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Volume 29 Number 2 / Summer 2014

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SCIENCE SERIES

Introduction to the Nervous System, Part 2: The Autonomic

Nervous System and the Central Nervous System

� Agnella Izzo Matic

COMMONPLACES

My Little Black Book of Texts for Teaching Medical Writing

� Lora Arduser

AROUND THE CAREER BLOCK

Not for the Fainthearted: Growth of Performance

Improvement CME Presents Challenges, Opportunities for

Medical Writers

� Don Harting

2014 AMWA ANNUAL CONFERENCE PREVIEW

Shake, Rattle, and Write in Memphis � Lori Alexander

2014 SWANBERG AWARD

� J. Patrick Barron

PRACTICAL MATTERS

Soft Skills: The Critical Accompaniment to

Technical Skills

� Kelleen Flaherty

MELNICK ON WRITING

Spice Up Your Lead: Get the Lead Out � Arnold Melnick

FREELANCE FORUM

� Brian Bass, Lori De Milto, Debra Gordon, and Elizabeth L. Smith

How Do You Keep Track of Business Expenses for

Tax Purposes?

Tips for Tracking Time

Tips for Creating Job Numbers

SOCIAL MEDIA

Five Social Media Gurus to Follow � Cynthia L. Kryder

TECH TALK

Password Management: Staying Safe and Sane

� Laura Mizoue

Tech Notes: Wired Magazine Study

� Jeanne McAdara-Berkowitz

Contents

V29 N2

SUMMER

2014

Contents

EDITOR Victoria J. White, MA, ELS

EDITORIAL BOARD Peggy Boe, RN

Tracey Fine, MS, ELS

Randall Fritz, DVM, ELS

Douglas Haneline, PhD

Cynthia L. Kryder, MS, CCC-Sp

Peggy Robinson, ELS

Barbara Snyder, MA

Deb Whippen

SECTION EDITORS

Around the Career Block Hilary Graham, MA

Commonplaces Lora Arduser, PhD

Conference Coverage Amy Karon, DVM, MPH, MA

Find Michelle A. Kraft, MLS, AHIP

Media Reviews Evelyn B. Kelly, PhD

Practical Matters Julie Ravo

Regulatory Insights Peggy Boe, RN

Jennifer Grodberg, PhD, RAC (US)

Science Series Randall Fritz, DVM, ELS

Social Media Cynthia L. Kryder, MS, CCC-Sp

Tech Talk Jeanne McAdara-Berkowitz, PhD

REGULAR CONTRIBUTORS

Freelance Forum Brian Bass

Melissa L. Bogen, ELS

Sherri Bowen, MA, ELS

Lori De Milto, MJ

Cathryn Evans

Debra Gordon, MS

Donna Miceli

Phyllis Minick

Elizabeth L. Smith

In the Service of Good Writing Laurie Endicott Thomas, MA, ELS

Melnick on Writing Arnold Melnick, DO

EDITOR EMERITUS Lori Alexander, MTPW, ELS

EDITOR IN MEMORIAM Ronald J. Sanchez

2013–2014 PRESIDENT Brian Bass

EXECUTIVE DIRECTOR Susan Krug, CAE

GRAPHIC DESIGNER Amy Boches, biographics

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ext 127. All advertising is subject to acceptance by AMWA and should be for

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responsible for the content of advertising and does not endorse any advertiser or its

products or services.

SUBSCRIPTION: The AMWA Journal is published quarterly. Subscription is included

with AMWA membership. Nonmember subscriptions cost is $75 per year.

CONTACT: American Medical Writers Association, 30 West Gude Drive, #525,

Rockville, MD 20850-4347. Phone: (240) 238-0940; Fax: (301) 294-9006;

E-mail: [email protected].

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the CINAHL database, and the Cumulative Index of Journals in Education (CIJE).

The opinions expressed by authors contributing to the Journal do not necessarily

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contributors to the Journal.

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inform, and educate them. The Journal furthers dialog

among all members and communicates the purposes,

goals, advantages, and benets of the American Medical

Writers Association as a professional organization.

80 FIND

Making the Most of Google Scholar � Michelle A. Kraft

83 CALENDAR OF MEETINGS

84 SOUNDING BOARD

My Philosophy of Editing: Pruning and Nurturing

to Help Manuscripts Bloom

� Mary E. Knatterud

86 IN THE SERVICE OF GOOD WRITING

Colorless Green Ideas Sleep Furiously

� Laurie Endicott Thomas

88 MEDIA REVIEWS

Review of How the NIH Can Help You Get Funded. An

Insider's Guide to Grant Strategy

� Karen Potvin Klein

89 AMWA NEWS

Your AMWA at Work � Brian Bass

Slate of Candidates for 2014-2015 Election

Annual Financial Report, 2012-2013

� Christine F. Wogan

Quarterly Update on Certication

� Thomas Gegeny and Marianne Mallia

In Memoriam: Joseph H. Bloom

� Barbara C. Good

96 INSTRUCTIONS FOR CONTRIBUTORS

V29 N2 / 2014

Cover image courtesy of the National Institute on Aging, National

Institutes of Health, Department of Health and Human Services.

AMWA Journal / V29 N2 / 2014 / amwa.org 51

ABSTRACT

An overview of the healthy human nervous system is pre-

sented, covering some important anatomical and functional

characteristics, as well as clinical applications and diseases of

the nervous system. In the ﬁrst article of this two-part series,

we discussed the basics of nervous system communication,

sensory nervous systems, and motor neurophysiology. This

article will discuss the autonomic nervous system and the cen-

tral nervous system. Many body functions we are not routinely

aware of are controlled by our autonomic nervous system,

which is composed of the sympathetic system, the parasym-

pathetic system, and the enteric system. The neurons of the

autonomic system innervate gland cells, cardiac muscle,

and smooth muscle to regulate physiologic activities such as

sweating, blood pressure, and heart rate. The central nervous

system acts as the communication hub of the body, interpret-

ing incoming neural signals and, if necessary, dispatching

other neural signals to relevant areas of the body. Within one

functional area of the central nervous system, such as audi-

tory perception, there are several distinct, yet interconnected,

structures that carry out different roles to process the incom-

ing neural signals.

AUTONOMIC NERVOUS SYSTEM

Many body functions we are not routinely aware of are con-

trolled by our autonomic nervous system. The neurons of

the autonomic system innervate gland cells, cardiac muscle,

and smooth muscle to regulate physiologic functions such

as sweating, blood pressure, and heart rate. There are three

divisions of the autonomic nervous system: the sympathetic

system, the parasympathetic system, and the enteric system.

Sensory signals are relayed through autonomic neurons to a

higher processing center in the brain, which interprets the

signals and sends a corresponding neural signal to either

increase or decrease a certain function.

The sympathetic and parasympathetic systems act in

opposition to each other, as will be discussed below. The auto-

nomic nervous system is always functioning, and most of the

time a balance is achieved between the sympathetic and para-

sympathetic divisions regarding their inﬂuence on bodily func-

tions. At certain times of the day and for certain functions, one

division will have more inﬂuence than the other.

Sympathetic System

The phrase “ﬁght or ﬂight” is often used to summarize the

function of the sympathetic nervous system. Essentially, the

sympathetic nervous system acts to maximize the resources

used by the body when presented with a stressful or threaten-

ing situation. For instance, blood vessels constrict in less criti-

cal organs such as the skin and gastrointestinal tract to make

more blood available in muscles for exertion. The sympathetic

system also increases heart rate and heart contraction force

and relaxes and opens lung airways. At the same time that

these functions increase, less survival-critical functions such as

digestion decrease. Most sympathetic neurons release a neu-

rotransmitter called norepinephrine, which along with its close

relative epinephrine can bind to two types of receptors on

receptor organs: alpha and beta adrenergic receptors.

The neurons that control the sympathetic system arise pri-

marily from the spinal cord and ganglia (masses of neuron cell

bodies) that lie outside of the spinal cord. Many of the func-

tions inﬂuenced by the sympathetic system can be activated

individually and in a graded fashion. This is helpful when exer-

cising at the gym, so that your heart rate and breathing rate

increase, but your pupils don’t dilate and the hair on your skin

doesn’t stand on end as if ready for a ﬁght.

By Agnella Izzo Matic, PhD / Principal, AIM Biomedical, Evanston, IL

Introduction to the Nervous System, Part 2:

The Autonomic Nervous System and the

Central Nervous System

SCIENCE SERIES

feature

52 AMWA Journal / V29 N2 / 2014 / amwa.org

Parasympathetic System

The parasympathetic system counterbalances the sympa-

thetic system and puts the body into a “rest and digest” mode

to conserve energy. When the parasympathetic system is exert-

ing inﬂuence, there is an increase in salivation and secretion

of digestive enzymes and a decrease in heart rate and airway

diameter. The neurons that transmit information for the

parasympathetic system mostly originate in the brainstem,

although elimination functions are inﬂuenced by neurons

that originate in the lowest (sacral) portion of the spinal cord.

Almost all parasympathetic neurons release a neurotransmit-

ter called acetylcholine, which can bind to two types of recep-

tors on the effector organs: muscarinic receptors and nicotinic

receptors.

Humans can voluntarily control some of the parasympa-

thetic impulses that are received, most notably urination and

defecation. In contrast, there is very little voluntary control

over sympathetic impulses. Certain functions are inﬂuenced

by the sympathetic system but not by the parasympathetic

system, including sweating, blood vessel dilation, and release

of epinephrine by the adrenal medulla.

Clinical Applications

Many pharmaceuticals act on the autonomic nervous

system, with wide-ranging effects. Albuterol, used to dilate

airways in patients with asthma, binds to beta-adrenergic

receptors found in the sympathetic system. Atenolol, used

to reduce abnormally rapid heart rates, blocks the action

of the sympathetic system at beta-adrenergic receptors.

Pilocarpine, used to treat dry mouth from cancer treat-

ment, as well as glaucoma, binds to muscarinic receptors

in the parasympathetic system. Numerous other agents

have a direct or indirect effect on the autonomic nervous

system. Pharmaceuticals often have side effects that mani-

fest through the autonomic nervous system.

Enteric System

The third and least well-known division of the autonomic

nervous system is the enteric system, which is a local ner-

vous system for the digestive system. Although, as was just

discussed, the digestive system is under sympathetic and

parasympathetic control, the local enteric nervous system is

inﬂuential in how food is processed and can act independently

of the sympathetic or parasympathetic system. The enteric

system is composed of various networks of neurons located

within the walls of the digestive tract. The enteric neurons

allow digestive functions to continue without the input of sym-

pathetic or parasympathetic signals. These neurons respond

to changes in the local environment to control gastrointestinal

(GI) motility, ﬂuid retention, electrolyte exchange, and diges-

tive secretions. The enteric system has many connections with

the central nervous system, so that there is local and global

control of the digestive process.

CENTRAL NERVOUS SYSTEM

Think of the central nervous system (CNS) as the communica-

tion hub of the body: Neural signals arrive, are interpreted by

the CNS, and if necessary, other neural signals are dispatched

to relevant areas of the body. Within one functional area of the

CNS, such as auditory perception, several distinct yet inter-

connected structures carry out different roles to process the

incoming neural signals.

Spinal Cord

One of the most important functions of the spinal cord is to

serve as a relay station for neural signals passing between the

brain and peripheral neural structures. However, neural cir-

cuits that terminate in the spinal cord can also execute func-

tions such as normal walking movements and motor reﬂexes to

withdraw from painful stimuli without the inﬂuence of neural

signals from the brain. In cross-section, the organization of the

spinal cord is seen to be preserved throughout its length, with

white matter around the outside and gray matter on the inside.

The cell bodies of neurons make up the gray matter, which

roughly resembles a butterﬂy in a cross-sectional (horizontal)

view. Within the gray matter, the dorsal (toward the back) horn

of the spinal cord carries the cell bodies of somatosensory neu-

rons (eg, touch, pain) relaying information from the periphery.

The ventral (toward the belly) horn of the spinal cord is com-

posed of motor neurons that send signals out to muscles. The

lateral horn comprises autonomic neurons that connect to

internal organs. Signals enter and exit the spinal cord through

the roots of spinal nerves located between the vertebrae

(Figure 1). The dorsal and ventral roots of the spinal nerves

merge just outside the spine to form a whole spinal nerve that

contains sensory, motor, and autonomic neurons.

The white matter of the spinal cord largely carries the

axons of neurons within the spinal cord and is organized into

columns and tracts based on function. The dorsal columns

carry somatosensory information toward the brain. The lateral

columns contain nerves that transmit signals from the brain

(more speciﬁcally, the cortex) to the spinal motor neurons. The

ventral columns carry neural signals in both directions. Pain

and temperature information is carried from the periphery

to the brain; motor information is carried from several brain

structures to the spinal cord motor neurons.

AMWA Journal / V29 N2 / 2014 / amwa.org 53

Clinical Applications

Because the spinal cord contains neurons that control and

coordinate many physiologic functions, an injury to the

spinal cord can affect a variety of systems with a range of

severity. Most spinal cord injuries are caused by a sudden

blow to the spine that breaks the vertebrae. Some inju-

ries can heal completely and some result in permanent

paralysis. Spinal cord injuries are classiﬁed by the vertebral

level at which they occur, and this level dictates the likely

impairment(s) that will occur from the injury; for instance,

an injury in the sacral region of the spine will commonly

affect bowel and bladder function.

Brainstem

The brainstem is the physical juncture between the brain

and the spinal cord and is located at the base of the skull.

The brainstem is made up of the medulla, the pons, and the

midbrain, each of which plays a different role in the CNS.

Brainstem functions can be broadly categorized into three

groups: information throughway, cranial nerve functions, and

vital function control. The medulla is the section of the brain-

stem closest to the spinal cord, and it regulates vital physi-

ologic functions such as breathing rate, heart rate, and blood

vessel diameter. The medulla also acts as a crossing point for

many axons passing between the spinal cord and the contralat-

eral (opposite) side of the brain.

The pons is involved in motor control and conscious-

ness level, including sleep. The pons also acts as a major relay

point for information passing between multiple brain centers.

The midbrain serves as a throughway for motor nerve axons

that are traveling from the cerebral cortex to the spinal cord.

The midbrain also contains the superior and inferior colliculi,

which are collections of neurons that play critical roles in the

visual and auditory senses, respectively.

The brainstem also contains the axons and cell bodies of

many head and neck neurons that are involved in sensory and

motor functions. Most of the cranial motor and sensory nerves

enter the brainstem at the pons. These nerves include the

motor nerves that control facial expressions, eye movements,

and chewing. In this sense, the brainstem can be viewed as

an extension of the spinal cord, which houses axons and cell

bodies of sensory and motor neurons originating below the

neck. Because the brainstem plays a critical role in several basic

bodily functions and senses, any trauma to this region, includ-

ing stroke, can be extremely debilitating or life-threatening.

Limbic System

The limbic system has been frequently described as the “emo-

tional brain” because of the large part it plays in originating

and regulating our emotions and behavior. The limbic system

is not as anatomically discrete as other sections of the brain; it

is organized more by functional relationships and neural con-

nections. As a result, reports differ on which structures are

included in the limbic system.

If you imagine the brain as a sphere, the limbic system is

located toward the middle of this sphere. The hypothalamus

(Figure 2) is a very small structure that controls functions such

as body temperature, water regulation, and circadian rhythm.

It can also inﬂuence endocrine hormone release from the pitu-

itary gland. The hypothalamus is involved in regulating sexual

satisfaction, fear, and aggression.

The amygdala is another major portion of the limbic

system and is largely a behavior awareness area. It coordinates

behavior and autonomic responses to the external environ-

ment. Early research indicated that the amygdala is involved

with emotional responses to fear and anxiety. More recent

studies have linked the amygdala to attention and a general

ability to deﬁne a stimulus and evoke an appropriate response.

The amygdala also helps form memories of emotional events.

The hippocampus is most well-known for its role in learn-

ing and memory, although it also plays a role in understand-

Figure 1. The spinal cord within the vertebral column. Notice the

gray matter in the middle of the spinal cord, which is colored

black and resembles a buttery shape. Surrounding the gray

matter is the white matter, which is primarily composed of

neuron axons. The roots of spinal neurons enter and exit the

spinal cord through openings between adjacent bony vertebrae.

In this image, the ventral (belly) side of the spinal cord is facing

the viewer. The image is courtesy of the National Institute of Arthritis

and Musculoskeletal and Skin Diseases, National Institutes of Health,

Department of Health and Human Services.

Spinal cord

Nerve roots

Vertebra

Intervertebral

disk

54 AMWA Journal / V29 N2 / 2014 / amwa.org

ing the body’s spatial position. The hippocampus consolidates

short-term memories of experienced events into long-term

memories. When a lesion occurs in the hippocampus, a person

can’t form new long-term memories but can usually access

memories that were consolidated before lesion formation. The

hippocampus also aids with spatial memory and navigation,

allowing people to remember where they have been or how to

get somewhere.

Cerebellum

The cerebellum, meaning “little brain,” is a spherical structure

that is estimated to contain 50% of the total neurons in the

brain. The cerebellum plays a major role in coordinating move-

ment, but it cannot initiate motor function by itself. Fast move-

ments, such as running and typing, are smoothly executed

under the control of the cerebellum. The cerebellum inﬂuences

the timing of coordinated movements and makes corrections

to monitored motor signals. The cerebellum can do so because

it receives motor information about what should happen and

sensory information about what is happening and compares

the two inputs to see if they agree.

When muscle loads change, the cerebellum compensates

by changing the force of muscle contraction. The cerebellum

also relays information to the motor cortex to plan the next

movement in a sequence so that the movement is smoothly

executed. Motor learning happens in the cerebellum, both

learning new skills and learning from previous movement

errors.

Cerebral cortex

If we go back to our analogy of the brain as a sphere, the

cerebral cortex would correspond to the outer shell covering

the top approximately three-fourths of the sphere. However,

the surface of the cortex is not smooth but rather has folds,

called sulci, in which more than two-thirds of the cortical

surface resides.

The cerebral cortex is often referred to as “gray matter”

because of the gray color of the tissue, which is largely due to

the presence of neuron cell bodies. The functional portion of

the cortex is approximately 2 to 4 mm thick in humans, and

most of it is composed of six morphologically distinct layers

of neurons. The cortex is organized into right and left hemi-

spheres, which are divided by a longitudinal ﬁssure.

