KEY TAKEAWAYS

• Scientific image editing serves a vital role in clear communication, but seeking presentation clarity must not compromise data integrity.
• Combatting image manipulation requires systematic collaboration across the research ecosystem, including standardised guidelines and new verification technologies.

As concerns mount over image manipulation in scientific publishing, the research community has begun developing new strategies to balance visual clarity with data integrity. Writing in Nature, Sara Reardon explores the “fine line between clarifying and manipulating”, highlighting the challenge of making figures both accessible and faithful to original data.

The art and science of visual presentation

Scientific images often require editing for clarity, like adjusting brightness, adding scale bars, or enhancing contrast. While such modifications are essential for effective scientific communication, a 2021 study by Helena Jambor and colleagues revealed that poorly presented figures remain surprisingly common, suggesting researchers need better training in visual data presentation.

When enhancement becomes manipulation

The boundary between legitimate clarification and misconduct can be perilously thin. Science integrity consultant Elisabeth Bik warns that even minor edits – such as cloning image sections to cover dust particles – can undermine data credibility. Echoing a seminal 2004 article, Bik emphasises that “the images are the data”, meaning they should present the results actually observed rather than those the researchers expected. Any undisclosed alteration that changes the scientific message could constitute misconduct. As Reardon notes, the cardinal rule remains to “show your work” – enhancing clarity without obscuring underlying data.

“The boundary between legitimate clarification and misconduct can be perilously thin… the cardinal rule remains to ‘show your work’ – enhancing clarity without obscuring underlying data.”

Detection and prevention strategies

Phill Jones examines potential systemic solutions to what Bik calls science’s “nasty Photoshop problem” in The Scholarly Kitchen. Journals increasingly conduct pre-publication screening using image-integrity specialists or AI tools that have demonstrated substantial promise in identifying manipulated images. Guidelines such as those from the International Association of Scientific, Technical & Medical Publishers aim to standardise best practice, while individual journals are also establishing specific image integrity requirements. Beyond journals:

• Institutions are urged to provide training and embed image integrity expectations into research culture.
• Post-publication peer-review platforms also play a role in identifying problematic images after publication.

Looking ahead, technical innovations offer promise. Jones highlights developments such as encrypted hashes and digital ‘signatures’ embedded in images, akin to secure web certificates, that could enable reliable verification of image authenticity. Ongoing collaboration and systematic change across the research ecosystem will be required to ensure scientific images are both clear and credible.

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KEY TAKEAWAY

• The RIVA-C checklist helps to create clear, accurate, and standardised infographics and avoid misinterpretation of results of comparative studies.

In the evolving landscape of scientific communication, visual tools such as infographics and visual abstracts are increasingly used to present research findings. While they offer quick and accessible summaries, concerns have emerged about their accuracy, clarity, and completeness – especially when used to convey complex comparative studies. To address these challenges, Joshua R. Zadro and colleagues developed the Reporting Infographics and Visual Abstracts of Comparative studies (RIVA-C) checklist and guide, a tool designed to improve the quality and reliability of infographics summarising comparative studies of health and medical interventions.

Why was RIVA-C developed?

Studies have shown that infographics can reduce full-text views, as readers turn to the infographic for a quick summary rather than reading the full article. However, infographics do not always include all the details needed to fully understand a study, increasing the risk of misinterpretation. The authors argue that previous infographic guidelines were either not rigorously developed or focused mainly on formatting and design.

Previous infographic guidelines were either not rigorously developed or focused mainly on formatting and design rather than content quality.

How was RIVA-C developed?

The checklist was developed through a structured consensus process involving 92 participants from a range of professional backgrounds. This process was led by an international Steering Group to ensure diversity of input and methodological robustness.

The RIVA-C checklist

The full checklist  comprises 10 items across 3 categories: (1) study characteristics, (2) results, and (3) conclusions/takeaway message—each accompanied by detailed explanations and examples to aid practical implementation. The checklist was piloted over a 6-month period to evaluate its clarity, relevance, and usability.

The future of RIVA-C

RIVA-C aims to enhance the transparency and completeness of infographic reporting, reducing the risk of misinterpretation—especially in the context of influential studies like randomised controlled trials and systematic reviews.

The authors recommend that journals endorse RIVA-C, similar to other checklists listed on the EQUATOR Network, by including a link and relevant information on their “instructions for authors” page. They also stress that evaluating the implementation of RIVA-C will be essential to inform future modifications to the checklist, ultimately increasing its impact.

RIVA-C may provide a path to improving the clarity and integrity of comparative study infographics. The Steering Group also hopes RIVA-C will lead to the creation of similar checklists in other areas of healthcare research.

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KEY TAKEAWAYS

• Visuals are an important tool in science communication, particularly for making complex information easier to understand.
• Visuals should be incorporated in storytelling from the start and designed for impact, inclusivity, and accessibility.

Effective use of visuals is a powerful tool in scientific storytelling: the subject of an article by Madhukara Kekulandara. Kekulandara (National Association of Science Writers) reported on a ScienceWriters2024 workshop where panellists Rachel Ehrenberg (Knowable Magazine), Jen Christiansen (Scientific American), and Beth Rakouskas (Science magazine) looked at benefits and potential pitfalls with visuals in scientific publishing.

The panellists discussed several key uses of visuals:

• acting as an “invitation” to a story
• driving the scientific narrative
• communicating complex ideas, sometimes through visuals that “function independently of the text”.

Opportunities to incorporate graphics should be identified early in the development process, with clear objectives set for each visual.

The panel raised potential challenges with using visuals in storytelling:

• Inclusivity of images: Ethical concerns arise when using sensitive images. Care must be taken to ensure inclusivity for under-represented groups whilst avoiding stereotypes. Engaging impacted communities in the process can be beneficial.
• Accessibility of visuals: Inclusion of effective alt text is crucial for visually impaired or blind readers.
• Engagement in the digital era: Interactive graphics or short-form videos can be particularly impactful in this digital age. Graphics should also be adjusted for viewing on smaller screens.
• Leveraging AI: The panellists recognised AI’s potential in visual creation, but warned against it substituting human creativity, as it “can perpetuate biases and stifle creative problem-solving”.

“AI should be viewed as an additional collaborator in developing engaging and informative visuals, working alongside writers and designers.”

There is no doubt that visuals can transform storytelling. Looking to the future, the panellists urged that AI should be viewed as an additional collaborator in developing engaging and informative visuals, working alongside writers and designers – not replacing them.

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KEY TAKEAWAYS

• A recent article from the ISMPP’s MAP newsletter highlights the importance of effective data visualisation.
• Collaborative working across all stakeholders is needed to facilitate the creation of credible and impactful data visualisations.

Visualising data using well-designed figures, charts, and infographics can improve scientific communication and make research data more accessible. In a recent article for the International Society for Medical Publication Professionals (ISMPP)’s MAP newsletter, Louise Brown et al. called on all those working in medical publishing to ensure effective data visualisations are prioritised throughout scientific publications.

“We must take learnings about the power of data visualisation, and the importance of getting it right, into our world of publications.”

A call to action

The group recommend key actions for each stakeholder who may play a role, alongside authors, in developing medical publications:

• Pharmaceutical industry
  • Encourage use of data visualisations.
  • Plan early with publication authors and consider data visualisation within core publication content, as well as in enhanced or additional features.
  • Ensure scientific rigour via compliant processes.

• Medical communications agencies
  • Provide teams with training in data visualisation.
  • Educate stakeholders on the value of data visualisation and on best practice.
  • Support the planning and development of effective data visualisations.

• Scientific publishers
  • Offer guidance to authors on how to incorporate data visualisations across publication content.
  • Work towards cross-publisher uniformity in processes such as editorial and peer review.
  • Enable feedback for authors through metrics and other means.

Brown et al. hope that, by working collaboratively in this way, the medical publishing community can promote better understanding of complex scientific data, including among time-poor clinicians, ultimately improving clinical practice and benefitting patients.

What could the future hold?

Looking ahead, the group also considered the potential of technologies such as improved metrics and artificial intelligence (AI) in ensuring data visualisations are impactful. While Nature recently banned the use of AI to create data visuals, Brown et al. point to AI’s ability to produce multiple visual representations of the same source data, based on individual preferences, learning needs, or health literacy levels. In their recent position statement, ISMPP emphasised the importance of human oversight when using AI in medical communications to ensure accuracy, which will surely be as critical for data visuals as for other publication content.

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The 10^th European Medical Writers Association (EMWA) symposium, entitled ‘Communicating with the public – what has the COVID-19 pandemic taught us?’ took place on 5 May. The symposium explored this topic through presentations and panel discussions, focusing on insights relevant to medical writers and communicators.

A summary of sessions 1 and 2 of the symposium is provided below to benefit those who were unable to attend, and as a timely reminder of the key topics for those who did.

You can also read our summaries of sessions 3 and 4.

Session 1

Introduction and welcome

KEY TAKEAWAYS

• Health messaging has evolved to become more patient-centric, with trust, transparency, and consistent communication key.

The symposium was opened by Lisa Chamberlain James (Trilogy Writing & Consulting) and Tiziana von Bruchhausen (Boehringer Ingelheim Pharma), who noted that scientific misinformation is not a new phenomenon; however, the speed and voracity with which it is propagated, particularly via social media, is a concerning trend.

