Writing: Do Make a MEAL of It!

Writing for publication fulfills a professional obligation to contribute to the body of knowledge. In the past decade, we’ve seen increases in the number of journals and in the number of NPs and PAs—providing more publishing opportunities and more potential authors. Yet many of my colleagues have little interest in publishing; perhaps they fear the writing process or believe they lack the skills to compose a manuscript.

How, then, do we cajole them into sharing their expertise in written form? Much has been written about why you should write.^1,2 What is needed is guidance on the process to help overcome the common ­barriers to success in publishing. If it’s been a long time since you were in school at all—or at least since you took English Composition 101—allow me to offer a solid starting point for the journey of writing.

A manuscript, in essence, is a collection of paragraphs that follow a traditional flow. But to be sufficiently developed, paragraphs must (1) contain a main idea, (2) be structurally coherent, and (3) maintain a sense of unity around the idea.³ Once authors master the composition of a strong paragraph, the development of the manuscript comes naturally. Here are seven tips—four on content development and three on form—for compiling a manuscript worthy of publication and personal pride.

1. Start strong. Everyone understands the importance of grabbing a reader’s attention right out of the gate, right? A strong topic sentence does more than introduce the subject; it sets the tone for those that follow. A short sentence at the beginning of a paragraph establishes an understanding that a discussion will follow—and offers a preview of what the discussion will entail. But writers need not be limited; a topic sentence can take the form of a question or be placed later in the paragraph. Less experienced authors may prefer to open the paragraph with the topic sentence, however, as this allows for a quick assessment of whether the subsequent sentences follow logically. In other words, start simple—there is room to grow as you gain confidence with writing.

2. Use the MEAL plan. A paragraph should extend from the topic sentence. Collectively, the paragraph’s sentences should follow the steps outlined in the “MEAL plan,” a valuable resource conceptualized by the Duke University Thompson Writing Program.⁴ The “M” stands for the main topic; “E,” for the evidence that supports or refutes the topic sentence; “A,” for analysis and its importance; and “L,” for the link back to the larger claim (ie, the overall topic of the paper).

Using the MEAL approach is relatively straightforward. Picture yourself as the sender of a message; the reader is your recipient. You need to convey the information to your reader so that he or she understands it.

Limiting the number of words in a sentence and the number of sentences in a paragraph may help. Exceedingly long sentences are cumbersome and threaten to muddle the author’s message. They also pose the risk for improper noun/verb agreement, irregular punctuation, and hindered readability. (But then, what are editors for?)

A paragraph presents a well-formulated argument; one that contains only two sentences is unlikely to support the author’s assertion. Novice writers, however, often go to the other extreme, which dilutes the point. As a rule of thumb, if you can speak the entire paragraph with a single breath, the length is adequate. Reading your work aloud also helps identify hidden hazards.

3. Make connections. The result would be confusing and nonsensical. Similarly, you wouldn’t conclude your paragraph before you’ve started it. Imagine if you tried to clean out a wound after applying a dressing. The key to a good paragraph is cohesion.

If you’re scratching your head at the previous paragraph, you take my next point: All sentences within a paragraph should have a natural flow. In a well-developed paragraph, each sentence directly relates to the one before and the one after; they work together to convey your point. If the topic sentence contains an assertion, the following sentences provide supporting evidence. In medical writing, this evidence comes from citations to published literature.

If you are using the MEAL plan, you have an outline for how to support your topic sentence in a logical manner. You can then link sentences by capitalizing on words or phrases to form bridges that carry the reader through the paragraph.⁵ These links are created through repetition of key words or through parallel grammatical forms.

4. Pump the brakes. No one likes an abrupt stop. When you’re winding down on a paragraph, you need to signal to the reader that you’re going to shift gears. The last sentence of a paragraph should serve as a natural transition to the next paragraph.⁶ Equally important is the transition line at the beginning of the next paragraph.

