Moving Against the Grain: Combining Writing Center Theory and In-House Editing Services to Create a Graduate Writing Center

Brian Harrell, M.A., Northeast Ohio Medical University
Brook Wyers, M.S., Northeast Ohio Medical University
Craig Theissen, M.A., Northeast Ohio Medical University

Abstract

The Northeast Ohio Medical (NEOMED) University Writing Center was founded in the winter of 2022 to support its medical, pharmacy, and graduate students. Through trial, error, and creativity, the Writing Center Specialists developed a successful writing center offering collaborative synchronous and asynchronous sessions. Often, graduate education needs a different type of support than undergraduate students do: in-house editing combined with traditional theory. This initiative highlights the importance of writing and editing support in medical education, addressing diverse needs across NEOMED’s colleges and promoting effective writing practices.

Keywords: Graduate Writing Support, Asynchronous Feedback, Screenshare Editing, Medical Writing Centers, Pilot Programs

On February 21, 2022, in a small meeting space between two offices, Brian sat at a large, wooden, boardroom table staring out the large window into the Aneal Mohan Kohli Academic & Information Technology Center, the official name of the Northeast Ohio Medical University (NEOMED) Library, waiting for the first students to appear for in-person writing tutoring. One week prior, Brian had signed a part-time (20 hours a week) contract to lead a writing center pilot project that ended on June 30, 2024. Brian was the Writing Center Specialist and was tasked with creating a writing center to support the more than 1,000 medical, pharmacy, and graduate students at NEOMED and had less than 30-months to do it.

NEOMED is a stand-alone medical university in the rural community of Rootstown in Northeast, Ohio. It is not connected via physical space to any hospital system. NEOMED does not confer any undergraduate degrees but does offer several master’s and PhD programs for its students within its College of Graduate Studies. There are over 600 medical students, 300 pharmacy students, and more than 100 graduate students attending NEOMED. The school is within 50 miles of several teaching hospitals that partner with the NEOMED students in Cleveland, Akron, Canton, and Youngstown areas. The closest clinical location is a 20-mile drive from NEOMED’s campus.

Brian’s background was in English Composition and Rhetoric, having taught at several universities since 2010. He worked in a Writing Center as a graduate student and followed writing center theory closely. Now, he was creating a writing center, carte blanche. He was given a common room and two offices. He had a small budget for paper products, a laptop, a bulletin board, and access to various means of communication. He met with the leaders of the three different colleges and asked the same questions: how can a writing center help your students? The answers were all different and began to mold the theoretical approach.

NEOMED was founded in 1973 to meet Northeast Ohio’s critical need for primary care physicians. Much of the writing support for the College of Medicine (COM) was provided by the Assistant Director of Student Affairs and the Assistant Dean of Student Affairs. In the College of Pharmacy (COP), the Assistant Dean of Student Success worked with students as they navigated writing assignments. In the College of Graduate Studies (COGS), individual professors were tasked with this writing support. While the individual colleges attempted to support their students in their writing, typically, only the high-stakes professional writing—resumes, curriculum vitae (CVs), personal statements, and letters of intent—were given priority. As an example, the Assistant Director of Student Affairs for the COM reviewed 150-160 CVs and personal statements between May and July each year. The group of third-year medical students submitted their applications for residency programs through the Electronic Residency Application Service (ERAS), the system used by medical graduates to apply for specialized training positions in hospitals.

COGS, in which Brian had been an adjunct professor since 2018, needed academic writing support for its students. Many of the nine graduate programs had writing assignments throughout the semester. Some of the program’s students wrote master’s theses and others wrote doctoral dissertations. Many of these students utilized the Writing Center for support. Professors in COGS also asked Brian to create several writing specific videos which covered topics on grammar, punctuation, research writing, and formatting.

COP had one goal in mind for the Writing Center, and that was supporting their second language learning (SLL) students. The SLL students struggled with plagiarism, understanding prompts, taking notes, research writing, and reaching out for help. In August 2023, 18 months after Brian was hired, funding was allocated to hire an SLL specialist, and Brook was hired to support the SLL students, specifically those in pharmacy.

COM had a detailed list of needs for the Writing Center, much of which was high stakes writing. The number one need of the COM was to support the 600+ medical students as they create their professional CVs. Then, the Writing Center was asked to collaborate with the students as they create personal statements for residency applications and research opportunities. Medical students also created oral and poster presentations, journal articles, and many other writing projects.