To set the scene, Suzann Johnson (Janssen) provided a historical overview of health messaging to the public, beginning with the era of the ‘charismatic influencer’ in the 1980s, epitomised by the founder of Weight Watchers. The advent of direct-to-consumer advertising in certain countries in the 1990s was a key milestone that brought an increasingly scientific approach and increased recognition of the benefit of patient support programmes. Johnson outlined the transition to a more holistic view of patients with the rise of the wellness movement in the 2000s, and subsequent efforts to support patient empowerment in the 2010s, which continues to evolve into an increased focus on patient centricity in the present day. This change in thinking represents the important realisation that patient audiences are not one-dimensional and that each patient is an individual with a full and complex life, driving a shift away from doing things ‘to’ or ‘for’ patients and towards doing things ‘with’ patients, in a manner rooted in trust and transparency. From a present-day perspective and particularly considering COVID-19, Johnson noted the importance of clear communication from a trusted partner, transparency, and delivery of consistent messaging via different formats and across diverse channels.

An increased focus on patient centricity in the present day…represents the important realisation that patient audiences are not one-dimensional…driving a shift away from doing things ‘to’ or ‘for’ patients and towards doing things ‘with’ patients.

Fake news and data misreporting in the COVID-19 pandemic

KEY TAKEAWAYS

• Misinformation may be nuanced, based on inaccurate interpretations. Asking ourselves what mistakes could arise when audiences engage with our content could help mitigate this.

John Kerr (Winton Centre for Risk and Evidence Communication) provided perspectives on misinformation during the COVID-19 pandemic, and what can be done to prevent misinformation appearing and spreading.

Kerr began by differentiating between misinformation that is intentionally false and misinformation that may be more nuanced or complex. Blatant COVID-19 misinformation may be widely shared, but often remains a fringe belief. However, people exposed to these ideas may subsequently endorse increasingly counter-scientific positions or become more vaccine hesitant; thus, combatting such misinformation is paramount. Social media companies are increasingly removing deliberately false information, and from the audience side, gamification approaches such as Go Viral! have been shown to improve the ability to spot misinformation and reduce the likelihood of sharing. Kerr also discussed examples of complex misinformation, for example where information is factually reported but the audience may read it and form a misleading impression, or where statements are made in good faith but based on an inaccurate understanding of the data or using faulty statistical assumptions. Such information from otherwise credible sources may then be picked up and widely spread by conspiracy theorists. Tools to help prevent similar errors include RealRisk!, which converts relative to absolute statistics and may be useful for both public audiences and science communicators.

Kerr also signposted the audience to the five rules for evidence communication: inform, not persuade; offer balance, not false balance; disclose uncertainties; state evidence quality; and inoculate against misinformation.

Five rules for evidence communication: inform, not persuade; offer balance, not false balance; disclose uncertainties; state evidence quality; and inoculate against misinformation.

Kerr noted the particular importance of the last rule and asking yourself what mistakes your audience might make in data interpretation or what inaccurate conclusions might they draw when engaging with your content. Kerr closed the presentation by highlighting the Harding Prize for Useful and Trustworthy Communication, which aims to showcase examples of effective information communication.

EMA’s reaction and communication initiatives throughout the pandemic – COVID-19 vaccines as an example

KEY TAKEAWAYS

• The EMA has used strategies including increasing transparency, rapidly sharing contextualised information, and engaging in two-way dialogue to help combat COVID-19-related misinformation.

In the final talk of the first session, Morgane De Verdiere (EMA) provided a regulator’s perspective on communications during the pandemic. Although the EMA had practices in place following previous public health crises, challenges arose in the form of polarised views on vaccines, increased public scrutiny, ambitious plans for vaccine delivery (coupled with differences between individual member states’ approaches to how vaccines were used), and the unprecedented wave of misinformation. From the WHO declaration of the pandemic in March 2020 to the end of the year, the EMA had approved 4 vaccines, and within the following 9 months, extended licences to cover children and booster vaccinations and renewed licences granted under conditional marketing authorisations. This effort was enabled by collaboration within existing networks, instigation of a dedicated multistakeholder COVID-19 task force to assess vaccines and therapeutics, and collaboration with national and international bodies such as the Centers for Disease Control and Prevention.

Substantial efforts to increase transparency were put in place to help combat perceptions that accelerated development meant corners had been cut, including shortening timeframes to publication, publishing extra information such as clinical trial data and monthly safety updates, and providing additional information on the EMA website. Information gap identification and content development were driven by public concerns and queries. De Verdiere noted that a high volume of misinformation was identified via media and social media monitoring and queries from the public. The EMA aimed to address this via providing and promoting reliable information and engaging in a two-way dialogue.

De Verdiere noted that demand for safety information on COVID-19 vaccines was high. There was regular scrutiny of adverse event reports in the context of the full scope of available scientific data to evaluate the ongoing benefit/risk ratio for a particular vaccine, and extra resource allocated to these important efforts. The EMA had followed transparent communication practices for several years prior to the pandemic, which provided a foundation of trustworthiness for communicating on COVID-19 vaccine safety concerns. De Verdiere highlighted the importance of rapid dissemination of key information with appropriate context, not avoiding uncertainties, communicating strength of evidence, and stating when further information is expected to emerge.

De Verdiere highlighted the importance of rapid dissemination of key information with appropriate context, not avoiding uncertainties, communicating strength of evidence, and stating when further information is expected to emerge.

De Verdiere concluded that within the past 2 years, multiple treatments and vaccines for COVID-19 have been approved. The EMA has remained a technical and scientific authority, with a high regulatory standard that remained unmodified for vaccine approvals. Efforts are ongoing to prepare for the upcoming winter season, and the EMA has an important role in continuing to combat misinformation and managing future public health crises.

Session 2

The importance of visualisation

KEY TAKEAWAYS

• Using visuals in healthcare communications can enhance understanding, retention, and trust in information.

The second session of the morning started with a presentation by Carola Krause (Codex Biomed) on the importance of presenting data visually when communicating with the public.

Visual information can be an impactful medium for scientific communication, as people retain 80% of visual information compared with only 20% of read information and 10% of heard information.  Images are easier to decode than text: individuals with low literacy levels can often better engage with visuals, making them an inclusive tool for communication. Visualisation, both in form and content, can communicate complex information in a more appealing and easily understood way. Visualisation can also contextualise the storytelling aspect of communication.

Images are easier to decode than text: individuals with low literacy levels can often better engage with visuals, making them an inclusive tool for communication.

Visual representations accompanying text are particularly important for health authorities communicating health risks to a diverse audience, as explored for the H1N1 swine flu and COVID-19 pandemics in a recent article in BMC Public Health. Easily assimilated and effective communication is particularly pertinent during periods of crisis. In the context of public health emergencies, combining plain language text with visuals of non-visible entities (such as viruses) can increase audience trust and understanding of healthcare communications.

Combining plain language text with visuals…can increase audience trust and understanding of healthcare communications.

The WHO Strategic Communications Framework provides a set of standards for communicating with the public, recommending that materials are:

• accessible
• actionable
• credible
• relevant
• timely
• understandable.

Krause finished by highlighting that there is a general ongoing trend for information to be delivered in shorter-form communications. Text information has reduced from book to publication, and further into tweets that place increased limitations on word count. In parallel, visuals have also evolved, from drawings in books to the posters of the conference era, and then into graphical abstracts and infographics to meet the demands of social media. In the future, this will evolve further into more visually engaging media, such as:

• animated graphical abstracts – for example, where parts of visuals are sequentially highlighted to emphasise a particular point
• interactive graphical abstracts
• augmented reality
• virtual reality.

 Presentation of a checklist for writing in social media channels

KEY TAKEAWAYS

• Social media offers many positive attributes, and guidelines exist to help maximise its potential while avoiding potential pitfalls.

Nicole Bezuidenhout (Uppsala Monitoring Centre) provided some useful advice for navigating the social media world of misinformation and disinformation.

Firstly, Bezuidenhout outlined the many positive attributes of social media:

• It has a wide and fast reach, which is why researchers chose media such as Twitter to post news of the first genome sequencing of the COVID-19 coronavirus.
• It can facilitate targeted communication through algorithms that direct content to users based on their preferences and activities.
• It allows for two-way communication, making it both interactive and fun.
• Importantly, social media platforms are mostly free to use.

One drawback of social media is the propensity towards information overload, with an overwhelming and often confusing volume of content. Posts mandate concise language, leaving little room for nuance, which can result in misunderstandings. There is little quality control, so misinformation can be rife; this also provides an opportunity for those wishing to spread disinformation. The two-way communication that can facilitate great discussion and collaboration can also misfire, creating a ‘social media storm’.

To avoid potential pitfalls while maximising the potential to rapidly reach a wide and engaged audience, guidelines such as the Quality and Effectiveness in Science and Technology communication checklist (QUEST checklist) can help researchers to communicate about science effectively and responsibly on social media.

Bezuidenhout has also composed her own checklist, applicable to all communications, but particularly relevant for social media:

1. Define your message and aim, considering whether you are trying to convey information or persuade the audience.
2. Define your audience and consider their preferred platform and format for information.
3. Fact-check content, reading it fully, and use the Source, Headline, Analyse, Retouched, Error checklist (SHARE checklist) to ensure you only link to credible sources and references.
4. Follow ethical standards.

