This editorial discusses graphical abstracts (GAs) as a relatively new tool used to concisely summarize a scientific paper and promote it on social media to boost the visibility of research and the number of citations. This article attempts to define GA as clearly as possible and to explain the role of GAs as scientific communication tools in medical journals.
A clear definition of a GA is lacking. Several definitions from the literature are presented, which illustrates that the terms “visual abstract” and “graphical abstract” can be used interchangeably. The role of GAs can be described in 3 aspects: 1) time required for communication (GAs are meant to convey the key contents of a scientific paper in a time much shorter than required for reading the full text), 2) means of communication (social media), and 3) mechanism of communication (research results in many fields of medicine can be better conveyed through visual or at least more visual means rather than plain text).
A review of the existing literature concerning the effectiveness of GAs presents studies regarding the use of GAs in promoting scientific papers on Twitter – visual abstracts attracted significantly more engagement than plain English ones, especially from medical professionals. Visual abstract tweets were associated with a significantly higher number of impressions, retweets, and link clicks compared to text abstract tweets. Journals that have introduced GAs demonstrated significantly higher impact factor (IF) increases for the past 3 years than those of journals without GAs. The longer GAs have been utilized in a journal, the higher the IF the journal had.
The experience of the editors of Advances in Clinical and Experimental Medicine (ACEM) concerning GAs are discussed, divided by types of papers published in this journal (original papers, meta-analyses, reviews, research-in-progress articles, and editorials), illustrated with examples of well-prepared GAs, and supplemented with a brief description of the feedback from authors and readers amassed following the introduction of GAs in ACEM. Finally, the authors offer the readership of ACEM 8 practical tips on how to prepare a useful GA, and list 8 common mistakes and misconceptions regarding GAs – both in text form and summarized in tables.
The conclusion of the paper is that there is currently no universal standard for GAs, which can lead to inconsistencies in their formats and content; therefore, more detailed guidelines to standardize GAs for scientific research are warranted.
Key words: graphical abstract, visual abstract, social media, dissemination of science, visual communication
With thousands of scientific papers published every day, strong competition involves not only their scientific merit but also visibility. It can be easily imagined that an important paper is simply overlooked by both specialists in the field and the general public, because it becomes overlapped by other publications momentarily after its release. Therefore, both authors of papers and editors of scientific journals strive to enhance the visibility of published research – among peers and the general public. The present editorial concerns primarily the former target group. Such visibility encompasses both reading the paper online and downloading it from the journal’s website, as well as posting information about it on social media (mainly Facebook, Twitter and LinkedIn).
Along with the rise of social media, it became apparent that “visibility” in this context should not be understood only metaphorically, since content with visual elements (illustrations, videos) is much more popular among the users of such media and attracts broader audiences than plain text only. Such rise has been scientifically observed already in 2011 when Eysenbach showed that tweets presenting or citing already published papers can predict highly cited articles within the first 3 days of article publication,1 while subsequent research by Fox et al. in 2015–2016 did not confirm a direct relationship between promoting papers on social media and the number of views or citations.2, 3 Some of the more recent studies show that a positive correlation between exposure to social media and article citations indeed exists, as argued, e.g., by Özkent.4 Studies analyzing the efficacy of scientific communication using social media and offering suggestions on how to optimize its usage have appeared (e.g., Habibi and Salim analyzed static compared to dynamic methods of delivery for scientific communications on Twitter and TikTok).5 Research concerning the potential of social media as a means for competence development and professional communication among practicing physicians has also been performed, as evidenced in a study by Khan et al., who assessed the effects of social media usage among healthcare providers.6 In some scientific medical journals, already in 2016, a dedicated position of social media editor was present among the editorial staff. Their responsibilities, as well as goals and barriers to their position, were studied by Lopez et al.7 Qualitative analysis of scientific communication on social media has also commenced: Pandey et al. chose 6 popular Facebook pages presenting scientific materials and performed their content analysis.8 The bibliometric approach has also been implemented in such research: Yeung et al. analyzed the presence of medical scientific literature on Twitter to obtain quantitative information on the dominant research topics, trending themes, key publications, scientific institutions, and prolific researchers.9
According to an anonymous editorial published in Nature Chemistry,10 single-panel graphics presenting key issues described in the articles were employed as a regular feature in 1976 in the West German Angewandte Chemie chemistry journal, and then again in 1977, in the international edition of the same journal. In 1986, another chemistry journal adopted this idea (Tetrahedron Letters), but until recently, this trend concerned only single journals (e.g., Chemical Communications in 1994 and Journal of the American Chemical Society in 2002) among many, and only in chemistry – a field in which visual representation of findings is unavoidable.10 For medical scientific periodicals, the adventure with visual/graphical abstracts began in 2016 when Andrew M. Ibrahim, chief editor of Annals of Surgery, decided to implement visual abstracts in this journal to improve the dissemination of publications, primarily on social media. Of note, Ibrahim and his editorial team produced the visual abstracts themselves after the papers were accepted for publication. As the practice of using such abstracts has been adopted by more and more medical journals, some editorial offices decided to prepare visual/graphical abstracts for papers that qualified for publication. However, others required that the author design them. As of now, there are no studies discerning how many journals stipulate that visual/graphical abstracts are mandatory and in how many journals they remain only an option for authors who wish to boost the circulation of their work.