The cerebral cortex is often classiﬁed by physiologic func-

tion. For instance, there is an auditory cortex responsible for

perceiving sound, a somatosensory cortex responsible for

touch perception, a visual cortex responsible for seeing, and a

motor cortex responsible for executing voluntary movements.

Each cortical section is subdivided. The primary cortical area is

involved in the direct perception of a stimulus or in executing

a movement. The secondary cortical area (or associated area)

is tasked with interpreting the signals delivered to the primary

sensory cortex or, in the case of motor cortex, selecting the vol-

untary movements to execute.

In the somatosensory cortex, body areas that are more sen-

sitive to touch (eg, ﬁngers and lips) compose a larger portion

of the brain than body areas that are less touch sensitive. The

two hemispheres of the somatosensory cortex receive infor-

mation almost exclusively from the opposite side; ie, touch

information from the left hand will be transmitted to the right

somatosensory cortex. Neurons in the visual cortex are highly

activated by high-contrast edges (light-dark) in images, with

Figure 2. A rendering of an adult human brain within the skull.

The image shows a cross-sectional view through the middle of the

brain in the sagittal plane (parallel with the ssure that separates

the right and left hemispheres). Several major anatomical struc-

tures are labeled, including the brainstem, portions of the limbic

system (amygdala, hippocampus), the cerebellum, and the cere-

bral cortex. The image is courtesy of the National Institute on Aging,

National Institutes of Health, Department of Health and Human Services.

AMWA Journal / V29 N2 / 2014 / amwa.org 55

different neuron locations responding preferentially to differ-

ent orientation angles of the edge/bar. Stereo vision aids in

depth perception and is achieved by mixing the input from

both eyes into each hemisphere of the visual cortex.

Similar to the somatosensory and visual cortices, the audi-

tory cortex contains a topographical map corresponding to

different acoustic frequencies at different cortical locations.

Some areas of the auditory cortex are suited to process fre-

quencies found in speech, whereas others are specialized to

extract information about variations in amplitude (loudness)

or timing. The motor cortex receives inputs from the spinal

cord and brainstem on the contralateral side of the body. The

topographical organization of the motor cortex largely mirrors

that of the somatosensory cortex, with a larger representation

for areas with ﬁne movements, such as the hands and face. It

appears that the motor cortex acts to execute one functional

movement by a neural circuit, rather than each area of the

cortex corresponding directly to a single muscle.

In addition to well-deﬁned sensory and motor cortices,

there are many association areas of the cortex that receive and

process information from other cortical and subcortical struc-

tures. The association cortices process complex information,

compare information from different sensory cortices, extract

related information, and plan any necessary responses. For

instance, Wernicke’s area is associated with language compre-

hension, whereas a separate area, Broca’s area, is associated

with speech and language expression. (There are other cortical

areas involved to a lesser degree in language skills.)

Association area functions have been determined mostly

through lesion/deﬁcit studies in humans and animals. The

parietal association cortex is concerned with body awareness

and external stimuli that act on the body. The temporal asso-

ciation cortex aids in facial and complex image recognition

and is thought to participate in long-term memory. The frontal

association cortex, also known as the prefrontal area, is largely

responsible for personality expression and executive functions,

such as judgment, reasoning, and working memory.

Clinical Applications

The cortex is not a static entity, but rather has plasticity,

which is the ability to change and develop in response to

its environment and inputs. The cortex can be modiﬁed in

response to a change in sensory or motor system inputs

(increase or decrease). For instance, when a lesion on the

retina causes focal vision loss, the corresponding location

on the topographic visual cortex map will regain function

with inputs from areas neighboring the retinal lesion. Similar

changes to lesions have been seen in other sensory cortices.

CONCLUSION

The overview of the nervous system provides a brief look at the

complex communication and regulation that takes place in

humans. Although much is known about neuron function and

sensory systems, there is so much more that research has yet to

uncover.

Author disclosure: The author notes that she has no commercial associ-

ations that may pose a conﬂict of interest in relation to this article.

Author contact: [email protected]

GLOSSARY

ganglion (pl. ganglia) – Mass of neuron cell bodies.

gray matter – Tissue in the central nervous system that is

mostly composed of cell bodies and is gray

in color.

plasticity – Changes in synapses and neural circuits due

to changes in the neural environment or inputs.

sulcus (pl. sulci) – A fold on the outer surface of the

brain.

white matter – Tissue in the central nervous system that

is mostly composed of myelinated nerve ﬁbers and is

white in color.

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Neuropsychopharmacology – 5th Generation of Progress.

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Guyton AC, Hall JE. Textbook of Medical Physiology. 12th

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Kandel ER, Schwartz JH, Jessell TM, Siegelbaum SA,

Hudspeth AJ, eds. Principles of Neural Science. 5th ed.

New York, NY: McGraw-Hill; 2012.

Purves D, Augustine GJ, Fitzpatrick D, et al, eds.

Neuroscience. 5th ed. Sunderland, MA: Sinauer

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Speert D, ed. Brain Facts: A Primer on the Brain and

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Neuroscience; 2012.

teach a graduate class in science and medical writing in

the professional writing program at UC. The students

in our graduate degree program come from a variety of

backgrounds. Many of them know they want a career in writ-

ing or editing, but have not pinpointed a speciﬁc ﬁeld in

which they would like to work.

Most of our students go into workplace positions rather

than academic positions. My general goals for the class are to

1) develop their critical analysis skills to inform their writing

skills and 2) hone their writing skills. As such, I designed the

course so the students will learn to:

• Explaintheconventionsofscienticandmedicalwriting

• Producewritinginavarietyofformsspecictoscientic

and medical writing and for speciﬁc purposes and

audiences

• Evaluatethedifferencesbetweenonlineandprint

scientiﬁc and medical writing

• Analyzepopulardiscourseaboutscienceandhealth

• Deneanddiscussmajorissuesofethicsandhowthey

affect science and health writing

• Becomeadeptatresearchingmedicalandscientic

subjects

• Acquireabasicmedicalandsciencevocabulary

My list is the result of numerous years spent teach-

ing and studying medical communication as well as work-

ing with medical professionals to write and design texts for

patients and the general public. I don’t use all the texts in the

following list in a term; it represents the bank of resources,

my little black book if you will. Here I have divided resources

into the categories of critical analysis and production. This

division highlights how I approach the class: I ask the stu-

dents to critically think about the rhetorical implications of

medical, science, and health writing then to apply these

lessons to the production of such documents. Using princi-

ples from rhetoric, the art of effective or persuasive speaking

My Little Black Book of Texts for

Teaching Medical Writing

By Lora Arduser, PhD / Assistant Professor, Professional Writing, University of Cincinnati, OH

People who teach medical writing in colleges and univer-

sities and practitioners of medical writing share common

interests, knowledge, and practices, but we often lack the

opportunity to exchange ideas and share knowledge. This

new section is designed to be a space for doing just that. We

named the section “Commonplaces,” a word that can refer

to a place where writers collect ideas and information (a

commonplace book is an idea hundreds of years old) and a

community space such as a commons that can be used for

discussion.

Here is how “Commonplaces” will work. Each issue, you

will hear from a teacher/student or practitioner on a par-

ticular topic, and in subsequent issues, similar themes will

be addressed from a different perspective. In this issue, for

example, Lora Arduser, an assistant professor of professional

writing at the University of Cincinnati, will talk about a set

of key texts for students who take medical writing courses. In

upcoming issues, we expect to feature key resources that may

be emphasized in the ﬁeld. Other topics ahead may include

theories of empowerment and writing, designing shared deci-

sion-making tools; the role of the hospitalist in medical com-

munication; and audience analysis.

Our hope is that the dialogue between academics and

practitioners in these pages will cross what is often charac-

terized as a divide between theory and practice. In so doing,

we can open up the conversation about medical communi-

cation between people working in the industry and people

teaching in academic institutions.

We encourage you to e-mail us (JournalEditor

@amwa.

org) with ideas for upcoming topics and let us know if you

are interested in writing for the section. With your help, we

will try to keep it from being commonplace.

Commonplaces: A New Section of the AMWA Journal

CommonplaCes

56 AMWA Journal / V29 N2 / 2014 / amwa.org

or writing, can help future medical writers become strate-

gic communicators who can produce well-written and well-

designed documents and persuasively engage an audience.

Critical Lens Resources

Accommodating Science: The Rhetorical Life of Scientiﬁc

Facts. Journal Article.

Jeanne Fahnestock (1986). Written Communication,

Volume 3, pages 275–296.

Fahnestock investigates genres written for scientiﬁc audiences

versus those written for nonscientiﬁc audiences.

A Field of Expertise, the Organization, or Science Itself?

Scientists’ Perception of Representing Research in Public

Communication. Journal Article.

Maja Horst (2013) Science Communication, Volume 35,

page 758.

This article looks at the role of scientist as spokesperson, “rep-

resenting science as both ‘speaking on behalf of’ science and

symbolically ‘standing for’ science and its organizations.” The

author draws on literature from the ﬁeld of organizational

communication, a subﬁeld of communication studies that

analyzes the role of communication in organizational contexts,

to argue that science communication should be considered as

an activity linked with perceptions of identity and organiza-

tional culture.

Forms as Boundary Genres in Medicine, Science, and

Business. Journal Article.

Susan L. Popham (2005). Journal of Business and Technical

Communication, Volume 19, Issue 3, pages 279–303.

Popham’s article analyzes medical treatment forms as genres

to argue that medical forms represent a “commingling of the

business, science, and medical professions in ways that show

evidence of tension and conﬂict between the disciplines.”

Health and the Rhetoric of Medicine. Book.

Judy Z. Segal (2005). Carbondale: Southern Illinois University

Press.

Segal’s book uses rhetorical theory to investigate the persuasive

elements of clinical and public medical discourse.

Realms of Rhetoric in Health and Medicine. Journal Article.

Colleen Derkatch and Judy Segal (2005). University of Toronto

Medical Journal, Volume 83, pages 138–142.

Derkatch and Segal introduce rhetorical theory into the study

of health and medicine and suggest ways that a rhetorical per-

spective can offer insight into medical research and practice.

The authors argue that an awareness of rhetorical principles in

medicine can provide medical professionals with new perspec-

tives on familiar problems of human interaction in health care

contexts.

Rhetoric of Healthcare: Essays Toward a New Disciplinary

Inquiry. Book.

Barbara Heifferon and Stuart C. Brown, eds. (2008). Creskill,

NJ: Hampton Press.

This collection looks at the role of rhetoric in various health

care and medical discourses and examines what rhetoric can

contribute to the ﬁelds of medicine and health.

Women Will Get Cancer: Visual and Verbal Presence in a

Pharmaceutical Advertising Campaign About HPV.

Journal Article.

Jamie Landau (2011). Argumentation and Advocacy, Vol. 48,

pages 39–54.

This article discusses Merck’s 2006 “Tell Someone” direct-to-

consumer advertising campaign, which was created to educate

the public about the link between the human papillomavirus

and cervical cancer. The author uses the concepts of presence

and absence, which are verbal or visual strategies for making

persuasive arguments, to analyze two videos from this cam-

paign that aired across major US television networks.

Writing Resources

Style Guides

AMA Manual of Style: A Guide for Authors and Editors, 10th

Edition. Book.

Iverson C, Christiansen S, Flanagin A, et al. New York, NY:

Oxford University Press; 2007.

Publication Manual of the American Psychological

Association, 6th Edition. Book.

Washington, DC: American Psychological Association; 2009.

The CSE Manual for Authors, Editors, and Publishers, 8th

Edition. Book.

Council of Science Editors. Chicago, IL: University of Chicago

Press; 2014.

Reporting, Editing, and Publication of Scholarly Work in

Medical Journals. Web page.

International Committee of Medical Journal Editors.

www.icmje.org. Updated December 2013.

COMMONPLACES

AMWA Journal / V29 N2 / 2014 / amwa.org

Writing Guides

AMWA Toolkit for New Medical Writers. Web page.

www.amwa.org/toolkit_new_med_writers

The toolkit provides information on medical writing as a

career, opportunities in medical writing, getting started

in the ﬁeld, and other useful information.

CDC’s Guide to Writing for Social Media. Web page.

www.cdc.gov/socialmedia/tools/guidelines/pdf/

guidetowritingforsocialmedia.pdf

This CDC guide offers guidance on using social media for

promoting health messages. The guide focuses on Facebook,

Twitter, and text messages (short message service, or SMS).

CDC’s Health Communication Digest. Web page.

www.cdc.gov/healthcommunication/sciencedigest/

index.html

The CDC’s Health Communication Science Digest provides

access to recently published articles and reports relevant for

the public health communication community. Abstracts and

PDF copies of most articles are available through the digital

object identiﬁer (DOI) hyperlink included with each citation.

CDC’s Simply Put: A Guide to Creating Easy to Understand

Materials. Web page.

www.cdc.gov/healthliteracy/pdf/simply_put.pdf

Simply Put provides guidance for translating complicated sci-

entiﬁc and technical information into communication materi-

als general audiences can understand.

Creating Patient Education Materials. Web page.

BioMedical Library at University of Minnesota

Maintained by: Katherine Chew [email protected]

http://hsl.lib.umn.edu/biomed/help/creating-patient-

education-materials#toc20622

The page provides lists of many relevant articles, books,

videos, and illustrations.

A Field Guide for Science Writers: The Ofﬁcial Guide of the

National Association of Science Writers. Book.

Deborah Blum, Mary Knudson, and Robin Marantz Henig,

eds. (2006). New York, NY: Oxford University Press.

The guide presents material on effective science writing. The

book combines practical how-to advice about writing on

science and medical topics in general and covers a range of

workplaces students could ﬁnd themselves in.

Genres in Scientiﬁc and Technical Rhetoric. Journal Article.

Carolyn R. Miller and Jeanne Fahnestock (2013). Poroi:

An Interdisciplinary Journal of Rhetorical Analysis and

Invention, Volume 9, Issue 1.

Miller and Fahnestock discuss differences and difﬁculties with

deﬁning genres and their relevance to science and technology.

They provide an outline of the issues and questions.

Health Writer’s Handbook. Book.

Barbara Gastel (2004). Ames, IA: Blackwell Publishing.

The book is written for the new medical writer. It gives

guidance on selecting topics and gathering and analyzing

information, and provides an overview of ethical and legal

issues, and how to build a career in medical writing. I use

the ﬁrst section that includes resources for gathering

information and strategies for interviewing medical

professionals and patients.

The Illusion of Certainty and the Certainty of Illusion:

A Case Study of Misunderstandings in Scientiﬁc Articles.

Journal Article.

Tom Lang (2013). AMWA Journal, Volume 28, Issue 3,

pages 105–109.

Lang discusses “analytical editing,” which involves the critical-

thinking skills necessary to edit a scientiﬁc article. These skills

are questioning the assumptions, documentation, and impli-

cations of the research. To illustrate the analytical editing pro-

cess, Lang provides an example of a singe sentence as

a case study. He shows how the sentence raises important

issues about meaning, measurement, statistical analyses,

presentation of data, and interpretation of results.

Judging the Quality of Medical Literature . Journal Article.

Teresa L. Rogstad (2009). AMWA Journal, Volume 24, Issue 4,

pages 176–181.

Rogstad states that medical writers need to be able to evaluate

the quality of the articles they use as information sources or

choose to cite in their own writing.

COMMONPLACES

58 AMWA Journal / V29 N2 / 2014 / amwa.org

COMMONPLACES

Khan Academy Stats Tutorials. Web page.

www.khanacademy.org/math/probability/descriptive-

statistics

Most of my students have backgrounds in the humanities,

so I try to ﬁnd approachable resources on statistics. The

Khan Academy, a nonproﬁt organization that offers free

educational resources, has several videos about statistics.

Medical Tables, Graphics and Photographs: How They Work.

Journal Article.

Alan G. Gross (2007) Journal of Technical Writing and

Communication, Volume 37, Issue 4, pages 419–433.

The author’s examination of samples from four medical

journals—the Lancet, the New England Journal of Medicine,

JAMA: the Journal of the American Medical Association, and

the Journal of Laboratory and Clinical Medicine—reveals

that one-ﬁfth of the space of articles in medical science is

devoted to an average of three tables and three ﬂow charts,

graphs, or photographs. Noting the importance of visuals in

medical articles, Gross argues that we need to develop a

coherent vocabulary for talking about tables and visuals.

The Non-Designer’s Design Book.

Robin Williams (2008). Berkeley, CA: Peachpit Press.

All students in our program are required to take technol-

ogy and design courses, but students often take our medical

wiring course ﬁrst. Williams’ text covers the basic principles

of good design and can help the students when executing

assignments such as creating a website or brochure.

Nude Mice and Other Medical Writing Terms You Need to

Know. Book.

Cynthia L. Kryder (2009).

Nude Mice is a language resource for students with little or

no background in science and medicine.

Online FDA Regulations: Implications for Medical Writers.

Journal Article.

Rita C. Tomlin (2008), Technical Communication Quarterly,

Volume 17, Issue 3, pages 289–310.

Tomlin argues that the availability of online Food and Drug

Administration (FDA) regulations contributes to a change in

the organizational role of medical writers. This shift is from a

peripheral role to a central role. As such, Tomlin argues that

the curricula for medical writers should include instruction

in persuasion, collaboration, strategic and project manage-

ment, the drug development process, and the location and

interpretation of FDA regulations.

Occupational Handbook Description. Web page.

www.bls.gov/ooh/media-and-communication/technical-

writers.htm

Technical writers, also called technical communicators, pre-

pare instruction manuals, journal articles, and other sup-

porting documents to communicate complex and technical

information more easily. They also develop, gather, and dis-

seminate technical information among customers, designers,

and manufacturers.

PubMed Tutorial. Web page.

www.nlm.nih.gov/bsd/disted/pubmedtutorial/cover.html

To help students learn how to research medical and scientiﬁc

topics and publications, I ask them to complete the PubMed

tutorial. The tutorial teaches students about PubMed’s scope

and content and Medical Subject Headings (MeSH). It also

teaches them how to build a search, manage search results,

and save search strategies.

The Science Writers’ Everything You Need to Know to Pitch,

Publish, and Prosper in the Digital Age. Book.

Thomas Hayden and Michelle Nijhuis, eds. (2013).

Philadelphia, PA: Da Capo Press.

The book is an all-around good resource and touches on

topics that many other texts also cover, such as ethics and

how to ﬁnd article topics. I use the short chapter “By the

Numbers: Essential Statistics for Science Writers” to start our

class discussions on reading statistics.

