Organizing nonfiction writing around learning objectives

As nonfiction writers, we strive to educate our readers. Our goal is to communicate interesting ideas clearly and concisely. Sometimes the early stages of nonfiction writing are overwhelming. Sifting through all of our research, and trying to convey our ideas in a meaningful way can be challenging. One strategy to help organize your writing in the early stages is to create a set of learning objectives. Try to limit these to 3-4 per chapter or article. For smaller pieces, such as blog posts, 1-2 learning objectives is sufficient. Objectives should capture the main points that you intend for the reader to learn from your writing. It’s most useful to create these before you develop an outline or first draft. These objectives will provide you with a structural framework, around which you can build your entire work of nonfiction. 

One common system used for developing educational learning objectives is Bloom’s taxonomy (1). Using this system, you can create goals based on whether you want to increase a reader’s knowledge or comprehension of an area or their abilities to apply, analyze, evaluate, or synthesize something new based on what they learn from you. Helpful sites that explain in greater detail how Bloom’s is used for curriculum development are found here and here.

Knowledge-based objectives are the most straightforward to create. These focus on what you want your reader to remember. Think of objectives that use verbs, such as recognize, list, or recall. Let’s look at an example. If you are writing an article about breast cancer therapy for medical students, one of your objectives may be for your readers to be able to list the names of drugs used to treat specific types of breast cancer. Having this first learning objective in mind will help you know what kind of research to do, and what content to include as you build your outline and first draft. If your objective is to improve a reader’s comprehension or understanding of a topic, structure your writing around objectives that help the reader explain, compare, or summarize. Using the same example of an article about cancer therapy, you may include an objective for a reader to be able to explain how chemotherapy affects cancer cells. Deeper learning goals equip a reader with the abilities to critique or design specific endpoints. Sticking with the example of a breast cancer therapy article, your deeper objectives may be for readers to be able to apply facts about cancer therapy to predict how normal cells will be affected, or to be able to design an individualized treatment plan for a patient. Having these goals in mind before doing your research will ensure that you include enough information for readers to make evidence-based predictions and conclusions.

Once you have a set of objectives for your article or chapter, you can further develop each to build a detailed outline. The best part of creating learning objectives is the clarity you will gain regarding the goals and purpose of your article. Clarifying exactly what you want to communicate to your readers is a critical early step for keeping your writing focused and organized. Ultimately, taking the time upfront to develop clear goals will help your writing flow and enrich your reader’s learning experience.

(1) Bloom, B. S. (1956). “Taxonomy of Educational Objectives, Handbook I: The Cognitive Domain.” New York: David McKay Co Inc.

Communicating research to a broader audience

Research is all about increasing knowledge. Everyone should have access to that education. Unfortunately, research findings often remain trapped for years in academic circles. Science graduate programs train students to speak to other scientists, with manuscripts and talks usually targeted to professional audiences. Although this is critical for driving research programs forward, it does not allow the general public to access new research information. One reason for the breakdown in communication from academic science to the public is the lack of training in effective public engagement. During the past decade, scientific writing and presentation courses have been added to graduate curricula. Equal attention should be paid to fostering communication outside of academic circles. Most science training programs do not include opportunities for public engagement. Only with practice can scientists actually learn how to convey their research in a meaningful, interesting, clear and concise manner that is relevant to a general audience.

In the absence of established activities, students can work with their advisors to seek out opportunities to write for public audiences. This could include sharing research through school newsletters, blog posts, or social media. Professors can also integrate lessons focused on speaking or writing for the public into existing courses and seminars. Simple assignments could include writing lay abstracts and general research summaries or presenting brief public seminars about a specific research project. Students can work with mentors to develop a 1-minute elevator pitch of their research to clearly articulate the intention or impact of their work. Remember that storytelling and analogies are highly effective ways to communicate complex information. Keeping the message simple with 1-3 main teaching points will reduce the chances of getting lost behind your words. Colleagues from writing and communications departments can be invited to review and critique students’ written summaries or public presentations. Outreach activities will also provide students with unique opportunities to speak at middle schools or community events, which will improve skills in public communication.

Bridging this gap in communication positively impacts academia and the public. Educating a wider audience imparts deeper meaning and purpose to the everyday work of scientists and graduate students. Most importantly, improved access to research findings empowers the public to advocate for their needs. As an example, patients should be privy to research news that may help clarify treatment decisions. Receiving a medical diagnosis is frightening and confusing, often because of the unknowns. Education is one of the biggest weapons we have to combat those fears, ask informed questions, and be proactive about our own healthcare. The academic community has a responsibility to disseminate research to the public in a timely manner. Science graduate programs should prioritize building skills in public communication and engagement to facilitate broader access to research advances and education.

