From an idea to an outline

An idea becomes a draftable plan when its subject, main point and boundaries are clear. A focus statement or problem statement guides the selection of material, and an outline arranges that material into a structure that can be tested before drafting.

Ideas and boundaries

Useful ideas can emerge from practical problems discussed with colleagues, an area of expertise, or the clinical implications of a public issue. ¹ A timely idea should be recorded and acted on before it grows cold; writing about a subject that excites the writer can sustain interest and support career development. ¹

Ideas can arise outside writing sessions, including during ordinary activities or on waking, and should be captured before they disappear. ² A substantial project can benefit from incubation and accumulating facts, phrases and connections, with notes filed by likely section or chapter. ³

Broad topics usually need narrowing. ⁴ Headache diagnosis, for example, can narrow to migraine diagnosis, then to a population such as adolescents or older adults, or to the decision about diagnostic imaging. ⁴ A piece about that imaging decision should make clear that blood tests, drugs, doses and diets lie outside its scope. ^{4, 5}

Prewriting includes considering alternative approaches before choosing one. ⁶ A general sinusitis topic can yield articles on mechanisms, acute versus chronic disease, populations, diagnostic presentations, imaging, treatment or referral. ^{6, 7, 8} One exercise is to choose a clinical area and generate at least ten possible review-article approaches. ⁸

A focus statement

A focus statement expresses the single idea a nonfiction piece is intended to communicate. ⁹ It should be developed early, around receiving the assignment or beginning research, so it can guide the work before drafting is far advanced. ¹⁰ A short statement provides an anchor when attention to detail threatens to obscure the central idea. ¹¹

A recommended form is a simple independent clause with a subject, a transitive action verb and an object, adding prepositional phrases where needed. ¹² The recommendation seeks a specific, concrete cause-and-effect statement that the piece can demonstrate, kept simple enough to guide later decisions. ^{12, 13} Keeping it short and specific avoids the abstraction or complexity that can arise in main-idea or thesis statements. ¹⁴ It is usually an unpublished working tool, although some pieces call for stating it directly. ^{14, 15}

Ways to develop the statement include summarising the client’s request in six words, imagining one intelligent but busy reader, and identifying the stakeholders and what is at stake if the information does not reach them now. ^{16, 17} Free writing can explore what is most important or interesting, and three to five disposable introductory paragraphs, or “burner leads”, can help discover the promise the piece makes. ^{17, 18} Further approaches are to annotate research notes, visualise what the reader should think, feel or do, discuss the statement with colleagues or clients, and revisit it as needed. ¹⁸

The statement gives the piece an intended intellectual or emotional destination; several competing destinations can undermine that direction. ^{13, 19} An assignment triggered by a completed study, awareness day, service need or news still needs something valuable to say to its reader. ^{20, 21}

The focus statement helps select relevant research rather than use everything collected. ^{22, 15} It guides the outline and subsequent decisions about what to retain during drafting and revision. ^{15, 21} Introduction, context, body and conclusion have distinct jobs but remain connected by that focus, rather than merely repeating one statement. ^{15, 23} A book may allow a short excursion into a related topic, while a 400-word lay article allows less; either should return promptly to its focus. ²⁴

A problem statement

A scientific document should state the problem it addresses clearly enough that readers need not infer it from the title, discussion or their existing knowledge. ²⁵ A project’s purpose is to solve a problem, whether by answering a question, testing a hypothesis, explaining a phenomenon or gathering knowledge. ²⁵

Terms such as aim and objective can be ambiguous when they stand for tasks, targets, methods, outcomes or expected results; describing the problem helps clarify what the work seeks to find out. ²⁶ One recommended approach is one central problem per document, with subsidiary problems organised beneath it even in a thesis. ²⁷ More than one broad problem may warrant another document. ²⁸ Methods then explain how the problem is approached, literature supports its importance and the method choice, and discussion addresses whether it was solved. ²⁷

The “What’s your problem?” exercise develops a problem statement and a concise project summary to guide document design, structure and logic. ^{29, 30, 31} It applies to original research reports and to interpretation of others’ research, and may help with non-scientific projects. ²⁹ Its eight questions cover problem definition through interpretation; the final question returns to the first because findings can generate new problems. ²⁹

1. What is the overall problem? List linked problems, retain directly relevant ones, and summarise one broad problem and its main features in a paragraph distinguishing what is known from what is unknown.
2. Why is it important? Explain its scientific and societal importance, supported by literature; citations do not replace an explicit statement.
3. What problem does the project aim to solve? Narrow to what the document can address, locate it within the broader field, and place subsidiary problems in background or future directions.
4. How is it approached? Summarise methods or analysis, including the scope in time and magnitude.
5. What are the results? Summarise the consequence of the methods or analysis and the answer obtained.
6. Why were these results obtained? Identify explanatory factors and reasons.
7. Was the problem solved and the aim achieved? Interpret whether it was solved fully or partly and what conclusions, hypotheses or principles the results support.
8. What is the problem like now? State implications, recommendations, possible new principles and transferability, limitations, and remaining or new problems; unclear results also require explanation.

