Give an author criticism they can use
Criticism helps an author only as far as the author accepts it and acts on it, and the author usually decides what to accept. How a reviewer or editor words, explains, orders and delivers each comment, and how the author is treated while receiving it, therefore decides whether a critique is used.
Why criticism needs care
Of the soft skills of medical writing, which are often underestimated beside its scientific and technical skills, the art of giving and receiving feedback is key. Giving feedback, whether as a document reviewer, a manuscript editor or a writer of error messages, is an art that takes years to cultivate.
In 1862 Emily Dickinson chided the minister and writer Thomas Wentworth Higginson, apparently for criticising poems she had sent him too timidly, with a surgical analogy: "Will you tell me my fault, frankly as to yourself, for I had rather wince, than die. Men do not call the surgeon, to commend—the Bone, but to set it, Sir, and fracture within, is more critical." She did not want a surgeon idly praising a broken bone, or a literary expert blandly praising possibly broken poetry; she wanted the bone set so that it could heal and grow stronger, and she wanted Higginson to set out what he thought her poems required, even if doing so involved initial wrenching and lingering discomfort. She had asked him to say whether her verse was alive and to tell her what was true, and of his first reaction she wrote: "Thank you for the surgery; it was not so painful as I supposed."
In one editor's reading of the letters, when a patient's body or a poet's body of work is invaded through exposure to the light of day, in an operating theatre or in an exchange of letters, pain is to be expected and endured, as proof that someone cared enough to go beyond the surface and do something constructive that would make a positive, if temporarily painful, difference. The key, she holds, is that surgeons or critics, and she adds editors, must be careful and respectful, for a trusting supplicant's physical or emotional life is on the table, in their hands.
Even the most confident surgeon-scientists have tender egos about the personal craft of writing, even in supposedly objective research articles, in the view of one long-serving author's editor who, as a writer herself, knows what it is to be bruised by clueless or even cruel reviewers and other uncaring gatekeepers. In her view, the manuscripts that reach her, whether overgrown or desiccated, almost always hold the promise of publication someday.
One editor and reviewer works by four T's:
- Thank you. Start by thanking the author, and acknowledge the effort that went into the piece.
- Time. Give yourself sufficient time to review; the author deserves no less. If you do not have the time, delegate to someone else. Give the writer a fair chance to revise or rewrite the piece, which means ample time for revision.
- Tone. Tone makes a world of difference when delivering unwelcome news. Give feedback, positive or negative, in a professional and kind manner.
- Turning tables. Ask how you would feel if the tables were turned.
The author's last word
The long-serving author's editor notes that she is not a journal editor, an acquisitions editor, a rewrite editor or a copyeditor, that as an author's editor she has no power other than the power of persuasion, and that whether to accept her suggestions is up to the authors. Unpersuaded authors have the last word, along with the byline, and the long-serving author's editor says so in her cover email: "Feel free to ignore any of my suggestions if they're not quite what you want or need. It is your paper, after all." Her authors usually do accept them, judging by their expressions of gratitude.
Where the editor sees the document at several stages, the final review is another chance to resolve issues, but accepting or rejecting the input is ultimately the author's decision. In one manuscript editor's account, editors are expected to point out errors and offer suggestions, and where authors disregard the guidance, her advice is "Do your best work and let it go." The authors' names go on the publication, not the editor's.
The long-serving author's editor wants every author who seeks her input to know that she is on their side, and she and each lead author, as part of the same departmental team, are also on the reader's side, and in medical editing on the patient's side as well. One editor emphasises that editing is not personal and that editors look at the writing from a different perspective, advocating for readers.
The long-serving author's editor sums up her philosophy of editing in the word kindness, rained down on authors for the sake of readers and patients alike. She shows no kindness to grammatical errors, syntactic lapses, factual mistakes and other distracting slip-ups, and considers weeding them out meticulously a kindness to her authors, their readers and patients everywhere. Her suggestions rest on sound rhetorical principles and best practice for effective, efficient communication, with a commitment to clarity, conciseness, consistency and connectedness. While respecting the author's own voice, she tries to make sure it does not muddy readability or trample up-to-date style conventions, and keeping the primary audience and the specific genre in view, she aims to share her language expertise without inflicting inordinate pain on the tender egos of her colleagues. She typically marks the changes in bright-red tracked changes, or with a red felt-tip pen on proofs and other graphics-heavy items that she then scans and sends, and sends them with a warm-toned cover email to the lead author that summarises and explains the edits and, more vitally, encourages and thanks the author.
