08954356/91 $3.00 + 0.00 Copyright 0 1991 Pergamon Press plc

J Clh Epidemiol Vol. 44, No. 8, pp. 739-740.1991 Printed in Great Britain. All rights rcscwcd

Dissent STRUCTURED

ABSTRACTS:

A MODEST DISSENT

MICHAEL B. HELLER Division of Emergency Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA 15206, U.S.A. and Center for Emergency Medicine, U.S.A. (Received for publication

One can easily imagine the popular game show Jeopardy in the year 2005. The category is “scientific faux pas” and the answers are “Cold Fusion”, “SD1 (Star Wars)“, and “Structured Abstracts”. The question of course would be “what were three ideas from the late 20th century that sounded nice but never really worked out”. The proposal that medical abstracts be structured in a well-defined, rather rigid format is certainly not illogical. Many possible advantages of such a change could be imagined, indeed have been imagined, by its proponents [l-3]. Unfortunately, however, the structured abstract format has been adopted by several prestigous medical journals without the fiublication of a single shred of evidence to support the contention that any of these advantages do in fact exist. The long and undistinguished list of medical and surgical fads that were introduced without critical analysis, only to be discarded when more rigorous investigation proved them worthless or harmful, is testimony to the folly of the unquestioning adoption of innovation. Structured abstracts are not a clinical innovation per se, but they clearly have the potential to alter the amount and type of medical information conveyed to practitioners. In fact, the sheer volume of today’s medical literature, almost all of it appearing in abstract form, as well as its nearly universal dissemination, makes it likely that any significant change in the format of medical abstracts would have effects that are far more

16 May 1991)

widespread than those resulting from any single clinical innovation. The practice of clinical medicine is at best part art, part science; research is not. Few medical researchers, or scientific investigators in any field for that matter, would disagree with the premise that changes in long-established standards and procedures should be based on scientific evidence of safety and efficacy; this is particularly true when there is no great urgency to adopt a change and the presumed benefits of the proposal are subject to rather straightforward confirmation or refutation by standard research methods. Who should be held to a higher standard of scientific rigor than the editors of scientific journals or the reviewers of scientific grant proposals? Such individuals are in a sense the very guardians of our scientific heritage. It is difficult to understand why they should be exempt from the scientific scrutiny that they impose upon others. To be sure, there are times when an innovation, whether clinical or journalistic, is so likely to be of benefit and so unlikely to have adverse effects that its institution may be justified without prior formal rigorous proof. The introduction of structutred abstracts does not appear to be in this category, however. Several potential drawbacks to the structured format place the burden of proof clearly on those who wish to discard the long-established form. First, there is the question of length. It seems clear that structured abstracts will simply be longer than abstracts in the standard format. 139

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The difference would no doubt vary depending on the study, the degree of detail called for by the structure, and the skill of the author. But there is every reason to believe that such abstracts will regularly be significantly more verbose than traditional abstracts. In the example given by Naylor et al. [4] in this issue of the Journal, for the example, the traditional narrative summary takes 15 typed lines amounting to 160 words; the structured summary describing the same proposal required 41 lines and over 400 words. Of course, this single example may not be typical of the disparity between the two formats. But even if the difference could be halved, it would still represent an overall increase in verbiage (and in time required to read it, and in print inches required to reproduce it, and in computer space required to store it, and in time required to save and retrieve it . . .). Considering the already massive volume of medical literature and scientific abstracts that appear every day, month, and year, such a significant increase in the demand for printer’s ink could be justified only if definite advantages were demonstrated, and this is precisely what has not been done. Some journal editors and abstract services have resisted conversion to the structured format for this reason [5]. Other effects of the structured format may be more difficult to quantitate. For example, proponents of the structured abstract have argued that the abstract is the most commonly read portion of a scientific report or, frequently, the only portion that is read. Also, it is pointed out that readers review many abstracts in a single sitting. If these statements are in fact true (and few would debate them), the readability of the abstract takes on increasing importance. “Readability” is of course a subjective concept; there may be, somewhere, some savant who sees beauty in the formalized rigidity of the structured format. But even proponents seem to accept that a loss of esthetic value is the price to be paid for what they view as a more functional (e.g. computer-compatible) form. Although there is vigorous debate as to what William Osler [6,7J would have preferred, it should be emphasized that beauty, “esthetics”, readability, and the like, although elusive concepts to define, are perfectly amenable to study. For example, a comparison of 10 studies abstracted both in the traditional form and the structured form could be presented

to medical practitioners of various types and their preferences, as well as objective measurements of the knowledge obtained from the two formats, could be tested. It is remarkable that such basic investigations have not yet been performed. The proposal from Naylor et al. in this issue, to extend the use of the structured format by making structured summaries a requirement of clinical and epidemiologic research proposals, is actually much more sensible than the advocacy of structured abstracts for medical journal articles. Study proposals and grant publications are not published, so increased length is of less concern. A reviewer ordinarily does not read many grant proposals at one sitting as is frequently done with abstracts, and the readability issue is also less important. Finally, grant proposals are usually graded on a precisely delineated scale, points being awarded or subtracted for defined characteristics of the study site, investigators, etc. This is not the way journal articles are either read or judged. Although one may yawn or chuckle over the author’s 13 (count’em) “key items” including such pop jargon as-“paradigm” and study architecture”, structured formatting of study proposals is less likely to have untoward effects than a similar structuring of journal abstracts. But the philosophical objection still remains: does it make sense to mandate the expansion of new practice -the use of the structured format-to a broader arena before it has been validated in the first place?

REFERENCES 1. Ad Hoc working group for Critical Appraisal of the Medical literature. A proposal for more informative abstracts of clinical articles. AM Intern Med 1987; 106: 598-604. 2. Mulrow CD, Thacker SB, Pugh JA. A proposal for more informative abstracts of review articles. Ann Intern Med 1988; 108: 613-615. 3. Haynes RB, Mulrow CD, Hugh EJ et al. More informative abstracts revisited. Ano Intern Med 1990; 113: 69-76. 4. Naylor CD, Williams IJ, Gyatt G. Structured abstracts of proposals for clinical and epidemiological studies. J Clin Epidemiol 1991; 44: 731-737. 5. Newell FW. Written communication; Nov. 1990. 6, Heller MB. Structured abstracts (correspondence). Ann Intern Mod 1990; 113-722. 7, Haynes RB, Mulrow CD, Altman DG. Structured abstracts (correspondence). Ann Iotem Med 1990; 113: 722-723.

Structured abstracts: a modest dissent.

08954356/91 $3.00 + 0.00 Copyright 0 1991 Pergamon Press plc J Clh Epidemiol Vol. 44, No. 8, pp. 739-740.1991 Printed in Great Britain. All rights rc...
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