AMWA Journal / V29 N2 / 2014 / amwa.org

20 Tips for Interpreting Scientiﬁc Claims. Web page.

www.nature.com/news/policy-twenty-tips-for-interpreting-

scientiﬁc-claims-1.14183

William J. Sutherland, David Spiegelhalter, and Mark

Burgman

This list will help nonscientists to critically assess informa-

tion provided by scientiﬁc resources. Items on this list include

issues of statistical power and the inherent imprecision of

measurement.

US Government Photos and Images. Web page.

www.usa.gov/Topics/Graphics.shtml - Health_and_Nutrition

For some of our class assignments, students are directed to

locate and use images. USA.gov has some resources that are in

the public domain or US government works and may be used

without permission or fee.

US Department of Health and Human Service’s Plain

Language: A Promising Strategy for Clearly Communicating

Health Information and Improving Health Literacy. Web page.

www.health.gov/communication/literacy/plainlanguage/

PlainLanguage.htm

This Web page discusses plain language and health literacy. It

also provides links to numerous other resources on the topics.

Writing in the Health Professions. Book.

Barbara A. Heifferon (2005). New York: Pearson Longman.

This textbook is aimed at medical professionals such as nurses,

but the chapters on audience analysis, ethics, and project

management are useful to professional writing students.

Writing Online Style Guide. Web page.

http://writingspaces.org/wwsg/title

The Writing Spaces Web Writing Style Guide was created as a

crowdsourcing project of Collaborvention 2011: A Computers

and Writing Unconference.

Writing Science in Plain English. Book.

Anne Greene (2013). Chicago, IL: University of Chicago Press.

The short guide (124 pages) offers 12 principles for writing

complex information based on readers’ needs. The principles

include understanding the importance of audience analysis,

the need to tell a story, and proper uses of the active and

passive voices.

Writing in the Sciences. Exploring Conventions in Scientiﬁc

Discourse. Book.

Ann M. Penrose and Steven B. Katz (2010). New York: Pearson.

I assign three chapters of this textbook: Science as a Social

Enterprise, Considering Ethics in Scientiﬁc Communication,

and Communicating with Public Audiences.

Author disclosure: The author notes that she has no commercial associ-

ations that may pose a conﬂict of interest in relation to this article.

Author contact: ar[email protected]

COMMONPLACES

60 AMWA Journal / V29 N2 / 2014 / amwa.org

AMWA Journal / V29 N2 / 2014 / amwa.org

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62 AMWA Journal / V29 N2 / 2014 / amwa.org

lexandra Howson, PhD, CCMEP, belongs to a rare

new breed of medical writers. Howson serves cli-

ents who provide physicians with the newest, most

complicated, and most expensive form of continuing medical

education (CME) today. Howson’s clients deliver instruction

via the performance improvement format, called PI-CME for

short. These highly customized learning projects often require

cooperation among half a dozen organizations, 2 or 3 years to

design and complete, and budgets of more than $1 million.

PI-CME is “a fairly complex beast,” Howson, an AMWA

member trained in medical sociology at the University of

Edinburgh, says in her soft Scottish accent. The many clinical

and research stakeholders involved, and the frequent require-

ment for institutional review board approval, make PI-CME “a

bit like doing a research project. It’s not for the fainthearted.”

After a slow start, PI-CME is ﬁnally gaining more accep-

tance nationwide as a learning format. The number of physi-

cians who participated in a PI-CME activity more than tripled

from 2011 to 2012 (Table 1). Although the more traditional live

meetings, self-paced Internet modules, and regularly sched-

uled events like hospital grand rounds remain far more pop-

ular, PI-CME now draws more physician participants than

Internet searching and learning activities, according to annual

ﬁgures published last year by the Accreditation Council for

Continuing Medical Education (ACCME).

Responding to criticism about the effectiveness of tradi-

tional CME, in 2005 the American Medical Association (AMA)

approved both PI-CME and Internet search as novel learn-

ing formats worthy of earning continuing education credits.

Around the same time, AMA ofﬁcials began to tout PI-CME,

in particular, as the most powerful way to not just educate

clinicians but also improve patient and community health

(Figure 1). Proponents even claimed PI-CME would become

“the core of the new CME.”

However, Internet search enjoyed

explosive growth from the start, drawing more than 50,000

physicians in its ﬁrst year, compared to only 3,000 for PI-CME.

Until about 2010, CME providers struggled to ﬁnd an audi-

ence for activities that use PI-CME’s unusual and highly struc-

tured format. The Internet searching and learning format

was much simpler—learners just needed to identify a rele-

vant practice-related question, ﬁnd the answer online from a

trusted source, apply the new knowledge to patient care, and

demonstrate what they had learned. There was no requirement

to demonstrate an improvement in patient care. PI-CME sets a

higher standard. Barriers to uptake among physicians included

a general lack of familiarity with the concept, challenges in

shifting from knowledge-based to performance-based out-

come measurements, and time constraints on both teachers

and learners. PI-CME also suffered from a reputation of being

too expensive for education companies to develop, per capita,

compared to other formats.

“It took the CME community awhile to warm up to this

conceptually and learn how to do it right,” explains Mila

Kostic, director of the Ofﬁce of Continuing Medical Education

within the Perelman School of Medicine at the University of

By Don Harting MA, ELS, CCMEP / Freelance medical writer, Downingtown, PA

Not for the Fainthearted:

Growth of Performance Improvement CME Presents Challenges,

Opportunities for Medical Writers

AROUND THE CAREER BLOCK

Year Internet Search PI-CME

2010 75,844 29,371

2011 92,114 44,275

2012 108,856 141,860

Table 1: Growth in Physician Participation

in CME Activities

Source: ACCME 2012 Annual Report

feature

AMWA Journal / V29 N2 / 2014 / amwa.org 63

Pennsylvania in Philadelphia. Attrition remains a common

problem, as physicians often start a PI-CME activity with the

best intentions, but then don’t ﬁnish. Time-consuming and

tedious data entry continues to be a key barrier to participa-

tion by physicians. Adds Kostic: “This has been a growth and

learning opportunity for all of us, as educators.”

GROWTH DRIVERS

Technically, nonphysicians may also participate in PI-CME,

but as a practical matter, few do: ACCME data from 2012 show

that physicians outnumber nonphysicians by a ratio of 15:1.

Diverse factors appear aligned to drive increased physician

participation in the future. Kostic, a fellow of the Alliance for

Continuing Education in the Health Professions (ACEHP),

predicts the ACCME’s 2013 annual report—to be released this

summer—will show continued growth. Major drivers include:

• Popularity among medical specialties. Of the eight catego-

ries of membership within the ACEHP, the medical specialty

category is where PI-CME enjoys the strongest foothold in

physician participation. Nearly 80% of physicians who took

part in PI-CME activities nationwide in 2012 did so through

nonproﬁt physician membership organizations, according

to ACCME data.

• Popularity among hospital executives. PI-CME seems a nat-

ural ﬁt within larger hospitals and groups of hospitals, where

the culture of continuous quality improvement already

has deep roots. According to ACCME data, 57% of the 631

PI-CME activities offered nationwide last year were offered

by hospitals and health care delivery systems.

• Federal mandates. Beginning in 2015, the Centers for

Medicare and Medicaid Services’ Physician Quality

Reporting System will impose penalties for nonreporting

of performance data. Meanwhile, the Affordable Care Act

requires health plans and insurance issuers to show how

health outcomes are being improved in several ways, includ-

ing quality indices. These are the same types of quality data

used to drive and evaluate PI-CME activities.

• Electronic medical records (EMRs). Used properly, these

can be a powerful resource for an intervention that uses the

PI-CME format. Every EMR system requires creation of a

database, and once the database exists, it can be searched to

inform physicians how their patients are doing on many out-

come variables. These patient care data can then be used to

set a baseline, plan an intervention, and measure the results.

These three steps are common to all PI-CME activities.

• Publications in the medical literature. Outcomes data from

performance improvement initiatives were previously lim-

ited mostly to nonmedical journals; for example, a PI-CME

study of improved diabetes care at the Joslin Clinic was pub-

lished by an educational journal in 2011.

More recently,

however, medical specialty journals not just in diabetes,

but also in therapeutic areas as diverse as leukemia,

lung

cancer,

and osteoporosis

have begun accepting and pub-

lishing PI-CME outcomes reports. As physicians read these

articles in journals that cover their specialty areas, accep-

tance of the PI-CME format may continue to grow.

• Word of mouth. PI-CME does require signiﬁcant time and

effort upfront, but once this initial investment is made, phy-

sicians often begin to feel a sense of ownership. According

to Kostic, they ﬁnd the outcomes deeply rewarding because

they can actually see how their actions are improving

patient care.

ROLES FOR MEDICAL WRITERS

Gregory Liptak, president of a small, for-proﬁt company out-

Level 1: Participation

Level 7: Community Health

Level 6: Patient Health

Level 5: Performance

Level 4: Competence

Level 3: Learning

Level 2: Satisfaction

Performance

Improvement

CME

Traditional

CME

Figure 1. High-Level Outcomes. PI-CME is designed to produce

measurable improvements not just in physician competence, but

also patient outcomes and community health. This graphic, pro-

vided with permission from Intelligent Medical Decisions Inc, refers

to the now-familiar hierarchy of CME outcomes rst described in a

2009 landmark article by Moore et al.

64 AMWA Journal / V29 N2 / 2014 / amwa.org

side Philadelphia, started out as a medical writer about 8 years

ago, and worked on traditional CME projects. He worked his

way up to the position of director of medical education at a

medical education company before leaving to team up with

business partners to form Intelligent Medical Decisions, which

specializes in PI-CME.

Liptak vividly recalls a time about 5 years ago when he

faced a daunting PI-CME writing challenge in diabetes.

Physicians enrolled in the activity had been instructed to

review the records of their patients with diabetes and measure

their performance against a nationally approved standard for

quality care: hemoglobin A1C goal attainment rates. It became

Liptak’s job to write what was essentially a customized gap

analysis for each physician, indicating where his or her perfor-

mance met the standard, and where it fell short. These analy-

ses were prepared after all participating physicians had entered

their patients’ records into a database.

“For each section of the report that dealt with a diabetes

performance metric,” Liptak recalls, “the medical writer’s job

was to go into the guidelines, provide a very concise summary

that was highly relevant to that particular measure, and add

language to the visual display of data that showed the provider

that the current status was not within the guidelines and pro-

vide an explanation as to why.”

Today, while he no longer carries the title of medical writer,

Liptak frequently writes the grant proposals that make new

PI-CME projects possible. He also expects his next hire to be a

medical writer.

“Good writing is critical for these programs,” Liptak says.

“You need to be able to communicate at the front end about

what you are measuring, and on the back end, for publica-

tion.” Liptak advises medical writers who would like to work

on PI-CME projects to gain a working knowledge of the many

national organizations that develop and publish quality stan-

dards for medical practice.

Working from her home ofﬁce in the foothills of the

Cascade Mountains overlooking Seattle, Howson has devel-

oped a subspecialty: helping her clients prepare PI-CME out-

comes data for publication in peer-reviewed journals. She

advises freelance medical writers and editors who are starting

out in this complex ﬁeld to ask many questions at the outset,

as a way to gather detailed knowledge of the various stakehold-

ers involved and a clear vision of how they are meant to work

together.

Alexandra Howson’s advice to medical writers: Ask

many questions at the outset to form a clear vision

of how all the various stakeholders in a performance

improvement continuing medical education project

are supposed to work together.

[ ]

Stakeholders Involved in REMEDIES (Risk Evaluation

and Mitigation Strategies: An Employer-Driven CME

Initiative for Ecacy and Safety)

AMWA Journal / V29 N2 / 2014 / amwa.org 65

It is common for a PI-CME initiative to produce enormous

amounts of raw outcomes data, Howson says. The write-up

then begins to resemble a clinical study report, though on

a much smaller scale, and the medical writer’s job becomes

one of sifting through piles of documentation in search of a

compelling story angle.

“Someone with a keen eye, some time, and some

tenacity can help turn those data into a piece of gold,”

Howson says.

A former Boy Scout, Don Harting enjoys exploring the ever-

changing landscape of continuing education in the health

professions. He tweets daily using the handle @CME_Scout.

Author disclosure: The author notes that he has no commercial

associations that may pose a conﬂict of interest in relation to this

article.

Author contact: [email protected]

References

1. ACCME 2012 Annual Report. www.accme.org/news-publications/

publications/annual-report-data/accme-annual-report-2012.

Published July 25, 2013. Accessed May 9, 2014.

2. Kahn N, Bagley B, Tyler S. Performance Improvement CME:

Core of the New CME. Vol Spring. Chicago, IL: American Medical

Association; 2007.

3. Moore DE, Jr., Green JS, Gallis HA. Achieving desired results

and improved outcomes: integrating planning and assessment

throughout learning activities. J Contin Educ Health Prof. Winter

2009;29(1):1-15.

4. Brown JA, Beaser RS, Neighbours J, Shuman J. The integrated Joslin

performance improvement/CME program: a new paradigm for

better diabetes care. J Contin Educ Health Prof. 2011;31(1):57-63.

5. Stowell S, Baum HB, Berry CA, et al. Impact of performance-

improvement strategies on the clinical care and outcomes

of patients with type 2 diabetes. Clin Diabetes. January 2014

2014;32(1):18-25.

6. Sekeres MA, Stowell SA, Berry CA, Mencia WM, Dancy JN.

Improving the diagnosis and treatment of patients with

myelodysplastic syndromes through a performance improvement

initiative. Leuk Res. Apr 2013;37(4):422-426.

7. Hirsch FR, Jotte RM, Berry CA, Mencia WA, Stowell SA, Gardner AJ.

Quality of care of patients with non-small-cell lung cancer: a report

of a performance improvement initiative. Cancer Control. Jan 2014;

21(1):90-97.

8. Greenspan SL, Bilezikian JP, Watts NB, et al. A clinician performance

initiative to improve quality of care for patients with osteoporosis.

J Womens Health (Larchmt). Oct 2013;22(10):853-861.

EXAMPLES OF PERFORMANCE

IMPROVEMENT INITIATIVES

1. REMEDIES (Risk Evaluation and Mitigation

Strategies: An Employer-Driven CME Initiative

for Ecacy and Safety). This is a mixed-

methods educational program including live,

Web-based, interactive, and performance

improvement (PI) activities. Physicians who

complete the program may earn up to 24.5

continuing education credits, of which 20 come

from the PI component. In addition, learners

may earn a certicate of compliance with

FDA educational requirements for prescribing

extended-release opioid analgesics.

2. Performance Improvement Strategies in Multiple

Sclerosis. Now in its third year, this initiative

is designed to help health care professionals

assess their clinical practice methods according

to current evidence and expert consensus.

Physicians who complete the activity may earn

credit toward maintenance of certication

(MOC) requirements set by the American Board

of Psychiatry and Neurology and 20 continuing

education credits from the American Medical

Association (AMA).

3. Advanced Clinical Management of Diabetes

and Its Complications. Completed in 2012, this

PI program was designed to give physicians

the chance to assess their current practice by

submitting data on patients with diabetes and

receiving condential reports on how their

performance compared to quality standards

established by the American Diabetes

Association and the AMA. Participants could

earn up to 20 continuing education credits from

the AMA and help satisfy MOC requirements set

by the American Board of Internal Medicine.

66 AMWA Journal / V29 N2 / 2014 / amwa.org

By Lori Alexander, MTPW, ELS / 2013–2014 Annual Conference Administrator

Shake, Rattle, and Write in Memphis

Shake your medical communication blues, rattle your pen

(laptop?), and write your ticket for professional development

at the AMWA Annual Conference in Memphis! Whether you’re

a newbie or veteran medical communicator, you will gain valu-

able knowledge and skills at this year’s conference. And with

this year’s location, you’re bound to have more fun than ever

after conference hours.

The Wonder of the Conference Program

This year’s conference program offers open sessions on a wide

variety of topics, from the practical advice in “Put on Your

Own Oxygen Mask First: Getting (and Staying) Organized”

to an overview of the latest in medical science in “Organ on

a Chip and Other Exciting New Advances in Non-animal

Biotechnology.” Nearly 60 roundtables provide a similar range

of diverse topics for medical communicators at every career

level, from beginning to experienced. Twelve posters have been

accepted for display, with presenters from all over the coun-

try—and world. (Poster abstracts are planned for the September

issue of the Journal.)

Rounding out the program are three Intensive Seminars,

the session format that debuted last year. The goal of Intensive

Seminars is to provide a more robust learning experience in

a particular topic, especially one that is outside the expertise

of typical AMWA members. This year, the planned Intensive

Seminars focus on how to combine cognitive science and

common sense to make effective presentations; leading, man-

aging, and writing in a global virtual environment, with best

practices for effective virtual meetings; and strategies for creat-

ing online health content for readers with limited literacy that

is relevant, motivating, and actionable. Intensive Seminars are

2 hours and 45 minutes long (with a 15-minute break), are lim-

ited to 40 to 50 attendees, and cost $40.

You’re the Boss: Personalize Your Program

This year, it will be easier than ever to ﬁnd the events of most

2014 AMWA ANNUAL CONFERENCE PREVIEW

AMWA Journal / V29 N2 / 2014 / amwa.org 67

interest to you. We are again using tracks to categorize ses-

sions according to broad topics, such as freelance, regulatory

writing, social media/technology, etc, and this year workshops

have also been assigned to these tracks. We also have devel-

oped “Track Facts”—simple reference guides that include all

sessions within each track—not just open sessions and work-

shops, but roundtables and posters too! The new Track Facts,

coupled with the Schedule at a Glance, will help you create

your unique program quickly and easily. Track Facts will also

help you demonstrate the value of the annual conference to

your boss or to yourself, if you’re a freelance. Track Facts are

available on the AMWA website at www.amwa.org/events_

annual_conference.

The conference app will also be available in the fall to help

you manage our personal program in your mobile device.

You’ll Never Walk Alone

If you are a new AMWA member or have never attended an

AMWA annual conference, don’t worry about being alone.

Many AMWA members and staff will be on hand to help wel-

come you and guide you. The traditional New to AMWA event

has been enhanced to focus on providing the most relevant

information and resources to new members and ﬁrst-time

attendees. This event, Navigating AMWA and the Annual

Conference, will feature AMWA staff, chapter leaders, and

conference mentors who will help ﬁrst-time attendees get the

most out of the conference. The event will be held Wednesday,

4:30 to 6:15 PM.