This editorial has the following aims: 1) to present a definition of a visual/graphical abstract as clearly as possible, 2) to explain the role of visual/graphical abstracts in scientific communication using the example of medical journals, 3) to summarize the most important rules for creating a clear visual/graphical abstract formulated by professional graphic designers, 4) to review existing literature concerning the effectiveness of visual/graphical abstracts, 5) to discuss the experiences of the editors of Advances in Clinical and Experimental Medicine (ACEM) concerning visual/graphical abstracts and present remarks based on these experiences, and 6) to offer the readership of ACEM practical tips on how to prepare a useful visual/graphical abstract.
What is a graphical abstract?
A clear definition of a graphical abstract (GA) is lacking; moreover, there seems to be a terminological ambiguity concerning 2 expressions: “graphical abstract” and “visual abstract”. For example, Hoffberg et al. treated a visual abstract as a subset of GAs but neglected to explain the difference between them.11 Ibrahim consequently refers to visual abstracts,12 and the same term is used by Chapman et al.,13 Klaassen et al.,14 Aggarwal,15 Stahl-Timmins et al.,16 Lindquist and Ramirez-Zohfeld,17 Chisari et al.,18 and Ramos and Concepcion.19 However, in more recent literature, the type of abstract in question is more frequently called a GA, as seen in studies by Kim et al.,20 Zong et al.,21 Pferschy-Wenzig et al.,22 Lee and Yoo,23 and Bennett and Slattery.24 However, no reason has been provided for this shift. Also, in a primer by Ibrahim et al. on the professional creation of such materials, they are called visual abstracts.25 In other sources – both scientific and popular – these 2 terms are used alternately, and it can be safely assumed that the authors deem them interchangeable. For the sake of clarity, in this editorial, only the term “graphical abstract” will be consequently used. The reason for adopting this term in ACEM was to avoid confusion since some readers can understand a visual abstract as any abstract that uses visual means of conveying the message – i.e., a video abstract or a key figure would also be a visual abstract.
Graphical abstract is described as a visual representation of the key messages of a research paper,23 a visual representation of the key findings typically found in the abstract portion of an article, enabling the reader to quickly grasp the key findings and take-home message,12 a visual summary of the paper’s main content,20 a single, concise, pictorial and visual summary of the main findings of the paper,26 or a visual distillate of the take-home message of an article into an image that is not too cluttered, somewhat eye-catching and relatively simple to interpret.10 It is also stressed that such perception should be possible at a single glance,22 which we understand as follows: the GA should be comprehensible in its entirety when viewed in full-screen mode. It is important to note a significant difference in the above definitions. While some authors point out that the GA is a summary of only the text abstract of a scientific paper, others underline that the GA presents the whole article in a single-panel illustration. From the experience of the editors of ACEM, it transpires that such differentiation is purely academic. If the plain English abstract is well prepared (i.e., it reflects the structure of the paper and concisely presents its main materials and methods, results, and conclusions), the GA based on both solely the text abstract and full text of the paper will contain all required information, while a GA based on an incomplete abstract will also be incomplete in terms of content.
Role of GAs in scientific communication
The role of GAs can be described in 3 aspects: 1) time required for communication, 2) means of communication and 3) mechanism of communication. Regarding the 1st factor, the basic function of a GA is similar to that of plain text one – it is meant to convey the key contents of a scientific paper in a time much shorter than required for reading the full text. The main difference when compared to text abstracts is that GAs are more varied regarding the degree to which they attract attention and can “make readers pick out one’s article from a plethora of potentially interesting literature”, as put by Pferschy-Wenzig et al.22 Therefore, they not only help spare time but also direct the attention of the reader. Moreover, the “single glance” concept – when implemented expertly – may allow further shortening of the time required for comprehending the abstract. The function of GA and plain-text abstract is therefore virtually identical: They both do not substitute the whole paper but convey its main content at the same time enticing to read the whole article. The latter function is even more important regarding GA since its potential in “avertising” the paper is broader. A GA should truly summarize the paper, not only complement it.
Means of communication are – in this context – the channels through which GAs are disseminated, i.e., the journal’s website and social media. Social media (particularly Twitter, Facebook and Instagram) favor visual elements of the message, with longer texts often offered only as a URL to access material for further reading. Twitter restricts the length of a single tweet to 260 characters, while Instagram offers the possibility of providing text only as a description of an image, which the user has to click to view the description. Social media accounts of scientific journals are perceived as a powerful means of disseminating knowledge and promoting individual papers to encourage a broader audience to read them. It should be noted that social media is used both by professional circles and larger audiences, so using GAs in such media does not necessarily mean that GAs must be understood as a means of disseminating the results of scientific research among the general public. A potential for the latter always exists, but popularizing science among lay people requires specifically dedicated design of GAs, often resembling infographics encountered, e.g., in public healthcare facilities.
