Farooq Azam Rathore  ( Department of Rehabilitation Medicine, CMH Lahore Medical College, University of Health Sciences, Lahore, Pakistan. )
Sahibzada Nasir Mansoor  ( Department of Rehabilitation Medicine, Combined Military Hospital, Panoaqil Cantt, Pakistan. )

Medical writing has become an essential skill for anybody in academia and engaged in teaching. Workshops on medical writing are an effective way to teach the essential skills of medical writing to students and faculty members. There is a huge demand for these workshops all around the globe. Usually there is no curriculum of medical writing for the undergraduates or dedicated structured training sessions for the faculty members. One of the authors won an Author AID grant to conduct a series of workshops on medical writing. Eight workshops were conducted in three months, benefitting more than 200 students and faculty staff. We share our experience of holding this successful series of workshops with the aim that it might serve as a guide for researchers and faculty members who are eager to share and transfer their skills and knowledge. We also offer lessons learnt during this educational activity, tips to improve the quality and delivery of the content with limited resources and maximizing the impact. Experienced medical writers need to conduct these workshops to transfer their skills and to facilitate their colleagues and students to become better medical writers. Planning, rehearsal, motivation, resource management, good team work, audience analysis and feedback can make a workshop successful. Well prepared workshop content delivered in an interactive way with a variety of activities makes the workshop an engaging and interesting educational activity.
Keywords: Medical writing, writing skills, presentation skills, education, learning, workshop.


Introduction

Medical writing has become an essential skill for anybody who is in academia and is imperative for professional growth and development of the field. Revision of the faculty promotion rules by Pakistan Medical and Dental Council,¹ globalization and migration of physicians abroad and international exposure has led to a paradigm shift towards medical writing. Increase in the number of medical colleges and students in Pakistan in the last one decade² who sometimes have a better understanding of the process of medical writing have made it imperative for any faculty member to consider "Publish or Perish" seriously.
Usually there is no defined curriculum or formal training for medical research and writing for the under-graduate medical students in most of the medical schools all around the globe. Although faculty members are supposed to engage in medical writing, they too are rarely formally taught to write for referenced biomedical literature.³ Some commendable efforts and steps have been taken in Pakistan by individuals and some institutes to promote medical research and writing.⁴ At post graduate fellowship level College of physicians and Surgeons of Pakistan (CPSP) holds mandatory workshops on research methodology and biostatistics for the trainees. The aim is to help in dissertation writing but the scope of medical writing is much beyond that and the students lack the opportunity to start learning the art and other forms of medical writing from the very beginning.
Workshops on medical writing,⁵ peer support writing groups,^6,7 buddy writing⁸ and faculty development workshops^3,9 can improve the knowledge and skills of the participants, increase writing productivity, publication rates and presentations of scholarly work at medical conferences. In March 2014 one of the authors (FR) won a competitive AuthorAID grant of USD 2500 to conduct a series of workshops on medical writing.¹⁰ The initial plan was to conduct five workshops with an aim to train at least one hundred faculty members and medical students in medical writing. By the end of June 2014 we had successfully conducted 08 workshops at four different places in Lahore and Rawalpindi.¹¹ We will share our experience of holding this series of workshops with the aim that this will serve as a guide for other experienced and knowledgeable researchers and faculty members all around the globe, particularly in developing nations who are eager to share and transfer their skills and knowledge. We will be presenting this in the forms of learning points and tips below.

1. Don\'t wait for the perfect moment

There is no perfect time to start. You do not have to know very thing to get going. Just get into the game. You will learn by doing

Jack Canfield

We keep on learning throughout our lives and if we wait for the perfect moment or the moment of perfection in a particular field to transfer our knowledge and skills, it might never come. Nobody is perfect and the quest for knowledge cannot end at a fixed point in time. If you have published at least 15- 20 manuscripts as a lead author this means you are better than hundreds of faculty members and thousands of medical students who have yet to achieve this milestone. It is said "the best way to learn is to teach". Make up your mind, form a team and plan to hold a small workshop on medical writing at your college/institute within next three months. You will get to know your deficiencies, learn from others and get a unique opportunity of sharing knowledge and skills which will enhance your writing ability too!

2. Plan ahead

Failing to plan is planning to fail.