Nature is full of abundance

Sometimes writers forget to take breaks. We disappear into foreign worlds deep within the pages of our notebooks or screens of our tablets. Hours fly by. We forget to look up, and rarely wander far from our project. The unfortunate side effect is that we isolate ourselves, forgetting about the outside world. Instead, we sit, restlessly struggling with how to transfer ideas to paper. Ironically, the best solution for a frustrated writer may be to break out of isolation, forget about writing, and leave it all behind, at least for a while.

Yesterday, I left all my writing gadgets behind. No pen, no paper, no phone. I left all of those inside and ventured out. The dogwood trees were in full bloom. The azaleas were at their peak. The park was full of giggling children, motivated runners, and dogs chasing frisbees. I watched for a while before continuing on my walk. My first reaction was that I would have missed this if I had stayed at the keyboard. Then, I kept looking up. I’m not sure why, but I felt compelled to look up. I saw birds and a clear sky, and I felt a rush of gratitude. 

We spend so much time striving, pushing forward, and working for tomorrow. We forget about today. Slowing down, and paying attention to what surrounds us right now may be the healthier choice. Remembering to stop, reconnect, and appreciate nature and all its life forms may renew our energy, so we can return more optimistic and productive. We work hard seeking abundance in its many forms as we grow older. But maybe there’s nothing to seek. Maybe abundance has always been here, surrounding us in all her beauty. Maybe while we sit, thinking, working, worrying, she waits patiently, waiting for us to reconnect. If we regain our awareness, forget about distractions, leave manmade walls behind, and venture outdoors, maybe then we can openly invite nature to share her abundance. 

Combining endocrine therapies for metastatic breast cancer

Breast cancer remains the most commonly diagnosed cancer among women worldwide and is a leading cause of cancer-related death (1). In 2018, more than two million new cases were diagnosed, and more than 600,000 deaths were attributed to breast cancer. Breast cancers that have metastasized, or spread to other organs, often benefit from treatment with a cocktail of drugs. Strategic selection of drugs is based on molecular analysis of a tumor biopsy.

Approximately 70% of breast cancers express the estrogen receptor (ER) and are amenable to therapies that block estrogen or ER activity (2). These therapies are often classified within a larger category of drugs called endocrine or hormone therapies. There are many types of endocrine therapies, each with different mechanisms of inhibiting hormone action. Aromatase inhibitors (AIs), such as anastrozole, block estrogen synthesis, whereas selective ER down-regulators, such as fulvestrant, bind and reduce levels of the ER. Because of their different mechanisms of action, drugs from different endocrine therapy classes may be combined to exert increased inhibitory effects on ER-positive breast cancer. This type of combination approach was used in the S0226 phase 3 trial (NCT00075764). In this trial, postmenopausal women with previously untreated metastatic breast cancer were treated with the combination of anastrozole plus fulvestrant and compared with patients who received anastrozole alone. The combination treatment was previously reported to increase progression-free survival compared with the single agent (15 vs 13.5 months) (3).

Updated outcomes of the S0226 trial were recently reported at a median follow-up of seven years (4). About 45% of patients in the single-drug arm had crossed over to the combination treatment by the time of follow-up evaluation. Among 694 patients included in the updated report, progression-free survival remained significantly higher for the group treated with the combination. In addition, median overall survival was significantly higher for those receiving the combination treatment vs anastrozole alone (49.8 vs 42.0 months). Importantly, the differences in overall survival appeared to be dependent on whether patients had previously been treated with another endocrine agent, the selective ER modulator tamoxifen. Among those who did not have a history of tamoxifen treatment, median overall survival was significantly different with the combination vs anastrozole alone (52.2 vs 40.3 months). However, if patients had previously received tamoxifen, median overall survival did not significantly differ between the combination and anastrozole-alone groups (48.2 vs 43.5 months). The authors of the updated report noted the importance of considering differences in patient populations when interpreting and comparing results across studies. Previous trials that failed to show significant differences between single-agent AIs and cocktails of AIs with fulvestrant included patients previously treated with endocrine agents. Response rates and survival outcomes may be lower in some patients in this subgroup due to underlying endocrine resistance resulting from prior exposure to other endocrine agents. In addition, any time more than one drug is used, there are increased concerns about safety and side effects. However, high-grade (≥3) side effects were similar between the two treatment groups, suggesting that safety and toxicity were not compromised by the combination treatment.