The 3rd aspect is particularly visible in the branches of science in which the GAs have been implemented so far – and medicine is a particularly good example. In many fields of medicine, research results can be better conveyed through visual or at least more visual means rather than plain text – tables, charts, graphs, schemes, flowcharts, and similar tools. In many scientific medical papers, visuals constitute the core of the publication, with the text being more of a commentary. If the same message were to be only in text form, it could become virtually incomprehensible or at least confusing. Although complex information presented using these tools must be (to some extent) simplified to fit a GA, a GA as an idea is still in concert with the ways of depicting scientific investigation in modern journals.
Limitations of GAs
Based on the ACEM editors’ experience with GAs, several limitations and challenges connected with such a form of science dissemination can be identified. The main limitation results from the restricted size of a GA – even the most creative researcher would be unable to fit very complex content into a design that would be comprehensible when viewed in full-screen without enlarging respective sections of the picture. Therefore, it can be assumed that there are papers that can be summarized using a GA only to a certain extent, albeit the ACEM editors encountered not a single situation when a given paper was unsuitable to be accompanied by a GA at all. Some general terms may be represented only symbolically – and inventing unambiguous symbols without additional commentary may be challenging. In many medical papers, the results are expressed as results of multi-step statistical calculations, and the final outcomes cannot be concisely formulated in a single sentence or picture. This is the case especially in manuscripts of a very limited scope (e.g., relations of expression of certain gene polymorphisms with certain tumors), but examining multiple problems at the same time (e.g., 20 polymorphisms in 3 types of cancer). In such publications, the possibility to express the results and conclusions concisely is limited, even in plain-text abstracts, not to mention GAs.
The most significant challenge when preparing a GA is the danger of oversimplification, and – in consequence – misrepresentation of the article content. Some authors seem to assume that a visual depiction of some key terms used in the paper and connecting them with lines or arrows will provide an appropriate visual summary of the manuscript, while a GA designed that way may easily create an impression that the terms in question are in quite different relationships than in reality. Misrepresentation may occur also when oversimplification has been avoided. One of the dangers is an error of proportion: some sections of the paper (e.g., methods) can occupy disproportionately more space than other sections, equally important in the whole paper, which in turn may suggest that the content featured more prominently in the GA is the main idea of the whole article.
Effectiveness of GAs
Since 2016, the effectiveness of GAs as a means of disseminating knowledge has been studied using different study designs and in both single journals and groups of periodicals. The researchers mainly focused on the following issues:
1) whether – and if yes, to what extent – GAs boost the number of citations of each paper,
2) whether – and if yes, to what extent – GAs enhance the visibility of papers on social media (primarily Twitter), and
3) whether – and if yes, to what extent – GAs cause the full text of a given paper to be downloaded from the journal’s website.
One of the first studies concerning the feasibility of introducing GAs in a scientific medical journal was helmed by their originator in the field of medicine, Andrew M. Ibrahim. A prospective case-control crossover study by Ibrahim et al. performed between July and December 2016 used 44 original research articles published that same year in Annals of Surgery.27 The study measured only Twitter visibility and revealed that when the same articles were tweeted as a GA, they had a 7.7-fold increase in the number of impressions and an 8.4-fold increase in the number of retweets.
In 2019, Chapman et al. performed a randomized controlled trial of the impact of papers published in BJS and presented on the journal’s Twitter account. Forty-one articles were randomized into plain English abstract (14 papers), visual abstract (14) and standard tweet (13) groups. Most engagements were from healthcare professionals (95%). Visual abstracts attracted significantly more engagements than plain English ones.13 A year later, Hoffberg et al. obtained similar results in a prospective, randomized crossover trial concerning papers on suicide prevention published in a medical journal indexed in PubMed by researchers from the Rocky Mountain Mental Illness Research, Education and Clinical Center (part of the MIRECC network; Aurora, USA). They compared Twitter posts with a visual abstract to those with a simple screen grab of the PubMed abstract (50 journal publications in total). Visual abstract tweets were associated with a significantly higher number of impressions, retweets and link clicks compared to text abstract tweets.11 In a similar vein and in the same year (2020), Chisari et al. performed a two-arm randomized controlled trial with crossover. Manuscripts from the Journal of Arthroplasty were allocated to one of 2 arms and disseminated via the journal’s Twitter account as either a text-based tweet or a GA. Their conclusion was that when GAs are used to communicate research through social media outlets such as Twitter, the overall research engagement significantly increases compared to plain-text tweets.18
In the last 2 years, studies on the influence of GAs on the number of citations of given papers started to appear. In 2022, Kim et al. stated that there has been no study on the influence of GAs on the impact factor (IF) of journals and the citation index or social media exposure of individual articles.20 Therefore, they investigated the presence of GAs, total citations and social media exposure of full-length original articles in the top 10 journals in the field of gastroenterology and hepatology over 3 years (2019–2021). Their research had a pronouncedly broader scope than most of the cited studies, as 4205 articles from 10 journals were evaluated over 3 years. Journals that adopted GAs demonstrated significantly higher IF increases over the course of 3 years than journals without GAs. The longer GAs have been utilized in a journal, the higher the IF the journal had. Moreover, individual articles with GAs had significantly higher Web of Science citation counts (median 14 compared to 12), more social media exposure (median 23 compared to 5) and more Altmetric.com tweet counts (median 15 compared to 7) than those without GAs.20
Examples of GAs in medical papers: the ACEM experience
Graphical abstracts were implemented in ACEM beginning with the January 2023 issue, but since most of the papers published in this journal are disseminated online in advance of the print release, the first articles containing GAs were published in September 2022. Until June 30, 2023, approx. 100 papers with GAs appeared in ACEM. Of note, the editorial office of this journal requires that a GA accompany all types of papers – including editorials, research letters and research-in-progress works. The ACEM editors’ experiences from these 10 months (September 2022–June 2023) can be summarized as follows.