Alan Lakein

This is very true for any workshop on medical writing especially when it is being held for the first time. Do plan ahead of the workshop atleast 2-3 months in advance. Some important considerations are arranging a conference room, co-facilitator(s), format and mode of delivery of the workshop, permission from the administration, announcements, registrations, facilities at the conference venue and date etc.
Additionally preparing an engaging and interactive workshop is absolutely important if one needs to keep his/her audience engaged till the end (See No 7 below). This requires a lot of effort, planning, revisions and input from multiple sources. You should also try to revisit and think about the workshops on medical writing you attended in the past. Try to recollect the good learning points and deficiencies about these workshops and aim to address all these in your own workshop.

3. Delegate responsibilities: save time and energy

Holding a workshop is a time consuming and mentally stressful job. Micromanagement makes this even tougher. Learn to delegate different responsibilities to other team members and administrative staff. This will save time and energies which can be better utilized in revising the content and improving the delivery based on the participant\'s feedback.
We recruited a resident, as a coordinator. His job was to arrange for workshop posters, folders, stationery, stickers and certificates. He did a wonderful job, and we bought all the items in bulk at a reduced cost. He also entered online into Survey Monkey (an online survey website) the data from all the feedback forms so that we could allocate that time to preparing for the next workshop. Similarly arrangements for tea-break and lunch were the responsibility of the administration staff of the host institute.

4. Know your audience

It requires wisdom to understand wisdom: the music is nothing if the audience is deaf.

Walter Lippmann

Students and faculty members have different learning needs and strategies. It is important to know the target audience so that the workshop material and slides can be tailored to their needs. We ran workshops for the students and faculty separately as it was difficult to conduct workshops for two different types of audience with variable experience in one sitting. It gave us an opportunity to address the concerns of the students (relatively inexperienced and naïve) and faculty members (with some background knowledge) in an adequate manner.

5. Offer something of everything

We noticed that there is a huge demand and enthusiasm for workshops on medical writing in Pakistan. We usually had a time allocation of 5 hours at our disposal. We decided to give a brief overview of the whole process of medical writing instead of focusing on few aspects only. It helped the participants to get an overview of the whole process and then decide what aspect to go for in detail without getting confused. We felt that adults being self-directed learners will get an idea of different terms used in medical writing and will engage themselves in learning and improving. The participants learnt about new terms and explored them in their own time to improve upon their skills of medical writing. Feedback and email correspondence with some workshop attendees over the last six months has revealed that this approach of offering something of everything was correct.

6. Plan for breaks

Monotony is bad for the participants who get bored after a forty minute presentation. Always plan mini-breaks in between the presentations and let the audience getup and stretch their legs. It is difficult for the presenter to break the flow of presentation and allow time to the participants to relax, but it is essential trick to keep the audience engaged till the end. Plan hands-on exercises and group activities in between for better learning and attention.
This is especially relevant for the medical students as some of them considered the knowledge being transferred in one sitting as information overload.

7. Engage your audience

A good teacher, like a good entertainer first must hold his audience\'s attention, then he can teach his lesson.

John Henrik Clarke

Preparing an engaging and interactive workshop is absolutely important if one needs to keep his/her audience engaged till the end. This requires a lot of effort, planning, revisions and input from multiple sources. An engaging lecture and presentation results in improved long-term retention of information, decrease in distractions during lecture, and increased confidence with the material.¹² Never stand like a statue and deliver sermon in a monotonous tone. Be excited and enthusiastic! Engage the audience! Ask them questions! Roam around and make eye contact.
In addition we engaged the participants by conducting 4-5 hands on exercises. Topics of these exercises included literature searching, reading the instructions to authors and ethics of medical writing.

8. Bring in humour

The key attributes for a good speaker are someone that\'s articulate and someone that puts a fair amount of humour into what they do.

Jo Brand

Humour helps in breaking the monotony of a serious presentation, lightens the mood, refreshes the mind and helps the presenter to engage the audience. We inserted memes (http://memegenerator.net/) and funny images at the end of the presentations. This helped us grab the attention of the audience for the next presentation.
We also showed TED talks (www.ted.com) related to humour and success to the audience during tea-break to keep them engaged. It was appreciated by the participants many of whom listened to the TED talks for the first time.

9. Practice! Practice!Practice!

The only way you can make good at anything is to practice, and then practice some more.