Overall, the updated results from this phase 3 trial support the efficacy of combining the AI, anastrozole, with fulvestrant as a first-line option for patients with postmenopausal ER-positive metastatic breast cancer. This treatment combination has the potential to improve survival outcomes in patients who have not previously been treated with endocrine therapy.

References: (1) Bray et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018 Nov;68(6):394-424. (2) Waks and Winer. Breast Cancer Treatment: A Review. JAMA. 2019 Jan 22;321(3):288-300. (3) Mehta et al. Combination anastrozole and fulvestrant in metastatic breast cancer. N Engl J Med. 2012 Aug 2;367(5):435-44. (4) Mehta et al. Overall Survival with Fulvestrant plus Anastrozole in Metastatic Breast Cancer. N Engl J Med. 2019 Mar 28;380(13):1226-1234.

Five ways to gain confidence as a new freelance writer

Making the decision to venture into freelance writing can be scary. Trying to generate income from your combined love of writing and education seems almost too good to be true. Imagine the scene, or, if you have been there, think back to when you began. You make contacts, perhaps by networking on LinkedIn or joining the major writing associations in your field. You build a beautiful, navigable website that highlights your services and best work. You even send out your first set of e-mail pitches for writing gigs, by far the scariest proposition of the whole process when I first started out. Achieving each of these essential first steps lays a foundation for confidence and self-belief. But the real test of your ability to persevere comes with each passing rejection or criticism. You may feel like giving up on what seems like a dream. Inside, you know that if you persist and keep trying, you will almost certainly land new assignments, which could result in regular clients. But how do you maintain confidence and not feel overwhelmed at the beginning? Here are a handful of strategies that can help you build your writing practice, while maintaining a healthy mindset as you move towards your freelance goals.

Write often. To build any skills set, you must practice. Writing is no exception. The more time you dedicate to developing your writing style, the more confident you will feel with your unique voice. You will also begin seeing trends in what types of pieces you prefer writing. As a new freelancer, you may not understand which markets, clients, and audiences you want to impact through your writing. Establishing a regular writing practice will help you identify interests and areas of knowledge that you could market. Writing each day will also help you overcome writer’s doubt. Success is motivating. You will feel a sense of accomplishment with each finished product. You will improve your basic skills in researching, outlining, and developing a first draft without being hindered by your internal editor. That’s a skills set that causes struggles even for some advanced writers! As you continue through multiple drafts, a regular writing practice will help you learn how to edit, and develop your ability to communicate clearly and concisely. If you do not have a steady flow of clients yet, practice by writing blog posts or longer pieces to include in your portfolio. Practice writing concise pitches that clearly communicate a unique concept you would like to develop for a targeted client. Establish a habit of writing each morning. Setting aside this dedicated time is critical, especially if you are starting your freelance career while still employed full-time.

Build a community. We learn from those with whom we spend the most time. As a writer, you will benefit from building a network of writers, freelancers who understand business, and those who give you positive energy. It has never been easier to access information than now. In fact, you run the risk of information overload with the amount of content available online. Take time to identify virtual and live mentors who provide you with the guidance you need now. Multidisciplinary mentorship also works well, with individual mentors for writing, business, marketing, and niche-specific topics, for example. Choose the mentors and coaches with whom you best resonate. There are many outstanding virtual mentors who offer incredible value to new freelancers. Here are a few to check out for strategic advice- Ed Gandia, High-Income Business Writing, b2blauncher; Lindy Alexander, thefreelancersyear; Janine Kelbach, WriteRN; and Michelle Guillemard, healthwriterhub. These are just a few of the many seasoned freelance writing professionals who offer online content, as well as additional courses and coaching, to help new writers succeed.

In addition to searching for virtual mentors, identify professional associations in your field that can help you achieve your goals. For example, medical and scientific writers may benefit from joining the American Medical Writers Association (AMWA). Writing associations like AMWA provide educational webinars, in-depth courses, certification programs, in-person and virtual networking, regular newsletters, and online groups to answer specific questions. These are just a few of the ways that associations can help you grow professionally.

You can also build your community by joining local or virtual writing groups. These groups foster accountability and often provide educational content, ongoing advice as questions and problems arise, and feedback to continuously improve your writing. My first writing group was virtual, and I was a little skeptical about how useful it would be. However, within the first few months, I saw a spike in my productivity and confidence. Each participant shared their weekly struggles and successes. I soon realized that my self-doubt and obstacles were shared among the group. Understanding that others, especially those who are now thriving, have dealt with the same challenges and persevered to meet their goals is reassuring. The online writing group helped me stick to my goals, broaden my writing circle, and learn from others.

