American Association for Clinical Chemistry
Better health through laboratory medicine
April 2010 Clinical Laboratory News: The Path to Success for Early Career Laboratorians

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April 2010: Volume 36, Number 4

The Path to Success for Early Career Laboratorians
How to Survive Publish or Perish
By Bill Malone

With the ever-expanding number of laboratory tests, the incoming generation of lab directors must go through a structured and demanding sequence of academic degrees, formal training, and certifications in order to be successful. This is why many young professionals are attracted to organizations like AACC’s Society for Young Clinical Laboratorians (SYCL), a professional network for AACC members under the age of 40 that helps them tackle challenges like passing board exams, finding a job, or securing travel grants.

One of the keys to professional achievement where SYCL and other leaders in the lab field are now focusing attention for early-career laboratorians is getting published in academic journals. Many young laboratorians remain long overdue for help in this area, where the roadmap to success seems to go cold and a lack of formal instruction or training leaves them feeling unprepared.

This is why the first step in getting published usually amounts to overcoming fear and building confidence, emphasized Thomas Annesley, PhD, professor of clinical chemistry at the University of Michigan and deputy editor of Clinical Chemistry. “A lot of people think that because they’re younger, they can’t write good articles. And that just isn’t true. Younger individuals can sometimes write better papers than well-known individuals,” he said. “It’s about ignoring your fears and going for it. It’s deciding you’re going to break the ice and try writing something up. You have to go through the learning curve, so the younger you start the better.”

It turns out that there are, in fact, many common threads in how successful early-career professionals go about building their skills to become well-respected, published authors. While not usually a part of their formal education and training, there is a fairly predictable path that involves trial and error, mentorship, effective networking, and a strategic approach to holding together the many threads of a demanding profession.

Easier…But Harder

A counter-intuitive trend in scientific publishing is that even while the number of academic journals has exploded over the last two decades, with more than 8,500 unique titles in the ISI Web of Science indexing service, the high-impact journals that professionals aim for have become much more competitive and highly selective. As a result, it’s much easier to get a manuscript published by any means, but much harder to break in to the more elite publications in a specialized field, like Clinical Chemistry, which only accepts about 15% of submitted original reports. This leaves early-career laboratorians with more choices than ever when it comes to where to publish, but higher pressure to turn out excellent, well-written papers if they want to publish in the more prestigious publications.

The ease of electronic manuscript submissions and expanding resources in developing countries have led to a swell of manuscripts competing for the pages of each journal, Annesley explained. “With the explosion of research throughout the world, especially in China, India, and other developing countries, it’s just the sheer numbers of people doing research and submitting papers that has increased,” he said. “But Clinical Chemistry still publishes about the same number of pages as it did 20 years ago, meaning that we have to be much more selective. So it has become more difficult to publish over time in the higher impact journals, and I think we’ll become even more selective in the future.”

The issue is critical for those doctorate-level clinical lab professionals because getting published has a big impact on a person’s career, and for those at academic institutions, publishing is a necessary element for promotion through the academic ranks, Annesley pointed out. Even for laboratorians not directly involved in teaching or research, a record of publication enhances their national and international recognition, which can be a contributing factor towards promotion in commercial jobs or community medical centers. Furthermore, laboratorians who publish are often chosen as peer reviewers, invited speakers, and members of committees and panels, activities which also factor into career advancement. Yet scientific writing courses and workshops to help prepare young professionals for publishing are “infrequent or nonexistent” at many universities and training programs, Annesley noted.

Despite the high stakes and competitive nature of publishing, several factors remain in the laboratorian’s favor, said Joshua Bornhorst, PhD, assistant professor of pathology at the University of Arkansas for Medical Sciences in Little Rock and the director of the clinical chemistry, immunology, neonatal, and point-of-care testing sections of the University of Arkansas Hospital System. In 2009, AACC honored Bornhorst with the Award for Outstanding Scientific Achievements by a Young Investigator. “In some ways, I think it has gotten easier to get published: there are more journals, online resources are better, and there is more computer archiving of data that can be accessed,” he said. “At the same time, I’m not convinced that all the journals out there are as rigorous as they should be in requiring solid scientific contribution and presentation. I’m worried about a dilution in the quality of some publications.”

Annesley recommends that young laboratorians focus on preparing high quality manuscripts. “Those who publish fewer papers but in the high-impact journals, or perform studies that are highly cited and highly recognized—that does more for your reputation than publishing a large number of papers that just get lost in the ocean of all the other papers out there,” he said. “The quality of what you do is what stands up in the long run. If you don’t do high-quality work, people realize that you’re not making a significant contribution over time.”