Regardless of where the transition occurs, the goal remains to help the reader follow your logic. A subsequent paragraph can extend or refute the argument that has been presented, or it can introduce an entirely new point. No matter what, you want the reader to be prepared for a change in focus and to stay with you through your transition to a new perspective or subtopic.

On the other hand, if the argument is exhausted—it stops. When your discussion is complete, the transition to the next paragraph is very different (eg, “In summary…”). This is an appropriate time to move to a new paragraph and new section.

Speaking of a new section, let’s switch our focus to form.

5. Take action. There are two types of “voice” in communication: active, in which the subject is taking some form of action (eg, You are reading this article), and passive, in which the action is performed upon the subject (eg, This article is being read by you). Active voice is preferred for several reasons—namely, clarity and space. An active sentence identifies who is doing what. The same conclusion may be reached through a passive sentence, with some effort on the reader’s part—but active sentences tend to be more concise. They also convey a sense of immediacy, hopefully drawing the reader into your article.

6. Punctuate like a pro. Punctuation is important! It provides structure, improving clarity and comprehension. Can you fathom the confusion that would occur if an author misused (or failed to use) appropriate punctuation?

Thankfully, rules regarding punctuation have not changed much over the past century. One notable exception is use of the serial (or “Oxford”) comma, which incites passionate debate among both amateur and professional linguists.⁷ (For the record, this publication uses the Oxford comma. Just ask the editors: Karen, Ann, and Amy.)

A full review of punctuation is beyond the scope of this article; however, be it known that the most problematic marks—the ones to double-check in your own writing—are the apostrophe (plural or singular possessive use), the semi-colon, the comma (or lack of), and quotation marks.⁸ To improve your punctuation, obtain a basic grammar handbook or search online.

7. Don’t volley with verbs. Verb tense should remain consistent throughout the paragraph.⁹ Paragraphs with multiple verb tenses bounce the reader’s mind back and forth. It’s like watching a ping pong match, but less enjoyable.

To check for consistency, print the manuscript and mix the order of the pages. Circle the verbs. Look at the circled words and assess the tense of each. Then, repair the damage.

It is easier to identify these types of problems with a manuscript when you’re reading the pages out of order. Editors will tell you that it is difficult to focus on particulars when you are distracted by the content of the paper. Out-of-order pages are harder to read for “sense,” so you can focus on tense, voice, and punctuation.

In conclusion, I hope I’ve helped you see that writing is a process—some say a craft—but it is one that anyone can tackle with the right mindset and preparation. Most authors have a key message; they may just need help expressing it. Starting with small elements, such as the paragraph, helps the author deliver the message clearly.

Writing for publication fulfills a professional obligation to contribute to the body of knowledge. In the past decade, we’ve seen increases in the number of journals and in the number of NPs and PAs—providing more publishing opportunities and more potential authors. Yet many of my colleagues have little interest in publishing; perhaps they fear the writing process or believe they lack the skills to compose a manuscript.

How, then, do we cajole them into sharing their expertise in written form? Much has been written about why you should write.^1,2 What is needed is guidance on the process to help overcome the common ­barriers to success in publishing. If it’s been a long time since you were in school at all—or at least since you took English Composition 101—allow me to offer a solid starting point for the journey of writing.

A manuscript, in essence, is a collection of paragraphs that follow a traditional flow. But to be sufficiently developed, paragraphs must (1) contain a main idea, (2) be structurally coherent, and (3) maintain a sense of unity around the idea.³ Once authors master the composition of a strong paragraph, the development of the manuscript comes naturally. Here are seven tips—four on content development and three on form—for compiling a manuscript worthy of publication and personal pride.