Another important consideration for growing and protecting your confidence is your immediate circle of contacts. Not everyone understands the desire to live the life of a freelancer or a writer. Combining the two? Well, you will meet many who won’t understand your decision. Try to minimize time spent with people who drain you of the energy you need to feel strong and self-sufficient. Surround yourself with empowering, positive people who will help keep you grounded and driven in pursuit of your goals.

Understand your goals. Defining 3- to 5-year goals is important for guiding your intentions, but for new freelancers, starting small could be a worthwhile approach. Clarify your top three daily, weekly, and monthly goals. These could be as straightforward as creating a draft homepage for your website, listening to and acting on a podcast, writing a blog post, or submitting 10 new pitches. Make your short-term goals specific, measurable, realistically achievable within the time frame, and relevant to your long-term goals. One approach is to write down your top three goals for the next day each evening. Similarly, spend 15 minutes on Sunday thinking through and writing down your top three weekly goals, which should be broader but still encompass most of your daily goals for that week. Dedicate time for reflection and forward planning during the last few days of each month. The time investment for setting these small goals is minor, and the payoffs are huge.

Know your strengths. One reason new writers often feel discouraged is that they feel they have nothing new to contribute. Take time to reflect and understand your unique background. Consider the following questions. What have you excelled at professionally and personally during the past three years? What degrees, certificates, specialized training, awards, testimonials, or recognition have you received? What or who have you impacted through your work or personal life? Where do you spend your free time and weekends? In what areas do others seek your advice? Going through these questions thoughtfully, and jotting down lists of responses will help you identify themes related to your unique interests and skills. Identifying these strengths will help you understand the value you bring to prospective clients.

Reframe how you view writing. Stop worrying about the end goal; instead, focus on the words. Writing is a process, a lifelong learning process. Once you shift your mindset to embrace writing with a growth, rather than fixed, mindset, you will change your trajectory and start experiencing success. When you adopt a growth mindset as a writer, you seek to learn from each writing experience. You willingly look at feedback as information you need to improve, and you understand that challenges will strengthen you. As a new freelance writer, you know that hard work and persistence are required to gain new clients or publish your work. When your results are not working out, seek help, learn from others and your perceived failures, and redesign your path to achieve your goals. Adopt a positive attitude about writing by viewing it as an opportunity to continuously learn and educate. Reframing what it means to be a writer can open up a world of opportunity, helping you remain mentally tough, so you can keep moving forward.

Heading towards a better preclinical model of uterine leiomyoma

Uterine leiomyomas, which are also called uterine fibroids, are non-cancerous tumors arising from the smooth muscle of the uterine myometrium wall. The lifetime incidence of fibroids is estimated to exceed 70%, making these the most frequently diagnosed benign tumor of the female genital tract. Fibroids represent a major cause of heavy uterine bleeding, pain, and reduced fertility.

The biology of fibroid development is poorly understood, although its growth is largely thought to be estrogen-dependent. Currently, the only reliable curative medical option is hysterectomy. Other treatment options, such as uterine arterial embolization and hormonal therapy, can alleviate symptoms and reduce tumor size, but typically do not resolve the condition.

A major challenge with studying fibroids is the lack of physiologically relevant models in the lab. Evaluation of myoma tumor tissue ex vivo is complicated by eventual overgrowth of tumor-associated fibroblasts. Two recent papers published in Endocrine Related Cancer and Journal of Biological Methods report a method for developing patient-derived uterine leiomyoma xenografts (1,2). The investigators used tissue from the most common genetic subtype of uterine leiomyoma, the MED12-mutant subtype. After the tumor was surgically removed from the patient, the tissue was digested and cultured for 1-3 days. Cells were mixed with collagen and grafted into the subrenal capsule of ovariectomized mice. PDX uterine leiomyoma growth was documented in mice supplemented with both estrogen and progesterone. Removal of estrogen and progesterone resulted in a rapid reduction of tumor size of about 60%. Limitations of the model include differences in the hormonal and microenvironment of the kidney vs uterus.

Development of models that more closely mimic human uterine fibroids will allow us to gain increased knowledge about the biology and molecular mechanisms driving the development and growth of these tumors. These models may also be suitable for evaluating new treatment approaches for this common and debilitating condition.

(1) Serna VA, Wu X, Qiang W, Thomas J, Blumenfeld ML, Kurita T. Cellular kinetics of MED12-mutant uterine leiomyoma growth and regression in vivo. Endocr Relat Cancer. 2018 Jul;25(7):747-759.

(2) Serna VA, Kurita T. Patient-derived xenograft model for uterine leiomyoma by sub-renal capsule grafting. J Biol Methods. 2018;5(2).