Graphical abstracts in original papers presenting clinical research
Preparing a GA for a paper about clinical research (including randomized controlled trials and other clinical trials) is especially challenging since, in this type of research, the material (i.e., enrolled participants) and the methods employed are equally important as the results, and the conclusion in this regard can lead to a serious misinterpretation. Although – as has been stated above – a GA is never a substitute for the text, it cannot be misleading. Therefore, we hypothesize that the type of paper for which GAs utilize the 3-panel concept is submitted most frequently. Moreover, this design can be realized in different forms – e.g., Kisiel et al. divided their GA into background, materials and methods, and results sections – although not titled, they are clearly distinguishable, and the whole GA is very clear (Figure 1).28 A similar design was used by Wnuk et al.29 Przybylski et al. employed a more bulleted text in their GA, so titles of the panels proved necessary.30 Among GAs for clinical research published in ACEM, there is also an example of a GA containing primarily text but optimally communicative – the work by Gao et al.31 This last GA shows that if graphical elements (e.g., drawings) within a GA are to be purely ornamental in function, it is sometimes better to abandon them altogether. Gao et al. also employed a 3-panel design with the title serving as the background section.
However, there is another option of GA design for clinical research, encountered especially in research letters covering clinical research and published in ACEM. In their GA for a study encompassing a cohort that qualified for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination, Stępień et al. concentrated on the composition of the study population and the outcomes, deeming them the most important (which shows the importance of information selection; Figure 2).32 A more radical approach was adopted by Paszkiewicz-Kozik et al., who took the risk of incorporating 2 tables and 2 figures (charts) into the GA, but the simple tables had been prepared specifically for this purpose and the charts are comprehensible in this context.33 Together with a clear composition in 2 columns and the title of the paper serving as the background section, this GA can be called a model example of such an abstract for articles describing clinical research.
in other original papers
This is certainly the most diverse pool of GAs – not only because original papers not describing clinical research constitute roughly 60% of all articles published in ACEM, but also because almost all types of content organization within a GA can be found in them. A circular way of reading the GA was employed by Chen et al.34 and Wang et al.35 – such design proves sound in compositions aimed to familiarize the reader only with the general thematic field and the idea of the presented research, because of the scarce use of text. The circularity enables viewing the GA at a single glance. A less detailed abstract can also be more vertical, like in Wang et al.,36 combining schematic drawings and single terms. Similarly to GAs for original papers presenting clinical research, a dominant type of design is a 3-section one, with the sections with or without titles. However, implementations of this general concept can vary, with 2 discernible patterns.
1) The sections are arranged vertically, whereas the content of each section is read horizontally – with the dominance of graphical material (Grotowska et al.37) or text (Ventruba et al.38). The latter GA is an example of a well-thought use of text in such abstract – the title serves as the background section, and the 2 whole sentences stating the conclusions are not an excess because they provide the key message which could not be expressed with any illustrations (or at least not that clearly), and at the same moment do not dominate the whole composition because the main part of the text is represented by minimalistic boxes and clearly marked relationships between them. The former GA is a good example of a non-intrusive application of a slightly tongue-in-cheek approach – drawings of experimental animals are not meant to be fully serious. A similar horizontal design was used by Lubiński et al., with titles of the subsections placed in the middle panel (Figure 3).39 In this GA, the illustrations evoke desired associations with the described problem, while the text clarifies the necessary details. Deliberate use of 2 contrasts, but not overly bright colors (light yellow and deep red) should also be noted. Kosowski et al. reduced the number of subsections in the middle panel to 2, which allowed for more extensive use of schematic illustrations that help visually discern multiple points in each subsection.40
2) The sections are arranged vertically, with the contents of each section also read vertically. In the GA for a paper by Li et al., the upper panel (title) and lower panel (conclusions) are text-only, while the middle panel (the largest one) employs 3 separate flowcharts in 3 subsections (background – group & design – key results).41 Using different, contrasting colors prevents confusing the subsections and directs attention to the “key results” subsection. In the GA by Tian et al., text and pictograms are balanced, and therefore, the color palette could be narrower (shades of blue with only the title highlighted).42