Explaining each change
An editor should explain why each change is recommended and back it with data, resources or an authority such as a style manual. To one author's editor, it is not enough to say that "my version just sounds better": editors need to learn the reasons behind the changes they suggest and how to explain why the edits are necessary for improving the document. Justifying edits helps authors accept them, improves the editor's credibility and requires the editor to think critically about the editing, and the more aggressive the edits, the more they may need explaining. A justification is specific: rather than saying that a sentence is vague, it explains why the sentence is vague.
Knowing the rules of Standard English syntax enables an editor to justify changes to an author, and editors who can explain any change they recommend earn the respect of most authors. An editor who, when asked, justifies each change by appealing to an authoritative source such as the AMA Manual of Style lets authors who choose to learn to correct their own errors and become better writers, and so, in that author's editor's account, is a teacher as well as an editor. Such feedback helps authors become better writers, which saves everyone time and hassle in the long run. Emotional intelligence is also an important skill for editing, in one editor's view, so that proposed changes can be explained to authors eloquently.
Correcting rather than rewriting
To one author's editor of more than 25 years, rewriting is not editing, and editing is much harder. Rewriting is akin to amputation: it removes most of what the author wrote, except the idea, and replaces it with the editor's text, and an author who believed the writing was good and needed only minor polishing often feels the work has been chewed up and does not understand why the changes were made. The minimally invasive editing this editor proposes tries to correct defects rather than amputate them and to preserve as much of the author's original language as possible. It starts with microediting: in this editor's experience, many of a document's flaws are errors of grammar, punctuation and sentence structure, which can be corrected with minimal damage, preserving the author's style and much of the author's language.
One manuscript editor advises avoiding complete rewrites where possible: rewriting can change the author's voice and style, so it should be reserved for correcting obvious errors that can easily be fact-checked. Leaving the original text in the document beside the suggested replacement may help authors. Asking an author to rewrite is problematic if the text already represents their best effort, but obvious flaws of logic that cannot be deciphered still require the author's input.
Writing queries the author will answer
Whether to just change something, change it and query, only query, or let it go is a matter of judgement, and one editor's default is "If you aren't sure, ask": a colleague or a message board where there is one, or the author, and, as two editors note, people writing science manuscripts are happy to talk about their research. Whether and when to query can depend on how long the editor has worked with the author or team, and with someone new a little more care is called for.
Effective queries can prompt the author to give clear answers, foster good working relationships with authors and help the editor save time, and one manuscript editor's overriding approach to them is to "be brief and diplomatic". Comments are usually better phrased as questions than as statements, as in "Did an IRB approve the study?" rather than "The study should have been approved by an IRB", and changes are suggested tactfully and with compliments where possible: "sell, don't tell".
One manuscript editor suggests querying strategies by type of author:
- The busy author, common among clinicians, can skip over longer queries. Limit the length of individual queries, and break a complex query into several shorter ones. For a recurring problem, highlight each instance but query only once, to avoid overwhelming the author.
- The writer with limited English proficiency has characteristic problems of clarity. Where feasible, seek clarity in conversation, face to face or by phone, because their conversational English may be stronger than their written English. Avoid vague comments that a passage is unclear: state the problem explicitly, offer a possible solution, and structure the query to elicit a yes or no answer. Where a passage is truly indecipherable, a best-guess rephrasing might prompt the author to give less ambiguous wording.
- The protective or sensitive writer can be defensive and critical of certain types of edit, a sensitivity that may emerge only after feedback, so be especially polite with new authors. Be conscious of the tone of queries and strive for friendliness. Convey a sense of supportive teamwork. Justify changes by citing house style, as appropriate, and do not edit according to editorial preference alone. Remind authors of the needs of the target reader or reviewer to justify suggested changes.
- The incremental updater keeps adjusting the document as new data become available, which challenges deadlines and can introduce errors. Double-check the document for inconsistencies. When clarification is needed, email the queries or individual paragraphs rather than sending the full document back for review.
These querying tips include several that save time:
- Use an introductory query to preface multiple queries or to give the context for extensive revision.
- Treat the first review as a copy edit and note potential uncertainties in the text; a later substantive pass may answer some of the initial queries.
- Avoid offering two wordings as "Do you mean [a] or [b]?", because authors may simply reply "Yes". Structure the query to elicit an unambiguous answer; ending it with "Please clarify" often prompts the author to state the correct answer explicitly.