Burning Love for the Profession

If you are passionate about your profession, the annual con-

ference is the place to learn more about two professional

development opportunities: becoming an AMWA workshop

leader and taking the medical writing certiﬁcation examina-

tion. Special tables will be available in the registration area,

where you can talk individually to AMWA staff and volunteers

involved in these initiatives. Special brief group talks (10 to 15

minutes) will also be scheduled throughout the day. In addi-

tion, you can learn more about becoming a workshop leader or

a certiﬁed medical writer by viewing posters on those topics in

the poster display section.

Can’t Help Falling in Love with AMWA Award

Recipients

The annual conference is also a time to honor AMWA award

recipients, and this year, recipients will be highlighted more

than ever (see box). As mentioned in the last issue of the AMWA

Journal, AMWA awards will be presented in a variety of venues

this year, offering you a greater opportunity to celebrate their

accomplishments with them. Onsite, look for posters describ-

ing the background and achievements of our award winners.

Online, you’ll be able to listen to award winners describe their

AMWA service in brief deskside chats.

You can also become better acquainted with the Alvarez

and McGovern award winners, Rosemary Gibson and Gary

Schwitzer, at the AMWA Meet and Greet Table, which will also

host AMWA members who have written a book. If you’re an

AMWA member and wish to take advantage of an opportunity

to promote your book, sign up for a time to be at the table by

sending an e-mail to [email protected].

Get All Shook Up for the 75th Anniversary

Celebration

Next year marks the 75th anniversary of AMWA, and plans are

underway for a full year of celebrating. Join us Saturday eve-

Week of June 16: Registration brochure available

July 1: Registration opens

August 30: Early registration ends

ning at the closing reception to kick off the celebration

that will culminate in the 2015 Annual Conference in San

Antonio.

Put on Your Blue Suede Shoes for a Tour

No visit to Memphis is complete without a visit to

Graceland. Even if you’re too young to have been an Elvis

fan, Graceland offers a glimpse into a historic time and an

even more historic celebrity. Tours of Graceland, with trans-

portation, will be offered on both Wednesday and Sunday,

starting with pick-up at 9:30 AM at the AMWA hotel (the

Sheraton) and returning between 12:30 and 1 PM. The ticket

price is $40.

For medical communicators, another must-do in

Memphis is a tour of St. Jude Children’s Research Hospital,

which is less than 1 mile from the convention center.

Complimentary tours exclusively for AMWA conference

attendees are being planned for Wednesday.

» Keep up to date on the conference by visiting the AMWA

website (www.amwa.org). Also, learn about more details

as they happen with the AMWA Conference Connector,

the Conference Blog—now available through AMWA’s

home page, Twitter (@AmMedWriters, #amwa14), and

LinkedIn groups.

2014 AMWA AWARD RECIPIENTS

Swanberg Award

J. Patrick Barron

Founder, International Medical Communications Center,

Tokyo Medical University

To be presented at the Sablack Award Lunch

AMWA Fellowships

Lori De Milto, MJ, Delaware Valley Chapter

Joanne McAndrews, PhD, Mid-America Chapter

Deborah Whippen, Florida Chapter

Justina Molzon, US Food and Drug Administration

(honorary fellowship)

To be presented at the Sablack Award Lunch

Golden Apple Award

Thomas Gegeny, MA, ELS, New England Chapter

To be presented at the Sablack Award Lunch

President’s Award

To be named

To be presented at the Opening Session

Eric W. Martin Award

Professional Audience: Art Gertel (with Cindy Hamilton,

Adam Jacobs, Gene Snyder, and Karen L. Woolley) for

“The Global Alliance of Publication Professionals: Update

on a Small Group with a Big Mission”

Public or Health Care Consumer Audience:

Randi Redmond Oster for “A Beautiful Choice: Living, and

Dying, with Dignity”

To be presented at the Closing Session

Student Scholarship

To be named

To be presented at the Welcome Reception

©Mr. Littlehands / CC-BY-SA-2.0

©Thomas R. Machnitzki / CC-BY-SA-3.0

68 AMWA Journal / V29 N2 / 2014 / amwa.org

The Harold Swanberg Distinguished Service Award is presented

each year to “an active member who has made distinguished

contributions to medical communication or rendered unusual

and distinguished services to the medical profession. The 2014

award will be presented to J. Patrick Barron at the annual con-

ference in Memphis, Tennessee. The winner will give an address

at the Sablack Awards Luncheon on October 10. J. Patrick

Barron submitted the following about his background in medi-

cal communication.

I am honored to be selected as this year’s recipient of the

Harold Swanberg Award. When I moved to Japan as a student, I

had no idea my career would lead me to this award.

In 1969, after completing a bachelor’s degree in English

literature at the University of Pennsylvania, I moved to Japan

where neither the country nor I knew that medical writing

existed. However, I began translating medical texts in 1971,

later enrolled in the MPhil/PhD program of the University of

London’s School of Oriental and African Studies, and in 1980

became associate professor of English, St. Marianna University

School of Medicine, in Kawasaki.

In 1975, I proposed a center to enhance the ﬂow of scien-

tiﬁc information from Japan to the rest of the world by provid-

ing authors full English-language, medical writing, editing,

and translation support. In 1991, at Tokyo Medical University, I

founded the International Medical Communications Center—

the ﬁrst of its kind in Japan—to provide these services to all

clinical and academic departments and to educate medical

and PhD students in English for medical purposes, scientiﬁc

publications, and publishing ethics. The center became a full

academic department in 2009, the only one in the country

authorized to develop and offer master’s and doctoral pro-

grams in medical communications.

In the new Department of International Medical

Communications, we created a standardized curriculum

to globalize the teaching of English for medical purposes.

The website now contains 18 clinical modules and videos of

physician-patient consultations, reading materials, and self-

assessment tests for medical students. South Korea and several

European countries are now implementing or considering this

program under the aegis of the European Union’s sTANDEM,

a standardized assessment system for English for medical pur-

poses, of which Tokyo Medical University is the only non-Euro-

pean partner.

In the meantime, I started the Medical Interpreters and

Translators Association (MITA) in 1993 and have been vice

chair of the Board of the Japanese Society for Medical English

Education for several years.

In 2005, I started what has become one of the largest web-

sites in the world on scientiﬁc publications and career develop-

ment, www.ronbun.jp. My colleagues and I invested more than

5,000 hours making more than 100, 60-minute videos for the

site, which also includes all the instructional materials I have

produced on medical writing and scientiﬁc publications during

the past 40 years.

I have been an editorial board member for several journals,

including the Journal of Gastroenterology, Breast Cancer, Haigan

(Lung Cancer), the Journal of Cardiac Surgery, and the Journal

of the Japanese Society for Geriatrics. As an editorial board

member for CHEST, I edited a monthly column called “Medical

Writing Tip of the Month.”

I received the 2005 Inagaki Educational Award for

Educational Achievements from Tokyo Medical University and

the 2007 Albert Soffer Award for Editorial Excellence from the

American College of Chest Physicians. I am also an adjunct

professor at Bundang Hospital, Seoul National University,

South Korea, and a member of the Committee on Publication

Ethics (COPE).

In addition to writing more than 35 peer-reviewed articles,

most on medical writing, medical education, and cardiopulmo-

nary medicine, I have edited and translated several key medi-

cal texts into English, two of which received Japan’s Translation

Publishing Culture Prize.

I retired in 2013 and became the ﬁrst non-Japanese to be

awarded emeritus status at a Japanese medical school. My

tenure at Tokyo Medical University has been marked by many

successes, but perhaps the most important to me is that the

number of manuscripts published each year by TMU authors

rose from 18 in 1989 to nearly 300 in 2013, an increase more than

4 times the average of all other Japanese medical universities.

To have these activities and accomplishments recognized

by AMWA is, indeed, one of the highest honors I have received.

Thank you.

2014 SWANBERG AWARD

J. Patrick Barron

AMWA Journal / V29 N2 / 2014 / amwa.org

ou can write. That’s why they want you. You have

experience writing the types of materials they need:

regulatory documents, continuing medical education

activities, promotional education materials, journal articles.

That’s why they want you. You specialize in the central ner-

vous system or metabolic disorders or cancer, and you know

all the regulations and guidelines and American Medical

Association style rules. That’s why they want you. This expe-

rience and training, and these skills, are the technical proﬁ-

ciencies you possess.

However, it’s only half of what you need to be a “com-

plete professional.” The other half is that constellation of

qualities collectively referred to as “soft skills”: the nontech-

nical characteristics that make a technically talented person

a desirable professional. The term soft skills (in some places

they are referred to as transferable skills) is unfortunate; the

soft implies that they’re not that important when, truth be

told, they are as important as your technical skills.

So what are they? Before they acquired their own titu-

lar status, soft skills were the kinds of things you learned in

kindergarten, scouting, church, team sports, and yes, even

from your parents and teachers. No cheating, killing, lying,

or stealing. The Seven Deadly Sins might be entertaining at

a party, but gluttony and vanity would be looked upon with

disfavor in the workplace. There is no ofﬁcial list of soft

skills. You can ﬁnd many resources online, but rarely will

two of them have the same set of skills, or group the skills

the same way, or emphasize the same items as the most

important skills.

Soft skills crop up in every job description. That’s usu-

ally the de rigueur part of the job description you gloss over,

since of course “everyone” has those skills: “enthusiasm,”

“ability to work in a fast-paced environment,” “good team-

building skills,” and the ubiquitous “deliver on time and

under budget.” I gloss over these desirable qualities myself

when I read job descriptions, despite the ﬂaws I know I have:

I am not enthusiastic when clients wait 3 months before

signing off on a project; the “fast-paced environment” is

just ﬁne until I get four concurrent assignments; I break out

in hives when directed to role-play during corporate team-

building retreats; and there truly is no such thing as “under

budget” when clients start down the path of “project scope

creep.”

This makes me a bit of a hypocrite to talk about soft

skills, but at least I know what these critically important skills

are, even if I sometimes struggle with manifesting some of

them. So what are they, exactly? Here is a sampling of them.

No one truly possesses of all of them (even if some individu-

als think they do possess them all, which is actually worse

than not possessing some of them). Think about the items

on the list. Can you apply them to yourself? It will probably

be easy to think of people you know who lack some of these

skills. What’s important is being able to recognize if you are

lacking a particular skill. If you can identify your challenges,

you can work to improve them. Note that these skills are uni-

versal; they do not apply only to medical communicators.

Interpersonal skills

Smile, make eye contact, be nice, listen to others, be sensi-

tive, cover your mouth when you sneeze or cough, and prac-

tice good grooming and hygiene.

Etiquette

Turn your mobile phone off during meetings, and never

answer it in a restaurant or when speaking to someone. Lose

the ear buds. Be sincere when saying please and thank you,

and say these things all the time. Be polite.

Positive attitude

Assume your projects will succeed. Conversely, never go into

a project thinking it is doomed to fail.

By Kelleen Flaherty, MS / Assistant Professor, Biomedical Writing Programs, University of the Sciences, Philadelphia, PA

praCtiCal matters

Soft Skills: The Critical Accompaniment

to Technical Skills

70 AMWA Journal / V29 N2 / 2014 / amwa.org

Self-condence

Believe in yourself, and believe in your skills. Recognize your

strengths. Poor self-conﬁdence is obvious to others and will

limit your responsibilities and opportunities for promotion.

Self-conﬁdence is not, however, the same thing as “arrogance.”

Unfortunately, the arrogant are pretty clueless about this.

Work ethic

Work hard. Work full days. Miss work rarely, but avoid “presen-

teeism” if ill. Take your work seriously. Help others even if it’s

not your job. Take on extra responsibilities if you have enough

time. Enjoy your work. Work hard but maintain work-life bal-

ance.

Cultural competency and sensitivity

Recognize that not everyone is like you with regard to age,

country of origin, religion, gender, sexual orientation, physical

ability, political afﬁliation, or marital and family status.

Time management

Never ever miss a deadline. You often have people working

downstream who require your deliverables before they can

start their work. Do not be late to work or meetings. Do not

procrastinate (you know who you are). You do not have to “just

ﬁnish this e-mail” while your colleagues wait for you for lunch.

I heard the movie producer and director Steven Soderbergh

speak once, and he said the greatest thing I ever heard: “If

you’re on time, you’re already late.”

Being a team player

Go on that retreat. Try to role-play without being snarky about

it. Help your teammates, consider and support their ideas,

make suggestions, and help. Serve as a mentor when pos-

sible, and be a respectful mentee when the situation calls for

it. Tolerate and try to help improve the limited competencies

some of your teammates might have, but at the same time do

not tolerate incompetency or toxicity in others.

Written and spoken communication

As a writer, your competency in writing is assumed, but you

also need speaking skills: lucidity, clarity, animation, enthusi-

asm, eye contact, and engagement. And you also should know

when to shut up. This applies to one-on-one interlocution as

well as speaking to a group or an audience.

Critical thinking

Can you assess things legitimately for their merit and accu-

racy? Can you set aside your biases (you have them, everyone

does) when judgment is called for? Can you restrain knee-jerk

responses? Can you listen to opposing views and assess them

for their merits? Can you practice both analytic and holistic

thinking? Do you understand logical fallacies? Can you think on

your feet and reﬂect and evaluate evidence? Are you scientiﬁ-

cally literate? You need critical-thinking skills to be able to use…

Problem-solving and decision-making skills

Can you assess a problem rationally and critically and evalu-

ate the pros and cons? Can you use both inductive and deduc-

tive reasoning? If you look at the trees, can you back up and

look at the forest? If you tend to see the forest, can you zoom in

to the trees? Can you brainstorm new ideas, even wacky ones?

“Thinking outside the box” may be a cliché, but it is a good skill

to possess. Good problem-solving skills are necessary for…

Negotiation

If you are on a team and everyone agrees with each other, or

you work with a client who loves everything you pitch, you’re

working in some kind of fantasy dreamland. Business would

slam to a halt without compromise. Dig in your heels when

necessary, but be able to identify the things you can cede to

others and the things that can be acceptably modiﬁed to sat-

isfy the parties involved. Be respectful, but be tough.

Conict resolution

Technically under the aegis of problem-solving, conﬂict resolu-

tion is a type of problem-solving that is interpersonal. Conﬂicts

can be toxic, affect morale, delay project completion, imperil

deadlines, and lose you your clients. Conﬂicts need to be iden-

tiﬁed and resolved as soon as they appear.

Computational skills

For many of us, avoiding math is a lifelong goal, but you should

be able to understand budgets and cost modeling, basic math,

and statistics commensurate with the type of writing or editing

that you do. If you’re a freelance or entrepreneur, understand

the math associated with running your business.

Ethics

Personal, business, and medical ethical behavior is a must, for

yourself and for those you afﬁliate with professionally. If you

AMWA Journal / V29 N2 / 2014 / amwa.org

PRACTICAL MATTERS

work for a company that alters, withholds, is selective about,

or outright steals data (or that plagiarizes regularly), quit. Quit

even if you don’t have another job. Unethical behavior in medi-

cal communications can result in damage or death to a patient.

Working under pressure

Writing is by default a deadline-driven profession, and there

is nothing like a deadline to ramp up the pressure in one’s

life. Pressure can be compounded by multiple simultaneous

assignments, travel, family demands, and working with dif-

ﬁcult teammates, superiors, clients, or consultants. When the

job description actually mentions “working under pressure,”

they’re not kidding.

Good judgment

In any job, you will be faced with problems and choices, and

you may suddenly ﬁnd yourself in awkward situations. You

may have to make snap decisions. Does your behavior some-

times reﬂect bad judgment, such as relaxing too much with a

client or consultant, telling inappropriate jokes, or downing

too many drinks at a reception? Good judgment includes being

a good judge of character. People might not be who you think

they are; they might not be as trustworthy or respectful as they

outwardly appear.

Taking and giving criticism

Criticism is necessary for personal and professional growth.

Criticism can range from positive feedback to scathing

rebukes. Criticism is effective when it is constructive and

respectfully tendered, whether you are on the receiving end

or are doling it out yourself. You have to be open to receiving

it. It might not all be legitimate and might not all be useful,

but listen to it. You will never make it as a medical writer if you

become devastated or infuriated by criticism.

Flexibility

The last thing you want to hear (apart from “we’re going to do

a little role-playing exercise now”) is a client saying “I think we

want to go in a different direction” after you have submitted a

project you have been working on for 3 months. You have to be

able to adapt when project managers quit, new bosses arrive,

or you are suddenly shifted to a new project.

Leadership

You don’t have to be a vice president to be a leader. There are

responsibilities you’re going to have where you are the de facto

leader. It is easy to deﬁne a good leader: He or she simply pos-

sesses all the soft skills. A good leader listens and is compas-

sionate, transparent, fair, inclusive, and respectful and avoids

top down management. And, at least in my opinion, he or she

will never make you role-play.

No one has all the soft skills. You are deluding yourself if

you think you do. Individuals who are conﬁdent that they pos-

sess all these qualities are arrogant and serve as toxic speed

bumps on teams or in management. It is important that you

recognize where you have challenges and try to improve them.

I know my failings: I can be uncooperative and stubborn at

times, I procrastinate too much, and I can get snarky and sar-

castic when pushed. I’m dismal at math, and by all that is holy

I will resist role-playing until I draw my last breath. Sometimes,

to get what I need, I have to take the “ask for forgiveness rather

than permission” route, but if that’s what it takes to yield a

ﬂawless product, I’ll do it. So much for my leadership skills.

But recognizing where I am deﬁcient in soft skills does help me

to develop and strengthen them and become a better profes-

sional.

Think hard about each of these skills. Don’t do the “job

description glossover.” Make a table. Write an example of

one thing you do right for each, and one thing you do wrong,

however minor. Think about the qualities and ﬂaws of other

people. There’s a reason certain coworkers annoy you, and it’s

very rarely because they don’t write well or don’t know AMA

style. It’s because they interrupt you when you are speaking,

are always late to meetings, are reading e-mail on their mobile

phones during meetings, or they are arrogant or insulting. Or

they make you role-play.

Author disclosure: The author notes that she has no commercial associ-

ations that may pose a conﬂict of interest in relation to this article.

Author contact: k.ﬂ[email protected]

RESOURCES

Fisher R, Ury WL, Patton B. Getting to Yes: Negotiating

Agreement Without Giving In. Revised edition, 2011. NY:

Penguin Books.