Other authors offered less sophisticated but no less communicative designs with a simple vertical orientation and dominance of text (Özgökçe et al.43) or a balance between text and graphical material, and with deliberate use of white space (Demirtas et al.44). Xie et al. proved that text (only single words or short expressions) combined with pictograms can allow for a cohesive, but relatively detailed understanding (Figure 4).45 Okur et al. used a horizontal flowchart with text only, but employed 2 well-considered visual tools: 1) boxes stating the nature of the information in green, while boxes with the information itself were blue, 2) a single pictogram on the left side of the GA that attracts attention and provides a clear suggestion who the members of the study population were.46 Ferlengez et al. sparsely used text in horizontal material and the methods section and combined it with black-and-white schematic illustrations while keeping the conclusions in the text form – such design is aesthetically consequent and prevents distraction during reading.47
When the aesthetics are in question, 3 more GAs for original papers deserve particular attention. The work by Kisielowski et al. uses professional artwork, which, together with the title, gives a specialist in the field a general idea of the study design and methods, while results and conclusions are provided in short sentences and do not dominate the picture. Thoughtful choice of typeface is also worth noting (Figure 5).48 Edebal and Doğan were clearly inspired by infographics as a form of disseminating scientific knowledge among the lay public – the level of complication of their GA still allows for full-screen reading on desktop computers and laptops and the amount of lucidly conveyed content is truly massive (Figure 6).49 Finally, Wojtera et al. abandoned illustrations altogether in favor of a geometrical composition consisting of hexagons in different shades of blue as box-clusters.50
Graphical abstracts in meta-analyses
The highly abstract nature of a meta-analysis – a paper in which the material is other scientific papers – causes many authors to think that it is very hard or nearly impossible to prepare a proper GA for an article of such type. However, several research teams who published their meta-analyses in ACEM show several creative ways to deal with this challenge. Although re-using one of the figures from the paper is prohibited, the editors can make an exception if the meta-analysis flowchart is combined with a new graphic or other graphics, preferably with some additional text comments. Such exceptions are granted because – contrary to figures in other types of papers – a flowchart can provide comprehensible information about the materials and methods employed in the meta-analysis, and this information cannot be successfully conveyed by other visual means. The other part of such GA provides the necessary context about the thematic field of the analyzed papers and signals the results (and preferably also implications) of the meta-analysis. Examples of GAs using the above concept can be found in articles by Sun and Wu51 (Figure 7), Li et al.,52 and Wang et al.53
However, some authors focus solely on the content of the papers subject in the meta-analysis, deducing that the procedure of the meta-analysis is not as important as the discussed problem itself. Therefore, they design a vertical scheme focused on the new perspective on a given issue elucidated in the process of the meta-analysis (the process itself is rather obvious for a professional investigator and does not have to be demonstrated since it is known from the accompanying title of the paper that it is a meta-analysis). Such designs can be simple, like in the papers by Zhuo et al.,54 Chen et al.,55 Yang et al.,56 Zhou et al.,57 Wang and Zhang,58 and Chen and Zhang,59 or more elaborate, somewhat similar to the triptych template proposed by Andrew M. Ibrahim, as in Chen et al.60 (Figure 8). Worth mentioning is the outstanding GA submitted by Bi et al., in which high-quality illustrations were combined with a clear, simple composition (Figure 9).61
Graphical abstracts in reviews
Authors designing GAs for review papers face problems similar to those encountered regarding meta-analyses: less strictly stipulated structure of the paper is difficult to transpose into visual language. The Introduction and Objectives sections of such papers contain scientific terms that can be represented visually (names of diseases or treatment methods), but the structure of the sections between Objectives and Conclusions (these 2 sections are mandatory in reviews published in ACEM) is not stipulated by any checklist or other guideline (Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist does not apply in this regard). In the main part of the paper, several complex aspects of an already complex problem are discussed, and many different articles are cited not only as a reference but as a main topic of discourse. Therefore, a GA simply reflecting the course of the argument would be impossible to design or too intricate to the point of incomprehensibility. Moreover, many papers of this type do not contain any figures, so the authors may not exhibit the appropriate mindset to think more visually about their article.