When considering how to target the right audience:

• Select the best communication channel for the audience and tailor content.
• Use clear, concise language.
• Consider the frequency of posts so the audience stays engaged and your posts remain visible.
• Consider the optimal timing of posts (although seeing when readers are active may only be available for those with a business account).
• Use hashtags, mentions, and links to drive traffic to the site.
• Ask permission before tagging people.
• Include a call to action that gives people the option to comment or share the article.
• Interact with your audience and online community, engaging with other people’s content and adapting to what is going on in the wider online community.

To tackle misinformation, be proactive with pre-bunking activities instead of reactive debunking, thereby helping to populate social media with good quality information.

To tackle misinformation, be proactive with pre-bunking activities instead of reactive debunking, thereby helping to populate social media with good quality information.

Bezuidenhout concluded her talk with some tips for readers, also recommending the Go viral! game as a tool that can help readers identify COVID-19 misinformation techniques and make them better able to discern credible information. The WHO also offers guidance on reporting misinformation online, covering the most popular social media sites.

Panel session

KEY TAKEAWAYS

• Establishing trust and tackling misinformation on social media platforms are crucial for communication with the public to be effective.

The morning of the symposium closed with a panel session chaired by Art Gertel (MedSciCom, LLC). Speakers from the morning sessions (Kerr, De Verdiere, Krause, and Bezuidenhout) were invited back to further discuss how best to communicate with the public.

The panel identified establishing trust as an important aspect to communicating with the public. Since there are cultural differences in preferred sources of information, it is important to be consistent across authorities, including both traditional sources of valued communication in science and medicine, and less conventional ones. To build trust, it is important to include balanced and impartial information that tries to convey, not persuade. Sources of information that are transparent about uncertainties in the data are more likely to be perceived as trustworthy, particularly when communicating to those sceptical of the topic.

To build trust, it is important to include balanced and impartial information that tries to convey, not persuade.

The role of preprints in the spread of misinformation was discussed in light of the proliferation of misinformation narratives during the COVID-19 pandemic. It was felt that journalists were generally good gatekeepers, did not report on preprints unless advised by independent experts, and included clear caveats about the non-peer reviewed nature of the information, that the conclusions of the research are not established, and that it should not be used to guide patient care. Nevertheless, non-experts need a clearer explanation of preprints, which will stem from a better understanding of the peer review process and the significance of research that has not undergone this quality control process. The American Medical Writers Association (AMWA), EMWA, and International Society for Medical Publication Professionals (ISMPP) joint position statement on medical publications, preprints, and peer review addresses concerns of speed versus accuracy, and the risk of misrepresentation of data derived from preprints.

Identifying trustworthy content on social media can be achieved by using universally credible sources, such as the EMA and WHO. It is also necessary to trust peers within the scientific community to share information from credible sources.

Nevertheless, social media platforms and users are still working out how to curb misinformation and the misuse of social media platforms. The WHO has several ongoing initiatives to combat misinformation online, including development of their global principles for identifying credible sources of health information on social media. Indeed, the first step to combatting misinformation is to identify which ‘fake news’ or conspiracy theories are gaining traction or the most attention. Efforts should then be focused on debunking these, which is best achieved by providing alternative theories and highlighting the truth, rather than merely arguing that the misinformation is wrong.

 [Debunking misinformation] is best achieved by providing alternative theories and highlighting the truth, rather than merely arguing that the misinformation is wrong.

Writing in simple language when communicating to a lay audience can simply be achieved by avoiding the use of jargon. If readers are left puzzled or irritated by a piece, this can erode their trust in the content. The panellists noted that there is a lack of statistical literacy in the general population, particularly when comparing fractions or probability. To check that a piece is correctly pitched, the panellists recommended undertaking informal review (by asking someone to look at it) or more formal review (using a focus group) to check that the content is being understood in the way intended. EMWA workshops on writing for a lay audience are also available. In closing, the panellists noted that to ensure success, it is particularly important to try to understand the audience, their prior experience, and any misconceptions they may have about science.

Why not also read our summaries of sessions 3 and 4.

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Written as part of a Media Partnership between EMWA and The Publication Plan.

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The 18^th Annual Meeting of the International Society for Medical Publication Professionals (ISMPP) took place in Washington, DC on 9-11 May and was themed ‘Future-Ready Medical Communications’.  This year, 595 attendees participated in the meeting, which was held in-person for the first time since 2019.

The meeting covered a range of topics through thought-provoking and engaging keynote addresses, oral presentations, interactive sessions and roundtables. A summary of the third day of the meeting is provided below to benefit those who were unable to attend the meeting, and as a timely reminder of the key topics covered for those who did.

Read our summaries of Day 1 and the morning and afternoon sessions of Day 2 of the meeting.

Summaries of Day 3

Good Publication Practice 4 (GPP4): Major changes, lessons learned, and next steps

KEY TAKEAWAYS

• GPP4 has been restructured to aid day-to-day usability and training for new members of the profession.
• GPP4 will include key updates with respect to authorship, working with patients, preprints, enhanced content, and social media.

The first session on the final day of the meeting was an eagerly anticipated discussion about the development of GPP4, moderated by Lisa DeTora (Hofstra University) with panellists Faith DiBiasi (Otsuka), Laura Dormer (Future Science Group), and Eline Hanekamp (Excerpta Medica).  All the speakers were GPP4 Steering Committee members.

DeTora noted that the GPP4 manuscript was recently submitted for journal review: as such, the panellists were able to provide an overview of the document during this session. Reflecting on the GPP4 development process, DeTora noted that while negative attention surrounding the profession during the preparation of GPP3 guided its development, GPP4 has been written in a much more positive environment, as demonstrated by the coverage of ISMPP and the profession in the recent Advancements with Ted Danson segment. The profession is also growing year-on-year, with new people entering the industry and the scope of publication types expanding. DeTora explained some changes to the structure of GPP4 compared with GPP3, noting that GPP4 aims to provide a more detailed introduction to the field to make processes more understandable for stakeholders we work with, as well as to provide a platform for training new entrants to the profession. GPP4 clarifies that standard operating procedures (SOPs), policies, and team education are part of the role of the publication professional. To help with the day-to-day usability of GPP4, the structure is more unified across the document, with more accessible and digestible sections for different topics and stylistic changes to improve consistency and remove redundancies. DiBiasi noted that SOPs and policies should not require drastic updates in light of GPP4, but the structure should facilitate the refinement or development of SOPs for companies that do not have these in place already. GPP4 is not proscriptive, but should support publication professionals in their different contexts.

A significant proportion of the audience had participated in reviewing GPP4, with 122 sets of comments received from ISMPP member groups and 38 sets of invited expert reviews. DeTora thanked reviewers for their valuable comments, many of which highlighted areas that required clarification, and all of which the GPP4 Steering Committee aimed to address. GPP4 aims to reflect what is best for the entire community, based on member input. Dormer also pointed out that, from the journal perspective, involvement in GPP4 development has been a very valuable process as it is important for publishers to be aware of guidelines so that their instructions for authors can be aligned.

DeTora and the panellists gave an overview of some of the key topics updated in GPP4:

• Aligning with the updated International Committee of Medical Journal Editors (ICMJE) recommendations on authorship: wording has been updated around the number of authors, as ICMJE recommendations no longer suggest any limits. In recognition of potential difficulties when journals do limit the number of authors, GPP4 will provide some recommendations and signpost to resources that can help to guide author selection and order.
• Working with patients: this key theme for publication professionals is addressed in GPP4, ensuring that the value of patient expertise is respected and providing guidance that should be useful for both the pharmaceutical industry and agencies. Patients have different backgrounds, so publication professionals may need to provide assistance to ensure that patients can reach their full potential for contributing as authors.
• Preprints: it was a challenge to come to a balanced position on preprints, as one size does not fit all. GPP4 will recommend avoiding preprints as a routine part of publishing key clinical trial data that will form part of the product label, unless required by the journal or for urgent medical purposes; however, there are many scientific areas in which preprints are well-established within the publishing paradigm, particularly in basic research fields. The panel advised that some journals increasingly encourage posting on preprint servers, so caution may be required during submissions if this is not the intention.
• Enhanced content: this is becoming increasingly popular, relevant, and valuable, and improves accessibility of publications for different audiences. It is crucial that any enhanced features, including plain language summaries (PLS), reflect the original content accurately and are not commercial in nature. Development of enhanced content should follow the same processes and guidelines as the original, be built into publication plans from the start, and be considered when identifying target journals.

It is crucial that any enhanced features, including plain language summaries (PLS), reflect the original content accurately and are not commercial in nature.

• Social media: social media posting does not belong with the job of the publication professional. Regulatory environments differ based on location and employer, so local laws and appropriate channels should be followed (in biopharmaceutical companies, this may require consulting with public relations, commercial, legal, and regulatory; for academia, institutional policies should be adhered to). Dormer noted that journals may request social media content, but nobody should feel obliged to use social media if they do not believe it is appropriate; company policies should be followed.

Regulatory environments (related to social media) differ based on location and employer, so local laws and appropriate channels should be followed.