Gallo A. How to work with someone you hate [blog post.]

Harvard Business Review website, January 30, 2012. http://

blogs.hbr.org/2012/01/how-to-work-with-someone-you-h/

Haden J. 8 qualities of remarkable employees. Inc., February

21, 2012. www.inc.com/jeff-haden/the-8-qualities-of-

remarkable-employees.html

Zimmerman, E. Smartphones should know their place

at work. New York Times, March 10, 2012. www.nytimes.

com/2012/03/11/jobs/etiquette-for-using-personal-

technology-at-work-career-couch.html

72 AMWA Journal / V29 N2 / 2014 / amwa.org

orry, I had to revive an old heteronym to grab your eye!

If we go by sound, that head should read Spice Up Your

Leed: Get the Led Out. Any of us writers who have been

exposed to newspaper journalism know the rule: Your lead (leed)

should contain the ﬁve W’s: who, what, when, where, and why.

(Random thought: We don’t have this kind of trouble with heed and

head—or with read or read !) The purpose was to give the reader the

gist of the article (without details) in the ﬁrst paragraph, so that the

reader could quit at that point and still know the main points of

the article.

Yes, like a lot of my readers, I learned those ﬁve w’s early in my

career. And, I might add, I can still turn out a formal news story with

that pattern when I need to. We also know that feature stories (or

magazine articles) are a different thing. They don’t have to conform

to that rule. Occasional attention-grabbers—known colloquially

as “the hook”—add a little spice to your work to make it attractive,

readable, and interesting.

Sometimes the hook is the title, sometimes the lead following it,

and often both together. Here are some examples.

The title as hook

Writing with Suspenders This: ( ), That: — —, and The

Other Things: , ,

Sharp...but Dull

Title is Vital

This is a Complaint

Times, They Are A-changin’

The title as a question

Good Ole Days?

Have You Ever Seen...the Singular?

Two attention-grabbing leads

“First, I will advise you: Do not write a speech.”

“Years ago, it was easier. Most students didn’t know

the answer.”

Or, familiar song lyrics, familiar book quotes or jokes -- used to

create curiosity

“Your lips tell me no-no, but there’s yes-yes in your eyes”

“Someone once said that a camel was a horse put

together by a committee.”

Or, a combination of head and lead

By Arnold Melnick, DO / Aventura, FL

Spice Up Your Lead:

Get the Lead Out

MELNICK ON WRITING

Some newspapers carry a heading in addition to the

columnist's name (and maybe picture). In some instances, that

title is written by the columnist, and in others it is a regular news

headline added by the newspaper itself. Other publications

use a regular news headline written by the newspaper itself.

Fortunately for me, for all of the more than 160 signed columns

I have written in the past few years, I have been allowed to write

my own heading (title, not a newspaper headline). By this, I

was able many times to create a point with the heading and a

counterpoint with the lead—and together create an attention-

getting mechanism—a written hook. Some examples:

For a column on people who are brilliant in their ﬁeld but

turn out to be boring speakers, my head was “Sharp…Dull” and

the tie-in lead, hoping to make the reader curious, was “How can

that be? Isn’t that an oxymoron?” A much duller lead could have

been “It is important for the physician not to discharge a patient

until he is certain that all her questions had been answered.”

For a column on the most important question a physician

can ask a patient, I titled it “Your Most Important Question,” and

the lead was “All right, Mrs. Brown, that about does it. I’ll see you

in three weeks.”

For a column headed “Listen to the Patient,” the lead was: “A

red light means STOP. A ﬂashing red light means STOP! LOOK!

LISTEN!”

On a column about a newspaper article on patient care:

“What can you expect to learn about patient care from the Wall

Street Journal?”

All instances of eye-catching titles or clever leads, or both,

must be followed with an intelligent segue to the serious matter

of the article. In other words, once you have captured their

attention, quickly go to the meat of your column.

Remember, that your column—no matter how important it

may be, or how good you think it is—must ﬁrst be seen by the

reader and then read. Thus, sometimes you have to think ahead

about attracting attention to it and then corral your readers.

My advice: Try to get away from the lead, that is, the heavy,

formal, stilted leads and go to something more attractive—and

interesting—to the reader. So heed my words and use your head,

read this column again and after it has been read, spice up your

lead by getting the lead out of it.

AMWA Journal / V29 N2 / 2014 / amwa.org

I use QuickBooks Pro from Intuit for all my business book-

keeping and timekeeping, and have been using this soft-

ware (upgraded versions, of course) since 1993. I love it and

highly recommend it. When a business expense comes in

(eg, monthly Internet fee), I log it into accounts payable

using the appropriate class designation. When I write the

check, the expense automatically attributes to the class,

so when I run my quarterly report, the expense is appro-

priately reported. I use this same process when I receive

invoices from writers and editors on my team, assigning

them as direct expenses to the appropriate job number.

That takes care of the expense side of my balance sheet.

On the ever-more-important income side of the balance

sheet, I use the estimating function in QuickBooks to pre-

pare estimates for every assignment. Then, when it comes

time to invoice, I simply identify the project by its job

number and turn the estimate into an invoice. QuickBooks

allows me to invoice for 100% of the total estimate, for a

percentage of the total estimate, or for any amount or per-

centage per line item, which makes “progress invoicing”

a snap. The sent invoice goes automatically into accounts

receivable, where I can track it until payment is received. I

then use QuickBooks to record received payments.

Because I track all my company’s business ﬁnances

in one place, it’s simple to prepare for my quarterly and

year-end meetings with my accountant. I am busy enough

running my business, so I am glad managing my business

ﬁnances doesn’t get in the way of making sure I have plenty

of money to manage.

—Brian Bass

I start by never using cash for anything and only using my

corporate credit card. This way I always have a receipt.

With American Express, you can also see all your expenses

by category.

My business is set up as a subchapter S corporation. I

have two bank accounts—regular checking and payroll—

with automatic transfers set up each month from regular

checking to payroll, from payroll to my home checking

account, and from regular checking to my 401K. Again,

keep it paperless.

I track everything in QuickBooks, and I use it for invoic-

ing and accepting payments. I used to manage it all myself,

downloading everything from the bank and American

Express, but about a year or so ago I hired a bookkeeper.

Her hourly rate is far lower than mine, and she’s far better

at it than me. She also pays my payroll taxes (which is all

done electronically), handles quarterly ﬁlings, and provides

me with a spreadsheet each year showing how much to pay

myself, taxes, etc. I use the online version of QuickBooks,

so my accountant and bookkeeper can access it and main-

tain it.

I do stick my receipts in a folder, then just store each

year’s.

I don’t have to do anything at tax time; my accoun-

tant can access income and expenses (by category) from

QuickBooks. She e-mails me any questions, tells me how

much I should put into my retirement fund, and ﬁles

everything.

Yes, I pay for these services, but it costs far less than it

would for me to do it myself, and I have peace of mind that

the experts are handling what they do best, while I handle

what I do best (writing and running my business).

— Debra Gordon

In our business, this is very easily accomplished, without

fancy programs or software. We have a corporate check-

ing account for all corporate business deposits and expen-

ditures. We use a corporate-only major credit card for all

expenses (travel and meal expenses generally). Ofﬁce

supplies are billed to a corporate account at Staples or

Ofﬁce Depot.

Whenever we do need to do reimbursements for out-

of-pocket expenses (mileage, hotel porters, maids, tolls,

etc), the check stub is used to divide the funds into various

categories to be applied to the appropriate expense item.

Brian Bass Elizabeth L. SmithDebra GordonLori De Milto

freelanCe forum

How do you keep track of business expenses for tax purposes?

74 AMWA Journal / V29 N2 / 2014 / amwa.org

We use a certiﬁed public accountant who set up our system

20 years ago (with minor modiﬁcations over the years), so he

can easily calculate income and expenses for tax purposes.

Our business spreadsheet (which we still do by hand) balances

each month with our corporate bank checking statement. We

do not have a great deal of major business expenses, so the

system works for us. It is a simple system, one that takes us less

than an hour each month to record all business income and

expenses.

—Elizabeth L. Smith

TIPS FOR TRACKING TIME

Whether you bill hourly or by the project, it is crucial that you

track your time so you know how much time you spend on a

project. I prefer a software approach to tracking it manually

on a spreadsheet.

In my pre-Mac days, I used TraxTime, available at www.

spudcity.com/traxtime/ for $39. It is extremely simple to use.

You add the project, then punch in and punch out as you’re

working on it. You can run reports to see how many hours you

spent on it, or across all projects that day, week, or year.

Now that I’m a Mac person, I use OfﬁceTime, available at

www.OfﬁceTime.net for $47. (A Windows version is available

at the same price. iPhone and iPad apps are also available.)

It works similarly to TraxTime but also enables you to track

expenses, sync with iCal, and invoice right from the app. It

also creates pretty graphics from your data.

One of the best features of both programs is a reminder

box that pops up when you haven’t been typing but haven’t

logged out. It asks you if you still want to count the time that’s

passed. In other words, it keeps you from cheating!

—Debra Gordon

Track how you’re spending your time (per client, per project,

and on administration) by putting a small notebook next

to your computer. When you start working, note the client,

project, and time. When you stop, note the time. Do this for

every client and every project you work on, and also note the

amount of time you spend on administrative tasks.

At the end of each day, transfer your times onto a weekly

work log, either on paper (stored in a three-ring binder) or on

your computer. The work log should have rows for each day

and the weekly total, and columns for total hours, billable

hours, client (with room to track time for multiple clients),

and administration.

This method lets you quickly see whether you are spend-

ing too much or too little time on each client and on admin-

istrative tasks, and how much you’re actually working (eg, not

surﬁng on the Web or talking to family or friends) during your

hours in the ofﬁce.

—Lori De Milto

TIPS FOR CREATING JOB NUMBERS

Assigning a job number to every project makes it simple to

track the job from start to ﬁnish. Job numbers serve several

important purposes. They provide a logical way to save all the

ﬁles related to each project. They also enable you to track the

project ﬁnancially including your estimates, invoices, and any

expenses you may have that are related to the job. Another

important function of job numbers is providing a way for you

to track down a job you did long ago. There’s no right or wrong

way to assign job numbers, but here are a few tips for creating

job numbers that may prove helpful down the line.

Tip #1: Consider how many projects you work on during the

year. If you don’t work on many projects throughout the year, a

job number might serve as simply a name for the project so you

can identify it. You could call it “1,” or “01,” or almost anything

else, and that would probably sufﬁce. You could even give it a

name if you prefer, like “Product X CSR” or “Gary.” But if you

work on a lot of projects during the year, you might want a

slightly more sophisticated numbering system.

Tip #2: Consider what is most important to identifying the

job. If you work with a lot of clients, you might want to create a

job numbering system that identiﬁes the client associated with

the project. You might prefer to use a numbering system that

identiﬁes the product on which you’re working. Or, you might

want a numbering system that identiﬁes both the client and

the product.

Tip #3: Consider what will be most helpful in tracking down

the job. Regardless of the type of job numbering system you

use, it’s important to have a master job number list. This way,

you can cross-reference to the master list when you’re search-

ing for a particular project. If you’re most likely to remember

the client for whom you did a certain project, using a number-

ing system that identiﬁes the client ﬁrst and a master list that

groups job numbers by client would be best for you. If you’re

most likely to remember when you did a particular project (eg,

“Last fall, I think…”), then a numbering system that reﬂects

the month or season and a master list that groups job numbers

the same way would be best. Adding a year to your numbering

system might also be helpful.

Tip #4: Consider what is most important to your success.

Logging in a certain number of projects for a particular client

might be the key to knowing whether you are having a good

year. If so, a job numbering system that identiﬁes the client and

the number of projects you have done for that client might be

helpful. If you track projects by the month or season, you might

want to marry that with the number of projects to create your

job numbering system. If the sheer number of projects you log

in a given year is indicative of income, then a simple number-

ing system that counts the number of projects might work best

for you.

Remember, there’s no right or wrong way to create a job

numbering system. Use these tips to create a system that works

best for you.

—Brian Bass

FREELANCE FORUM

AMWA Journal / V29 N2 / 2014 / amwa.org

think most of us could beneﬁt from greater knowledge

and understanding of social media. I know I could.

The problem is wading through the array of informa-

tion clamoring for our attention online to ﬁnd people who

really know what they are talking about when it comes to

social media marketing. To make that task easier, I’ve com-

piled an alphabetical list of ﬁve online inﬂuencers who are

well known as experts in marketing and social media. These

people are passionate about social media, and I eagerly con-

sume the ideas, strategies, and tactics they share on their

blogs and in their books. Now, if only I could put all of their

wonderful ideas into practice. Start following any of them

and you will probably feel the same!

Seth Godin (www.sethgodin.com). Godin is an author,

entrepreneur, and marketer who writes about marketing,

leadership, and the ways ideas spread. His book, Permission

Marketing, which launched 15 years ago, focused on con-

necting brands and consumers through online marketing

campaigns that ﬁrst sought the consumer’s permission to

engage, that is, to opt-in to receive marketing messages. At

the time, the idea of seeking consumers’ permission was

revolutionary and not very well received by direct market-

ers, as you can imagine. Today, opting-in is the standard on

the Internet. Godin has written numerous books, includ-

ing Unleashing the Ideavirus, Tribes, Purple Cow, and All

Marketers Are Liars. He offers a variety of content for free, as

downloadable PDFs, on his website. Godin is also the cre-

ator of Squidoo (www.squidoo.com), a platform that enables

users to create custom Web pages called lenses on various

topics of interest.

Neal Schaffer (nealschaffer.com). Schaffer is a social

media consultant and adviser who delivers a wide range

of social media tips, with a focus on LinkedIn. You’ll ﬁnd

useful content on either one of his websites: Maximize

Your Social http://maximizeyoursocial.com and Maximize

Social Business http://maximizesocialbusiness.com. He

is the author of Maximize Your Social: A One-Stop Guide to

Building a Social Media Strategy for Marketing and Business

Success, a useful book if you are struggling to design a social

media strategy for your business. He also has written two

other highly regarded social media books: Maximizing

LinkedIn for Sales and Social Media Marketing, and Windmill

Networking: Understanding, Leveraging, and Maximizing

LinkedIn.

By Cynthia L. Kryder, MS, CCC-Sp / Medical Communications Consultant, Phoenixville, PA

Five Social Media Gurus to Follow

SOCIAL MEDIA

76 AMWA Journal / V29 N2 / 2014 / amwa.org

Mari Smith: (www.marismith.com). Dubbed “the Pied

Piper of Facebook,” Smith is considered to be a global leader

in social media strategy and THE top Facebook marketing

expert in the world. Dun & Bradstreet identiﬁed her as one

of the most inﬂuential small business people on Twitter

and Forbes named her as one of the top ten inﬂuencers

online.

She is author of The New Relationship Marketing

and coauthor of Facebook Marketing: An Hour A Day. Smith

has made social media her specialty and her website is ﬁlled

with content you can use to develop relationships and build

your social media network.

Michael Stelzner. Another leading voice in social media,

Stelzner is the founder of Social Media Examiner (www.

socialmediaexaminer.com), the world’s largest online

social media magazine. He also is one of the driving forces

behind the Social Media Success Summit, a live, online con-

ference with presentations by some of the world’s leading

social media inﬂuencers. He has written the books Launch:

How to Quickly Propel Your Business Past the Competition

and Writing White Papers: How to Capture Readers and

Keep Them Engaged. He hosts the Social Media Marketing

Podcast show (https://itunes.apple.com/us/podcast/

social-media-marketing-podcast/id549899114), designed

to help businesses thrive with social media.

Gary Vaynerchuk (http://garyvaynerchuk.com/).

Vaynerchuk used social media to propel his family’s liquor

store in New Jersey from a $3 million business into a $45

million enterprise. In the process, he created Wine Library

TV (http://tv.winelibrary.com) and built a loyal commu-

nity of wine lovers. In 2009, Vaynerchuck and his brother

launched VaynerMedia, to help Fortune 500 companies ﬁnd

their social voices and build their digital brands. He is the

author of three books: Crush It!: Why Now is the Time to Cash

in on Your Passion, The Thank You Economy, and Jab Jab Jab

Right Hook: How to Tell Your Story in a Noisy Social World.

Author disclosure: The author notes she has no commercial associa-

tions that may pose a conﬂict of interest to this article.

Author contact: [email protected]

References

1. Luther D. The most inﬂuential small business people on Twitter.

D&B Credibility Insights blog. June 2011. http://blog.dandb.com/

2011/06/20/most-inﬂuential-small-business/. Accessed May 5, 2014.

2. Shaughnessy H. Forbes. Who are the top 50 social media

power inﬂuencers 2013? April 2013. www.forbes.com/sites/

haydnshaughnessy/2013/04/17/who-are-the-top-50-social-media-

power-inﬂuencers-2013/2/. Accessed May 5, 2014.

SOCIAL MEDIA

AMWA Journal / V29 N2 / 2014 / amwa.org

78 AMWA Journal / V29 N2 / 2014 / amwa.org

decade ago, Bill Gates declared that the password

would soon be dead.

Instead, passwords have con-

tinued to proliferate, and there doesn’t seem to be a

good alternative on the horizon. For most people, passwords

have become an integral and frustrating part of daily life.

Better off dead. Despite continued high proﬁle data

breaches that underscore the need to protect online infor-

mation, most Internet users manage their passwords poorly.

This is hardly surprising. Creating and recalling dozens of

complex, individual passwords is a formidable and oner-

ous task. To simplify matters, people often write down their

passwords, store them in insecure places, or choose weak

ones that are easy to remember. In 2013, 123456 and pass-

word were still the two most common passwords.

One of the

worst habits is password reuse. A 2012 study found that most

adults in the United Kingdom were using the same password

at multiple (or even all) websites.

Although there isn’t a perfect solution to the password

management problem, implementing some fairly simple

measures can help mitigate risk.

Train your brain. Consider using a passphrase instead of

a password. Passphrases are usually long and sufﬁciently

complex, but are easy to type and remember. It’s important,

however, to avoid phrases that can be easily guessed, such as

popular quotes, movie titles, and song lyrics. For these rea-

sons, some experts suggest inventing a lie or using a nonsen-

sical sentence. Others suggest using a series of common but

unrelated words (eg, correct horse battery staple),

or using

person-action-object statements, such as “Bill Gates swal-

lowing a bicycle.”