1. Start strong. Everyone understands the importance of grabbing a reader’s attention right out of the gate, right? A strong topic sentence does more than introduce the subject; it sets the tone for those that follow. A short sentence at the beginning of a paragraph establishes an understanding that a discussion will follow—and offers a preview of what the discussion will entail. But writers need not be limited; a topic sentence can take the form of a question or be placed later in the paragraph. Less experienced authors may prefer to open the paragraph with the topic sentence, however, as this allows for a quick assessment of whether the subsequent sentences follow logically. In other words, start simple—there is room to grow as you gain confidence with writing.

2. Use the MEAL plan. A paragraph should extend from the topic sentence. Collectively, the paragraph’s sentences should follow the steps outlined in the “MEAL plan,” a valuable resource conceptualized by the Duke University Thompson Writing Program.⁴ The “M” stands for the main topic; “E,” for the evidence that supports or refutes the topic sentence; “A,” for analysis and its importance; and “L,” for the link back to the larger claim (ie, the overall topic of the paper).

Using the MEAL approach is relatively straightforward. Picture yourself as the sender of a message; the reader is your recipient. You need to convey the information to your reader so that he or she understands it.

Limiting the number of words in a sentence and the number of sentences in a paragraph may help. Exceedingly long sentences are cumbersome and threaten to muddle the author’s message. They also pose the risk for improper noun/verb agreement, irregular punctuation, and hindered readability. (But then, what are editors for?)

A paragraph presents a well-formulated argument; one that contains only two sentences is unlikely to support the author’s assertion. Novice writers, however, often go to the other extreme, which dilutes the point. As a rule of thumb, if you can speak the entire paragraph with a single breath, the length is adequate. Reading your work aloud also helps identify hidden hazards.

3. Make connections. The result would be confusing and nonsensical. Similarly, you wouldn’t conclude your paragraph before you’ve started it. Imagine if you tried to clean out a wound after applying a dressing. The key to a good paragraph is cohesion.

If you’re scratching your head at the previous paragraph, you take my next point: All sentences within a paragraph should have a natural flow. In a well-developed paragraph, each sentence directly relates to the one before and the one after; they work together to convey your point. If the topic sentence contains an assertion, the following sentences provide supporting evidence. In medical writing, this evidence comes from citations to published literature.

If you are using the MEAL plan, you have an outline for how to support your topic sentence in a logical manner. You can then link sentences by capitalizing on words or phrases to form bridges that carry the reader through the paragraph.⁵ These links are created through repetition of key words or through parallel grammatical forms.

4. Pump the brakes. No one likes an abrupt stop. When you’re winding down on a paragraph, you need to signal to the reader that you’re going to shift gears. The last sentence of a paragraph should serve as a natural transition to the next paragraph.⁶ Equally important is the transition line at the beginning of the next paragraph.

Regardless of where the transition occurs, the goal remains to help the reader follow your logic. A subsequent paragraph can extend or refute the argument that has been presented, or it can introduce an entirely new point. No matter what, you want the reader to be prepared for a change in focus and to stay with you through your transition to a new perspective or subtopic.

On the other hand, if the argument is exhausted—it stops. When your discussion is complete, the transition to the next paragraph is very different (eg, “In summary…”). This is an appropriate time to move to a new paragraph and new section.

Speaking of a new section, let’s switch our focus to form.

5. Take action. There are two types of “voice” in communication: active, in which the subject is taking some form of action (eg, You are reading this article), and passive, in which the action is performed upon the subject (eg, This article is being read by you). Active voice is preferred for several reasons—namely, clarity and space. An active sentence identifies who is doing what. The same conclusion may be reached through a passive sentence, with some effort on the reader’s part—but active sentences tend to be more concise. They also convey a sense of immediacy, hopefully drawing the reader into your article.

6. Punctuate like a pro. Punctuation is important! It provides structure, improving clarity and comprehension. Can you fathom the confusion that would occur if an author misused (or failed to use) appropriate punctuation?

Thankfully, rules regarding punctuation have not changed much over the past century. One notable exception is use of the serial (or “Oxford”) comma, which incites passionate debate among both amateur and professional linguists.⁷ (For the record, this publication uses the Oxford comma. Just ask the editors: Karen, Ann, and Amy.)

