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©2022 American Medical Writers Association. All rights reserved.  
ISSN 2163-5315

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ABSTRACT 
Communicating the results of research using concise, jargon- 
free language optimize its likelihood of being read and cited 
by other researchers. More than 3 decades of publishing 
scientific articles has convinced us that the most efficient 
approach to writing a scientific paper is one that starts in the 
middle and works outward. Such an approach means that 
the first items to finalize and polish are the actual tables and 
figures that will be included in the body of the paper (includ-
ing supplemental tables and figures). This entails decid-
ing on the order of these elements that, when viewed alone, 
should be able to tell the story of the paper. This first step is 
often the most difficult, requiring the most thought. 
However, once achieved, it is usually a straightforward 
process to write the Results section (that refer to these 
elements) followed by the Methods section. After these 
sections are proofed and polished, a quick review of the 
Methods, Results and associated figures and tables high-
light the points that need to be made in the Discussion sec-
tion. The last sections written should be the Introduction, to 
set up the entire Methods, Results and Discussion, and the 
Abstract, to summarize it all.
 When this approach is combined with frequent proof-
reading of the article on some medium that is different 
from the one used to write it, experience has shown that the 
result will be a clear, uncluttered paper that is completed 
with a minimal number of drafts and that is most likely to 
be favorably reviewed and accepted for publication.

Good biomedical science requires good communication, 
and scientists who clearly and unambiguously communi-
cate their observations, analyses, and conclusions in writ-
ing1 are likely to reach a bigger audience. In our experience 
over the last 35 years, an approach to writing a paper that 
is adaptable to any topic, simple, reduces the number of 
drafts, and consistently results in a clear paper is one that 
starts in the middle and works outward.2 Such an approach 
begins with the tables and figures of both the main paper 

and any appendix, continues with the Results, Methods, and 
Discussion, and ends with the Introduction and Abstract. 
Each of these steps is described below.

A: FIGURES AND TABLES
A paper generally includes figures and tables that clearly 
communicate the main message of the paper. Indeed, an 
approach to reading a scientific paper is to first read its title 
and Abstract and Conclusions sections and then flip to the 
figures and tables before deciding whether to read the full 
paper. Moreover, a paper’s figures are often presented by 
other scientists when discussing their own work. It is for 
this reason that the creation of the figures and tables is an 
ideal place to start when writing a manuscript. This includes 
those that will be included in the main paper as well as in 
any supplement and that together will “tell the story” of the 
entire manuscript. As in any story, the order in which these 
elements are discussed needs to be carefully considered. 
Thus, before writing the Results section, it is best to decide 
the specific order of these elements (eg, Table 1, Table 2, 
Figure 1, Supplemental Table 1, Figure 2, Supplemental 
Figure 1, and then Table 3). Even if the author ultimately 
modifies this order, deciding on the initial order will facili-
tate writing the first draft of the Results section.

B: RESULTS SECTION
The Results section typically starts with a general descrip-
tion of the data that are analyzed, followed by the specifics 
of the analyses and findings with reference to the figures 
and tables. Brevity is a virtue for all parts of a scientific 
paper, and a succinct, clearly written Results section that 
tells the story that is shown in the tables and figures in a 
logical and uncluttered way will communicate the findings 
effectively. A supplement is the ideal spot for any informa-
tion that does not directly address the study hypotheses.

C: METHODS SECTION
A clear set of figures and tables and a straightforward 
Results section facilitates drafting of a clear and concise 

Hertzel C. Gerstein, MD, MSc1-3; Diana Sherifali, RN, PhD, CDE1,4; and Imran Satia, MD, PhD3,5  /  1Population Health 
Research Institute, McMaster University, Hamilton, ON, Canada; 2Hamilton Health Sciences, Hamilton, ON, Canada; 
3Department of Medicine, McMaster University, Hamilton, ON, Canada; 4School of Nursing, McMaster University, 
Hamilton, ON, Canada; 5Firestone Institute for Respiratory Health, St Joseph’s Healthcare, Hamilton, ON, Canada

Writing Your Paper from the Middle

PRACTICAL MATTERS

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AMWAJournal.org     20Writing Your Paper from the Middle