Creating a visual or story that goes with

the words can aid memorization.

Although passphrases can help you memorize long

strings of characters, they do not address the problem of

remembering which one goes with which account. One

solution is to create a strong base password, and then apply

a rule that incorporates elements of the website to which

it belongs. This enables generation of custom passwords

linked to a speciﬁc website and only requires remembering

the password core and formula. One problem with this strat-

egy is that different websites often have different charac-

ter requirements (length, allowable symbols, etc), so it may

be difﬁcult to create a base password and rule that can be

applied across the board. Moreover, hackers are well aware

of the common techniques for creating and obfuscating

passwords, so the formula must be clever.

One password to rule them all. An alternative to memoriz-

ing all of your passwords is to have a software program do it

for you. Password managers like OnePassword and LastPass

store encrypted login information for all of your accounts

behind a single master password. There are many types of

programs to choose from, and most offer basic services that

are free or available for a nominal fee. Many password man-

agers will evaluate the strength of existing passwords and

can also generate long, random passwords for you. Some

offer additional features such as ﬁlling out forms automati-

cally or tracking other bits of data such as personal iden-

tiﬁcation, bank account, or credit card numbers. Because

creating a single point of failure creates a major vulnerability,

some password managers also offer a two-factor authentica-

tion system that uses biometrics or a hardware device.

Don’t forget the reset button. Even highly complex, unique

passwords won’t be effective if hackers can simply change

By Laura Mizoue, PhD / Research Specialist, Howard Hughes Medical Institute, Department of

Chemistry and Biochemistry, University of Colorado, Boulder, CO

teCh talk

Password Management:

Staying Safe and Sane

AMWA Journal / V29 N2 / 2014 / amwa.org

them on the ﬂy. The challenge questions used for retriev-

ing or resetting forgotten passwords are often based on per-

sonal information that can be easily guessed or found online

(What is your favorite color? What is your mother’s maiden

name?). One work-around is to use false or counterintui-

tive answers, such as “pizza” instead of your mother’s actual

maiden name.

Of course, this adds to the amount of infor-

mation that must be remembered.

Unfortunately, no password is unbreakable, and hack-

ing techniques are only going to improve with time. By vary-

ing your passwords, however, you can at least reduce the

likelihood that a hacker breaking into one site can use that

information to gain access to your other accounts. Although

it’s difﬁcult to know how effectively companies are protect-

ing your private information, a good password management

system can help ensure that you aren’t the weakest link.

Author disclosure: The author reports that she has no commercial

associations that may pose a conﬂict of interest in relation to this

article.

Author contact: [email protected]

References

1. Gruener W. Bill Gates: The password is dead. Tech Guru Daily website.

www.tgdaily.com/technology/5166-bill-gates-the-password-is-dead.

Published November 16, 2004. Accessed May 11, 2014.

2. Doel K. “Password” unseated by “123456” on SplashData’s annual

“Worst Passwords” list. Splashdata website. http://splashdata.com/

press/worstpasswords2013.htm. Published 2013. Accessed March 7,

2014.

3. Adults’ media use and attitudes report. Ofcom website. http://

stakeholders.ofcom.org.uk/binaries/research/media-literacy/adult-

media-lit-13/2013_Adult_ML_Tracker.pdf. Published April 2013.

Accessed March 3, 2014.

4. Munroe R. Password Strength. XKCD website. http://xkcd.com/936/.

Published August 10, 2011. Accessed March 2, 2014.

5. Blocki J, Blum M, Datta A. Naturally rehearsing passwords. arXiv

website. http://arxiv.org/pdf/1302.5122.pdf. Published September 9,

2013. Accessed March 8, 2014.

6. ‘What everyone needs to know’ about today’s cyberthreats. NPR

website. www.npr.org/2014/01/14/262387292/what-everyone-needs-

to-know-about-todays-cyberthreats. Published January 14, 2014.

Accessed March 2, 2014.

TECH TALK

Wired Magazine: Study Finds Widespread

Vulnerabilities in Hospital Equipment, Medical

Devices, and Electronic Health Records

A 2-year internal study by a Midwestern health care

network identied a disturbing and extensive lack

of security that could potentially leave nearly every

aspect of the health care system open to hackers.

Vulnerabilities were found in medical devices such as

drug pumps for insulin and pain management, im-

plantable cardioverter-debrillators (ICDs), CT scan-

ners, and robotic surgical systems; hospital storage

and climate control systems including refrigeration

units that store blood and pharmaceuticals; and

medical record and image-archiving systems. Many

of these systems lacked rigorous authentication

protocols for allowing access and reconguration,

and many were connected to intranets or even the

Internet, leaving them wide open to manipulation.

The study was conducted in about 100 hospitals,

health clinics, and pharmacies by Scott Erven, head

of Information Security at the Essentia Health

network. To their credit, Essentia Health leader-

ship decided to publicize the ndings of the study,

recognizing that the problem is likely rampant

throughout the nation and around the world.

For more in-depth coverage, please read the full

story in Wired. www.wired.com/2014/04/hospital-

equipment-vulnerable/

— Jeanne McAdara-Berkowitz

TECH NOTES

Even highly complex, unique

passwords won’t be effective

if hackers can simply change

them on the ﬂy.

e all do it, even though some of us may hesitate

to admit it. We search Google and its more aca-

demic cousin Google Scholar for medical infor-

mation. According to a 2010 survey, the three most popular

databases among science researchers are PubMed, Web of

Science, and Google Scholar.

Google Scholar may not have the scholarly reputation of

the other two, but it requires no subscription (unlike Web of

Science), is easy to use, and can even yield results not avail-

able in PubMed. When searched effectively, Google Scholar

can be an important and helpful resource to supplement

information found in other academic literature databases. As

with any database, the key to searching Google Scholar effec-

tively and efﬁciently is to understand what it can and cannot

do (Table 1) and to use some of its unique properties.

Google Scholar will retrieve published and unpub-

lished literature, conference papers, technical reports, dis-

sertations, pre-prints, drafts, patents, abstracts, and many

By Michelle A. Kraft, MLS, AHIP / Senior Medical Librarian, Cleveland Clinic Alumni Library, Cleveland, OH

Table 1: Comparison of Academic Literature Databases

Database Features Google Scholar PubMed Web of Science

Controlled vocabulary No Yes (MeSH) No

Period covered ? 1946 may have some older

material

1900-

Publications covered ? ~5600 journals 12,000 journals & 150,000

conference proceedings

Update frequency Google says several times a

week, but updates to some

existing records take more

than 6 months.

Daily Weekly

Citation counts Yes No Yes

Export to reference

software

1 record at a time Yes Yes

Alerts Yes Yes Yes

Truncation symbols No Yes Yes

Provides search limits

(date, publication type,

age, etc.)

Limited. Date, journal name,

author

Extensive. Can limit by age group,

humans, animals, type of article

such as guidelines, randomized

control trial, meta analyses

Yes

Searches full text Yes No No

Boolean Searching (and,

or, not)

Yes Yes Yes

find

80 AMWA Journal / V29 N2 / 2014 / amwa.org

Making the Most of

other document types. It ﬁnds these items from publisher

sites, online repositories, professional societies, and universi-

ties. Google Scholar provides a way to track article citations

and follow the links to citing articles. Searchers with college or

university library privileges can add links to their institutions

(under “library links” in the settings area of Google Scholar).

The library links are added to search results, making it easy to

gain access to articles that normally require a fee but are paid

for through library subscriptions.

Although Google Scholar has the ability to retrieve a lot of

resources from very diverse areas, it does not search the “deep

web” that consists of sites that require logins, have pay walls,

or are otherwise buried deep in university

repositories or websites.

Document Retrieval

Google Scholar lists results by date or accord-

ing to “relevancy,” which it determines

through its own algorithm. Although Google

does not disclose the exact nature of the algo-

rithm, it uses information within the full text

of the article, author, and journal informa-

tion, and the number of times an article has

been cited by other journals to help build the

list of relevant results. Other databases, such

as PubMed, rely on their indexing systems,

which use controlled vocabulary terms, in

addition to author and journal names, article titles, and other

article information, to build the list of relevant results. The lack

of information about the Google Scholar algorithm is one of its

downsides, as it is easier to create effective searches by know-

ing how a database retrieves articles.

Term Mapping

One key difference between Google Scholar on the one hand

and PubMed and other scientiﬁc databases on the other hand,

relates to the issue of “term mapping” and how synonyms are

handled. Google Scholar does not use controlled vocabulary

to index items. Google Scholar ﬁnds items only if the speci-

ﬁed terms actually appear within the full text of the article

or abstract. There are no subject terms added to increase

retrieval.

This can have positive and negative implications. Web

searchers and authors tend to use terms common to their pro-

fessions or every day language in their articles and search strat-

egies, not the indexing terms in controlled vocabulary. The use

of familiar language makes it easy and can yield some good

results. It does, however, limit the ability for people to ﬁnd

articles that use alternative spellings or synonyms. By contrast,

PubMed maps popular key words and terms to Medical Subject

Heading (MeSH) controlled vocabulary index terms (Figure 1).

Google Scholar has not developed a way to map similar terms.

Therefore, to retrieve all relevant articles on breast cancer, for

example, Google Scholar searchers might also need to include

the terms tumor and neoplasm. For medical communicators,

this term mapping issue can be important in many situations,

such as preparing systematic reviews or meta-analyses or iden-

tifying gaps in the research literature.

Truncated Words

Google Scholar does not recognize truncation symbols. It uses

“automatic stemming,” which means it looks at the word and

adds any additional letters on the end of that word. The word

jump would also include the terms jumps, jumped, and jump-

ing. Unfortunately, searching by the shortened root of the word

does not get all variants. Searching for the term surge will not

retrieve surgery, surgeries, or surgeon. Google Scholar search-

ers must not only include possible variants and synonyms for

terms and include them in their search strategy but also be

aware that automatic stemming might require them to use

additional terms.

Boolean Operators

Google Scholar uses Boolean operators, but there are some

things to be aware of. Scholar automatically adds the word

AND between search terms or sets of search terms in parenthe-

ses. The searcher must deliberately type the word OR between

terms or sets of parentheses. Additionally, the Boolean term

Figure 1. Example showing how PubMed maps words entered into the search box to

nd synonyms. A search for breast cancer will retrieve articles that have been indexed

under the medical subject heading term breast neoplasm.

Search Details

Query Translation:

"breast neoplasms"[MeSH Terms] OR ("breast"[All Fields] AND

"neoplasms"[All Fields]) OR "breast neoplasms"[All Fields] OR

("breast"[All Fields] AND "cancer"[All Fields]) OR "breast

cancer"[All Fields]

PubMed

breast cancer

FIND

AMWA Journal / V29 N2 / 2014 / amwa.org

OR must be in all capital letters or it will be ignored. Somebody

doing research on cancer may want their search strategy to

look like this: cancer OR neoplasm OR tumor.

Google Scholar does understand parentheses that are used

in search statements. Much like in addition and multiplication

problems, the parentheses force Google Scholar to combine

search terms in a speciﬁc way. For example, someone look-

ing for information on colon cancer might want to type colon

AND (neoplasm OR cancer OR tumor). If the searcher does

not use parentheses and capitalized Boolean terms, then he

or she might get articles about the colon as well as articles on

other types of cancer, cluttering their results on colorectal neo-

plasms. Searchers who don’t want any articles on rectal cancer

can use the minus symbol (hyphen) to eliminate the word

rectal. The search phrase would look like this: colon (neoplasm

OR cancer OR tumor) -rectal. (There are dangers, of course, in

such a strategy. The word rectal could be mentioned brieﬂy in

an article that otherwise would meet the searcher’s needs.)

Google Scholar’s advanced search function enables searchers

to look for speciﬁc authors, publications, titles, date ranges,

and subject areas. Any search result can be turned into an

automated e-mail alert to be notiﬁed of new papers.

Limitations

Unlike other databases, Google Scholar does not actually con-

tain any full text articles or abstracts. Instead, it data mines

websites and uses its algorithms to display the search results.

Therefore if the information that Google Scholar ﬁnds is incor-

rect, then the search results will be incorrect. In the past,

Google Scholar’s server has had some problems correctly

identifying authors, titles, and journals. The article “Google

Scholar’s Ghost Authors” by Peter Jasco describes how Scholar’s

crawling techniques misidentiﬁed many authors of articles as

“subscribe” or, in the case of a Lancet article, “fabricated the

ﬁrst initials and the last name of the ﬁrst author from the sub-

title of another paper and the second author’s name from the

title of a third paper.”

While it appears Scholar has addressed

some of the indexing issues, it still seems to have problems. As

recently as February 2013, blogger Karen Blakeman reported

Google Scholar erroneously listed an author as “MA Lib”

instead of the correct author K. Fraser.

Since Google Scholar

factors the number of times a paper has been cited to help

build the list of relevant results, Google Scholar’s ghost authors

may affect search results.

Citation searching is a helpful way to supplement a Google

Scholar subject search. Simply click on the “cited by” link to

see the authors who cited that speciﬁc work. Although the cita-

tion searching is helpful, it is important to know that this can

be easily manipulated artiﬁcially. In the article, “Manipulating

Google Scholar Citations and Google Scholar Metrics: simple,

easy and tempting,” researchers reported that they could arti-

ﬁcially increase an article’s display rank by uploading fake

papers to the Web that are discovered by Google’s Web crawl-

ers. Their experiment resulted in an increase of 774 citations

for 129 papers.

While there hasn’t been a documented case

of somebody manipulating citations to increase their article’s

ranking, it is important to be aware of as other databases such

as PubMed, Web of Science, and Scopus are not as vulnerable

to this type of manipulation.

Several recent studies have found that searching Google

Scholar can be helpful and yield interesting and relevant

results. For quick clinical research, Google Scholar can be quite

effective. A study of nephrologists seeking information for clin-

ical questions found “Google Scholar returns twice as many

relevant articles as PubMed and provides greater access to

free full-text articles.”

Scholar may be effective for quick clini-

cal questions, but it may not be as effective for other search

queries. The authors of an article in Systematic Reviews found

Google Scholar’s article retrieval “too low” to be used as a

single database for conducting systematic reviews.

No database is perfect; every database has its strengths and

weaknesses when it comes to indexing, structure, and cover-

age. To ﬁnd comprehensive information on a subject, search-

ers must look at a variety of databases. Because each database

is created differently, it is essential to know how those differ-

ences affect searching and to adjust the search strategy accord-

ingly. Google Scholar is a very helpful database and can serve

as a great additional tool for retrieving articles.

Author disclosure: The author notes that she has no commercial associ-

ations that may pose a conﬂict of interest in relation to this article.

Author contact: kraftm@ccf.org

References

1. Hightower C, Caldwell C. Shifting Sands: science researchers on Google

Scholar, Web of Science, and PubMed, with implications for library

collections budgets. Issues in Science and Technology Librarianship 2010.

www.istl.org/10-fall/refereed3.html. Accessed February 4, 2014.

2. Jasco P. Google Scholar's ghost authors. Library Journal 2009; http://

www2.hawaii.edu/~donnab/lis670/lj_print.pdf. Accessed February

4, 2014.

3. Blakeman K. Google Scholar author fail. 2013; www.rba.co.uk/

wordpress/2013/02/04/google-scholar-author-fail/.

4. Lopez-Cozar ED, Robinson-Garcia N, Torres-Salinas D. Manipulating

Google Scholar citations and Google Scholar metrics: simple, easy and

tempting. 2012. http://arxiv.org/abs/1212.0638

5. Shariff SZ, Bejaimal SA, Sontrop JM, et al. Retrieving clinical evidence: a

comparison of PubMed and Google Scholar for quick clinical searches.

J Med Internet Res. 2013;15(8):e164.

6. Bramer WM, Giustini D, Kramer BM, Anderson P. The comparative recall

of Google Scholar versus PubMed in identical searches for biomedical

systematic reviews: a review of searches used in systematic reviews.

Systematic reviews. 2013;2(1):115.

FIND

82 AMWA Journal / V29 N2 / 2014 / amwa.org

AMWA Journal / V29 N2 / 2014 / amwa.org

Committee on Publication Ethics North

American Seminar

August 13, 2014

Philadephia, PA

http://publicationethics.org/events

International Society of Managing and

Technical Editors

August 14–15, 2014

Philadephia, PA

www.ismte.org

6th Conference on Open Access

Scholarly Publishing

September 17–19, 2014

Paris, France

http://oaspa.org/

Council for Programs in Technical and Scientiﬁc

Communication

September 25–27, 2014

Colorado Springs, CO

www.cptsc.org/

Regulatory Affairs Professionals Society

September 27–October 1, 2014

Austin, TX

www.raps.org

National Association of Science Writers

October 17–21, 2014

Columbus, OH

http://nasw.org

New Horizons in Science

October 19–20, 2014

Columbus, OH

http://casw.org/

Health Literacy Annual Research Conference

November 3–4, 2014

Bethesda, MD

www.bumc.bu.edu/healthliteracyconference/

European Medical Writers Association

November 6–8, 2014

Florence, Italy

www.emwa.org

American Public Health Association

November 15–19, 2014

New Orleans, LA

www.apha.org/meetings/AnnualMeeting/

Calendar of Meetings

y philosophy of editing: What a big wide deep

topic, impossible to fully delve into in a few sen-

tences! The roots of those two words (the Greek

philos, beloved or loving, grafted onto sophia, knowledge,

learning, or wisdom, as applied to editus, the past participle

of the Latin verb meaning to publish or produce) are inex-

tricably tangled—tangled like the roots in the bottom of a

too-small terra cotta pot whose out-of-control plant is dying

for some help, in need of being lovingly and knowledgeably

cut apart and then transplanted into larger terrain. As a long-

time author’s editor at two major research-intensive medical

schools (the University of Minnesota in Minneapolis and the

University of Arizona in Tucson), I know that my job entails

loving knowledge or learning or wisdom enough to help cul-

tivate it into publishable form, to organically tend it (perhaps

to uproot parts of it) so that it produces its best ﬂowering in

the appropriate target journal or textbook.

Note that I am not a journal editor, an acquisitions editor,

a rewrite editor, or even a copyeditor; basically, as an author’s

editor, I have no power whatsoever, other than the power

of persuasion. My substantive editing services are available

as a departmental asset that faculty and staff members, fel-

lows, and residents can ask to tap anytime, all at no charge

to themselves or their subdivisions; whether or not to accept

my suggestions is up to them. (They usually do, if their many

expressions of gratitude to me are any indication.)

