of a writing center where writing consultations were provided by a writer/editor to faculty member. 13 In this program, 95% of the users reported that the program helped them achieve their writing goal and 99% indicated they would recommend it to others. But the center did evolve to expand from individual consultations to workshops and even writing cafés with retreats, writing courses, and writing groups in their future.
Discussion
The key element of the WAGs is to remove stress associated with writing while building confidence in a judgement free group setting. 8 This is a key element that we tried to keep within our own writing groups. There were other important aspects including: keeping the groups small, setting the rules up front, such as the sessions will not be recorded, informal structure of the presentations allowing participants to chime in with responses to questions, allowing participants to set parts of the curriculum, all contribute to the bonding of and building of trust among the group, and reminding the participants that the purpose of the writing group was to focus on the practical by sharing past experiences and examples.
In a 1-day workshop in India, 120 professionals were surveyed prior and post workshop attendance. It was found that 20% to 70% of the attendees reported some deficit in basic principles of writing prior to the workshop, and post workshop and 88.3% found it useful. Between 50% and 75% had a high awareness of how to publish and wanted more sessions on how to present the statistical outcomes. In addition, attendees wanted more time on how to evaluate manuscripts and their ask was to expand the workshop from 1- to 2-day. These are similar questions to our own experiences where a major goal of our participants was to learn how to evaluate and review manuscripts to not only improve their own writing but to eventually become a journal reviewer. Participants often asked to view manuscripts which received peer reviewed responses with the goal of by improving their communication skills when resubmitting articles.
Contributions of writing groups have included but not limited to adopting daily writing practices (whether 15 min or an hour), increased accountability, ease of collaboration (by facilitating communications), informal mentoring, increased confidence in writing, peer support and friendly pressure to write through attendee comraderies, developing disciplined writing habits, improvement of writing skills, building a community and receiving needed support and needed motivation and encouragement. 5 Because writing groups help motivate, promote accountability for writing, and develop regular writing habits, it has been recommended they be offered to all new hires early in their academic careers. 5 Whereas this has not been formally adopted yet within our institution, we have observed that many of the 25 past attendees were early in their careers as are the attendees in programs scheduled to start in the next 6 months.
One of the limitations of the current study was that it is based on 3 sets of completed sessions of a writing program comprised of a total of 25 health care professionals over a 3-year period. Each program was individualized to the participants with each program having some similar elements, at the same time they had unique elements which makes comparison between the programs a bit of a challenge. In addition, attendance was not consistent among all sessions or groups. Due to the patient care and prioritization of their clinical calendar attendance was never a guarantee among participants. For each group there was a small group of participants (4-5) who consistently made each of the sessions, while others requested access to recorded videos of the presentations (it should be noted that the participant’s presentation of their own work was not recorded to promote confidentiality). In addition, the program did not exclude individuals based on prior writing knowledge or experience, therefore attendees had varied experiences with writing; but the program did not dictate to the participants which type of manuscript they had to be working on to be eligible for attendance. In addition, presentation of the participants work was voluntary as well as the section of the manuscript they chose to share with the group. Some individuals were very enthusiastic to present and share their work, even asking for repeat presentations and yet others delayed presenting as much as possible. Finally, it should be noted that the program was not designed to follow a research or education model. It was a collaborative peer offering of academic writing and as such it did not include formal/timely pre-post evaluation comparison data.
The program had many strengths including they were highly popular and requests for additional programs have been increasing and expanding to not just focus on early career health professionals. This has been noted in the number of one-on-one sessions provided as add-ons by the facilitator and increasing number of requests for lists of resources used within each writing group—including recorded presentations and tutorials. The key to these writing groups is to be non-judgmental, if you’re the facilitator or faculty, opening yourself up to your attendees by sharing your own personal journey, your mistakes, your successes, being humble, and being honest.
Based on input from the satisfaction survey and requests for further writing programs, the writing program has been deemed a success, but, as with all good things, it is important to note that it is a delicate balance in the evolution of improvement. The key to this program is to be open to the input of the group attendees. As each new group begins, we need to maintain the trust of the group, ask for their input on what their needs are for that group and respond to those needs.
Footnotes
Acknowledgements
The study team is grateful to Larry J. Prokop, M.L.I.S., Reference Librarian, Mayo Clinic Libraries, Mayo Clinic, Rochester, for diligence and assistance with the literature searches. We would also like to thank Jennifer A Ferguson, M.S., for managing the survey deployment and data collection. Finally, a special thanks to all workshop attendees, without their participation, this work would not have been possible.
Author Contributions
All the authors participated in the program concept and design, survey analysis and interpretation of data, drafting and revising the paper, and have seen and approved the definitive version of the manuscript.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Facilitator (ITC) time for the writing groups was supported in part by the Department of Medicine Research Hub, Mayo Clinic Rochester, MN. SBD time was supported by the National Institute on Minority Health and Health Disparities (NIH K23 MD016230).
Ethics and Consent to Participate
This program was a practice improvement initiative. Institutional Review Board review was not needed.
Availability of Data and Materials
All data supporting the study findings are contained within this manuscript.