Instructions for authors
Physicians are generally curious by nature. They want to know
not only about new advances in medicine but also how this new
knowledge can be applied. Program descriptions address this interest
and often herald new trends in both professional development and
health care delivery.
Program descriptions pertaining to professional development might
cover a new component of an undergraduate medical curriculum[1]
or new ways for a licensing body to ascertain and improve physicians'
level of competence.[2] Most program descriptions, however, focus
on the clinical aspects of health care. They might report on primary,
secondary or tertiary disease-prevention strategies, health promotion,
or health-protection techniques. They may describe programs designed
for hospital[3] or outpatient[4] settings.
The goal of this article is to update a previous one[5] and to
describe the attributes of a good program description. To assess
the appropriateness of a program description for publication in
CMAJ, authors should ask themselves three questions: Is
this program of interest to readers of a general medical journal?
Is it original or innovative? Does a preliminary evaluation suggest
that it is effective? An affirmative answer to all three questions
is necessary. Other questions that can be posed by authors, reviewers
and readers to assess the completeness of a program description
are summarized in Table 1. Program
descriptions are usually 15001750 words long (not including
the abstract and references).
Structured abstract
CMAJ is now promoting the use of structured abstracts for
program descriptions to help focus the efforts of authors and
to meet the reader's need for succinctly summarized information.
We have established the following subheadings: "Program objective,"
"Setting," "Participants," "Program,"
"Outcomes" and "Conclusions."
Authors should state the objective of the program in a single
sentence. This is a critical sentence: it should provide the rationale
for the program and describe the main components of the program
(i.e., screening, counselling and referral). Under "Setting,"
the location of the program should be noted along with such features
as the facility's level of care (e.g., tertiary care hospital
or community health care centre) and whether the setting was rural
or urban. Under "Participants," the authors should describe
who was offered the program and note any criteria for inclusion.
Under "Program," they should specify what was offered
and how (e.g., through workshops, pamphlets or small-group discussions). The "Outcomes" section should briefly identify the results
of a preliminary evaluation of the program, and the "Conclusion"
should address the implications of the new program for others.
The structured abstract should be approximately 250 words long.
Introduction
Although program descriptions do not constitute research per se, their goal is the same as that of any research article:
to answer a specific question or resolve a particular problem.
In the introduction authors are expected to state the problem
that prompted the introduction of the program. This often includes
descriptive statistics from previous studies to quantify the extent
of the problem. It may include a case example to bring the problem
to life. To set the program description in a broader context,
a brief review of the literature is needed to indicate whether
and how the problem has been addressed in the past. The specific
objective of the program should be identified, usually at the
end of the introduction. A clearly stated objective is essential;
the program cannot be assessed or evaluated without it.
Program description
The program description should be similar to the methods section
in an original research article. Thus, the acid test of a good
description is whether a colleague, after reading it, would know
what would be involved in replicating the program. This does not
mean that the description must be exhaustive; a balance needs
to be struck between completeness and succinctness. It is helpful
to organize the program description by addressing both the structure
of the program and the process of program delivery.
Structure
A description of the structural features of a program answers
the questions Who? Where? and When? Who were included in the target
population? Who offered the service (e.g., physicians, nurses
or volunteers) and had they received special training? Where was
it offered? When was it offered (e.g., during working hours, evenings
or weekends) and for how long? All these structural aspects are
important to identify, as each one can affect outcome.
Process
The process description reveals the What? and How? of the program.
What information or service was offered? How was it delivered?
Was it carried out on a one-to-one basis? Was written material
provided to participants? Were workshops held? Obviously, not
all of the information offered in a program can be described;
summarizing the content and highlighting key points is sufficient.
It is useful for the authors to note that further information
can be obtained from them directly.
Outcomes
Any program description needs to respond to the implicit question
"What is the benefit of such a program?" To be considered
for publication in CMAJ, a program description must include
an initial evaluation of effectiveness. Without this evaluation
readers will have
no way to know whether the program is likely to be effective.
Preliminary evaluation generally includes descriptive statistics
as well as appropriate outcome measures. Descriptive statistics
provide information about the participants in the program and
state how many withdrew before the program was completed. Outcome
measures vary according to the nature of the program. The preliminary
evaluation of new programs generally involves a before-and-after
comparison of knowledge, skills, attitudes or behaviours of the
target group. Their level of satisfaction with the new program
is also commonly assessed.
Authors may wonder what distinguishes a program description from
an evaluative study, given that both include an evaluation. There
are several key differences. The primary emphasis of a program
description is the program itself; the evaluation is secondary.
In an evaluative study the emphasis is reversed. In a program
description, the evaluation usually offers only preliminary evidence
of effectiveness, whereas in an evaluative study the evidence
is more definitive. For example, in a preliminary study there
is generally no comparison with a similar group of people who
did not participate in the program. An evaluative study, on the
other hand, should include a well-matched control group.[6] The
two types of studies are certainly not mutually exclusive: a program
description may be followed by a definitive evaluative study.
Discussion
The discussion section generally begins with a single sentence
summarizing the uniqueness of the program. The rest of the discussion
should follow the general outline used in all scientific papers.
The program should be compared with related programs, and the
implications of the new program discussed. It is critical to outline
carefully the program's strengths and limitations. Similarly,
the direction of future efforts, whether in program development
or definitive program evaluation, should be identified. The most
common problem with program descriptions in the past has been
excessive enthusiasm whereby authors overestimate a program's
strengths and fail to consider its weaknesses. It is important
to ensure that all conclusions and recommendations are justifiable.
Program descriptions are of interest to readers in identifying
what's new in education, professional development and health care
delivery. When carefully presented to address a well-defined problem
-- with a clear objective, a complete description, an initial
evaluation and a balanced discussion of strengths and limitations
-- program descriptions offer readers a realistic picture of what
can be done and may pave the way for more definitive health services
research.
We thank Dr. Milos Jenecik at the Université
de Montréal for his constructive comments on a previous
draft of this manuscript.
References
- Robinson GE, Stewart DE. A curriculum on physicianpatient
sexual misconduct and teacherlearner mistreatment. Part
2: Teaching method. CMAJ 1996; 154: 1021-5.
- Page GG, Bates J, Dyer SM, Vincent DR, Bordage G, Jacques
A, et al. Physician-assessment and physician-enhancement programs
in Canada. CMAJ 1995; 153: 1723-8.
- Walker DE, Balvert L. A practical program to maintain neonatal
resuscitation skills. CMAJ 1994; 151: 299-304.
- Armstrong H, Wilks C, McEvoy L, Russell M, Melville C. Group
therapy for parents of youths with a conduct disorder. Can
Med Assoc J 1994; 151: 939-44.
- Squires BP. Descriptive studies: what editors want from authors
and peer reviewers. CMAJ 1989; 141: 879-80.
- Naylor CD, Guyatt GH for the Evidence-Based Medicine Working
Group. Users' Guides to the Medical Literature: X. How to use
an article reporting variations in the outcomes of health services.
JAMA 1996; 275: 554-8.
| CMAJ October 15, 1996 (vol 155, no 8)
| Medical Writing Centre |