To try to replant, into the rich soil of the wider scholarly

world, the manuscripts that typically overﬂow my surgery

department in-box, I don’t need my well-worn gardening

gloves or pointed trowel or watering can. To shake excess dirt

off the page, to divide and reassemble the cuttings so they

thrive, and to send the most healthily pruned specimens off

into the sunlight, I rely on my decades of experience in aca-

demia, on all those years of loving (the never-ﬁnished pur-

suit of) knowledge and learning and wisdom. The main tools

of my trade are my well-thumbed dictionaries and reference

books, my favorite journals (including the AMWA Journal,

the ﬂagship New England Journal of Medicine, and College

Composition and Communication), and online research

resources like PubMed. Rather than a pointed trowel, I might

grab a pointed red felt-tip pen for proofs and other graphics-

heavy items that I then scan and send, but I typically wield a

Dell computer cursor, digging into sentences and vigorously

tilling them with bright-red track changes. My workplace

watering can takes the form of a warm-toned cover e-mail

to the lead author, in which I gently spray a light mist of sup-

port over those starkly embedded suggestions to securely

tamp them down, summarizing and explaining my edits, and

even more vitally, encouraging and thanking the author.

I am a writer, too; like nearly all of the authors I edit for,

I know what it’s like to be bruised by clueless, even cruel

reviewers and other uncaring gatekeepers. I want all authors

who seek my input to know that I am on their side, emphati-

cally yet empathetically rooting for the success of their intel-

lectual seedlings, the manuscripts that are the heartfelt

outgrowths of their hard ongoing work. Ultimately, each lead

author and I, as part of the same departmental team, are also

on the reader’s side (and, in the case of medical editing, on

the patient’s side as well).

The copious editorial suggestions that I unabashedly

shower on the near-ﬁnal drafts of their manuscripts (and

elaborate on in my cover e-mail messages) are all grounded

in sound rhetorical principles and best practices aimed at

the sky of effective, efﬁcient communication, with an unwilt-

By Mary E. Knatterud, PhD / St. Paul, MN

What is your philosophy of editing? We asked readers that question at the end of

Arnold Melnick’s article “Reject, Rewrite, or Edit” in the last issue of the journal.

sounding board

My Philosophy of Editing: Pruning and

Nurturing to Help Manuscripts Bloom

84 AMWA Journal / V29 N2 / 2014 / amwa.org

ing commitment to sow and nurture clarity, conciseness, con-

sistency, and connectedness. While respecting authors’ own

unique voice, I try to make sure that it doesn’t muddy readabil-

ity or trample up-to-date style conventions. Keeping the pri-

mary audience and speciﬁc genre ﬁrmly in view, I focus always

on painstakingly sharing my rigorous language-oriented

expertise as a wordsmith without inﬂicting inordinate pain

on the tender egos of my colleagues. Again, if unpersuaded by

any given change I offer up, they have the last word, along with

the byline. “Feel free to ignore any of my suggestions if they’re

not quite what you want or need,” I note in my cover e-mail.

“It is your paper, after all.” (I truly believe that even the most

conﬁdent surgeon-scientists have tender egos when it comes

to the personal craft of writing, even with regard to suppos-

edly “objective” research articles. I also believe that the tender

shoots of their manuscripts, whether overgrown or desic-

cated when they ﬁrst land in my hands, almost always harbor

the promise of profusely blooming somewhere, of reaping the

rewards of publication someday, of somehow sprouting meta-

phoric wings. As lofty as all that sounds, I couldn’t get up in the

morning if I didn’t think what I do matters.)

If I had to distill my philosophy of editing into one word,

it would be kindness, directly and liberally rained down on

authors for the sake of readers and patients alike. Of course, I

show no kindness to grammatical errors, syntactic lapses, fac-

tual mistakes, and other distracting slip-ups but instead con-

sider it a kindness to meticulously weed them out—a kindness

to my authors, their readers, and patients everywhere. In the

epilogue to my 1997 doctoral dissertation, I quoted Aldous

Huxley, and his words still resonate, root and branch, with

me: “It’s a bit embarrassing to have been concerned with the

human problem all one’s life and ﬁnd at the end that one has

no more to offer by way of advice than ‘try to be a little kinder.’”

Author contact: [email protected]

Mary E. Knatterud is an editor-educator at the University of Minnesota

in Minneapolis with three research-oriented departments: Surgery,

Urologic Surgery, and Otolaryngology. From October 2008 through

May 2014, she was an associate professor in the Department of Surgery

at the University of Arizona in Tucson (a telecommuting faculty posi-

tion based in her home ofﬁce in St. Paul); before that, she worked at

the University of Minnesota for 30 years, including 21 years in the

Department of Surgery.

Her 1997 doctoral dissertation, First Do No Harm: Empathy and the

Writing of Medical Journal Articles, was published by Routledge (New

York and London) in 2002. Her work on medical communication has

appeared in Archives of Surgery, Science Editor, AMWA Journal, Obesity

Surgery, JAMA, Transplantation, Dialysis & Transplantation, and

Minnesota Physician, among other journals. Her poetry has appeared

in Annals of Emergency Medicine, The Pharos (the Alpha Omega Alpha

Honor Medical Society journal), and Harmony (the Arizona Health

Sciences Center medical humanities magazine), among other

publications.

SOUNDING BOARD

If I had to distill my philosophy

of editing into one word, it would

be kindness, directly and liberally

rained down on authors for the

sake of readers and patients alike.

AMWA Journal / V29 N2 / 2014 / amwa.org

86 AMWA Journal / V29 N2 / 2014 / amwa.org

edical communications are supposed to make

sense. Thus, one of a medical editor’s most impor-

tant responsibilities is to ﬁnd and ﬁx nonsensi-

cal sentences. Many different kinds of problems can cause a

sentence to be nonsensical. Some of these problems are syn-

tactical, which means that they arise from some ﬂaw in the

grammatical structure of the sentence. Others are semantic,

which means that they arise from the meanings of the words.

In his 1957 book Syntactic Structures, Noam Chomsky pro-

vided a classic example of a sentence that makes no sense

even though it is grammatically correct:

Colorless green ideas sleep furiously.

The sentence is grammatical. It contains a noun phrase

that serves as a subject (colorless green ideas) and a verb

phrase that serves as a predicate (sleep furiously). The noun

in the subject phrase and the verb in the predicate phrase

even agree in number. Yet the phrase colorless green ideas

makes no sense. Ideas have no color. Even if they had a color,

they could not be colorless and green at the same time. Nor

does the predicate make sense. Ideas cannot sleep, and noth-

ing can sleep furiously.

When I am editing someone else’s writing or reviewing

my own, I analyze the sentences for semantic problems of

that kind. Do the noun-verb transactions make sense? Does

each modiﬁer (ie, adjectival and adverbial elements) really

modify its head (the sentence element that it’s supposed to

be modifying)? In particular, I focus on each verb and think

about how it relates to each of its arguments and adjuncts.

The arguments of a verb are the nouns and noun phrases

that stand in some sort of relationship to a verb in a particu-

lar sentence: namely, the subject(s), direct object(s), and

indirect object(s) of the verb. A verb may also have adjuncts.

Adjuncts are sentence elements that are not structurally

necessary. In other words, the sentence would still qualify

as a complete, grammatical sentence if they were left out.

Nevertheless, they can provide some useful information.

Syntactic Structures

The syntactical arguments of a verb include the subject,

direct object, and indirect object. The adjuncts of a verb

include adverbial prepositional phrases and adverbial

clauses.

All verbs can have a subject. However, only transitive

verbs can take a direct object. Note that some verbs can be

used in a transitive or intransitive sense:

I eat. (In this sentence, eat is intransitive because there’s

no direct object.)

I eat cookies. (Here, eat is a transitive verb because there

is a direct object: cookies.)

The syntactical relationships are easily shown by dia-

gramming the sentence:

A good dictionary will tell you whether a verb can be

used in a transitive sense. If the dictionary lists a particu-

lar verb as only being intransitive, I avoid giving it a direct

object.

Verbs that can take an indirect object are sometimes

called dative verbs:

I sang to her.

Verbs that can take a direct and an indirect object are

called ditransitive verbs:

I gave him $20.

Laurie Endicott Thomas, MA, ELS

Colorless Green Ideas Sleep Furiously

eat

cookieseat

sang

her

gave

him

$20

AMWA Journal / V29 N2 / 2014 / amwa.org

There are also some tritransitive verbs, such as to trade,

which can take a direct object and two indirect objects:

I traded him my peanut butter sandwich for a Twinkie.

Semantic Structures

Linguists have come up with some terminology to describe

the semantic relationships between nouns and verbs. For

example, an agent is an entity that performs an action, and

a patient is an entity that undergoes an action. Note that the

agent of a verb is not necessarily the subject of the sentence.

Nor is the patient always the direct object. When the passive

voice is used, the patient is the subject of the verb and the

agent is in a prepositional phrase, if it is mentioned at all.

I broke the window. (Active voice: the agent is the subject

and the patient is the direct object.)

The window was broken [by me]. (Passive voice: the

patient is the subject and the agent can even be omitted.)

The table lists some common types of semantic arguments

and adjuncts, sorted according to their syntactical roles. Notice

that some of the arguments are subjects, direct objects, and

indirect objects, whereas the adjuncts are adverbial phrases or

adverbial clauses.

These terms are helpful in thinking about how a verb

relates to the nouns and adverbial elements in the sentence.

However, the boundaries between these terms are sometimes

hazy. For example, it may be hard to decide whether something

is a patient or a theme.

Verb Arguments

Careful writers and good editors think about whether the argu-

ment structure of each verb makes sense. For example, some

kinds of verbs can be performed by only certain kinds of sub-

jects. For example, an animal, an inanimate object, or a natural

event can kill you, but only another human being can murder

you. That’s because the word murder is deﬁned as the unlawful

premeditated killing of one human being by another.

When I am writing or editing, I think about whether the

arguments of each verb make sense. Can the agent of that verb

really perform that action? If there is a direct object, is the verb

really transitive, and does that verb express something that is

really happening to that direct object? For help in making these

decisions, I often turn to the dictionary. Besides providing deﬁ-

nitions of the words involved, dictionaries give you examples

of how those words are used. Often, those examples show the

kind of argument structures that are appropriate for particular

nouns and verbs.

Author contact: [email protected]

Subjects

Agent deliberately performs an action I spoke.

Force or natural cause mindlessly performs an action The wind blew.

Experiencer receives sensory or emotional input They suered.

Direct objects

Patient undergoes an action and changes its state I broke the window.

Theme undergoes an action but is not changed I gave him $20.

Indirect objects

Recipient someone or something that receives ownership I gave him $20.

Beneciary the entity for whose benet the action was per-

formed

I baked her a pie.

Adverbial phrases and clauses

Time when an action occurred The operation was performed on Tuesday.

Location where an action occurred The procedure was performed in the

examination room.

Source or origin where the action originated The foreign body was removed from his ear.

Direction or goal where the action is directed toward She was taken to the hospital.

Instrument something used to perform the action The incision was made with a scalpel.

Manner how some action was carried out The bill was sent to me in error.

Purpose why someone chose to do something She called to remind me about the

meeting.

Cause why an action occurred The ice in the freezer melted because the

power went out.

his slim volume begins with a refreshingly candid

assertion: The National Institutes of Health (NIH),

with more than 20 separate institutes and a multitude

of specialized ofﬁces, can be byzantine. Where the authors

take that premise, however, is less straightforward.

I was struck by this book’s title for two reasons. First,

this is the ﬁrst I heard that the NIH could help me. Second,

although Dr Berg is a former “insider” (he used to run the

National Institute of General Medical Sciences), he no longer

works for the NIH. His coauthor is a grant writer and editor

who assists researchers with developing their applications.

Thus, neither one is an “insider.” Perhaps a picky distinction,

but one I returned to as I read the book.

As the opening paragraph suggests, this book has good

points. The Appendix is a 20-page treasure trove of URLs

and Web pages for a plethora of pieces, parts, and institutes

within the NIH. The introduction to the Appendix notes

that updated links and information can be found at Ms

Kienholz’s blog, thereby deftly addressing the top problem in

writing a how-to book about grant applications—timeliness

of information, especially online information. I also liked the

brief introduction, “Essential Steps for Securing NIH Grant

Funding: A Quick Guide to Key Concepts.” The 15 key con-

cepts are each linked to a chapter in the book, allowing read-

ers to browse based on their needs and interests.

And that leads me to a dreaded mineﬁeld in writing

about grants—abbreviations. After the “Essential Steps” sec-

tion, there is a four-page list of abbreviations that jumbles

together names of grant mechanisms, institutes, ofﬁces, and

miscellaneous terms—some arcane, some basic. It would be

churlish to blame the authors for the existence of all those

abbreviations. But who is the list for? Seasoned investiga-

tors won’t need it, and new ones will ﬁnd it overwhelming. In

addition, there’s no need to memorize or highlight terms that

seem useful, because (mercifully) they are spelled out in the

text later on.

The ﬁrst few chapters of the book delve into the struc-

ture of the NIH, which has the effect (as they say in the

newspaper business) of “burying the lede”—that is, keeping

the reader from getting to the good stuff. Nonetheless, as I

trudged through this material, I found a hidden gem: a clear,

two-page explanation of the NIH grant scoring system and

what the terms percentile, payline, and success rate mean.

This is something I’ve wanted to see for ages. But why put

this information before the key tips on how to write effec-

tively (chapters 8 and 9), when inexperienced grant writers

won’t know how to interpret it?

The puzzling organization of this book is its weakest

point. Why tell readers about their eRA Commons account

(the online “in box” for each principal investigator, which

includes self-populated demographic details, application

status updates, and reviewers’ critiques of submitted pro-

posals) on page 46, when it is not deﬁned until page 68?

Why explain the mechanics of a grant review panel (called a

study section) and how to get on one, when less-experienced

investigators still don’t understand how to write for that

audience (again, chapters 8 and 9)? Why say that the project

summary section of a grant application is not “a throw-away

30 lines of text,” without ever saying that the summary is

limited to 30 lines in length? Why discuss the federal budget

process (chapter 5), over which the applicant has little con-

trol, before discussing how to talk to people within the NIH

structure who could help you (chapter 10)?

My biggest source of confusion with this book is who

the authors believed their audience was, since the infor-

mation, its organization, and degree of detail (lots in some

places, none in others) suggests different audiences at dif-

ferent times. This confusion is reﬂected in the title, where

I began: Few readers will think the NIH exists to help them

get money, rather than to improve public health through

research. A more accurate title would have been “How

Knowing More About the NIH Will Help Your Grant’s Chances

of Funding.” The nuggets tucked away in this book do serve

that purpose, and seasoned grant writers will appreciate

them; less-savvy ones will get lost in the welter of details and

miss the nuggets altogether.

Brevity doesn’t mean a guide to grant writing is subopti-

mal. My favorite is Guide to Effective Grant Writing: How to

Write a Successful NIH Grant Application, by Otto O. Yang,

which is only 100 pages long. But tastes and needs differ; do

some homework into the best guides, and choose based on

your background and needs.

—Karen Potvin Klein, MA, ELS

Karen Potvin Klein is the director of grant development and medi-

cal editing, Translational Science Institute, Wake Forest University

Health Sciences, Winston-Salem, North Carolina.

media reviews

How the NIH Can Help You Get Funded.

An Insider’s Guide to Grant Strategy

Michelle L. Kienholz and Jeremy M. Berg

New York, NY: Oxford University Press, 2014; 188 pp., $29.95

88 AMWA Journal / V29 N2 / 2014 / amwa.org

n a my last column, I made a promise to you that the volunteers

and staff at AMWA would continue to work tirelessly to ensure

AMWA remains relevant to our members, to our profession,

and to our industry. If only you could have seen that promise kept

in Bethesda, Maryland, this past April!

Our usual spring Executive Committee (EC) and Board of

Directors (BOD) meetings began in a very unusual way. On April

10, 2014, leaders of the American Medical Writers Association,

the Drug Information Association (DIA), the International Society

for Medical Publication Professionals (ISMPP), and the Society

for Technical Communication (STC) met for the ﬁrst Medical

Communications Interorganizational Summit. The purposes of the

summit were to recognize the many similarities among the respec-

tive organizations; explore synergies that might beneﬁt the organi-

zations and their members; discuss challenges facing the medical

communications industry, the organizations, and their members;

and identify opportunities to share resources and experiences that

can strengthen the organizations, beneﬁt their members, and serve

their missions.

The participating organizations share certain core beliefs: a

commitment to integrity for the medical communications ﬁeld

and to being leaders in promoting excellence, both within the

industry and to their members, by providing guidance and con-

tinuing education. All of the participating organizations are

nonproﬁt, membership-based organizations. They are rich in edu-

cational resources and content, and their members are collectively

involved in all aspects of medical communications.

Summit participants were particularly interested in exploring

how to share educational resources, capitalize on the use of social

media to further their missions, and advocate for best practices

and industry standards that uphold their common commitments

to integrity and excellence. They agreed to reconvene soon via

scheduled teleconferences to address these and other topics war-

ranting deeper discussion.

If this summit was the only reason for us to gather in Bethesda,

that would have been enough. But it was just the beginning. The

EC met to discuss AMWA’s ﬁnances, which are outstandingly

healthy, and to continue our strategic work in furthering AMWA’s

mission. The Nominating Committee presented an outstanding

slate of ofﬁcers, which was then brought to the BOD the next day

for approval. Together, the EC and BOD took the next important

step forward in the certiﬁcation process, and now we’re on our way

to securing a trademark for the designation successful candidates

will be able to place after their names. I am purposefully holding

off telling you what that designation is until we have cleared the

ﬁrst hurdle at the US Patent and Trademark Ofﬁce.

The EC and BOD also took an important step forward in our

commitment to developing a top-notch online education program

that will be second to none and worthy of the AMWA name. Our

staff at headquarters has been empowered to research and pres-

ent recommendations for a learning management system that will

open up the e-learning environment for whatever we want to do.

Online learning was a message heard loud and clear from the med-

ical communicator needs assessment survey AMWA conducted

last year, and we are making progress.

During the BOD meeting, chapter representatives spent a few

hours brainstorming solutions to common chapter challenges. A

lot of innovative solutions were discussed as ideas ﬂowed freely

from chapter to chapter and from table to table. I believe all the

delegates were eager to get home to their chapters to discuss—and,

hopefully, implement—some of the great ideas that were shared.