^{28, 32, 33, 34, 35, 36, 37, 38}

A worked problem-statement example

A worked example from 2012 applies the eight questions to a pregnancy-risk analysis in an HIV-vaccine trial. ^{39, 40}

Question	Answer in the worked example
Overall problem	HIV-prevention trials in sub-Saharan Africa recruited women at risk of pregnancy while asking them to avoid pregnancy during investigational treatment because fetal safety was usually unknown.
Importance	Identifying pregnancy risk at screening could protect participants and reduce time off study product, improving trial efficiency.
Specific problem	Pregnancy risk during vaccine trials was poorly characterised; identifying modifiable factors could improve screening and support.
Approach	Report pregnancy rates and outcomes during and after vaccination and identify screening factors associated with incident pregnancy.
Results	Pregnancy incidence was 9.6 per 100 women-years overall, lower at sites providing contraception and among injectable-contraceptive or consistent-condom users. Rates tended to rise after vaccination, without a statistically significant difference. Multiple risk factors, including heavy drinking and marijuana use, predicted increased incidence.
Explanation	The proposed explanation was access to effective contraception and the requirement to use two forms during the trial; reasons for the substance-use association were not discussed.
Aim achieved	Risk factors were identified. The analysis proposed free on-site injectable contraception, support for consistent condom use, and screening for substance use, partnering and both partners’ HIV status.
Remaining problem	Preliminary implications concerned added pregnancy-prevention counselling for women with multiple risk factors, rather than heavy drinking alone. Their HIV risk could also make them suitable trial candidates needing trial risk-reduction packages. The identified factors were highly predictive, allowing screening through a few questions. Variable prevention messages and pregnancy-outcome ascertainment after the trial was interrupted limited the analysis.

^{39, 41, 42, 40, 43, 44, 45, 46}

Sorting and expanding

An outline is a short, organised description of what an article will contain. ⁴⁷ Once key sources are collected, sorting them into clusters can reveal three or four general headings from many smaller groups. ⁴⁸ Constructing this scheme reveals research gaps and unnecessary material before it dilutes the presentation. ⁴⁸

A concept outline provides a skeleton: main manuscript sections with one bullet for each major subsection or point, initially serving as placeholders for a detailed outline. ⁴⁹ An outline then grows from main headings to subheadings and the questions, examples or details each needs. ⁵⁰ In an illustrative article on five causes of oedema, the major headings are abstract, background, selected causes, clinical significance and references; background expands into epidemiology, definitions and importance, while clinical significance asks when to consider an uncommon cause and what matters in practice. ⁵⁰

An outline should remain open to new ideas consistent with the overall theme. ^{50, 51} Major structural changes halfway through drafting can be frustrating, and copyediting cannot repair the structure. ^{50, 8}

Outline forms and levels

The topic and target publication guide the outline format. ⁵² A focused topic’s component questions can supply its structure, as a title promising five reasons suggests a five-part body after background and before a concluding discussion. ⁵³ Flexible forms such as reviews and editorials can use a list, an update, questions and answers, or a controversy. ^{54, 55, 56, 57} Examples include ways to improve practice collections, a new regulation affecting practice, a question about who should perform a procedure, or competing ethical views of concierge medicine. ^{54, 55, 56, 57}

In a topic outline an entry is a heading such as “Types of medical review articles”; a sentence outline instead states “There are three important types of medical review articles.” ⁴⁸ Topic entries are economical, while sentence entries supply topic sentences and expose inconsistent verb tenses. ⁴⁸

A hierarchical outline can use letters and numbers, decimals, bullets or indentation alone to show levels. ⁵⁸ A subdivision should have at least one sibling; otherwise it may deserve its own heading or be removed. ⁵⁸ A short article needs fewer levels than a long chapter, thesis or book. ⁵¹

Testing and agreeing the outline

Seven common structural mistakes are: ⁵

1. Starting to compose without a unifying concept.
2. Working without an outline, especially as a beginning medical writer.
3. Using too many main headings with too little development; more than five is almost certainly too many for an ordinary medical article.
4. Covering too much ground rather than narrowing the topic.
5. Failing to introduce the purpose very early, leaving readers to wait until the third paragraph.
6. Developing a structure and then failing to follow it.
7. Starting the manuscript without thinking the project through, leading to painful rewriting.

⁵

Some creative, experienced writers can work without an outline. ⁵ A study comparing written outlining with no written outline found higher-quality documents by judges’ ratings in the outlining condition. ⁵ Outlining can save time, support budgets, maintain focus and deter excessive length. ^{49, 59, 60}

On collaborative projects, contributors can comment on and agree the structure and direction before drafting begins. ^{47, 49} A simple bullet list can also reveal that a proposed blog topic is too large and should become several pieces. ^{61, 62}

Three practical outlining recommendations are to: ⁶³

• Use a computer for efficiency, with bold major headings if helpful.
• Mark where key citations belong, so important referenced facts are included and not repeated.
• Expand the outline of a blocked section when other attempts to restart writing have failed.

⁶³

Building from keywords

A section can start from a keyword for each planned point, grow into phrases and sentences, then become a complete section. ^{64, 65, 66} Reporting checklists can supply these points; well-formulated sentences from study documentation may already provide suitable wording. ^{67, 64, 68} Key data and supporting messages can begin the outline even as single words or short sentences. ⁶⁹

Mind-mapping or brainstorming words can help identify the term that fits the intended meaning. ⁷⁰ Checking specificity is easier in an outline than in the full article, where vague words can be less noticeable. ⁷¹ Strong sentences can be written immediately; a writer unsure how to formulate one can begin with its keyword and return to it later. ^{65, 66}