Methods section. Although the amount of detail to include 
requires judgement, the guiding principle should be that it 
should be sufficient to describe what was done without con-
fusing, irritating, or distracting the reader. Any other details 
can either be omitted or included in a supplement.
 The Methods section, together with the Results, figures, 
and tables, represents the heart of the paper. Once it has 
been drafted, it is worth checking whether all the salient 
information, but no more, has been presented transparently. 
As with the any piece of writing,3 we have repeatedly found 
that a good way to do this is to print a clean (unmarked) copy 
of the Methods, Results, tables, and figures as well as the 
supplement and review these sections as if they were writ-
ten by someone else. Although one can never truly dissoci-
ate oneself from one’s own writing, such an effort can help 
the writer identify confusing or distracting text that interferes 
with the flow of the written presentation of the information. 
It is also useful at this time to have a colleague read these 
sections before continuing, as it is not worth writing any 
more of the paper until these sections are polished.

D: DISCUSSION
The Discussion section of a paper presents an opportunity 
to contextualize the findings, show how they support or 
refute the hypothesis being tested, and show how they lead 
to new hypotheses or research. This is also the place where 
writers present their conclusions, which need to be con-
sistent with the research design, the data quality, and the 
analytic approach used. For example, if a research finding 
is hypothesis generating, it is inappropriate to present it as 
hypothesis testing. In our experience, striving for clarity and 
brevity will reduce the likelihood of overstating the implica-
tions and relevance of a particular finding that happens to 
be consistent with a hypothesis and excusing or rationaliz-
ing an inconsistent finding.
 The contents of the Discussion should directly flow from 
the Results section and should mainly focus on the findings 
that were observed. This can include citing other literature 
pertaining to these findings and suggesting possible expla-
nations for the findings. Although every set of observations 
has limitations, a Discussion section that spends inordinate 
amounts of space on “explaining away” findings that do not 
support the investigators’ hypotheses is usually unhelpful 
and distracting.
 A simple structure for a Discussion section includes (a) 
restating the main findings, (b) a brief discussion of liter-
ature pertaining to these findings and how these findings 
advance an understanding of the hypothesis, (c) a possible 
explanation for these findings based on biologic mecha-
nisms or methodology, (d) the strengths and limitations, 

and (e) the next steps and overall conclusion. It is import-
ant to note that a detailed literature review regarding the 
hypothesis best belongs in a review article, as such a review 
generally cannot be accommodated in the space available 
for the Discussion section.

E: INTRODUCTION
Perhaps the easiest section to write is the Introduction. The 
Introduction should state and briefly justify the hypothesis 
and its implications and generally foreshadow all the key 
points that are included in the Discussion section. A short 
2-paragraph Introduction is ideal for many papers. As with 
the Discussion, the Introduction generally should include 
sufficient information to understand why the research was 
done. It should simply justify the reasons or motivation for 
doing the study, state the hypothesis in a few sentences, and 
provide a big picture as to what value this adds to science.

F: ABSTRACT
The Abstract of any paper should adhere closely to text writ-
ten in the rest of the paper. Most biomedical journals have 
word limits for Abstracts ranging from 250 to 300 words. 
Generally, the most effective way to write the Abstract it is to 
summarize each of the other sections in 1 to 2 lines.

SUMMARY
Writing clearly is difficult and takes practice. This is as true 
for writing a scientific report as it is for writing a novel, 
play, technical document, or financial report. Regardless of 
what is being written, having a clear underlying structure 
that supports the document, and a systematic approach 
to building that document on that structure, can facilitate 
the process of writing a paper, ensure that the final product 
communicates clearly, and increase the likelihood that it 
will be used to further advance biomedical knowledge.

Author declaration and disclosures: The authors note no com-
mercial associations that may pose a conflict of interest in rela-
tion to this article.

Author contact: gerstein@mcmaster.ca

References
1. Barroga E, Matanguihan GJ. Creating logical flow when writing 

scientific articles. J Korean Med Sci 2021;36(40):e275. doi:10.3346/
jkms.2021.36.e275

2. Lippi G. How do I write a scientific article?—A personal 
perspective. Ann Transl Med 2017;5(20):416. doi:10.21037/
atm.2017.07.43

3. Gerstein HC. Writing science that your colleagues can read. 
J Diabetes Complications 2014;28(1):4-5. doi:10.1016/j.
jdiacomp.2013.06.009

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