The EC and BOD then devoted several additional hours to

brainstorming on another very important topic: how to pay for

all the exciting new programs and projects we have planned for

AMWA. As I mentioned earlier, AMWA is in a very healthy ﬁnancial

state. We have the money we need to enable AMWA to keep doing

the great things we do now. But clearly, AMWA members want and

need more, and the medical communications ﬁeld demands more

of its leading organization. It’s not a matter of saying “We can’t

afford to do these things.” Rather, it’s a matter of asking “How can

we afford to do these things?” The EC and BOD came up with ﬂip

chart pages ﬁlled with ideas, and you will be hearing more about

these exciting developments in the coming months.

At the end of our ﬁrst full day together, the EC and BOD cel-

ebrated with a little downtime and were treated to brief remarks by

the proposed slate of ofﬁcers. I made a few brief remarks as well,

which I want to share with you here. I asked the board members to

look at the current EC members and proposed slate of new ofﬁcers,

and realize we were once all in their shoes. We all started as mem-

bers, became involved at the chapter level, served on the BOD, and

joined the EC. What’s special about EC members is what’s special

about BOD members, is what’s special about many members: We

share a love for and commitment to AMWA. I encouraged every

BOD member to consider service on the EC in their future, just as

I encourage you now to get involved at the chapter level. You’ll be

amazed at where it can take you professionally and personally.

By Brian Bass / 2013–2014 AMWA President

Your AMWA at Work

amwa news

FROM THE PRESIDENT

AMWA Journal / V29 N2 / 2014 / amwa.org

Each year, the slate of AMWA ofﬁcers is chosen by the

Nominating Committee, which consists of the president-

elect (who serves as chair) and six voting members who

are not members of the Executive Committee (EC). The

Nominating Committee receives from AMWA headquarters

the names and biographies of all members meeting the cri-

teria for the three elected ofﬁces: president-elect, secretary,

and treasurer. The EC interest form also was sent to quali-

ﬁed candidates, giving them an opportunity to express their

interest in serving in an elected ofﬁcer position. Members

of the Nominating Committee discuss the potential can-

didates and select one candidate for each position. The

names of these candidates are then presented to the Board

of Directors for approval at its spring meeting.

The following candidates were approved by the Board

of Directors at its spring 2014 meeting:

President-elect Stephen Palmer, PhD, ELS

Secretary Lori Alexander, MTPW, ELS

Treasurer Christine F. Wogan, MS, ELS

President: The president-

elect automatically assumes

the ofﬁce of president at the

annual business meeting

held during the annual con-

ference of the following year.

The 2014–2015 AMWA presi-

dent will be Karen Potvin

Klein, MA, ELS, GPC. Karen

is director of grant develop-

ment and medical editing in

the Translational Science Institute at Wake Forest University

Health Sciences in Winston-Salem, North Carolina. She

earned an AB in classics from Brown University and an

MA in liberal studies from Wake Forest University. Karen

joined AMWA in 1989 and become a fellow in 2006. Karen

previously served AMWA in the elected ofﬁce of secre-

tary; as administrator of special projects/communications,

awards, publications, and public relations; as Certiﬁcation

Commission chair and job analysis panelist; in various

roles on committees and task forces, including chair and

member of the Eric Martin Award Committee, member

of the Budget and Finance Committee, and member of

the Task Force on Partnering with Higher Education; as a

roundtable, workshop and klatch leader; as open session

moderator and panelist; and as peer reviewer, editor, and

author of manuscripts for the AMWA Journal and reviewer

for Essays for Biomedical Communicators: Volume 2 of

Selected AMWA Workshops.

President-elect criteria: The president-elect (1) must have

served on the Executive Committee for a minimum of 2 full

years and (2) must be a current member of the Executive

Committee when his or her name is being considered by the

Nominating Committee.

Nominated for president-

elect is Stephen N. Palmer,

PhD, ELS. Steve is a senior

scientiﬁc medical writer at

the Texas Heart Institute

in Houston. He earned a

PhD in social and health

psychology at the State

University of New York

at Stony Brook, where he

also earned his MS. He

holds a BA from Wesleyan University. Steve joined AMWA

in 2002 and become a fellow in 2011. He is currently serv-

ing on the Executive Committee as secretary. His previ-

ous AMWA service includes the following: administrator

of awards, administrator of the annual conference, admin-

istrator of chapters and membership; annual conference

roundtable and klatch leader; open session leader and

speaker; member of many committees, including Medical

Book Awards and Constitution and Bylaws; and, for the

Southwest Chapter, program chair, president, immediate

past president, and board delegate.

amwa news

Slate of Candidates for 2014–2015 Election

90 AMWA Journal / V29 N2 / 2014 / amwa.org

Secretary criteria: The secretary must have served on

the Executive Committee within the 3 years immediately

preceding his or her consideration by the Nominating

Committee.

Nominated for secretary

is Lori Alexander, MPTW,

ELS. Lori is president of

Editorial Rx, Inc, an inde-

pendent medical writing

and publishing company

based in Orange Park,

Florida. Lori received a

bachelor’s degree in English

(concentration in journal-

ism) from the University of New Hampshire and a mas-

ter’s degree in technical and professional writing from

Northeastern University in Boston. Lori joined AMWA

in 1998, received the AMWA President’s Award in 2009,

and became a fellow in 2010. In 2012, she received a spe-

cial award for her 10 years of service as AMWA Journal

editor. Lori’s service to AMWA also includes: administra-

tor of the annual conference (twice); member of numer-

ous AMWA committees, including the job analysis and

item writing committees supporting the development

of medical writing certiﬁcation; and annual conference

roundtable leader, open session moderator and speaker,

and workshop leader. Lori is a past president of the

Florida Chapter, and she coordinated several chapter

conferences for both the Mid-Atlantic and Florida

chapters.

Treasurer criteria: The treasurer must have served at

least 1 year on the Budget and Finance Committee within

the 5 years preceding his or her consideration by the

Nominating Committee. It is also desirable for the trea-

surer to have served on the Executive Committee before

assuming the ofﬁce of treasurer.

amwa news

AMWA Journal / V29 N2 / 2014 / amwa.org 91

Nominated for treasurer

is Christine F. Wogan, MS,

ELS. Chris is publications

manager in the Division of

Radiation Oncology at the

MD Anderson Cancer Center

in Houston. She earned a

BA in biology at Swarthmore

College and an MS in bio-

logical sciences at the University of Houston at Clear

Lake. Chris joined AMWA in 1989 and received the AMWA

President’s Award in 2010. She was named a fellow in 2012.

Chris currently serves on the EC as treasurer. Her previ-

ous AMWA service includes the following: administrator of

awards; Journal peer reviewer; annual conference editing/

writing sections chair, workshop leader, open session pan-

elist and moderator, and roundtable leader; and, for the

Southwest Chapter, director-at-large, treasurer, president,

and immediate past president.

Procedure for Additional Nominations

According to AMWA’s bylaws (Article III.2d), additional

nominations for president-elect, secretary, or treasurer

may be made by any member whose dues and special

assessments are current, provided that any such nomina-

tion is submitted in writing to the secretary of AMWA at

least 30 days before the annual business meeting (which

will take place October 11, 2014, at the annual conference

in Memphis, Tennessee). Any individuals so nominated

must meet the criteria outlined in the bylaws (Article

III.1.a through 1.d) for their names to be placed on the

ballot. Such a nomination must clearly state the qualiﬁca-

tions of the candidate, must be signed by 50 members in

good standing as of the date of the receipt of the nomina-

tion, and must be accompanied by a letter from the candi-

date stating that he or she is willing to serve if elected.

amwa news

The American Medical Writers Association (AMWA) operates

on a ﬁscal year from July 1 to June 30. At the end of the

ﬁscal year that ended June 30, 2013, AMWA had generated

$1,798,972 in revenue (including $105,199 in net investment

revenue) and $1,622,049 in expenses, for an increase in reve-

nue over expenses of $176,923.

Financial Performance Trends

The organization’s revenue sources for the ﬁscal years that

ended June 30, 2011, June 30, 2012, and June 30, 2013 (Figure 1),

reﬂect a stable organization, with more than 90% of revenues

coming from membership, the annual conference, and the cer-

tiﬁcate program.

A slight increase in membership dues each year accounts

for the revenue growth in that category. Revenue from the

annual conference remains relatively ﬂat, but revenue from

the certiﬁcate program has shown a steady increase. The small

investment income in 2011–2012 reﬂects the market perfor-

mance during that period.

Expenses for 2012–2013 were lower than those of the previ-

ous year (Figure 2). The rise in expenses during 2011–2012 pri-

marily reﬂects development costs for the certiﬁcation program

and a period of transition in which AMWA’s current execu-

tive director came onboard before the departure of the previ-

ous executive director to ensure the organization’s stability. In

2012–2013, despite increased investment in enhanced member

services and educational offerings, overall expenses declined

by 4.5% owing to restructuring of headquarters staff positions.

Major expense categories for AMWA are personnel, pro-

gram services, and supporting services (Figure 3). Personnel

costs reﬂect compensation for the AMWA headquarters staff.

Program services include the costs of all of the mission-based

activity of the organization, including the annual conference,

membership, the journal, online education, the certiﬁcate

program, and the certiﬁcation program. Supporting services

are deﬁned as administrative costs such as rent, telephone,

network systems and support, board meetings, insurance,

and supplies.

Figure 1. AMWA’s sources of revenue for the scal years that

ended June 30, 2013, June 30, 2012, and June 30, 2011, obtained

from the nancial statements for those years.

$200,000

$400,000

$600,000

$800,000

Membership

Annual

Conference

Certicate

Program

Investments

Other

2010/2011

2011/2012

2012/2013

Figure 2. AMWA’s total expenses for the scal years that ended

June 30, 2013, June 30, 2012, and June 30, 2011, obtained from the

nancial statements for those years.

2010/2011

$200,000

$400,000

$600,000

$800,000

$1,000,000

$1,200,000

$1,400,000

$1,600,000

$1,800,000

2011/2012 2012/2013

$1,523,894

$1,696,526

$1,622,049

By Christine F. Wogan, MS, ELS / 2013–2014 AMWA Treasurer and Publications Program Manager, Division of Radiation

Oncology, The University of Texas MD Anderson Cancer Center

American Medical Writers Association

Annual Financial Report, 2012–2013

92 AMWA Journal / V29 N2 / 2014 / amwa.org

Looking forward, AMWA continues to invest in products

and services that are of value to the medical writing commu-

nity. Our new association management software and web-

site improvements will enhance AMWA’s ability to meet the

needs of our members as well as those of other medical writ-

ers. Development of the certiﬁcation program and enhanced

online education offerings will require a continued investment

of resources. Financial performance through the second quar-

ter of the current ﬁscal year (June 1, 2013, through December

31, 2013) is consistent with the budget and is expected to result

in a modest increase in the organization’s reserves.

Reserves

Reserves are the accumulation of funds over years to allow the

organization to withstand an emergency or to invest in new

programs. Unrestricted reserves of 6 to 12 months of annual

operating expenses are a standard target for not-for-proﬁt

organizations. With budgeted annual operating expenses of

$1,816,285 for the current ﬁscal year (from July 1, 2013, to June

30, 2014), the target for AMWA’s reserves ranges from $908,142

to $1,816,285. AMWA’s current reserve level of $1,337,165 is

comfortably within this target range (Figure 4).

Financial Position

An organization’s ﬁnancial position is reﬂected in its asset and

liability holdings (Figure 5). AMWA is well positioned to pay its

obligations and invest for the future. Total assets had grown to

$2,180,832 by June 30, 2013, and the organization’s liabilities

totaled $498,794. The vast majority of AMWA’s assets are liquid,

including cash, CDs, and mutual funds.

Conclusions

AMWA is in a stable ﬁnancial position. The future of the orga-

nization is dependent on a stable membership base and

growth in our educational offerings. Targeted investment in

these areas began in ﬁscal year 2012–2013 and will continue

into ﬁscal 2015–2016.

Acknowledgment

I thank Vickie McCormick of Calibre CPA Group PLLC for provid-

ing the ﬁnancial data and the 2012–2103 Budget and Finance

Committee members for their invaluable insights in their review of

reports and budgets: Mary Alice Ditzler, Jane Krauhs, Leslie Neistadt,

Judi Pepin, Alison Woo, and Jeanie Woodruff (and ex ofﬁcio members

Brian Bass, Doug Haneline, and Susan Krug).

Author contact: [email protected]

Figure 3. AMWA’s expenses by major category for the scal

years that ended June 30, 2013, June 30, 2012, and June 30, 2011,

obtained from the nancial statements for those years.

$200,000

$400,000

$600,000

$800,000

2010/2011

2011/2012

2012/2013

Personnel Program Services Supporting Services

Figure 4. AMWA’s unrestricted reserves for the scal years that

ended June 30, 2013, June 30, 2012, and June 30, 2011, obtained

from the nancial statements for those years.

2010/2011

$400,000

$800,000

$1,200,000

$1,600,000

2011/2012 2012/2013

$1,228,779

$1,168,747

$1,337,165

Figure 5. AMWA’s total assets, by major category, and total

liabilities for the scal years that ended June 30, 2013, June 30,

2012, and June 30, 2011, obtained from the nancial statements

for those years.

2010/2011 2011/2012 2012/2013

$2,023,751

$2,131,801

$2,180,832

$500,000

$1,000,000

$1,500,000

$2,000,000

$2,500,000

$460,185

$626,686

$498,794

Cash CDs Mutual Funds Other Assets Liabilities

amwa news

AMWA Journal / V29 N2 / 2014 / amwa.org 93

During the past quarter, the Certiﬁcation Commission

has continued to move closer to launching a certiﬁcation

examination for medical communicators. The ﬁrst exam

is on target to be given at the 2015 Annual Conference in

San Antonio, Texas.

The commission has completed a draft of the Policies

and Procedures Manual and Candidate Handbook and

will be ﬁnalizing these documents in the next quarter.

We anticipate that these materials and the examination

application will be available online in the ﬁrst quarter

of 2015. The eligibility requirements for applying for the

examination were described previously in the AMWA

Journal [2014;29(1):47].

Bart Harvey, MD, PhD, who chairs the Examination

Development Committee, worked with the commission

this past quarter to deﬁne terms and responsibilities for

the committee. There will be seven to nine committee

members who represent a diversity of practice settings

and areas of skill and expertise in medical writing (eg,

regulatory writing, quantitative research methods, man-

uscript editing/writing, education, plain language, and

patient materials). The committee’s duties will include

By Thomas Gegeny, MS, ELS, and Marianne Mallia, ELS / 2014 Certication Commission Co-Chairs

AMWA has learned that Joseph H. Bloom, a long-time member, died June 26, 2013, at the age of

75 in Candler, North Carolina. He was a freelance writer who began his career in Philadelphia

and moved to the green hills of North Carolina in semi-retirement many years later. Joseph

joined AMWA in 1983 and was named a Fellow of AMWA in 1991. He served AMWA as presi-

dent of the Delaware Valley Chapter and was a board delegate from that chapter for a number

of years as well as a workshop leader at many conferences during the 1980s and 1990s. In 1994,

Joseph received the President’s Award, and from 1997 to 1999 he was administrator of chapters

on the Executive Committee. Joseph’s love of grand opera was legendary, and he was able to sing

selections from Wagner’s Die Meistersinger and other operas with aplomb. He is survived by his

wife, two sons, and two stepdaughters.

—Barbara C. Good, PhD

In Memoriam

Joseph H. Bloom

amwa news

Quarterly Update on Certication

Summer 2014

• Makingrecommendationsregardingthecertication

examination “blueprint” (ie, areas of knowledge, skills,

and abilities to be tested).

• Periodicallyreviewingandmakingrecommendations

regarding the list of resources suggested to candidates

for certiﬁcation examination preparation.

• Developingitemsforinclusioninthecerticationexam-

ination item bank, especially in areas of the examination

blueprint that require additional items.

• Reviewingandprovidingfeedbackregardingproposed

and existing certiﬁcation examination items.

• Recommendingitemstobeincludedinthecertication

examination.

• Reviewingitemperformanceonthecerticationexami-

nation (ie, item difﬁculty and item-total correlation) and

recommending any indicated item revisions.

Bart will also work with the consultant testing agency,

as needed, on tasks related to developing the certiﬁcation

examination.

These are exciting times. Continue to watch for more

information about the certiﬁcation exam in upcoming

AMWA Updates and in the AMWA Journal.

94 AMWA Journal / V29 N2 / 2014 / amwa.org

Writers Write.

So why not write for the AMWA Journal?

The Journal is seeking volunteers to cover speakers

and Open Sessions at the upcoming Annual

Conference. Volunteer by sending an e-mail to

[email protected]g.

AMWA Writers Write

for the AMWA Journal.

AMWA Journal / V29 N2 / 2014 / amwa.org

Explore New

Online Offerings

http://www.amwa.org/online_offerings

96 AMWA Journal / V29 N2 / 2014 / amwa.org

Unless otherwise noted, submit manuscripts and suggestions for

content to the Journal Editor at Jour[email protected].

FEATURE-LENGTH ARTICLES

Feature-length articles include topical features, original research in

medical communication, and Science Series articles.

Topical Features

The Journal accepts manuscripts on areas of interest to medical

communicators, including topics within such broad categories as

regulatory writing, continuing medical education, patient educa-

tion, medical marketing/advertising, public relations, medical jour-

nal management, publication ethics, health policy, etc. The Journal

especially encourages the submission of articles on the theoretical

underpinnings of speciﬁc types of medical communication. AMWA

Journal readers are primarily practitioners (not academicians),

and application of theory to practice is an essential component of

manuscripts. Word Count: 3,000 words (plus an informative abstract

of 250-300 words)

Original Research

The Journal accepts manuscripts reporting original research on

written communication, publication trends, and medical communi-

cators’ productivity and value added. Word Count: 3,000 words (plus

an informative abstract of 250-300 words)

Science Series

The Science Series accepts manuscripts that provide an overview of

a speciﬁc anatomic or physiologic topic (eg, body system), disease

or condition, diagnostic method (eg, laboratory tests, imaging

systems), or type of treatment (eg, devices). Submit manuscripts

for the Science Series to Randy Fritz, Science Series Editor, at fritz.

randall@mayo.edu. Word Count: 3,000 words (plus an informative

abstract of 250-300 words)