The only solution seems to be an approach similar to the 2nd one presented in the section on meta-analyses: to focus on the scientific hypotheses and findings presented in the papers discussed in the review and to clearly state what the broader view of the field (obtained through reviewing several articles) tells us about the current state of affairs (and what questions arise or remain open). Various types of content organization are employed. Liu et al. chose a vertical one with schematic, black-and-white yet suggestive pictograms (Figure 10).62 Bukłaho et al. proposed a version read from left to right and then towards the lower right corner (Figure 11),63 while Szmit et al. prepared an infographic in a radial arrangement, which allowed for presenting different aspects and implications of a single therapeutic technique (Figure 12).64 On the other hand, we encountered GAs for reviews that reflected the structure of the paper – a good example is the vertical design by Osypko et al., in which the key issues discussed in each section are clearly summarized in bulleted points and complemented with schematic illustration to enhance remembering (Figure 13).65 A completely different approach is represented by the GA for the paper by Nishi et al., which conveys only the general idea of the study by presenting a simplified visual representation of a phenomenon examined in the reviewed studies (Figure 14).66
Graphical abstracts in reviews: strengths and weaknesses
Each of the 5 presented examples have their strengths and weaknesses. The GA by Liu et al. conveys the main concept of the paper clearly and without distracting decorative elements, but the same characteristic is its limitations – the reader learns what the goal was, what medicament was used, and that the results are promising, but no information about the methods employed in different reviewed studies is provided. If the full title of the paper had not been placed on the top of the GA, it would not be clear what type of paper (original or review) this GA summarized.62
The main advantage of the GA prepared by Bukłaho et al. is its clear structure (the reader’s gaze follows a low arch) and emphasis put on the key issues discussed in the paper. In the focal point of the GA, 4 paramount challenges regarding ovarian cancer treatment are listed, while schematic imagery stimulates memorizing and attracts attention. Moreover, the composition is balanced – on the right, we can see not only that there is hope, but also why. The main disadvantage of this concept is – similar to the design by Liu et al. – its vagueness. This GA does not inform the reader what type of paper it presents.63
Szmit et al. decided to focus solely on the benefits for patients and doctors brought about by the discussed medical device. The sheer scope of the content clearly implies that a review or systematic review is being summarized here. Schematic, clipart-style illustrations easily evoke desired associations. However, this GA offers no information on specific studies that were analyzed and says nothing about the study selection process, which is paramount in systematic reviews.64
Osypko et al. managed to overcome one of the most common limitations of GAs for various types of reviews. Their design reflects (at least to a large extent) the structure of the main part of the paper (i.e., excluding Introduction and Objectives). It seems that a narrative review, which follows the course of the argument without any predetermined division (a given section ends simply when a given topic is satisfactorily explored), allows for a GA that summarizes the paper in a more detailed way (text elements of this GA provide such details in abundance, given its rather simple composition). The main weakness of the discussed GA is the lack of Discussion and Conclusions sections, which contain crucial content in the paper.65
Scoping reviews are commonly undertaken to clarify working definitions and conceptual boundaries of a topic or field. Therefore, Nishi et al. decided to primarily convey in their GA not the contents of the analyzed studies but the core of the discussed field itself, at the same time making sure that a schematic visual representation enhanced memorizing even among non-specialists. The main advantage of their design seems to be the thoughtful use of graphical elements and intertwining them with scarce text. Neither the text elements, comments, nor the graphics are meant to embellish the composition – their GA is a consistent, compact whole. Its main weakness is the usage of only general ideas, which does not reflect the meticulousness with which the authors tackle the subject in the paper.66
To sum up, the main weakness of GAs summarizing various types of reviews is the failure to provide any insight (neither detailed nor general) into the differences and specifics of the analyzed studies. Only the results of a summary of their contents are provided, and, in consequence, the specificity of a review as a type of scientific paper is “lost in translation”. However, it is possible that a technique to visually represent this aspect of reviews is yet to be proposed – using study selection flow diagrams in GAs of meta-analyses also seems only a half-measure.
Graphical abstracts in other types of papers
Editorials published in ACEM do not follow any particular predefined structure and usually offer some more generalized reflections of an experienced researcher on a given – broader or narrower – field of study. Therefore, GAs for such papers are not expected to reflect the structure of the text and present the general idea and primary notions discussed in the paper in a more cohesive or more linear way. Nevertheless, there are examples of GAs for editorials that are both communicative and well-conceived – e.g., an infographic for a paper by Vinker,67 a design combining text and pictograms in 4 boxes proposed by Piccoliori et al.68 (Figure 15), and a minimalistic GA by Tanaka et al.69 giving only the general idea of the paper and a handful of key terms (Figure 16).
A research-in-progress paper does not contain a conclusion but only preliminary remarks, since its main objective is to inform about the progress of the investigation, not its results. Therefore, GAs for such articles focus on the materials and methods used (since some assessment of their feasibility can be offered already at this stage) and on the clinical implications of knowledge acquired so far to point out the practical aspects of the conducted research. A good example is the GA for the paper by Szlenk-Czyczerska and Kurpas.70
Feedback from authors and readers
First piece of information regarding the implementation of GAs in the ACEM was disseminated on the journal’s website, on social media (Facebook, Twitter and LinkedIn) and through ACEM’s newsletter on June 1, 2022. Since such requirements simultaneously appeared in the system used for manuscript submissions, almost immediately, the editorial staff started to receive feedback from authors. Initially, many researchers were confused about the concept of a GA itself and expressed low confidence about their ability to prepare an appropriate one. Such attitude was a clear indication that GAs had yet to become obvious in scientific medical communication – a significant number of experienced authors from several different countries declared that they encountered such a requirement for the first time in their careers. However, there were only single cases of refusal to prepare a GA – most authors debuting in such a task faced the challenge, employed a trial-and-error approach and provided acceptable works.