Following the panel discussion, further interesting points were raised in the Q&A:

• To help incorporate different cultural perspectives and pressures, one of the Steering Committee members was from the Asia-Pacific region, and some language reflecting inclusivity in a broad sense is included in GPP4. The guidance should be adaptable enough to apply to different regions, and perhaps stakeholders might, in the future, look to provide guidance on applying GPP4 to the Asia-Pacific region (as was done for GPP3). Ultimately, best practice is best practice, regardless of region, so the guidance is provided without caveats to strive for as a target globally.
• As some high-tier journals may be less willing to engage with GPP4 and ISMPP, or developments such as PLS and enhanced content, hopefully documents like GPP4, continued uptake of enhanced content at other journals, and patient and healthcare professional (HCP) use of PLS will lead to a recognition of the demand and a change in approach. In the meantime, plain language summaries of publications (PLSPs), standalone PLS of an original publication, may be considered if a PLS is not permitted by the publisher of the original article.
• Future iterations of GPP may tackle topics like artificial intelligence and all-digital communications as industry practices in these areas continue to develop.

Publication guidelines roundtable session

During this session, attendees were able to select from 5 roundtables, each of which were focused on a different set of publication guidelines:

• CHEERS (Consolidated Health Economic Evaluation Reporting Standards 2022)
• ICMJE (International Committee of Medical Journal Editors) Recommendations
• GPP4 (Good Publication Practice 4)
• ACCORD (ACcurate Consensus Reporting Document)
• CONSORT (Consolidated Standards of Reporting Trials).

Attendees could then join the parallel session of their choice.

Non-clinical publications: Leveraging HEOR and RWE publications across the product lifecycle

In this parallel session, Charlotte Singh (Sanofi) and Rebecca Hahn (KJT Group) explained how product data are collected throughout the lifecycle of a drug or therapy and are provided from a range of sources beyond registrational studies. They highlighted strategic takeaways for non-clinical publications:

• agreement on strategy for communication at each phase of development
• publications build the overall value proposition for the product
• cross-functional alignment is necessary to provide consistent, cohesive messaging.

It was pointed out that health economics and outcomes research (HEOR) and real world evidence (RWE) studies are conducted and publications are developed across the product lifecycle, from Discovery to Prelaunch and Launch (eg, quality of life study publications, comparative effectiveness and safety, disease and treatment burden) to Growth and Maturity (eg, budget impact models, registry studies, electronic health records and claims registries). Other non-clinical publications were also discussed, like market shaping and thought leadership publications (eg, review articles, patient journey mapping, patient preference, and disease and treatment burden).

Consequently, the scope and complexity of publication plans and strategies have evolved to account for these wide datasets. Several future considerations for more thoughtful strategic communication were raised: the increased need for cross-functional execution, for publication teams to serve as strategic partners, and for medical communications involvement early on and across the product lifecycle.

Guided Poster Tour: Patient Centric Issues

The guided poster tour focused on the following posters (the presenting authors are shown in bold):

• Do healthcare professionals really value plain language summaries? (ENCORE) – Dawn Lobban, Jacqui Oliver, Marissa Buttaro, David Falleni and Melissa McGrath (Presenter: Amanda Boughey)
• Reviewing scientific publications to protect the privacy of clinical study participants (ENCORE) – Colin McKinnon, Friedrich Maritsch, Ingeborg Cil, Nicole Baumgartner, Jesse Potash, Borislava Pavlova, Valérie Philippon
• Reporting of patient-reported outcomes in the peer-reviewed literature from the mid-1990s to present day –Lisa Feder, Samantha Rivera and Larry Radican

 Defining metrics that matter

KEY TAKEAWAYS

• When choosing metrics, start with the objective of what you want to measure rather than what you can measure, stay aware of expanding/changing metrics to ensure the best selection of those aligned with your objectives, and embrace new technological developments, such as automated dashboards, to achieve objectives.

The need to quantify impact, and return on investment, of publications is universal, and yet there is no consistently used, established, standard metric. In this parallel session, Neil Adams (Karger Publishers), Jennifer Ghith (Pfizer) and Todd Parker (MedThink SciCom) explored how we can evaluate our publication activities to improve performance of data dissemination.

Defining meaningful metrics

Firstly, we need to define the objective of the metric assessment. For example, this could be amplification of publication reach or identifying a publication gap. Once the objective of the metric is established, this can be used to identify the best metric to use.

Ask yourself:

• what do you want to understand?
• how can you measure it?
• who is your audience?
• how can metrics be optimised and disseminated?
• what are you going to do with the information?

Assessing reach through the use of tactical metrics

Current metrics measure 3 factors: impact (eg Journal Citation Reports,), reach (eg views and downloads), and speed (time to decision, time to publication).

Many metrics are already available from journals in the form of metrics dashboards, such as that of NEJM and Elsevier. However, it is best to consider what you want to measure rather than what you can measure, and then see if this matches up with available metrics; it is always an option to reach out to publishers, as metrics such as time spent on page may not be routinely available but can usually be obtained upon request.

The current metrics landscape provides many ways to analyse how readers interact with publications. However, the truth behind the metrics can be complicated. Take, for example, the concept of ‘stickiness’ – if a person stays on the page for a long time, it could be that they were engaged, or it could be that the manuscript was confusing. Equally, an increase in social activity around a publication can be good or bad – not all news is ‘good news’.

Metrics that measure social media feeds must evolve and reflect new targets and platforms.

Metrics that measure social media feeds must evolve and reflect new targets and platforms. Bibliographic platforms such as Mendeley that allow users to quickly download publications to their library for later engagement, record a short period of attention/engagement, while summary download metrics, such as Altmetric, don’t record whether an article was later read or not. Similarly, the livestream conversation feeds for the ISMPP Annual Meeting have moved from Twitter to Whova – illustrating how metrics capturing social media activity must be flexible to change with user behaviour.

Knowledge- or behavioural-based metrics

As well as measuring the impact and reach of publications, it is important to gauge how these affect the knowledge and behaviour of the medical community. Although a publication may have a high impact factor in terms of views and citations, this does not reveal the sentiment of the ‘interaction’ with the publication. Tools such as Scite harnesses artificial intelligence to automatically assign the context of a reference citation as ‘supporting’, ‘contrasted’, or ‘neutral’. However, a pilot trial by Karger Publishers of 8-10 journals found that most results were classified as ‘neutral’ which wasn’t very informative.

The EMPIRE Index from PloS One addresses some perceived inadequacies of the current metrics landscape, such as the arbitrary weighting behind the Altmetric attention score, to include societal and social impacts. Using qualitative metrics such as these will be important when justifying future publication initiatives to colleagues.

Forward-thinking metrics

Engaging with colleagues from more active analytical functions (such as commercial and data analytics teams) can yield further insight into the best way to measure publication success and appropriate metrics. However, it is unlikely that one solution will provide all the information required to assess whether all publication objectives have been achieved.

An ABC set of criteria for establishing a framework for forward-thinking metrics was presented:

• Accuracy – does the chosen metric really measure what is to be assessed? One should be wary of social media activity counts, which may not indicate whether learning has taken place, and third-party sites that amalgamate multiple metrics, as these may not show the full picture.
• Brevity – use small amounts of data that require medics to transfer from one site to another, telling a story and in the process, measuring engagement and retention with that story.
• Consistency – be consistent with what you measure and how you measure over time to obtain the most meaningful metrics.

It was noted that the best metrics are:

• responsive to change
• long-lasting
• tied to business value and the target audience.

As well as optimising the metrics we use to evaluate interaction with publications, we should also be working to measure the findability of our data.

As well as optimising the metrics we use to evaluate interaction with publications, we should also be working to measure the findability of our data. Globally, HCPs spend ≥1.5 h a day on online research, and if they can’t find the data, then the metrics won’t matter. Article volume has increased, which can lead to information overload, making it difficult to find content and gain share of voice.

At the end of the session, the panel answered questions from the audience. Regarding the need for benchmarking the effect of a publication and the difficulty of interpreting metrics such as article download numbers, the panel suggested benchmarking against articles in the same issue of the journal. However, they cautioned that a lot of data need to be assimilated to achieve in-depth benchmarking. When asked if they use metrics to inform their publication plans, the panel responded that metrics were used to inform journal choice, and to see if the development of article enhancements are worth continuing. Lack of consistency in metrics reporting between publishers was raised, particularly with regard to page views, but the panel were able to confirm that there are as yet no discussions among publishers about having a consistent metrics platform, so authors/publication managers will still have to contact journals for this information on an individual basis. ISMPP provides several resources about best practice for metrics assessment, such as reports from the Social Media & Web-Based Metrics Working Group, which can inform journals, as well as industry members and authors.

Behind the infographic magic: How strategic cross-functional collaboration drives better content and engagement

KEY TAKEAWAYS

• Infographics are effective tools to deliver scientific messages. Cross-functional collaboration between stakeholders and enhanced visualisation of data are key to refine infographic content and boost audience engagement.

In this parallel session, Gerry Johnson (ICON), Amy O’Connell (ICON), Tanya Brinsden (ICON) and Maya Shehayeb (Amgen) presented a strategic approach to developing infographics, combining design principals with data translation using enhanced visualisation.