- Add prompts, such as highlighting, to flag revisions needed throughout several sections of the document.
- Use Microsoft Word's autocorrect shortcuts for standard queries, and styles and macros for formatting, rather than reinventing common queries or reformatting text by hand.
Editors on one panel often find their queries answered by the end of the manuscript, and they agree that queries should be reread before the document goes back to the author. A file of boilerplate comments can be kept and pasted into comments, or inserted with AutoCorrect entries or macros.
Ordering the comments
Prioritising a review does not compromise the quality of the work. It distinguishes issues that must be addressed, those that affect understanding or compliance, from issues that should be addressed to improve the document but are not necessary for its understanding. One editor communicated reviews to subject matter experts by email in three categories:
- Required: For Your Review. Items that affected the use and integrity of the document, such as ambiguous and unclear phrasing, which the experts had to address, either by correcting the wording or by explaining why the text did not require revision.
- Optional: For Your Consideration. Suggestions on writing style that would have improved the document although its content was accurate, which the experts could accept or not.
- Typos and Minor Corrections. Typographical errors and misspellings.
The most serious issues came first, in a list format that the experts used as a checklist to revise their documents and record their responses. The technology an organisation uses to edit documents affects how flexibly comments can be communicated, and possible approaches include a summary emphasising the key points of the review or brief explanations added to the edits. Whatever the approach, prioritising the comments is important; authors can feel overwhelmed when faced with pages of seemingly unrelated edits.
Coaching the author
The editor–author relationship is still perceived, arguably wrongly, as frequently antagonistic. Mark Twain complained for most of his career that editors, proofreaders, typesetters and typists turned his writing into "a mass of senseless, d—d stupidity", perhaps because printers in his day often accepted an editor's changes without consulting the author. The perception could make some authors hesitant to engage with manuscript editors at all, or keep them from building relationships based on trust, collegiality and shared purpose. Editors therefore need techniques that balance the need for a clear text with respect for the author's ideas, empowering authors while reaching the goal both share: an easy-to-read text that clearly and effectively communicates the author's message and intent.
The editor–author dialogue may be improved by the coaching techniques of college writing centre tutors. Writing centres encourage tutors to think of themselves as coaches, there to improve students' overall writing and to help them improve the writing in hand, and tutors practise communication skills — active listening, body language, and verbal and written comments — that convey patience and respect and encourage better written performance. Applied effectively to the editor–author dialogue, the same techniques can increase the comfort level of both editor and author and make their relationship more productive. The editor's primary purpose may not be to coach or teach writing, but editors and the authors they work with can benefit from the tutors' techniques.
Most writing centres have improving student learning as their primary mission, so tutors are taught to stress the writer's ownership of the text and to focus on the writer's development by asking questions about the text in hand and the writer's plans for revision. Studies of tutoring sessions point to specific communication techniques as useful in increasing the comfort level of tutor and student writer, and one study of more than 4,000 tutoring sessions found the tutee's comfort to be the top indicator of satisfaction with the session. The same study reported student comfort with tutors as correlating significantly with satisfaction with the session.
In a face-to-face meeting, active listening means allowing the author enough time to finish a thought before making a recommendation, making eye contact, mirroring and granting validity to the author's concerns, and keeping a friendly posture. The editor can also ask guiding, open-ended questions, such as requests for more information or clarification, and then make formative suggestions for revision. Asking how a text might affect its intended reader, rather than how it affects the editor, lets the editor maintain respect, professionalism and empathy. Some of the same techniques, especially open-ended inquiry, may be applied in written comments, on screen or on paper, where a professional and friendly tone is particularly important because, as with email, body language is not there to give the meaning its context.