Responses from section editors of the ACEM, responsible for their respective branches of medicine covered in the journal, were more diverse. While a majority of these specialists praised the authors’ creativity and declared that, in their opinion, most of the submitted GAs fulfilled their function, some voiced concerns. In their opinion, many submitted GAs presented the main ideas only partially, were misleading regarding the results or conclusions, or (the most often expressed criticism) were incomprehensible without the context of the whole paper.
Reactions from readers have so far been rather lukewarm. In private communications with the editorial office, a handful of readers singled out a small number of GAs which enticed them to read the whole respective papers – in their opinion, after a quick glance at a GA, they were convinced that a given paper is worth their attention, and that reading the whole paper confirmed this conviction. Nevertheless, the experience of the ACEM editors in this regard is scarce and does not allow any firm conclusions to be drawn about the influence of GAs in this journal on its perception within the scientific community.
Rules for designing graphical abstracts
Ibrahim et al., in their primer about creating GAs, formulated the following general guidelines25:
Focus on the user experience. The GA is meant to be informative for the reader, not only to fulfill a submission requirement in a given journal or to impress the editors. Try to imagine what the users will learn from your GA and whether it will entice them to read the whole paper – and design the GA according to your intuition in this regard. It is your paper, and you know best what is important in it.
Clarity of purpose. Particularly regarding complex articles, the GA should present only the key features; otherwise, it will become too complicated and can even significantly distract readers from the key message. It is not always possible to provide all context and retain comprehensibility. Some simplification of the presentation may be necessary to establish a clear focus. Prioritize the key messages over completeness.
Rapid prototyping and iterative improvement. There is no one best GA for a given paper – there are always infinite alternative possibilities. Your 1st, 2nd, or 10th visual abstract will not be your best one. You will improve significantly by trying new formats and seeing what works. Design thinking focuses on what is the next step to make your GA partially better rather than what is best.
From the experience of the editors of the ACEM, the following more detailed tips can be offered (they are discussed at length here and concisely summarized in Table 1):
1. Choose the graphical material wisely. Since the space at your disposal is limited, each picture, pictogram, chart, or table should have informative, not only decorative value. A GA cannot exceed the size of 1 A4 page and should be less complicated than a conference poster.
2. A GA has to have a clear structure, albeit it does not have to reflect the structure of the plain text abstract or the whole paper. If it proves impossible to present materials and methods as well as results and conclusions, it can provide a more general overview of the paper. It can be read horizontally or circularly, can have a radial arrangement, or employ a more eccentric design. It can have a rectangular, square, or round shape, but it must have a clear beginning. What is important is that it cannot be a single column read from top to bottom – such a format will not be useful for a screen display.
3. Regarding text within a GA, its size should be 12–16 points (smaller fonts will not be legible online). Use text sparingly, but if you feel that conclusions should be provided as full sentences or they will be ambiguous – include full sentences in a separate box/section. Do not use abbreviations that can be unclear without reading the text (obvious acronyms, like DNA, are, of course, a good choice).
4. A GA should include the title of the paper – its contents can be incomprehensible without it.
5. Use colors consciously – e.g., to discern different parts of a GA or to highlight key issues.
6. When using materials (e.g., illustrations) prepared by someone who is not a member of your research team, make sure that you have the right to use them to avoid copyright infringement.
7. The aesthetic dimension of a GA is also important, although not paramount. If you have such option, use the help of a professional graphic designer. If you do not have the opportunity or time for such consultation, do not hesitate to submit your GA as is.
8. When your GA is finished, consult with specialists in the field who are not members of your team. If they rate it as clear and informative, you have succeeded in preparing a professional GA.