Data show that people scan scientific posters for no more than 20 seconds before deciding whether to read on in more detail. Lots of dense text and figures can bury the important scientific message, meaning they get missed.

Lots of dense text and figures can bury the important scientific message, meaning they get missed. Infographics are an effective tool to quickly capture an audience’s attention.

Infographics are an effective tool to quickly capture an audience’s attention and allow data to come through clearly. Pairing design principles, ie clear communication and an organised story, with enhanced visuals helps to translate data, increase audience engagement, and drive impact. Cross-functional collaboration between scientific, creative, and other key stakeholders is a crucial component to the success of this process.

Understanding how an audience comprehends information is an important first step. Visual iconography can help draw an audience and aid their comprehension by acting as a mental shortcut. Of equal importance is an appreciation of what types of visual aids work best in different venues: what works well in a small room may not work well in a large auditorium.

The speakers outlined a phased process of developing infographics with an enhanced visual approach:

• Evaluation and planning – assess the audience and venue to identify the major points to be presented (use links and/or supplemental materials for complete data). Consider the layout and organisation of data.
• Translation – translate data using an enhanced visual approach to improve comprehension without oversimplifying (eg iconography, visual hierarchy, interactivity, and graphical visualisation).
• Refinement – check that the content is reading correctly, and it is an accurate representation, then edit and re-evaluate.
• Review and approval – seek approval from key stakeholders and ensure the layout is fact checked before submitting for medical and legal review. Incorporate any final edits.

Enhanced visual approaches are well received by audiences and metrics demonstrate that the increased investment is well spent in terms of impact and readership.

Testimonials have shown that an enhanced visual approach is well received by audiences and although budgetary and time constraints can be barriers to implementation, metrics demonstrate that the increased investment is well spent in terms of impact and readership.

ISMPP Authorship Algorithm Showcase

KEY TAKEAWAYS

• The ISMPP Authorship Algorithm Tool will soon be available for use via the ISMPP website.
• Based on a clear interpretation of ICMJE criterion #1, the tool can assist publications professionals with conversations and decisions surrounding authorship eligibility.

As previewed during this year’s ISMPP European Meeting, the ISMPP Authorship Algorithm Tool will soon be available for publication professionals to use, following testing and feedback on the pilot version. Karen Mittleman (member of the ISMPP Authorship Algorithm Task Force) opened the session with a historical perspective on how the ICMJE authorship criteria are related to Good Publication Practice, noting the age-old challenge of defining and quantifying authors’ contributions against ICMJE criterion #1. This issue led to the creation of the ISMPP Authorship Task Force. As described by Maggie Hodgson (Merck & Co.), and as later highlighted by Rob Matheis (ISMPP President and CEO), practical guidance on this matter has been long overdue.

“[So many of the questions I receive] are all about authorship – what are we going to do, how do we know if this person qualifies [for authorship] or not? So [the tool] was kind of an obvious thing to do that was long overdue.” – Rob Matheis, ISMPP President and CEO

Scott Thompson (Acceleration Point) outlined some of the technology under the hood of the online tool, which has been designed to easily integrate into users’ existing Microsoft ecosystems, along with forthcoming implementation aids that will be available to users on the website. Thompson then handed over to Jeff Clemens (Eli Lilly) who presented a video demonstration of the tool. Clemens walked through the steps required to set up a project, choose the appropriate weightings for the algorithm based on the type of project, and ultimately generate objective contribution scores for each potential author against the various facets of ICMJE criterion #1.

With the website soon to be up and running, Sonia Schweers (Bristol Myers Squibb) closed the session with a call to action, appealing for people to use the tool. Schweers noted that the more the tool is used in discussions surrounding authorship, the better it will become (through updates based on user feedback) and the easier it will be to implement as it gains credibility among the biomedical publishing community.

Why not also read the summaries of Day 1 and the morning and afternoon sessions of Day 2 of the meeting?

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Written as part of a Media Partnership between ISMPP and The Publication Plan, by Aspire Scientific, an independent medical writing agency led by experienced editorial team members, and supported by MSc and/or PhD-educated writers.

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The 18^th Annual Meeting of the International Society for Medical Publication Professionals (ISMPP) took place in Washington, DC on 9-11 May and was themed ‘Future-Ready Medical Communications’. This year, 595 attendees participated in the meeting, which was held in-person for the first time since 2019. 

The meeting covered a range of topics through thought-provoking and engaging keynote addresses, oral presentations, interactive sessions and roundtables. A summary of the morning sessions from the second day of the meeting is provided below to benefit those who were unable to attend the meeting, and as a timely reminder of the key topics covered for those who did.

You can also read our summaries from Day 1 , the afternoon sessions on Day 2,  and summaries from Day 3 of the meeting.

Summaries of the morning sessions on Day 2

Keynote: Flash of genius – learning the art and science of creativity

KEY TAKEAWAYS

• We all have the capability to be a creative genius – we just need to unlock that potential.

Amy Foreman-Wykert (Amgen) opened Day 2 of the meeting and introduced the keynote lecture, given by Allen Gannett (Founder and CEO of TrackMaven and author of The Creative Curve). Gannett’s thought-provoking presentation summarised his arguments that the art of creativity does not only belong to natural born creative geniuses but is within us all.

The art of creativity does not only belong to natural born creative geniuses but is within us all.

Gannett explained that the traditional creative genius model has four elements:

• individual – the ‘solo genius’ who is born with these talents
• easy – once overtaken by inspiration, success comes easily
• overwhelming – moments of brilliance overtake the creator
• manic – creators are somewhat mad or neurotic.

But is this true? What if creativity is obtainable for all of us? Gannett used the analogy of Mozart to demonstrate that the perception of Mozart as a child genius could in fact be wrong, and that it was all down to hard work and practice. A study in Austria looked at the relationship between intelligence and creativity. A positive correlation did exist, but this stopped at an IQ of 104. Above this, everyone was found to have the same creative potential: this is the threshold theory.

So, how can you unlock this widespread potential? Gannett used crossword puzzle solving to further explain the science of creativity and what is going on in the brain. Using logical processing or letter-by-letter to solve the puzzle is a ‘left brain’ process, while sudden insight to an answer is a subconscious process and comes from the right side of the brain. If you are too overloaded, you won’t ‘hear’ the sudden insights – you need moments of quiet when your left hemisphere is less active. Gannett described the insatiable appetite that creative geniuses have for consuming content within their niche throughout their lives. He highlighted the ‘20% principle’, where creative geniuses spend 20% of their waking hours devouring the raw ingredients for their creative output. Paul McCartney’s consumption of musical content caused a sudden insight moment one morning to record a melody – the hit song, Yesterday.

Gannett concluded that we all have the potential to be a creative genius: if we unlock it and listen to the right hemisphere of our brain, we too could make our mark.

We all have the potential to be a creative genius: if we unlock it and listen to the right hemisphere of our brain, we too could make our mark.

One small step for a congress, one giant leap for scientific presentations

KEY TAKEAWAYS

• A good scientific talk should be a story to which the audience can relate and want to pay attention. Scientific slides are an aid to that story, focusing the audience on what the speaker is saying.

The second talk of the day was delivered by Jude D’Souza (Spirit) and Nathalie Van Havre (European Hematology Association) and focused on the importance of storytelling in medical presentations.

Public speaking for scientific presentations has been done in the same way for many years, with masses of information and data overloading large slide decks. Often these slides are presented by speakers who are not experts in communication and, ultimately, the key messages are lost. Indeed, in D’Souza’s experience, top names in a given field are often chosen as speakers and their ability to present is a secondary factor. 

D’Souza and Van Havre want to improve medical presentations to better capture the audience’s attention and convey the message. In so doing, they developed the European Hematology Association (EHA) spotlight talk: a 20-minute presentation consisting of just 5 slides. The aim is that the slides act as a storytelling tool, much like for a ‘TED Talk’, and the focus shifts from what the speaker is showing to what the speaker is saying.

The EHA Congress is a long-standing and successful meeting and, initially, EHA took some convincing before agreeing to adopt the new approach, admitted Van Havre. D’Souza had also expected some hostility and push back from the spotlight speakers, but after some initial reluctance, the speakers, with a couple of exceptions, were very receptive and engaged with the training that was on offer to support the transition. The training, both one-on-one and workshop-based, served as a good support tool for those spotlight speakers who were nervous about the prospect of presenting so few slides. D’Souza outlined 4 areas of focus in the training:

• Trust in gut instinct: the speakers had good instincts but often pulled their punches.
• Find the story: weave data/science into the framework of a compelling story.
• Show the speaker’s perspective: think about how the data/science is relevant to the audience to make it relatable.
• Use strong openings: a strong opening can create intrigue and make people want to pay attention. This is especially important in a virtual environment.

D’Souza and Van Havre concluded the talk with some key learnings, starting with explaining that it is how slides are used that is important, and not the number of slides. Limitations to the number of slides was initially important to get speakers to commit to the approach, but more slides can, and should, be added to support the message if necessary. However, gaining buy-in from congresses in terms of limiting the number of permitted slides may well be crucial to move the needle – if there are no restrictions, authors and industry members are likely to stick with the familiar ‘loads of slides, all the data’ approach. If more congresses impose restrictions, more people will be exposed to this type of talk, see the benefits, and become more receptive to it. Indeed, both the audience and speakers were encouragingly positive about the 5-slide EHA spotlight talks: the slides were engaging, didn’t lose scientific depth, and very clearly conveyed their message.