A full review of punctuation is beyond the scope of this article; however, be it known that the most problematic marks—the ones to double-check in your own writing—are the apostrophe (plural or singular possessive use), the semi-colon, the comma (or lack of), and quotation marks.⁸ To improve your punctuation, obtain a basic grammar handbook or search online.

7. Don’t volley with verbs. Verb tense should remain consistent throughout the paragraph.⁹ Paragraphs with multiple verb tenses bounce the reader’s mind back and forth. It’s like watching a ping pong match, but less enjoyable.

To check for consistency, print the manuscript and mix the order of the pages. Circle the verbs. Look at the circled words and assess the tense of each. Then, repair the damage.

It is easier to identify these types of problems with a manuscript when you’re reading the pages out of order. Editors will tell you that it is difficult to focus on particulars when you are distracted by the content of the paper. Out-of-order pages are harder to read for “sense,” so you can focus on tense, voice, and punctuation.

In conclusion, I hope I’ve helped you see that writing is a process—some say a craft—but it is one that anyone can tackle with the right mindset and preparation. Most authors have a key message; they may just need help expressing it. Starting with small elements, such as the paragraph, helps the author deliver the message clearly.

Writing for publication fulfills a professional obligation to contribute to the body of knowledge. In the past decade, we’ve seen increases in the number of journals and in the number of NPs and PAs—providing more publishing opportunities and more potential authors. Yet many of my colleagues have little interest in publishing; perhaps they fear the writing process or believe they lack the skills to compose a manuscript.

How, then, do we cajole them into sharing their expertise in written form? Much has been written about why you should write.^1,2 What is needed is guidance on the process to help overcome the common ­barriers to success in publishing. If it’s been a long time since you were in school at all—or at least since you took English Composition 101—allow me to offer a solid starting point for the journey of writing.

A manuscript, in essence, is a collection of paragraphs that follow a traditional flow. But to be sufficiently developed, paragraphs must (1) contain a main idea, (2) be structurally coherent, and (3) maintain a sense of unity around the idea.³ Once authors master the composition of a strong paragraph, the development of the manuscript comes naturally. Here are seven tips—four on content development and three on form—for compiling a manuscript worthy of publication and personal pride.

1. Start strong. Everyone understands the importance of grabbing a reader’s attention right out of the gate, right? A strong topic sentence does more than introduce the subject; it sets the tone for those that follow. A short sentence at the beginning of a paragraph establishes an understanding that a discussion will follow—and offers a preview of what the discussion will entail. But writers need not be limited; a topic sentence can take the form of a question or be placed later in the paragraph. Less experienced authors may prefer to open the paragraph with the topic sentence, however, as this allows for a quick assessment of whether the subsequent sentences follow logically. In other words, start simple—there is room to grow as you gain confidence with writing.

2. Use the MEAL plan. A paragraph should extend from the topic sentence. Collectively, the paragraph’s sentences should follow the steps outlined in the “MEAL plan,” a valuable resource conceptualized by the Duke University Thompson Writing Program.⁴ The “M” stands for the main topic; “E,” for the evidence that supports or refutes the topic sentence; “A,” for analysis and its importance; and “L,” for the link back to the larger claim (ie, the overall topic of the paper).

Using the MEAL approach is relatively straightforward. Picture yourself as the sender of a message; the reader is your recipient. You need to convey the information to your reader so that he or she understands it.

Limiting the number of words in a sentence and the number of sentences in a paragraph may help. Exceedingly long sentences are cumbersome and threaten to muddle the author’s message. They also pose the risk for improper noun/verb agreement, irregular punctuation, and hindered readability. (But then, what are editors for?)