Pete Rose

There is no substitute for practice and experience. Very few people are born orators, public speakers and teachers. One needs to learn the art of presenting and teaching effectively. Practice your presentations many times at your leisure and time them using the inbuilt PowerPoint tool for rehearse timings (available in the Slide show tab at the top). Ask your colleagues, students or even spouse to listen to your presentation; there is always room for improvement and it works wonder.

10. Ask for feedback

We all need people who will give us feedback. That\'s how we improve.

Bill Gates

Feedback is mandatory for any service or activity for improvement. We used the AuthorAID approved feedback form to get the feedback from the participants on the workshop. Although the feedback was overwhelmingly positive it helped us improve the content and delivery of the subsequent workshops\' presentations. In order to ensure that every participant gave a feedback, we made it mandatory to hand over a completed feedback form before the participant received his/her certificate.

11. Revise and improve

Always be flexible with your slides and presentations keeping in view the target audience and their level of expertise. The same material should not be used for the beginners and advance level. Keep on improving your material based on latest developments and evidence and keep it up to date
We changed and improved our presentations many times during subsequent workshops based on the feedback, experience and audiences.

12. No free lunch please

There\'s no such thing as a free lunch.

Milton Friedman

Usually free workshops are not taken seriously. It is a common observation in Pakistan that students and faculty alike would like to register for free for a medical conference or workshop. Although we had received a grant, we still charged a token amount (Pak Rs 300 -1000 / 1 USD = 100 Rs) for these workshops mainly from the faculty members. Still some managed to sneak in unregistered but didn\'t stay long enough to complete the workshop, receive the certificate and the resource book. We strongly feel that by paying this token amount motivated participants are automatically short listed to attend the workshop and try to get a good value for money. In addition this small revenue helps in covering unforeseen expenses and improving the quality of future workshops in resource constrained settings.

13. Build your own audiovisual equipment and other resources

We conducted workshops at four different places where resources and conference support varied from excellent to average.
In order to conduct workshops on a regular basis, it is advisable to obtain your own resources (whenever possible) to make it easier while planning for future. The possible resources could be personal dedicated equipment like laptop, printer, speakers, remote slide changer, laser pointer, certificate templates, resource material, handouts, hands on exercise material and workshop feedback proforma. This reduces the dependence on others, gives you a confidence and makes you in charge of most (if not all) aspects of a workshop.


Conclusions

Workshops on medical writing are an effective way to teach the essential skills of medical writing to students and faculty members. There is a huge demand for these workshops in Pakistan. Experienced medical writers need to conduct these workshops to transfer their skills and to facilitate their colleagues and students to become better medical writers. Planning, motivation, good team work and practice can make a workshop on medical writing an engaging and interesting educational activity.


Acknowledgements

The authors would like to acknowledge the following for their support.
International Network for the Availability of Scientific Publications (INASP) and AuthorAID for the grant to conduct the workshops.
Julie Walker, AuthorAID Director, INASP; Andy Nobes, Programme Assistant, Publishing Support, INASP; and Ravi Murgenson, Member, Author AID team for the support and facilitation.
Barbara Gastel, MD, MPH, Professor, Texas A&M University, USA, and INASP Associate-Author AID, for sharing and allowing use of slides of her workshops on medical writing.
Dr Imran Ahmad, Trainee in Rehabilitation Medicine, Mayo hospital, Lahore for being an excellent administration coordinator and arranging the posters, printing the certificates and resource books.
Dr Amara Ilyas, Trainee in Rehabilitation Medicine for coordinating the workshop at Department of Rehabilitation Medicine, Mayo hospital, Lahore.
Dr Omar Yousaf, BDS, FCPS, for coordinating the workshop at Sharif Medical and Dental College, Raiwind, Lahore.
Maj Gen Akhtar Waheed MBBS, FCPS , Commandant ,Armed Forces Institute of Rehabilitation Medicine (AFIRM), Rawalpindi for giving permission to conduct two workshops.
Dr Rizwana, Officer Incharge Training affairs, for coordinating the workshop at AFIRM, Rawalpindi.
Dr Shakeel Afridi, Vice Principal and Dr Zafar Khurshid, assistant director, department of medical education for coordinating and facilitating the workshops at CMH Lahore Medical College and Institute of Dentistry, Abdul Rahman Road, Lahore Cantt.

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