Both the audience and speakers were encouragingly positive about the 5-slide EHA spotlight talks: the slides were engaging, didn’t lose scientific depth, and very clearly conveyed their message.

The following key points were raised in a question-and-answer session that followed the presentation:

• There is nothing in the literature that supports the paradigm of audio versus visual learners. The way we learn depends on what we are learning and the opportunities we are presented with to learn.
• In scientific presentations, it is often necessary to show full data sets for completeness. Zooming in on important data and greying out the rest highlights the key parts, without hiding any data.

ISMPP business meeting and financial report

KEY TAKEAWAYS

• The medical publications profession has come of age, and is now more responsible than ever for ensuring medical information is used effectively.

Mary Gaskarth (CMC Affinity) opened this session by announcing the winners of this year’s poster prizes:

• Best original research: Gender differences in how authors “hype” the importance of their research – Ira Mills, Suze Kundu, Bob JA Schijvenaars.
• Best practice: Reviewing scientific publications to protect the privacy of clinical study participants [encore] – Colin McKinnon, Friedrich Maritsch, Ingeborg Cil, Nicole Baumgartner, Jesse Potash, Borislav Pavlova, Valérie Philippon.
• Best visual communication: Future-forward approach to optimizing consumption of publication content – Jessica B Bessler, William Fazzone, Adam Ruth, William Miranda, Jim Lothrop, Nancy Sladicka.
• Publication star: Evaluating video abstract visibility and content in peer-reviewed literature – Aarthi R Gobinath, Deirdre A Rodeberg, Ann K Overton, Rebecca E Slager, Jeffrey D Stumpf.

With the poster prize winners announced, Valérie Philippon (Takeda), the outgoing Chair of the ISMPP Board of Trustees, presented her report to attendees. Philippon highlighted the achievements of the professional body during the last year, noting the successful ISMPP West meeting as well as the well-received ISMPP Virtual Roundtables series. She also drew attention to the Advancements with Ted Danson series on Bloomberg TV, which showcased ISMPP and marked the coming of age of the medical communications field. Elsewhere, the ISMPP Plain Language Summary (PLS) Working Group has published a study in Current Medical Research and Opinion that emphasised the key challenges and opportunities to inform best practice for PLS. The ISMPP Authorship Task Force also published its recommendations for objective and consistent interpretation of International Committee of Medical Journal Editors (ICMJE) authorship criterion 1 in Current Medical Research & Opinion this year.

Courtney Leo (Pfizer) then gave her financial report to delegates, outlining the state of ISMPP’s finances, which remain solid with a financial audit planned for later this year.

Dana Fox (Caudex) moved on to give an update on the ISMPP Certified Medical Publication Professional (CMPP) credentialing programme for 2022, reiterating the many reasons to (re)certify as a CMPP, all of which will serve to strengthen the credibility of the medical publications profession. Despite the pandemic, the CMPP programme has expanded, and this year saw the first applicants from countries including Brazil, Saudi Arabia, and Malaysia. Fox outlined plans to future proof the programme, including a remote online examination due to be rolled out soon, a programme of self-study activities, and the CMPP mentor programme. She also recapped the flexible response taken during the COVID-19 pandemic to support the CMPP community, including extensions to the deadlines for recertification.

Robert Matheis (President and CEO, ISMPP) provided a perspective on the current state of the profession and its future trajectory, noting again the coming of age of the medical communications profession as it gains maturity, autonomy, responsibility, and accountability. Matheis described how the profession has moved on from simply publishing medical communications to the present situation, where medical publications professionals are closer to patient care and take greater responsibility for ensuring that people make the best use of published information. Matheis closed his address with a call to action, encouraging all ISMPP members to stay engaged, and to seek out opportunities to get involved in ISMPP initiatives.

Matheis described how the profession has moved on from simply publishing medical communications to the present situation, where medical publications professionals are closer to patient care and take greater responsibility for ensuring that people make the best use of published information.

Incoming Chair of the ISMPP Board of Trustees, Dan Bridges (Nucleus Global), closed the session with a look at the coming year, mentioning the forthcoming Good Publication Practice 4 (GPP4) guidelines and reiterating Matheis’ call to action for all ISMPP members to get involved in the society’s activities.

To round off the morning, attendees could select from 3 parallel sessions, which looked at working with patient authors, dashboarding and data visualisation, and remote working.

Democratising medical research and publishing: how to work with patients as authors on company-sponsored studies

KEY TAKEAWAYS

• Patients, caregivers, and patient advocates can provide a unique insight and perspective on a disease and therapeutic interventions, as patient authors and as advisors throughout the drug development process.

The first parallel session looked at working with patient authors. Despite increasing recognition of the value of patient engagement in medical publishing, a quick ‘show of hands’ demonstrated that most attendees had limited or no experience of working with patients. This session explored the patient, pharmaceutical industry, and agency perspectives on patient participation in medical research and publishing, highlighting the main barriers and how to overcome them.

Representing the patient voice was Dakota Fisher-Vance (Young Adult Cancer Connection, BioCryst Pharmaceuticals, Global Patient Advocacy), a published young cancer survivor, and Dawn Richards, a patient with rheumatoid arthritis who has published on patient involvement in medical research. Yuan Wang (Bayer) provided the pharma perspective, drawing on her experience of working with patients for the development of a Plain Language Summary of Publication (PLSP) for a Phase 3 cancer study. Simon Stones (patient advocate and Envision Pharma Group) also gave his perspective on the many ways to involve patients.

The ideal patient author can be any informed patient who is able to provide insight into the area of focus for a publication and who expresses interest to be involved. There are diverse types of patient author – trial participants, caregivers, patient advocates, and younger patients who may have been training to join the medical/pharmaceutical industry at the point of diagnosis. For example, the patient support network Young Adult Cancer Connection has successfully partnered with a number of life sciences research organisations to help them develop a truly patient-centred approach.

Patients provide valued input in several ways:

• Patients have insight into their disease that even leading clinicians in the field may be unaware of, and this can be complementary to other professionals’ expertise.
• Patient perspective adds an extra dimension to patient journey mapping, providing the lived experience.
• Patient contribution adds credibility to publications, validating the content, particularly within patient communities.
• Patient authors can provide a bridge in scientific literacy and knowledge between the medical industry and patient communities.

Patient contribution adds credibility to publications, validating the content, particularly within patient communities.

Wang highlighted how patients can contribute at every stage of the drug development life cycle:

• deepening disease understanding
• advising on study design (patient-centric endpoints, schedule of assessments)
• evaluating the suitability of enrolment criteria
• participating in patient advisory boards
• reviewing channels for data dissemination, including social media analysis
• authoring PLS.

Wang explained how patient involvement in clinical trial design may improve the patient experience, leading to better quality of life, improved communication with the treating physician, and increased compliance.

Patient authorship resources are available, including evidence-based recommendations and Workgroup of European Cancer Patient Advocacy Networks (WECAN) training courses. Wang added her personal tips for including patients in medical publishing:

• Cultivate a close partnership with the patient community to identify topics of interest.
• Identify authors – including a clinical lead author and patients, patient advocates, or caregivers as co-authors.
• Agree on the target journal – preferably open access.
• Agree on author responsibility and time commitment.
• Provide editorial support for the patient perspective section.
• Plan budget for translation into multiple languages.

There are some key barriers to including patients as co-authors in medical research publications, which need to be addressed and accommodated for a successful partnership to flourish:

• considering scientific literacy and understanding of medical publication processes (which is set to be tackled in upcoming GPP4 guidance)
• time availability, with competing life and health demands, given patient authors are also having to manage their condition and its impact on daily living
• achieving authorship criteria – and convincing the publishing and scientific community that these can be met by patients
• recognition of the value of patient contributions to publications.

There are some key barriers to including patients as co-authors in medical research publications…[including] achieving authorship criteria – and convincing the publishing and scientific community that these can be met by patients.

Nevertheless, both Fisher-Vance and Richards emphasised that it is worth persisting and looking for the potential in patients. Specifically, they recommended:

• including patients in publications planning
• guiding patients through the publication process
• publishing in open access journals so that publications can be accessible to the patient communities that they concern
• being transparent and communicative in ways you may not normally be
• being honest, if working with patient authors is new for you as well!

Opportunities are growing for patients to get involved in medical communications. A growing number of key influencers are supporting patient authorship, including the Patient-Centred Outcomes Research Institute (PCORI), Patient Focused Medicines Development (PFMD), and medical journals, such as The BMJ. There are also specialist patient-focused journals, including Research Involvement and Engagement, The Patient, Journal of Patient Experience, and Research for All. The European Association of Urology has started a patient track for patient perspective abstracts and presentations, and congresses may also run podcasts targeted at patients. In parallel, organisations such as the Center for Information and Study on Clinical Research Participation (CISCRP) aim to improve health literacy among the public and patients, which should grow the pool of suitable patient author candidates. 

Best practice in dashboarding and interactive visualisation for deeper insights from data

KEY TAKEAWAYS

• When done properly, data visualisation enhances comprehension and provides new insights into complex data sets.
• Interactive dashboards allow users to formulate their own interrogation of data and so can help to build trust in the data.

