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Date: 11/10/2022

To: "Luke Patrick Burns"

From: "The Green Journal" em@greenjournal.org Subject: Your Submission ONG-22-1781

RE: Manuscript Number ONG-22-1781 Uptrending

Dear Dr. Burns:

Thank you for sending us your work for consideration for publication in Obstetrics & Gynecology. Your manuscript has been reviewed by the Editorial Board and by special expert referees. The Editors would like to invite you to submit a revised version for further consideration.

If you wish to revise your manuscript, please read the following comments submitted by the reviewers and Editors. Each point raised requires a response, by either revising your manuscript or making a clear argument as to why no revision is needed in the cover letter.

To facilitate our review, we prefer that the cover letter you submit with your revised manuscript include each reviewer and Editor comment below, followed by your response. That is, a point-by-point response is required to each of the EDITOR COMMENTS (if applicable), REVIEWER COMMENTS, and STATISTICAL EDITOR COMMENTS (if applicable) below.

The revised manuscript should indicate the position of all changes made. Please use the "track changes" feature in your document (do not use strikethrough or underline formatting).

Your submission will be maintained in active status for 21 days from the date of this letter. If we have not heard from you by 12/01/2022, we will assume you wish to withdraw the manuscript from further consideration.

EDITOR COMMENTS:

1. Thank you for submitting this work to Obstetrics and Gynecology. If you opt to revise the submission, please reduce the length by approximately 30%.

2. Rather than "transaminitis", please use elevated transaminase levels.

Please note the following:

* Help us reduce the number of queries we add to your manuscript after it is revised by reading the Revision Checklist at https://journals.lww.com/greenjournal/Documents/RevisionChecklist_Authors.pdf and making the applicable edits to your manuscript.

REVIEWER COMMENTS:

Reviewer #1:

Overall, I think this is a well-written piece that portrays a good story and makes some interesting points. I have offered some minor, specific, stylistic suggestions (see below). More importantly, I would like to see a bit more descriptive language in this personal perspectives - I think there could be improvement in "drawing the reader in." (see below for more specific examples)

Line 5 "...other diagnoses in obstetrics,..." (add comma)

Line 21 "complex laborers" seems awkward - suggest another term Line 26 "attendinghood" also seems awkward

Line 28 "...and certainly, now that I am an attending, the number of patients..." (add comma) Line 32 "... above all else, it..." (add comma)

Line 50 "while as a resident, I might have..." (add comma)

View Letter ..

1 of 2 12/2/2022, 9:46 AM

Line 51 "...as a resident, I felt the pain..." (add comma)

Line 67 suggest rewording to "Perhaps, (delete then) the skill in longevity as an attending is not becoming hardened by the errors (delete all) we make."

I would suggest more examples of "show don't tell". In other words, "bring" the reader to the labor floor with you. You start to do this a bit with the phrases like "coordinating airflighted transfers from outside hospitals and dipping into and out of a busy triage (lines 21-22) but I would suggest delving more deeply into these visuals - Give the reader the ability to

"visualize" themselves there with you. Love the phrase "dipping into and out of" - give more of this! What did the triage are look like? Sound like? "Bring" the reader in with you.

I like the paragraph from Line 32- 38 - the theme of loneliness is important, like the term "clinical solitude". Can you give it a little more visual, as above, to "bring the reader in" by showing not telling? (for example, "show" us the delivery of the patient w/ the decels)

Reviewer #2:

Summary: Experience of a new attending, now ultimately responsible for decision-making.

General comments: Well written and relatable. Would be excellent in a July or August Green Journal to coincide with the promotion cycle. I would use the "uptrending" title as a motif throughout, to draw the parallel between the labs you are following in the patient with the ascent to attendinghood.

Line notes:

"And certainly, now that I am an attending the number of patients I am responsible for at any given moment has

decreased significantly, perhaps for the first time since beginning my medical training." This is a run-on sentence. Needs either punctuation or editing.

"When the fetal heart tracing of a laboring patient recently in my care became increasingly concerning, I strongly recommended an emergency cesarean delivery." Again, this is a bit wordy and could be truncated.

"Instead, maybe the answer lies in getting the answer right enough times that eventually this role, the one thrust upon us seemingly at the strike of midnight one year in our training, is one we are entirely prepared for after all." Don't use

"answer" twice in one sentence. I would split this into two sentences and end on a punch.

-- Sincerely,

Torri D. Metz, MD, MS Deputy Editor, Obstetrics

The Editors of Obstetrics & Gynecology

__________________________________________________

In compliance with data protection regulations, you may request that we remove your personal registration details at any time. (Use the following URL: https://www.editorialmanager.com/ong/login.asp?a=r). Please contact the publication office if you have any questions.

View Letter

2 of 2 12/2/2022, 9:46 AM

Department of Obstetrics and Gynecology L4100 University Hospital South

1500 E. Medical Center Dr., SPC 5276 Ann Arbor, MI 48109-5276

November 30

^th

, 2022 Tori D. Metz, MD, MS Deputy Editor, Obstetrics

Obstetrics & Gynecology

Dear Dr. Metz,

Thank you for your review of my piece, entitled “Uptrending” (ONG-22-1781). Thank you also to the insightful feedback from the reviewers, who provide invaluable critique. I have made revisions based on the reviewers’ comments and am resubmitting for consideration for publication in Obstetrics &

Gynecology.

Below, please find point-by-point responses (bolded) to each of the reviewers’ comments and suggestions.

EDITOR COMMENTS:

1. Thank you for submitting this work to Obstetrics and Gynecology. If you opt to revise the submission, please reduce the length by approximately 30%.