Technical issues and further reading
A GA can be designed using various online, free, or more professional software. Ibrahim et al. prepared a detailed primer (57 pages) in which they – in addition to general rules – listed several suggestions on where to seek professional assistance and what software to use.25 Practical information with multiple examples of inspiring GAs can also be found in non-scientific, albeit reliable sources such as the instructions for authors by Elsevier26 and Cell Press,71 guides prepared by the editorial staff of other scientific medical journals (Diabetologia72 and Journal of Allergy and Clinical Immunology73), and blog entries by professionals – to name a few (among many others), Balbin and Rossi (Animate Your Science),74 Pamplona (Mind The Graph),75 Augustus (Researchers’ Writing Academy),76 BioRender,77 Scribendi,78 Edanz Learning Lab,79 and Future Medicine.80 Thiebes (Simplified Science Publishing) provided a set of diverse examples with free templates to create your own GAs.81
Experience of the ACEM editors amassed during publishing 6 issues and over 50 ahead of print papers with GAs allows for listing several common mistakes made by authors in submitted GAs (since the editorial staff of the ACEM does not offer any assistance in preparing such materials, the authors are solely responsible for both the content and design of the GAs). In the opinion of the editors, the mistakes discussed below are a result of the fact that GAs as a form of disseminating scientific research results are a relatively new phenomenon, and many medical journals – including several prestigious ones – did not implement them at all. In consequence, many authors, even seasoned researchers, are simply not accustomed to such requirements and, when doing it for the first time, adhere to common misconceptions about the GAs or follow their own notions, which sometimes deviate from the stipulations published on the journal’s website. The most often encountered mistakes include the following (they are discussed at length here and concisely summarized in Table 2):
1. Submitting one of the figures from the paper as a GA – in original papers, it is usually one of the charts or an RTG/MRI/USG image (if the article contains such materials). In meta-analyses, the flowchart of the meta-analysis (without other, new material) is often used. Some authors, by choosing one of the text figures as a GA, confuse the concept of a GA with the concept of a key figure – this distinction was discussed by Klaassen et al.14 So far, there are no studies measuring the effectiveness of GAs of different quality since there are no objectives and measurable aspects to assess such quality. However, from a study by Klaassen et al., when comparing the impact of GAs with key figures, it can be deduced that submitting only a chosen figure or a compilation of figures from the paper does not boost the paper’s visibility since the effectiveness of key figures proved to be lower than GAs.14
2. Compiling several (usually 2–6) or even all figures (and often also tables) from the paper into a single chart and submitting it as a GA, or pasting one or more figures and/or tables from the paper into a GA containing original material. It should be strongly stressed that a GA should be less complicated than conference posters. Therefore, it should not contain tables or figures taken directly from the paper, as well as it cannot be compiled from tables and figures from the manuscript. Most of the figures and tables taken directly from the manuscript will be illegible, incomprehensible, or unclear at best when presented out of context and downsized to fit into the GA.
3. A GA containing only a tabulation or plain text in the form of highlights. Sometimes, a flowchart with no graphical material will suffice, but there is usually a possibility to complement it with at least some clipart drawings to attract attention.
4. A GA consisting only of graphical material (figures, charts, graphs) that were not used in the paper, but their meaning is unclear out of the context of the whole paper, and the GA contains no text commentary. If the GA is not comprehensible in the presence of the paper’s title and cannot be properly understood after reading the text abstract or even the whole paper, it does not fulfill its role as a GA, which should entice to read the whole article, not only complement it. Sometimes, authors submit GAs consisting of a single figure without any comment or context, giving only a vague and general idea about the content of the paper. Such illustrations would be more suitable for a book cover than a GA.
5. A GA so complex that it is incomprehensible even if viewed in full-screen mode and requires panel-for-panel examination. In such cases, the risk of the reader becoming confused increases with each new section of the GA read. In a similar vein, some authors employ overly long text field sets with very small letters to fit into a GA viewed on screen and perceived in a single glance.
6. Stark color contrast between the letters and the background (e.g., red letters against a green background), which often makes the text – even very short – virtually illegible.
7. Employing several different typefaces, types of text highlighting (bold, italics, underlining) and colors within a relatively small space of a single GA – such visual chaos distorts any structure.
8. Presenting numerical data (like p-values) whose meaning is unclear outside the context of the whole paper.
Graphical abstracts exhibit a potential to improve scientific communication that remains largely unexplored. Every year, more scientific journals announce their adoption. It can be expected that GAs appearing in these journals will be more and more professionally prepared, and their impact will be deeper. There is currently no universal standard for GAs, which can lead to inconsistencies in their formats and contents.23 Therefore, more detailed guidelines to standardize GAs for scientific research are warranted.19 We are still at the beginning of the journey – GAs are a relative novelty, but new types of abstracts have already started to emerge: video abstracts, GAs involving GIFs, interactive GAs, etc. Science evolves – and ways of disseminating it evolve with it.
The main take-home message for the authors is as follows: 1) a GA cannot contain figures or any other material from the paper – it must be an original work, 2) the main challenge in preparing a GA is avoiding oversimplification while at the same time reflecting the content of the paper as fully as possible, 3) a GA should entice the reader to read the whole paper, not only complement it, and as literature shows, it can fulfill such a role when designed properly.
Potential future advancements in GA design involve 2 paths of development (which are complementary, not exclusive) concerning the medium and the content of the GAs.
Video abstracts have been mentioned in the paper, albeit only in passing. However, the potential of social media and other web services based on posting video releases (YouTube, TikTok) and video materials on social media enabling such posting as one of several modes of disseminating content (Facebook, Twitter) is still largely unexplored. Zong et al. discussed the usage of video abstracts in the New Journal of Physics,82 while Ferreira et al. presented their experiences from Ecology and Environmental Sciences.83 The advent of broader implementation of video abstracts in medical journals seems to be only a matter of time.
The possibility of incorporating brain imaging techniques or data visualization methods to represent neural substrates (NS) directly in GAs could boost their informative capabilities. A “neural substrate” is a term used in neuroscience to indicate the part of the central nervous system (i.e., brain and spinal cord) that underlies a specific behavior, cognitive process, or psychological state. The potential of NS in general has been discussed by Tanaka et al.,69 Tanaka et al.,84 and Di Gregorio and Battaglia.85 Neural network functioning in health and disease is being studied in more and more different contexts, and such graphical material could prove useful in GAs of papers concerning diverse topics from various fields of medicine.