A paragraph presents a well-formulated argument; one that contains only two sentences is unlikely to support the author’s assertion. Novice writers, however, often go to the other extreme, which dilutes the point. As a rule of thumb, if you can speak the entire paragraph with a single breath, the length is adequate. Reading your work aloud also helps identify hidden hazards.

3. Make connections. The result would be confusing and nonsensical. Similarly, you wouldn’t conclude your paragraph before you’ve started it. Imagine if you tried to clean out a wound after applying a dressing. The key to a good paragraph is cohesion.

If you’re scratching your head at the previous paragraph, you take my next point: All sentences within a paragraph should have a natural flow. In a well-developed paragraph, each sentence directly relates to the one before and the one after; they work together to convey your point. If the topic sentence contains an assertion, the following sentences provide supporting evidence. In medical writing, this evidence comes from citations to published literature.

If you are using the MEAL plan, you have an outline for how to support your topic sentence in a logical manner. You can then link sentences by capitalizing on words or phrases to form bridges that carry the reader through the paragraph.⁵ These links are created through repetition of key words or through parallel grammatical forms.

4. Pump the brakes. No one likes an abrupt stop. When you’re winding down on a paragraph, you need to signal to the reader that you’re going to shift gears. The last sentence of a paragraph should serve as a natural transition to the next paragraph.⁶ Equally important is the transition line at the beginning of the next paragraph.

Regardless of where the transition occurs, the goal remains to help the reader follow your logic. A subsequent paragraph can extend or refute the argument that has been presented, or it can introduce an entirely new point. No matter what, you want the reader to be prepared for a change in focus and to stay with you through your transition to a new perspective or subtopic.

On the other hand, if the argument is exhausted—it stops. When your discussion is complete, the transition to the next paragraph is very different (eg, “In summary…”). This is an appropriate time to move to a new paragraph and new section.

Speaking of a new section, let’s switch our focus to form.

5. Take action. There are two types of “voice” in communication: active, in which the subject is taking some form of action (eg, You are reading this article), and passive, in which the action is performed upon the subject (eg, This article is being read by you). Active voice is preferred for several reasons—namely, clarity and space. An active sentence identifies who is doing what. The same conclusion may be reached through a passive sentence, with some effort on the reader’s part—but active sentences tend to be more concise. They also convey a sense of immediacy, hopefully drawing the reader into your article.

6. Punctuate like a pro. Punctuation is important! It provides structure, improving clarity and comprehension. Can you fathom the confusion that would occur if an author misused (or failed to use) appropriate punctuation?

Thankfully, rules regarding punctuation have not changed much over the past century. One notable exception is use of the serial (or “Oxford”) comma, which incites passionate debate among both amateur and professional linguists.⁷ (For the record, this publication uses the Oxford comma. Just ask the editors: Karen, Ann, and Amy.)

A full review of punctuation is beyond the scope of this article; however, be it known that the most problematic marks—the ones to double-check in your own writing—are the apostrophe (plural or singular possessive use), the semi-colon, the comma (or lack of), and quotation marks.⁸ To improve your punctuation, obtain a basic grammar handbook or search online.

7. Don’t volley with verbs. Verb tense should remain consistent throughout the paragraph.⁹ Paragraphs with multiple verb tenses bounce the reader’s mind back and forth. It’s like watching a ping pong match, but less enjoyable.

To check for consistency, print the manuscript and mix the order of the pages. Circle the verbs. Look at the circled words and assess the tense of each. Then, repair the damage.

It is easier to identify these types of problems with a manuscript when you’re reading the pages out of order. Editors will tell you that it is difficult to focus on particulars when you are distracted by the content of the paper. Out-of-order pages are harder to read for “sense,” so you can focus on tense, voice, and punctuation.

In conclusion, I hope I’ve helped you see that writing is a process—some say a craft—but it is one that anyone can tackle with the right mindset and preparation. Most authors have a key message; they may just need help expressing it. Starting with small elements, such as the paragraph, helps the author deliver the message clearly.