Informational support
Explaining why changes are suggested and offering to answer questions about them is informational support. The reason for a change might be a style guide or a grammatical principle, and in substantive editing it might be framed as the change's positive effect on readers, such as improving comprehension or influencing perceptions, which affirms the author's expertise in the content while acknowledging possible reader confusion. In these examples, each recommendation comes with its explanation of reader impact beside it:
| Editor's recommendation or query | Editor's explanation of reader impact |
|---|---|
| Consider reordering the results section so that first you present data on the primary outcome (diabetes incidence), then you present data on the secondary outcomes (cholesterol levels, mean blood pressure). | This reorganization will create consistency across different sections of the article (methods, results, discussion), while keeping readers focused on your study's primary research question. |
| Is your inclusion of non-daily smokers in the trial innovative for the field? | If yes, stating this could help convince readers of the importance of your work. |
| Suggest you clearly indicate the specific outcomes that were reported in the earlier publication from this trial. | Doing so will make it very clear to reviewers (and other readers) that you are reporting on a different set of outcomes in this manuscript (no concerns about duplicate publication). |
| Is there a reason you don't devote any text in the Results section to the protein function "regulation of macromolecule metabolic process"? | Because this regulation function was very common in your proteomics results (a prominent slice in your pie chart), readers might wonder why you aren't giving this finding much attention in the text body. |
Reacting as a reader and, where there is a chance to meet in person, placing the document physically closer to the author are other ways to leave the author owning the text. In one study of 449 authors, the positive experiences with editors included editors who understood the authors' authority over their own texts and represented reader needs and perspectives. Paraphrasing to clarify understanding and perception checking — admitting confusion, guessing the basic message and asking for affirmation — are informational support as well. Perception checking is particularly important for an editor who is not a content expert; edits might at times inadvertently change the meaning of the text, but paraphrasing to clarify understanding lets the editor advocate for the reader while keeping rapport with the author and showing respect for the author's knowledge of the discipline. In a survey of authors, predominantly technical writers, who had used an editor's services, respondents were most likely to follow an editing suggestion when it came with a payoff statement describing how the edit would benefit the reader and so the author.
Emotional support
Writing centre tutors are trained to give writers emotional support and to earn their trust. They promote unconditional positive regard, in which the tutor neither approves nor disapproves of the writer or the writing but accepts the writer and is willing to help, and they listen actively and reflectively, grant validity to the writer's concerns, even about motivation or its lack, and offer empathy and encouragement. Reflecting a concern back to the writer and normalising it where appropriate acknowledges the writer's experience without agreeing with it, lets the writer be heard and shows a wish to understand the writer's perspective, which helps build trust. Like students working with tutors, authors working with editors benefit from feeling nurtured and respected. Two writers on coaching faculty to publish recommend validating and encouraging both the author and the manuscript, by acknowledging writing frustrations and by marking submission and acceptance with an email, phone call or note, and they discuss the editor's role in commending progress and encouraging perseverance.
These strategies create a helping relationship, in which the editor projects acceptance of the author and eagerness to help:
- Take the time to understand the author's meaning.
- Respond enthusiastically, in a concerned way that shows "stronger concern for people than for things."
- Provide a sense of acceptance of the author and convey a willingness to help, without a message of approval or disapproval of the writing.
- Leave no room for sarcasm, superiority, aggression or criticism.
- Summarise to give the author a sense of progress.
- Assist in responding to reviewers.
Some of these techniques, especially avoiding judgemental criticism, which is different from critique, may be most effective face to face, where nonverbal communication matters most. Even in written or electronic editing, helping relationships can be nurtured when editors take the time to go beyond simply fixing errors, with comments such as these, adapted as needed to the writer:
| Editor comment | Type of emotional support |
|---|---|
| I left the abstract alone for now but would be happy to review and edit it after you've finalized the rest of the manuscript and decided on the target journal. | Conveys a willingness to help. |
| I really like the information you present in this figure. It efficiently communicates the core preliminary findings that justify the research you propose in this grant application. A few small improvements could maximize the figure's clarity: First, … | Compliments the product. Summarizes to give the author a sense of progress. |
| The phrasing "support blood pressure" seems vague. Do you mean increase BP? or maintain some target level of BP? or something else entirely? I want to make sure your message is clear to all readers. | Makes the effort to understand the author's meaning. |
| I am glad to see some additional detail from the literature in this new draft. As a next step, I suggest you concisely summarize this new information into one tight paragraph that very clearly illustrates the need for your work (convince reviewers you aren't just doing another "me too" study). You're almost there! | Commends progress. Encourages perseverance. |
What authors valued
In an anonymous online survey with a 51% response rate, 26 researchers at a college of veterinary medicine who were editing clients of one editor, a mix of faculty, medical residents, postdoctoral associates and graduate students, rated the techniques as follows:
| Technique | Extremely important | Somewhat important | Not at all important |
|---|---|---|---|
| Explaining why changes or suggestions are made | 24 | 2 | 0 |
| Offering to answer questions about recommendations or changes | 24 | 2 | 0 |
| Having empathy and responding enthusiastically | 23 | 3 | 0 |
| Maintaining unconditional positive regard, with a sense of acceptance of the author and a willingness to help | 22 | 4 | 0 |
| Listening actively and granting validity to concerns | 21 | 5 | 0 |
| Creating an atmosphere of acceptance and trust | 19 | 7 | 0 |
| Remembering the golden rule and avoiding sarcasm | 19 | 7 | 0 |
| Perception checking by admitting confusion, guessing the basic message and asking for affirmation | 19 | 7 | 0 |
| Being patient by focusing on posture and tone of voice, and waiting for the author to finish a thought before commenting | 17 | 7 | 2 |
| Paraphrasing to clarify understanding | 17 | 9 | 0 |
| Leaning slightly forward, looking directly at the author, with friendly gestures of approval such as smiling or nodding | 13 | 9 | 4 |
| Summarising to give the author a sense of progress | 12 | 13 | 1 |
| Using third-person pronouns to stress reaction as a reader (24 respondents) | 10 | 10 | 4 |
| Sitting beside the author, not across a desk (25 respondents) | 10 | 9 | 6 |
The two techniques rated highest are both forms of informational support.