More Resources

The laboratorians interviewed for this article suggested the following books and articles.

Journal articles

  • Annesley TM. The title says it all. Clin Chem 2010;56:357–360.
  • Boyd JC, Rifai N, Annesley TM. Preparation of manuscripts for publication: Improving your chances for success. Clin Chem 2009;55:1259–1264.
  • MacDonald NE et al. Preparing a manuscript for publication: A user-friendly guide. Paediatr Child Health 2006;11:339–342.
  • Welch GH. Preparing manuscripts for submission to medical journals: The paper trail. Eff Clin Pract 1999;2:131–137. Available online.


  • Gopen, GD. The sense of structure: Writing from the reader’s perspective. New York: Pearson Longman; 2004.
  • Gopen, GD. Expectations: Teaching writing from the reader’s perspective. New York: Pearson Longman; 2004.
  • Zeiger M. Essentials of writing biomedical research papers. McGraw-Hill: New York; 2000.
  • Lang TA. How to write, publish, and present in the health sciences. American College of Physicians: Philadelphia; 2009.
  • Day RA and Gastel B. How to write and publish a scientific paper. Cambridge University Press: Cambridge; 2006.
  • Katz MJ. From research to manuscript. Springer: New York; 2009.
  • Matthews JR and Matthews RW. Successful scientific writing. Cambridge University Press: Cambridge; 2008.
  • Freeman JV, Walters SJ and Campbell MJ. How to display data. BMJ Books: London; 2008.

Changing Roles

Though not quite a make-it-or-break-it mentality, the current trends in publishing do mean that tackling scientific writing without formal instruction leads to what some early-career laboratorians refer to as “trial by fire,” a lot of which has to do with the sometimes awkward and always challenging and abrupt shift from student or fellow to that first professional position.

“If you’re in an academic medical center, it’s absolutely essential to be prolific,” said Alison Woodworth, PhD, director of esoteric chemistry, associate director of clinical chemistry, and assistant professor of pathology at the Vanderbilt University Medical Center in Nashville. “For most of us, publishing is actually a requirement, and there is a steep learning curve at the beginning of one’s career. It’s quite challenging because there is a significant transition from postdoctoral fellow to assistant professor.”

As director of the postdoctoral training program at Vanderbilt, Woodworth has experience mentoring lab fellows, as well as medical students and residents. She noted that classically-trained PhD students usually lack familiarity with the clinical lingo and are intimidated by writing for publication. In contrast, her residents are more confident and don’t have a problem just getting something out on paper, likely because they get a lot of practice writing interpretations for anatomical pathology. “Clinical chemistry fellows will come fresh from PhD training, and they’re very timid about the clinical language,” she said. “In most cases, they learn exponentially when they start to do clinical studies, where they delve into the patient charts and read how clinicians write. Fear of the unknown is significant. Appropriate mentorship is critical in building a fellow’s confidence.”

Woodworth also emphasized how critical it is to be persistent at this early stage. “A lot of our publications as clinical chemists come from writing invited reviews at the beginning. And when your name is not as well known, it’s challenging to get those invitations,” she said. “You just have to keep being persistent and get yourself out there. Present data or give talks whenever you can, and then the invitations will start to come.” Woodworth recommended presenting posters, abstracts, even brown bag sessions or symposia at the AACC Annual Meeting, and networking through SYCL to help gain name recognition among peers. “I’ve found that the more things I do, the more active I am with AACC, the more opportunities present themselves,” she said. “Once you build yourself a bit of a reputation, people start to get to know you and you get invitations for bigger projects.”

Chris McCudden, PhD, vice chair of the SYCL committee, highlighted how important it is to have realistic expectations. “It’s difficult to publish a big, high-impact project right out of the gate at a new job,” he said. “If you’ve shown up at a new place and you’re just learning your way around, then it is helpful to start with a small project that you can get off the ground, then work your way towards larger projects. You’re probably not going to start a multicenter trial in the first month of your new job. Early on, it’s better to do something simple very well than do something big and not do a great job on it.” McCudden is assistant professor of pathology and laboratory medicine and associate director of the core laboratory at the University of North Carolina, Chapel Hill.

