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Letters to the Editor and Short Communications

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Hello everyone! Welcome to this tutorial on how to write a Letter to the Editor. Here you will find all the information and our experience on how to publish your own Letter to the Editor.

What is a Letter to the Editor/Short Communication?

Letter to the Editor is an “umbrella” term that encompasses various brief publications and usually fit into 1 of three categories: Commentaries, Perspectives/Viewpoints, and Brief Reports. These 3 sub-categories have also various other names but are essentially the same.

What is a Commentary?

Commentaries are a response to a previously published article within that same journal you are submitting to (for example, if you read an article in journal X and want to write a commentary, it MUST be submitted to journal X). Commentaries either build-up on discussions started by an article or respectfully criticize its methodology, results or conclusions. You can think of it as a post-publication peer-review.

What is a Perspective/Viewpoints?

Unlike commentaries, perspectives are not related per se to a specific article and have a wider audience of possible target journals. Perspectives are more akin to opinion pieces and do not provide new data, instead relying on previously published data to further its point.

What is a Research Letter?

Unlike the 2 aforementioned examples, research letters do contain data analyzed by authors but are not a full-length structured manuscript. Research letters usually contain data that’s either not enough for a full-length publication or when authors do not have the time to write a full-length publication.

For any of these, remember to check the journal guidelines for each as they vary greatly.

How do I write a Commentary?

The first step is to identify a recent publication (the definition of “recent” varies from journal to journal) in which you identify a significant methodological concern, believe results should suggest an alternate conclusion, or wish to expand on the discussion.

Typically, start the commentary with:

To the Editor:

In the article X by X authors (BRIEF summary of findings) or alternatively something like “We read with great interest the article titled…” and briefly outline the points you’re making. Remember to be polite and respectful.

Criticism: Remember to be respectful. You must be prepared to uphold your suggestions with evidence and will usually have the authors reply directly to you. If your providing respectful criticism, think of it as a trial in which you are a lawyer and you need to build a solid case. Find two examples below:

In this first example, authors provide criticism to the aforementioned meta-analysis mainly centered on the methodology employed:

Criticism point #1:

Firstly, the authors mentioned that this study was performed in accordance with the PRISMA (Preferred Inventory for Systematic Reviews and Meta-Analysis) guidelines; however, a protocol was not registered at PROSPERO (Prospective Register of Systematic Reviews) or any other similar registry such as INPLASY (International Platform of Registered Systematic Review and Meta-Analysis Protocols).”

In this first point, authors express concerns over adherence to PRISMA criteria which explicitly advocate for registration in a review aggregator and the authors of the meta-analysis didn’t perform.

Criticism point #2:

Secondly, high heterogeneity was observed in a few outcomes thus affecting the robustness of the results authors should have performed a sensitivity analysis to explain this source of heterogeneity.”

In this second point, authors criticize the original authors management of heterogeneity in their study, citing that while a random effects model was adequately used, heterogeneity was not fully explored.

Criticism point #3:

“…In the present study, an evaluation for publication bias would have significantly improved the credibility of the findings.”

In this second point, authors criticize the original authors management of heterogeneity in their study, citing that while a random effects model was adequately used, heterogeneity was not fully explored.

Criticism point #4:

“Finally, the authors mention that they utilized the methodology suggested by Wan et al. to estimate mean and standard deviation for studies where median with range or interquartile range were provided.”

Lastly, the last criticism point revolves around the method used to estimate means from medians.

Abstracted from: Ali U, Tariq MA. Letter to the Editor: Minimally Invasive versus Open Surgery for Spinal Metastasis: A Systematic Review and Meta-Analysis. Asian Spine J. 2021;15(5):708-709. doi:10.31616/asj.2021.0395.r1

The full original author response can be read here:

https://pubmed.ncbi.nlm.nih.gov/34706406/

As you can see from this example, writing an adequate criticism requires a degree of expertise in the topic, both in medical and methodological knowledge. If you do not possess the current knowledge, you can check out our courses to teach you about clinical research and statistical analysis.

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Example 2: Comment on “Perioperative and Oncologic Outcomes of Single-Port vs Multiport Robot-Assisted Radical Prostatectomy: A Meta-Analysis” by Li, et al

In this second example, authors criticize the data-handling of the aforementioned meta-analysis,

Criticism Point #1

Overlapping studies

LtE authors point out that in the included studies for the meta-analysis, 2 of them had analyzed virtually the same population from the same institution, and thus inappropriately duplicated data.

Criticism Point #2

Different approaches

As a second point, authors point out that not all of the published studies analyzed the same surgical approach, as some where abdominal surgery and some transperineally.

Criticism Point #3

Inadequate grouping

Lastly, authors point out that the original authors mis grouped the included studies as most had mixed populations with intra and extraperitoneal approaches.

Hinojosa-Gonzalez DE, Roblesgil-Medrano A, Gonzalez-Bonilla EA, Flores-Villalba E, Olvera-Posada D. Comment on “Perioperative and Oncologic Outcomes of Single-Port vs Multiport Robot-Assisted Radical Prostatectomy: A Meta-Analysis” by Li, et al. J Endourol. 2022;36(3):421-422. doi:10.1089/end.2021.0772

Expansion: Expansions or extensions of the discussion are relatively easier than criticism, as you can pivot from the authors discussion if you think that there’s space for additional considerations in their discussion. Examples can be found here.