Satisfied authors may become repeat clients. Although writing is often a high priority, as for faculty expected to publish peer-reviewed papers, writers who are also researchers, instructors or practitioners often follow through poorly on writing projects because other responsibilities are more immediately demanding, and anticipating failure or embarrassment at peer review, or difficulty motivating themselves and staying focused, can also impede them. Authors who feel they have a highly supportive teammate in an editor may feel more encouraged to make progress, and when authors can focus on content and leave the fine-tuning to the editor, writer output might increase, as one study comparing 26 faculty members' publication rates before, with and without writing coaches found. Given evidence of a correlation between these techniques and writer satisfaction, editors who apply them might be more successful in attracting, retaining and influencing clients.
Editing a colleague's work
A 2014 assessment by the Harvard Business Review found that most people prefer receiving feedback to giving it, so an author who asks for an edit most likely wants real feedback, not just a rubber stamp of approval. Among the steps a writer can take to give a colleague clear, constructive feedback are five: be clear, use the author's preferred means for feedback, provide examples, take your time, and praise the effort.
Striking out a paragraph with a big red cross leaves the author not knowing why the text is unnecessary or even detrimental, so feedback that colleagues will value takes a minute to give clear reasoning for the edits where possible. A section reworded from passive to active voice, for example, gets a note specifically describing that change and why it was made, and in a digital document a link to the relevant editorial preferences or to a grammar website.
Beyond the familiar visual, auditory and tactile learning styles, a 2004 study counted at least 71, so rather than memorise them, the editor asks how the author prefers to receive edits and accommodates it. A co-worker may swear by tracked changes or prefer to sit down over coffee and watch the document being marked up, an auditory learner may prefer a phone call or an in-person meeting to go over the edits, and a supervisor may want an intensive rewrite of a presentation or only cursory thoughts on its tone. Getting these answers before beginning to edit saves both sides time and energy.
In most professional writing, and perhaps especially in medical writing, the wheel is very rarely being invented, so there is a good chance that old journals, presentations, research, websites and regulatory documents can supply examples of everything from a strong introduction to a well-structured bibliography. An author who struggles with passive and active voice can be given a few examples from other articles.
A colleague's edits are tempting to push further and further down a to-do list, since the project is not the editor's own, but a team player makes them a priority. The edit is not rushed either. The editor estimates how long the edits will take and plans extra time before committing to a deadline.
Recent research reports that seasoned professionals are more open to negative feedback, while novices prefer positive responses, so for someone new to writing the sandwich method of compliment, feedback, compliment can be tried. The sandwich can backfire and make the editor appear condescending, especially with someone who has more experience in the field. With more seasoned authors, the editor might consider skipping praise altogether, as it can be seen as condescending. Praise that is given should be transparent and aimed at effort rather than innate talent, particularly where the aim is to improve the colleague's writing in the future. In studies by Carol Dweck, students praised for effort, even effort that ended in failure, became more resilient and determined, while students praised solely for talent or ability became more risk-averse and sensitive to setbacks. For a less experienced author, the editor points out what the author did well, focusing on specifics; praising talent alone is not as motivating as praising persistence, effort and growth. While editing, the editor watches for the parts of the piece that work well, such as a conclusion that ties back to the introduction, and for how the author can use those strengths to improve other areas, such as a weak introduction. When the edit is finished, a positive note goes with the feedback, or the praise is shared face to face.