The second of the parallel sessions saw Richard White (Oxford PharmaGenesis) give a presentation on data visualisation. White encouraged the audience to not be scared if they are not experts in the area, but to try to explore and experiment with new approaches to presenting data.

Why is data visualisation important?

Approximately 90% of the information transmitted to the brain is visual, and the brain processes visuals 60,000 times faster than text. Data visualisation is not just about making things attractive: it is quicker and easier for people to interpret visual information. Interactive visualisations engage the audience, facilitating a deeper understanding and helping to build greater trust in the integrity of the data.

Interactive visualisations engage the audience, facilitating a deeper understanding and helping to build greater trust in the integrity of the data.

Data visualisation isn’t new and doesn’t need to be complicated

Although data visualisation is a hot topic, generating much interest and considerable debate in recent years, it isn’t something new. In 1854, John Snow produced a ‘heat map’ of cholera cases on the streets of London to reveal the clustering of cases around a particular water pump, identifying the pump as the source of the disease and alerting the local council to disable the pump, after which the outbreak ended.

Data visualisations, infographics, and dashboards

There is no clear definition of what constitutes a data visualisation and what is an infographic, and how the two differ. In practice, the terms are sometimes used interchangeably. However, White outlined some ways in which he understands the two to differ, including that data visualisations include a single representation of data, and are dynamic and increasingly interactive, whereas infographics tend to combine multiple data representations, and are static, rarely interactive, and often for lay audiences. Dashboards are interactive arrays that are key to the dynamic element of data visualisation, allowing users to drill down into complex data sets.

Best practice in data visualisation

The key principles of data visualisation include the need to understand the:

• data
• audience
• message
• channel.

With numerous types of charts available to show data, selection of the most appropriate option is important. When looking to visualise more complex data sets, it is likely that the more basic chart types such as simple line or bar graphs are not going to be up to the task of presenting the data in a way that is easily comprehended, aids understanding, and generates insights. More sophisticated chart types that can be useful for presenting more complex data sets include:

• heat maps, which show magnitude of a phenomenon using colours/colour intensities in two dimensions, sometimes overlaid on geographical maps (chloropleth maps)
• tree maps, which show the contribution of different components to the whole, usually represented as a rectangular area (the whole) divided up into smaller rectangles (the components)
• Sankey plots, flow diagrams in which the width of the flows between categories indicates the relative quantity taking that path
• Circos plots, which visualise data in a circular layout and are useful for exploring relationships between categories.

Regardless of the type of chart, appropriate use of colour is critical. Generally, the ideal is to use 3–5 colours, as it becomes increasingly difficult for people to interpret the plot as the number of colours rises above 5. Use of a relatively limited colour palette alongside shading and/or variations in colour intensity allows a large amount of information to be presented in a way that is easily interpreted. Recalling the 4 key principles for data visualisation, it is important to think about the channels through which visualisations will be delivered as, for example, 2 colours that are very different on a rainbow scale can appear identical when rendered as greyscale for black-and-white media. Colour choice should also take into account the possibility of users having different types of colour blindness.

Dashboarding best practices

The 4 key principles identified for data visualisation also apply to dashboarding. In this context, there are likely to be multiple messages and the channel is most often a digital device. The particular type of device is an important consideration, and the design and architecture of the dashboard requires careful thought. Greatest visibility and accessibility should be given to the key information and functions, similar to the layout of cockpit information screens for an airline pilot.

The design and architecture of the dashboard requires careful thought. Greatest visibility and accessibility should be given to the key information and functions.

White identified the following 10 principles of good dashboard design:

1. Avoid overcrowding.
2. Optimise layout/flow.
3. Prioritise simplicity.
4. Provide context.
5. Use the right data visualisation.
6. Consider accessibility.
7. Use consistent labelling.
8. Use interactivity.
9. Consider functionality.
10. Never stop evolving.

White closed by noting that a range of tools with increasing sophistication and ease of use (as well as increasing cost) are available to assist with data visualisation, along with a variety of courses and resources for those wanting to find out more and develop their skills.

Management of and working successfully in remote team environments

KEY TAKEAWAYS

• The shift to remote working during the pandemic has presented both challenges and opportunities for managers and employees.

The third parallel session saw Sarah Lochner Meuler (Avant Healthcare) and David Hogben (Complete HealthVizion) discuss the seismic shift to remote working environments due to the COVID-19 pandemic.

The shift to remote working has presented both challenges and opportunities for professionals working in our industries, whether the transition was temporary or permanent. Remote working has removed traditional face-to-face personal context and non-verbal cues that aid interpersonal interactions. Managers may have faced challenges to ensure that their teams remained productive and engaged, and continued to thrive, while employees may have had difficulty feeling connected with their colleagues and balancing their working lives with personal responsibilities (which have often been amplified during the pandemic).

Remote working has removed traditional face-to-face personal context and non-verbal cues that aid interpersonal interactions.

Hogben reviewed a COVID-19 impact survey of employees at a large global medical communications agency network. Respondents with 1 year or less working in the industry reported a higher negative impact on developing and maintaining work relationships, while those with greater than 1 year working in the industry showed a greater negative impact on team/company morale. For those hired during or after March 2020, when the COVID-19 pandemic began, there was less of an impact on team/company morale than on those hired before March 2020. Furthermore, most respondents replied that post-COVID-19, they preferred a hybrid work environment, instead of remote only or in office.  

Meuler and Hogben also looked ahead, considering how returning to the office or settling into hybrid working patterns can be navigated successfully.

You can also read our summaries of the sessions on Day 1 , the afternoon sessions on Day 2, and summaries  of Day 3!

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Written as part of a Media Partnership between ISMPP and The Publication Plan, by Aspire Scientific, an independent medical writing agency led by experienced editorial team members, and supported by MSc and/or PhD-educated writers.

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Recorded 07 October 2020 as a MedComms Networking webinar. Produced by NetworkPharma.tv

As Mike Morrison, a PhD candidate in organisational psychology at the University of Michigan, noted at the recent International Society for Medical Publication Professionals (ISMPP) Annual Meeting, the majority of scientific posters follow the same design, which has changed very little over the years. With his #betterposter campaign, Mike is pushing for a move away from traditional, text-heavy posters to a more user-friendly design. The Publication Plan talked to Mike to find out more.

Could you tell us how you became interested in scientific poster design and how your background as a User Experience Designer influenced the design of the #betterposter?

“Sure! The first lesson you learn being a User Experience (UX) Designer is that we are lazy-efficient in how we process information. People say they read everything carefully, evaluate every website logically, and of course need every last fine detail. But when you watch people use interfaces, everybody skims and filters frantically, looking for the bits they need and ignoring the rest, and they’ll give up the instant they feel overloaded. After ten years of watching and testing designs against visitor behaviours on the web, I started my PhD program in psychology with maybe fewer illusions about people’s information processing limits.

But of course, like every other terrified first year grad student, I started by completely ignoring all that and blindly conforming to what I saw everybody else doing. My first posters looked much like a traditional wall of text. Like most of us, I just assumed there was a good reason for the old poster approach. Then I would have posters get totally ignored, or when people did stop, they would start conversations that implied that they hadn’t even read the full title of the poster. After too many of those, I was just like “Wait, what am I doing?! What are we all doing?!”

When a design is extremely broken, you’re trained in UX design to wipe it clean and start over, adding one element back at a time, only when it becomes obvious that an element is indeed necessary. Usually, you end up with a more efficient design.

When a design is extremely broken, you’re trained in UX design to wipe it clean and start over, adding one element back at a time, only when it becomes obvious that an element is indeed necessary. Usually, you end up with a more efficient design, with a pile of unnecessary fluff that never needed to be added back. That’s what #betterposter version 1.0 was for me: a hard reset for posters. I’ve since reintroduced components to the approach over the last year as they’ve proven necessary (like big key figures), but only when I was confident that it would add more value than clutter.”

#betterposter version 1.5

Your YouTube video on how to create better research posters has gained over 500,000 views. With so much interest, do you think the scientific community has embraced the #betterposter design or is there some reluctance to move away from a poster design that has been the norm for over 30 years?

“Both! I was actually shocked at how positive the initial response was. The #betterposter template file now has over 250,000 downloads, so clearly a ton of people are using it, which I am really overjoyed about. I thought I’d be bugging conferences for years to try it! But we still have a long way to go.

Overall, tons of people have embraced it, and some have been reluctant. I get the impression that there is also a large ‘silent majority’ who really like it but are afraid of what their advisors will think if they break with tradition.

Incidentally, the new #betterposter version 2.0 layouts are faring better than version 1.0 on this front. They include more data and figures (the key concern with version 1.0), and also show the principles so presenters can make their own layouts.”

Example of a #betterposter version 2.0 layout

Are you aware of any concerns around the use of the #betterposter design? How would you respond to these?

“I’m extremely, painfully aware of the concerns. Some are really legitimate and helpful (eg presenters have highlighted the need to visualise methods, and raised concerns that the figures were too small on version 1), and those have led directly to the improvements in the #betterposter version 2.0 video and layouts. I intend to release improvements every year, and I need to listen to concerns and suggestions to do that!