He also reminded early-career laboratorians that following the common-sense advice to start small and have realistic expectations can sometimes pay off in a big way. “As a trainee you won’t be the senior investigator on the first project you do, but that doesn’t mean you can’t publish in the top journals as part of a group, depending on whom you work with,” he said. “But your role changes greatly from graduate school, to post doc, to faculty.” Early on, with multiple authors and mentors, a person may not have the opportunity to write the entire manuscript, he explained. For example, the less experienced person might just write a draft and someone else will edit it extensively. But with more experience and seniority, he or she eventually will become the last person who looks at a manuscript before submission with the final say about what is included.

Annesley echoed McCudden’s advice. “The normal path is to start small and develop a niche or expertise over time. Begin by writing a review article, case study, or special feature. These do not require that you be a funded researcher,” he said. “Look for or solicit opportunities to collaborate with someone on a project, look for unsolved problems, and look for a mentor. Senior faculty will often have a smaller segment of a larger project that they are willing to let you participate in, which may lead to a publication or even a new area of investigation. Also, co-peer review of a paper with someone can help you make connections.”

Annesley, along with the other deputy editor of Clinical Chemistry James Boyd, MD, and the editor-in-chief Nader Rifai, PhD, recently authored a paper in the journal to help younger scientists better formulate manuscripts for publication. Now Annesley is working on distilling his editorial experience in a series of articles in the journal called “The Clinical Chemistry Guide to Scientific Writing,” the first of which was published in March (See Box, below).

Clinical Chemistry‘s Guide to Scientific Writing

A new, unique series of how-to articles is planned for Clinical Chemistry that aims to make the practical and sought-after advice of the journal’s deputy editor, Thomas Annesley, PhD, available freely to subscribers and the public. On sabbatical to develop a biomedical writing course at the University of Michigan—a rare instance of formal education addressing the subject—Annesley has developed a series of educational articles for the journal instead of publishing the material in book form, thereby benefiting a wider audience. Published monthly, the articles will be compiled on the Clinical Chemistry website.

So far, these articles are planned as part of the series, covering the following topics:

  • Titles
  • Abstract
  • Introduction
  • Methods
  • Results
  • Figures
  • Tables
  • Discussion
  • Language use
  • Common statistical errors
  • Authorship

A common theme among laboratorians who have found success in publishing is to find and make full use of a mentor. In fact, working with a mentor is probably the most crucial step towards getting published. “Finding a good mentor and an area of research you are passionate about is key—someone to help you break into a field, get you started, and give you advice and opportunities to publish with them—someone who has already established a name for themselves,” said Amy Saenger, PhD, assistant professor of laboratory medicine, director of the central clinical laboratory, and associate director of the postdoctoral training program at Mayo Clinic.

“I have been fortunate to have a few outstanding mentors, and in that respect I make sure to utilize their knowledge to the fullest: I ask questions as much as I need to, brainstorm about ideas for studies, and ask to collaborate if there is something I feel I can productively contribute to. If you can make it a two-way street and benefit both parties, that’s ideal.” Saenger is the 2010 winner of the AACC Award for Outstanding Scientific Achievements by a Young Investigator.

Often, the line blurs between collaborator and mentor, and this is when an early-career person has a unique opportunity to learn, emphasized McCudden. “Typically you learn the most through co-authors or lead authors on a project, and you’ll write the first or second draft, then get their feedback on it, then go improve it, then send it back,” he said. “So they’re both mentors and collaborators at the same time, and they have a vested interest in the project, so you’re very likely to get constructive feedback.”

Once that first article is published, your networking with colleagues can take on momentum of its own, said Bornhorst. “Getting that first article out gives you a voice and it gives you recognition, which can lead to more opportunities for further research,” he said. “So once you get the boulder rolling downhill, you pick up speed and can do well in publishing.”

Manuscript Writing 101
A Workshop at the 2010 AACC Annual Meeting

An interactive workshop on July 26 at the 2010 AACC Annual Meeting in Anaheim, Calif. titled “Preparation of Manuscripts for Publication: Improving Your Chances for Success” will be moderated by Christopher McCudden, PhD. Thomas Annesley, PhD, and James Boyd, MD, will give presentations. For more information or to register, click here. Registration opens in late April.

Keeping Your Eyes Open

After that first publishing success and with growing confidence in his or her writing and research skills, the next mountain young laboratorians face is finding relevant and engaging projects based on personal ideas and research, experts noted. The common theme for this step could be summed up in what Annesley simply referred to as “keeping your eyes open.”

