The art of writing an effective cover letter

Journal editors read numerous manuscripts each day. A compelling cover letter can capture their attention, generate early enthusiasm for your work, and help it stand out among the many submissions they'll read. Unfortunately, not all authors take advantage of this opportunity. Here I offer practical guidance on how to write an effective cover letter. A well-crafted cover letter lets the editor quickly understand whether a manuscript is potentially interesting to the journal readership and how it might contribute to our understanding of a particular issue or problem (Box 1). Don't assume they already understand the problem. This is your opportunity to explain it briefly (i.e., one to three sentences). Even generalist physicians with a broad knowledge base have areas where their knowledge is only cursory or altogether absent. When editors understand the context of your study, they can more easily comprehend its significance. Dear Editors: Introduction We are pleased to submit our manuscript "Discharge in the AM: A Randomized Controlled Trial of Physician Rounding Styles to Improve Hospital Throughput and Length of Stay". Context Medical centers across the U.S. face capacity strain, characterized by an excess demand for hospital beds relative to available supply and staffing. To alleviate this strain, hospitals often encourage clinicians to prioritize early morning discharges. However, observational studies on the effectiveness of this practice have yielded mixed results, and the potential unintended consequences remain unexplored. What we did Over ~6 months, hospital medicine physicians were randomized to prioritize discharging patients first or round per usual practice. What we found We found that prioritizing discharging patients first 1) did not result in earlier discharges or significantly reduced length of stay, 2) did not cause delays in placing other patient care orders, suggesting that physicians adapted their workflow to address patient needs, and 3) led to perceptions of inefficiency. Why it's important Hospitals may not need to emphasize or incentivize prioritizing patient discharges over usual patient rounds. Such initiatives may actually be counterproductive by causing inefficiencies such as repeating work and requiring additional travel time to units across the hospital. Highlights elements required for publication This study was approved by the Colorado Multiple Institution Review Board, registered through clinicaltrials.gov (NCT05370638), and funded by the Agency for Healthcare Research and Quality (1R03HS027231-01A1). Additionally, there's no need to explicitly state why your manuscript is relevant to the journal audience; presumably, that's why you submitted it there. An editor discerns relevance by reviewing the context and significance stated in the cover letter and reading the abstract and manuscript. The cover letter functions similarly to the "significance" section of a grant. The goal is to draw in the reader, in this case, the editor. An effective cover letter makes the editor want to read more. The cover letter is not a forum to rehash the abstract. The editor will read the abstract and manuscript, so use the cover letter to share additional insight. Furthermore, do not rely too much on fancy words such as "innovative" or "novel." They've become so overused that they lose much of their impact and meaning. If you've approached a problem differently than others, simply state that you did so. Also, there is no need to make claims of primacy. Authors can twist themselves into knots trying to creatively complete a phrase like, "This was the first study to…" Don't tell them that your work is important; show them how it is. Demonstrate significance by stating what you did, what you found, and why it's important (Box 1). Typographical and grammatical errors in your cover letter can create a negative impression and undermine your credibility. To avoid this, tailor your cover letter to the specific journal. Spell the editor's and journal's names correctly. These details show that you have taken the time to personalize your submission and are genuinely interested in the journal. Alternatively, it's reasonable to use "Dear Editor," which reduces the risk of error if you subsequently submit your manuscript to another journal (Box 1). Perform a "spellcheck" or activate autocorrect as you write the cover letter. Be wary, however, because autocorrect obviously does not always understand medical terminology. In one cover letter, my abbreviation of an electronic health record intervention was automatically corrected from "EHR" to "HER." I could not see this despite reading the cover letter several times. It happens to all of us at one time or another. High-level tasks such as combining sentences into complex ideas require some effort on the part of your brain. To accomplish this efficiently, as your brain focuses on more complex tasks, it simplifies more basic components, such as turning letters into words and words into sentences.2 The challenge is that we know what we are trying to say and we anticipate that the meaning will be on the page. Science writer Nick Stockton notes, "Because we expect that meaning to be there, it is easier for us to miss when parts (or all) of it are absent."2 Thus, asking a friend or colleague to proofread your cover letter (and manuscript) is also helpful. A person unfamiliar with them will often catch mistakes you might have missed. Our "No Hassle" submission process at the Journal of Hospital Medicine means we accept initial manuscript submissions in any reasonable format.3 Journals differ in their approach, so it is important to review the journal's instructions to the authors. These instructions often include guidelines on word count, the number of images or tables, formatting, and other submission requirements. Virtually, all journals request a declaration of conflicts of interest and funding sources in the cover letter (Box 1) and on the manuscript title page. Adhering to these guidelines shows that you respect the journal's process and are serious about your submission. An effective cover letter engages the editor and provides them with a concise and compelling summary, making it easier for them to understand your manuscript's relevance and importance to the field. You may also be interested in our "Beginner's Guide to Manuscript Publishing" series, which provides practical guidance on preparing your manuscript for publication and disseminating your findings postpublication.4-6 The author declares no conflict of interest.