Ozair A, Negida A, Ghaith AK, Kanmounye US. In Reply: Predictors of Academic Neurosurgical Career Trajectory Among International Medical Graduates Training Within the United States. Neurosurgery. 2022;90(1):e28. doi:10.1227/NEU.0000000000001774

How do I write a perspective article?

Perspective articles are brief, opinion-like publications. These must be in the scope of journal (i.e you wouldn’t submit a surgery perspective to a pediatrics journal). While these publications have no data from the authors themselves (although in some cases they may), they rely on prior publications to support its arguments. Perspectives should address current, relevant issues. Some good examples are the published pass/fail USMLE step 1 perspectives, find those referenced below as well as additional examples.

Pass/Fail Step 1

Issue Addressed: Pass/Fail Step 1.

Perspective focused on the loss of objective metrics obtained from numeric graded step 1 and explores the evolution of its use as a screening tool. Ponders on the impact this change has on wellbeing as well as academic mobility.

Issue Addressed: Hurdles to residency commencing for IMGs during Covid.

Authors focus sharing their experience on obstacles suffered during onboarding IMG residents to neurosurgical residencies during the pandemic including travelling and deferred visa processing times.

Issue Addressed: IMG pathways into the US during the pandemic. Authors explore the current state of affairs during the pandemic and propose action plans for both graduates and medical students who strive to seek a residency in the United States.

Issue Addressed: Shortcomings of general surgery education in Mexico. This is a great example of how articles can address issues outside the US and still be published in a top journal. Authors argue there’s no Association of program directors in Mexico or a standardized curriculum.

Issue Addressed: Hurdles to residency commencing for IMGs during Covid.

Authors focus sharing their experience on obstacles suffered during onboarding IMG residents to neurosurgical residencies during the pandemic including travelling and deferred visa processing times.

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How do I write a Research Letter?

Lastly, research letters contain original data that may not be extensive enough for a full publication. It does not need to follow the typical introduction, methods, results, conclusion and thus may be beneficial for authors short on time. For a research letter, you will need study design and statistical analysis like a regular research article. If you would like to get these statistical skills, you can check out our course, Medical Statistics for Beginners.

Topic: Risk of dementia in patients on androgen deprivation therapy. Notice how this article has complex statistics and a similar structure to full-length manuscripts but is much shorter.

Topic: Cost of care in cancer patients. Authors explore the relation between financial distress and cost of care in patients with cancer.

Do I have to be an expert to write a Letter to the Editor?

It’s not a “hard” requirement that’s set on stone; however, the level of knowledge required to comment on a published article or find a topic that is of interest to write a viewpoint on (that is not already published) usually does require some degree of expertise in the area.

Do I need an attending co-author to write a Letter to the Editor?

Not really, but having a well-known physician among the authors definitely adds to the credibility of your letter. While that may be mostly true for perspectives and research letters, communications centered around valid, objective criticism with irrefutable proof may be easier to publish even if you or your institution are not world renowned

Are Letters to the Editor peer-reviewed?

The typical review process for any manuscript usually requires appraisal by an editor, who decides whether to send it out for peer-review or “desk” reject it. Letters to the editor most frequently only require to be reviewed by the editor and thus are published faster than a normal full-length article.

Are Letters to the Editor good for my CV?

Like everything else, cv is usually the culmination of all of its components. While having published letters to the editor may demonstrate critical ability, reflectiveness and perspective, we recommend you complement your CV with various other types of research.

How long does it take to write a Letter to the Editor?

It depends on your expertise and the topic but generally it takes between 4-24 hours.

How long does it take to get a Letter to the Editor accepted?

It varies based on the journal but generally between 2-90 days

How long does it take to get a Letter to the Editor published?

It varies based on the journal but generally between 1-6 months.

Summary table
Your Table
Type Journal Data Purpose
Commentary Journal 1: Must be the journal of the article you are commenting on. No original data. Provide criticism or commentary on a recently published piece.
Perspective Journal 2: Can be any journal to which the perspective is relevant to. No original data. Provide an opinion on a relevant topic.
Research Letter Journal 3: Can be any journal to which the data is relevant to. Original data. Provide a brief data analysis that is otherwise not large enough for a full publication.
Your Vertical Table
Type Commentary Perspective Research Letter
Journal Journal 1: Must be the journal of the article you are commenting on. Journal 2: Can be any journal to which the perspective is relevant to. Journal 3: Can be any journal to which the data is relevant to.
Data No original data. No original data. Original data.
Purpose Provide criticism or commentary on a recently published piece. Provide an opinion on a relevant topic. Provide a brief data analysis that is otherwise not large enough for a full publication.

That’s it! Hopefully with this info you’ll be well on your way to writing your first letter to the editor. Letters to the editor are a great start to any publishing career and are also a great way to learn about scientific writing and interesting articles. My own journey to publications started with a couple of letters to the editor and now I have over 40 publications of all types!

By David Hinojosa, MD

David E. Hinojosa-Gonzalez obtained his M.D. from Tecnológico de Monterrey, Mexico in 2020 and led the Surgical Research Outcomes Group for 2 years before joining Massachusetts General Hospital/Harvard Medical School as a Research Fellow in 2021. During this time, he has accumulated over 90 presentations, abstracts, and publications.

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