“If you get a question from somebody in the laboratory, or a clinician calls and says, ‘I have this unusual case and don’t understand why I’m getting this result with this disease,’ keeping your eyes open means you tend to recognize opportunities for tackling unsolved problems,” he said. “Look it up in the literature and see if anyone has really examined the problem yet, or go through patient records to see how often this anomaly or problem occurs. Be ready for those opportunities when they come. Think about the problems you encounter in your laboratory and ask, ‘why are they still problems?’ Maybe there is a solution no one has looked at.”

This strategy has been borne out in the experience of laboratorians who juggle clinical, research, and academic responsibilities. “In my position where I’m the director of several laboratories, of course there are clinical ‘problems’ that pop up all the time, some of which may be of unexpected academic interest,” said Bornhorst. “In my experience, having laboratory sections in addition to teaching responsibilities actually gives you a wealth of opportunity for individual projects.”

Saenger agreed, noting that the raw material and some of the best ideas for research projects and publications comes from seemingly humdrum clinical issues. “We try to take a recurring everyday problem, do as much research into it as we can, and investigate new methods or technologies to make the solution novel,” she said. “And to make it a productive project academically, we often have a resident or fellow working on the project with us—they often bring fresh perspectives and ideas and provide us opportunities to educate along the way.”

Another tactic to keep a steady stream of publication-worthy projects going is to have more than one project underway at a time, at least once you have some experience under your belt, suggested McCudden. “You have to be careful with high-risk research. If you have just one of these projects going on and it doesn’t work, you’re going to have a hard time having anything to show for it,” he said. “But if you have multiple things going on at a time, or some less-risky type of projects concurrent, you’re more certain you’ll have at least something to publish.” Even still, be prepared for spells of even a year or more when nothing works, he said. “It takes a lot of multi-tasking. One useful trick is to spin together a research study with a clinical project you’re already doing.” He offered the example of bringing in new technology or developing a new method for a clinical service, where if done in a certain way, it could become the subject of a paper.

Balancing Act

Of all the stories and strategies common to laboratorians who research and publish, the most vexing trial that transcends place, training, and even experience is the attempt to balance on the so-called three-legged stool of service, teaching, and research. Annesley stressed that even the most senior and prolific leaders in the field struggle to fulfill all of these roles at the same time.

“The image of the perfectly proportional three-legged stool is a good one, but not realistic,” he said. “Today most individuals are hired with an emphasis on expectations in one area. Therefore, it becomes difficult to be a true ‘triple threat,’ let alone split one’s time equally among the three. The key is to strive towards the three-legged stool without worrying about a perfect balance.”

Exactly in what proportion a person focuses his or her time depends on the person’s individual job description as well as where his or her time and talent are focused, said Bornhorst. Some might concentrate on clinical service, whereas others might aim to be influential through professional associations, in publishing clinical observations, or in obtaining grant funding—but you need to be good in at least one of these, or even better, some combination of them, he said. Bornhorst’s approach has been to tend toward short projects for which he can enlist residents to help him. This way he ties teaching with research, so that residents can complete their work within a few months.

“The typical workweek for an academic clinical chemist is long,” Woodworth commented. “I struggle with balance every day, so I’m constantly making lists of what’s important and prioritizing. Of course my primary appointment is to cover clinical service, so if given a choice, patients always come first.”

Annesley made a similar assessment. “For me, making it work has been that I decided long ago that I would devote some of what I would call my personal time to doing these sorts of things,” he said. “I would come in evenings and weekends to do experiments or write papers, really doing a lot outside of the traditional work week. We are all busy during our regular eight-hour days with whatever our primary responsibilities are, and it’s tough to carve out that time.”

The Right Journal

After building confidence, finding a mentor, honing skills through experience, and giving up extra time to work on writing, laboratorians interviewed for this article also called attention to the fact that specializing and finding your niche also means picking the right place to publish.

Sometimes this translates into publishing in different types of journals over the course of a career, McCudden said. “I’ve switched fields a bit, from pharmacology and physiology to more clinical research, and so my goals have changed in terms of which journals I might target,” he said. “When I was a grad student, the American Journal of Physiology was going to be the flagship journal for us, then as a basic science post doc, it had to be a one-word journal: Science, Nature, Cell, or it wasn’t really considered worth doing.” Now that he’s working in the clinical world, McCudden realizes that those journals are not going to be interested in the kind of work he does anymore, even though he believes it has more impact on patient care.

The next step is to read and study the journals that the manuscripts are going to be submitted to, suggested Annesley. It’s important to know how people write for these publications, what the standard is for a particular journal, and what is emphasized and how the papers are organized. “Then you go out and write your own papers and learn by experience how to improve them,” he said.