BUT, there are also some people whose concerns have been…less thoughtful. The traditional ‘wall of text’ poster does one thing well: it gives an overall impression of density, and difficulty, and effort. You look at all of those paragraphs and figures, and you think “Wow that’s a lot of effort and detail!” You don’t learn anything, but you just blindly trust that anybody who puts that much text and that many figures on a poster must have thought their study through. These new designs actually communicate well, but they also feel easier (by design!), which offends some people.

That bias, called the affective heuristic in cognitive psychology, has been my greatest foe in all of this. I made posters that are easier to understand, which ironically makes them feel less ‘sciencey’. It may take us some time to get comfortable with science feeling easier than it normally does.

If you still have concerns, please watch the #betterposter PART 2 cartoon. You may find that most of your concerns have been addressed in the new evidence, new data-centric layouts, and reliable design principles shown in the sequel cartoon. The PART 2 cartoon incorporates a year’s worth of feedback (both positive and negative). Don’t just glance at a thumbnail of the ‘base model’ version 1.0 that went viral and write off the whole endeavour.

Also, keep in mind that we have not been basing the traditional approach to posters on any evidence. Research on traditional posters finds them largely ineffective at transmitting knowledge, and surveys show ‘meh’ attitudes towards poster sessions. The #betterposter family of layouts (which now comprises four recommended layouts) are at least attempts at creating poster layouts based on extremely sound learning and design evidence, which I spelled out in the PART 2 video. We’re still working to test the specific layouts themselves, but it’s no longer #betterposter version 1.0 or traditional. Now it’s “Will you try applying evidence-based principles, or not?”

Finally, the most common concern I hear with #betterposter-style layouts is that they reduce detail and ‘lose rigour’. If that is your concern, consider that in most physical poster sessions, the presenter explains everything and most content on the poster doesn’t actually get read. Putting something on your poster is not the same as people actually reading it.

Putting something on your poster is not the same as people actually reading it…. Your poster can never be as detailed as a paper, and trying to force it to be as detailed will typically ruin it.

I’d argue that explaining your methods briefly enough that people can scan them quickly is better than adding so much detail that people gloss over it all and get nothing. You can always explain more in person, and link to papers for more detail! Your poster can never be as detailed as a paper, and trying to force it to be as detailed will typically ruin it.”

You have conducted research to assess whether the #betterposter design is more effective than a traditional poster – could you share some of your findings with us?

“Sure! We’re working to publish our initial results now in collaboration with multiple labs in different disciplines. To give you an idea of some preliminary findings:

• initial eye tracking results favour the #betterposter version 1.0 over the traditional layout
• initial preference data show that the #betterposter version 1.0 was preferred by presenters and attendees at three different conferences (a fourth conference had non-significant findings)
• #betterposters (version 1.0) got more visitors than traditional posters at two conferences where we attempted to measure this metric – however, this result was only significant in one pilot after removing an outlier.

We still want to collect more data, especially on browsing behaviours and learning outcomes, and hopefully we’ll be able to resume that after the pandemic. But given that all of these findings were based on the version 1.0 design, and many results were upheld across multiple conferences and multiple experimenters, I think there’s enough evidence to say that we’ve at least achieved a very promising start to what will hopefully become a trend of posters improving every year (instead of stagnating like they have for decades).

Version 1.0 was an imperfect step in the right direction. The version 2.0 layouts take another step forward past that…

#betterposter version 1.0 wasn’t perfect, but we’re seeing it move the needle on some really valuable outcomes like attendee engagement. One attendee commented to me while looking at a #betterposter version 1.0, not knowing that I was the creator, “You know, I think this is a step in the right direction.” That’s kind of been my impression of the data so far: version 1.0 was an imperfect step in the right direction. The version 2.0 layouts take another step forward past that, and I’m looking forward to including them in our experiments post-COVID.”

The COVID-19 pandemic has resulted in many scientific congresses adopting a virtual format this year, with some increasing the use of digital elements on posters. Your #betterposter design includes a QR code. What do you think is the best way to utilise a QR code on a poster?

“If your poster is virtual, you don’t need a QR– you can use a real link! The only purpose of a QR is to quickly link the physical world to the digital. QRs can be useful on physical posters, but on virtual posters they’re a higher interaction cost for the user than simply clicking a link.

Virtual posters are an entirely different user context and need a completely different design. Something like the ‘swipe-flipbook’ #TwitterPoster concept I launched earlier this year or this ‘animated scrolling’ concept from Dr Krista Byers-Heinlein is probably a better fit for the online context, but I’m still working on this problem. I will also hopefully have a new cartoon with new concepts coming out next month dedicated specifically to virtual posters.”

Do you think QR codes and other digital features are currently being used to maximum effect? Are there any plans to evolve the #betterposter design to encourage increased use of digital elements?

“We’re just at the beginning! There are lots more things we can do to marry physical and digital content. The next physical version 3.0 #betterposter concepts (expected in 2021–2022) will likely be paired with companion formats that are online-native. I’ve also experimented with augmented reality (AR) elements on posters (eg point your phone at a poster and see a 3D model of the organ being studied), which may become increasingly useful as AR technology becomes more popular.”

Some congresses have shared your #betterposter design as a template for presenters to use. Do you think congresses need to do more to improve the experience of poster sessions for presenters and attendees? If so, what steps could they take?

“After speaking to conference administrators from around science over the last year, I’ve come to the conclusion that they are all superhuman saints doing the absolute best they can. The unfortunate answer here is that most people in science have scientific backgrounds (naturally), and few have design skills. Conferences are enthusiastic about trying new approaches to improve poster sessions, but it’s understandably hard for them to know what to do. The best general change all conferences can make is to help attendees feel less pressure to conform. Like, actively encourage crazy experimentation with posters.

More than using any one poster design, it is crucial that scientists experiment wildly with posters. Like, try the most radical design you can think of instead of conforming to ‘every poster ever’ out of fear. And presenters need some reassurance that their conference supports and rewards creativity and risk-taking in posters. The more we encourage poster presenters to take creative risks, the more attendees will feel engaged in a lot of novel, surprising posters.”

Presenters need some reassurance that their conference supports and rewards creativity and risk-taking in posters. The more we encourage poster presenters to take creative risks, the more attendees will feel engaged in a lot of novel, surprising posters.

Finally, what’s next for the #betterposter design and are there any other areas of academic research that you feel would benefit from reform?

“This year, I released the #TwitterPoster and #betterposter PART 2 cartoons, featuring all-new #betterposter layouts, which are generally more polished and evolved than the original ‘viral’ version 1.0 layout (which is, in my humble opinion, still a decent foundation design). One of my goals with the #betterposter PART 2 video is to arm scientists with the principles so they can keep the poster revolution going, even if I get hit by a car tomorrow.

Next month, I’ll hopefully release my #virtualposter cartoon. After that, my plan is to expand to other areas of science that desperately need modernisation. Science is an ‘immature’ organisation when it comes to UX, in that science still thinks design means ‘making things look pretty’ and doesn’t realise how dramatically some good UX design can boost productivity (and happiness among scientists). Through my day job at a science-related start-up, we might have the chance to take a swing at improving scientific publishing, which is both the hardest design problem in science, and potentially the most impactful if solved. That one’s a long shot, but I’m having a lot of fun working on it.”

Mike Morrison is a PhD candidate in organisational psychology at Michigan State University. You can contact Mike via mikeamorrison@gmail.com.

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Well-designed graphs and diagrams can effectively communicate complicated science. However, poorly designed visuals can lead to misunderstandings and potentially mislead readers. In a recent article in Knowable magazine, Betsy Mason explains that as the volume and complexity of scientific data increase and data are shared with wider audiences, the importance of data visualisation is growing.

The topic of a keynote presentation at the recent 2020 ISMPP European Meeting, data visualisation is sparking much interest within the medical publications field. A good visual should clearly communicate the underlying message of a dataset, revealing trends and patterns that may be lost if the data were presented in, for example, a table. Research carried out in the 1980s to determine how well different types of graphic are perceived revealed that people are best at reading charts based on the lengths of bars and lines, such as bar charts, but struggle to judge differences in area, shading, and colour saturation. For this reason, the use of the ever-popular pie chart is rarely the best choice if the aim is to compare the sizes of each slice. Similar research conducted over two decades later confirmed that these findings still apply in the modern digital environment.

Mason explains that while bar charts are easy to read and understand, they are not always the best option for presenting certain types of data. For example, bar charts are not effective for the visualisation of continuous data and should not be used for small sample sizes where outliers can have a big impact on the mean represented by the height of the bar. Scatterplots, box plots, and histograms are all better ways of visualising the distribution of the data. Mason also discusses the impact of colour on the interpretation of visual displays of data, noting that the thoughtful application of colour can enhance the message of a graphic.

One of the problems contributing to poor data visuals is that scientists rarely have training on how to best present their data and typically just follow convention, thereby perpetuating bad practices.

Mason highlights the potential role of scientific publishers in improving standards in data presentation, noting that several journals prohibit or discourage the use of bar charts for continuous data. Mason concludes that increased training, awareness and better software tools are needed if scientists are to adopt better approaches to data visualisation, which is particularly important as scientific data become increasingly complex.

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Summary by Alice Wareham PhD, CMPP from Aspire Scientific

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