2. Rather than "transaminitis", please use elevated transaminase levels.

Thank you for this comment. The phrase “moderate transaminitis” was replaced with “moderately elevated transaminase levels” in the first paragraph. Later in the piece, the phrase “transaminitis worsened” was replaced with “transaminase levels continued to trend upward”.

As instructed, the word count has been reduced by approximately 30%, from 1087 words to 760 words.

REVIEWER COMMENTS:

Reviewer #1:

Overall, I think this is a well-written piece that portrays a good story and makes some interesting points. I have offered some minor, specific, stylistic suggestions (see below). More importantly, I would like to see a bit more descriptive language in this personal perspectives - I think there could be improvement in "drawing the reader in." (see below for more specific examples) I thank the reviewer for their specific edits, which I have addressed below:

Line 5 "...other diagnoses in obstetrics,..." (add comma) This comma was added.

Line 21 "complex laborers" seems awkward - suggest another term

This phrase was replaced with “laboring patients”.

Department of Obstetrics and Gynecology L4100 University Hospital South

1500 E. Medical Center Dr., SPC 5276 Ann Arbor, MI 48109-5276

Line 26 "attendinghood" also seems awkward

This sentence was deleted to reduce the word count, and this edit can therefore no longer be addressed.

Line 28 "...and certainly, now that I am an attending, the number of patients..." (add comma) This paragraph was deleted to reduce the word count, and this edit can therefore no longer be addressed.

Line 32 "... above all else, it..." (add comma) This comma was added.

Line 50 "while as a resident, I might have..." (add comma) This comma was added.

Line 51 "...as a resident, I felt the pain..." (add comma) This comma was added.

Line 67 suggest rewording to "Perhaps, (delete then) the skill in longevity as an attending is not becoming hardened by the errors (delete all) we make."

The words “then” and “all” were removed from this sentence.

I would suggest more examples of "show don't tell". In other words, "bring" the reader to the labor floor with you. You start to do this a bit with the phrases like "coordinating airflighted transfers from outside hospitals and dipping into and out of a busy triage (lines 21-22) but I would suggest delving more deeply into these visuals - Give the reader the ability to "visualize"

themselves there with you. Love the phrase "dipping into and out of" - give more of this! What did the triage are look like? Sound like? "Bring" the reader in with you.

I like the paragraph from Line 32- 38 - the theme of loneliness is important, like the term "clinical solitude". Can you give it a little more visual, as above, to "bring the reader in" by showing not telling? (for example, "show" us the delivery of the patient w/ the decels)

I thank the reviewer very much for the helpful suggestion of using more descriptive language to draw the reader into the experience. I have attempted this primarily by adding a paragraph to the beginning of the piece that places the reader in the opening scene, alluding to the sights and sounds of our labor and delivery triage. Initially, I had also made additional changes to the anecdote mentioned above by the reviewer involving the delivery of the patient with

decelerations—however, this entire paragraph was removed for purposes of preserving the word count goals.

Reviewer #2:

Summary: Experience of a new attending, now ultimately responsible for decision-making.

General comments: Well written and relatable. Would be excellent in a July or August Green

Journal to coincide with the promotion cycle. I would use the “uptrending” title as a motif

Department of Obstetrics and Gynecology L4100 University Hospital South

1500 E. Medical Center Dr., SPC 5276 Ann Arbor, MI 48109-5276

throughout, to draw the parallel between the labs you are following in the patient with the ascent to attendinghood.

I am thankful to the reviewer for their thoughtful suggestions. As suggested, I attempted to turn the concept of “uptrending” into a motif by changing the ending of the piece, where I compare the upward trajectory of skill and experience to the upward trend of data on a graph.

Other suggestions from this reviewer are addressed below:

Line notes:

"And certainly, now that I am an attending the number of patients I am responsible for at any given moment has decreased significantly, perhaps for the first time since beginning my medical training." This is a run-on sentence. Needs either punctuation or editing.

A comma was added to this sentence after the word “attending” as suggested by reviewer 1.

The dependent clause “perhaps for the first time since beginning my medical training” was removed to reduce the wordiness of this sentence.

"When the fetal heart tracing of a laboring patient recently in my care became increasingly concerning, I strongly recommended an emergency cesarean delivery." Again, this is a bit wordy and could be truncated.

The paragraph containing this sentence was removed to reduce word count. Therefore, no amendment was made here.

"Instead, maybe the answer lies in getting the answer right enough times that eventually this role, the one thrust upon us seemingly at the strike of midnight one year in our training, is one we are entirely prepared for after all." Don't use "answer" twice in one sentence. I would split this into two sentences and end on a punch.

To accomplish the reviewer’s suggested goal of ending “on a punch”, the final paragraph was significantly changed. The original sentence was:

“Instead, maybe the answer lies in getting the answer right enough times that eventually this role, the one thrust upon us seemingly at the strike of midnight one year in our training, is one we are entirely prepared for after all.”

This was changed to:

“Perhaps the skill in lasting so long as an attending is not in becoming hardened by the errors we make, but in becoming attentive to the number of times we make the right call. After all, to appreciate the upwards trend on a graph, sometimes all we need is a little more data.”

It is no longer possible to address the reviewer’s suggestion regarding the double use of the

word “answer” twice in one sentence, as in this version this word is not used at all.

Department of Obstetrics and Gynecology L4100 University Hospital South

1500 E. Medical Center Dr., SPC 5276 Ann Arbor, MI 48109-5276

Thank you very much for considering publication of my work. I feel the piece has been strengthened by the suggestions above and once again thank the reviewers for their feedback. Please contact me with any further questions.

Sincerely,

Luke P. Burns, MD Corresponding Author

Department of Obstetrics and Gynecology 1500 E. Medical Center Drive

Women’s L4000, Box 5276

Ann Arbor, MI 48109-0276