The University provided its students with 20 hours of writing support. Yet, after a week of being open, students did not come for the support they needed. Brian sent emails to cohorts. Announcements were made. It was clear that sitting at a table facing the window to the library and waiting for students to start coming in for in-person tutoring sessions was not happening. The typical, in-person consultation consisted of reading the paper out loud in the undergraduate writing center world that Brian was accustomed to. Undergraduate writing theory was not what the NEOMED students needed. Instead, it took trial and error, a lot of support, a little bit of money, and some creativity to establish the NEOMED Writing Center as a fully funded center of the University. Ultimately, the NEOMED Writing Center pilot program is a story that all graduate schools can use to create their own writing center. By promoting asynchronous sessions, screenshares, and collaboration, a graduate school writing center became successful.

A Foundation of Literature

In medical education, the Medical University of South Carolina (MUSC) started their writing center in the early 1990s. Smith et al. (2011) wrote, “the lack of writing instruction within academic health sciences may stem from a belief that students in graduate programs have already mastered writing skills. However, writing instruction is not a need that can be met through isolated precollege or undergraduate courses” (p. 298). Historically, writing centers have supported undergraduate students. At NEOMED, many students stated that they have not written to the extent they are being asked to in medical school, citing that the CVs, personal statements, and work in research is difficult because of the lack of writing support at the graduate level and their previous experience/education.

Research shows there is a need for writing center services in academic and medical education. Near the time that MUSC opened their writing center, Yanof and Burg (1988) determined that medical universities rarely taught skills in writing manuscripts and grant proposals, even though these skills were essential for physicians to have. McNiell et al. (2024) suggested, “one-way AHCs [academic health centers] can support faculty and trainees with manuscript and grant writing is through an in-house editing service” (p. 1). Their results showed an editing service within an AHC works in producing publishable manuscripts and funded grant proposals. In other research, McGurr (2020) stated, “When students attend graduate programs at pharmacy and medical schools, there is an increasing emphasis on and expectation regarding writing, as well as presenting and publishing research” (p. 84). They found that 38 (68%) medical or pharmacy universities have access to writing centers for their students. 60% of student responses believed the writing centers were needed in medical education (p. 87). The need is there, but often the funding or the expertise is lacking.

McGurr (2020) showed there are medical centers that provide writing support for their students. Wilson & Mikita (2018) wrote, “Our academic health sciences centre adapted the student writing centre model to provide writing support to faculty and other university researchers. In 2014, the university hired a writer/editor experienced in science and medical publishing to provide readily available, tailored, judgement-free writing consultations in person and via e-mail. Previously, the university had provided no formal writing services for faculty members” (p. 568) While their specific university was not named, Wilson & Mikita (2020) found similar needs in their research as NEOMED did in their medical school.

Asynchronous Writing Support

Crank (2023) points out, “While our colleagues in other support services or disciplines may not have a specific tradition of pedagogy for tutoring, we in writing center studies do. We know that in addition to some general approaches or pedagogies for one-on-one teaching, there are discipline-specific pedagogies, and perhaps we can help our new colleagues discover those as well.” Because of these pedagogical theories, we have practice in creating innovative writing center models. One approach is to integrate asynchronous writing support with in-house editing services tailored for graduate students, while also fostering a center that attracts and engages students.

Still, asynchronous work in Writing Centers is controversial. Weirick et al. (2017) wrote, “The medium itself often complicates and influences how collaborative work is facilitated” (p. 10). The process can be difficult for the student and the tutor (Hewitt, 2010), especially in terms of the time gap and technology gaps. Asynchronous support seems to go against the core idea of sharing a writing space to discuss a student’s writing (Neaderhiser & Wolfe, 2009). In addition, the lack of face-to-face interaction can be hard for students. This can be solved through recorded videos where the specialists purposely keep their cameras on so the student sees who is speaking. In addition, feedback is another issue that gets a lot of push back in terms of asynchronous work. Rambiritch & Carstens (2022) wrote, “Although it is debatable whether there is a dichotomous difference between product and process approaches to feedback, it may thus be merited to teach writing consultants in their training to think about what they want to achieve with the feedback before they respond” (p. 38). This is where the difference between undergraduate and graduate student needs start revealing themselves.

In one study of asynchronous sessions, Towle (2022) found that creating asynchronous workshops with faculty can help bridge the gap between the classroom and the tutoring space and provide “flexibility of instruction while also making room for student interaction” (p. 11). Graduate students have shown that this flexibility provides the best chance of success. Inflexibility with time is a large reason for a lack of students reaching out to the writing center for assistance. Flexibility and clear feedback are two significant reasons students use the writing center, according to assessments at NEOMED.

For asynchronous sessions to work most efficiently and feedback to be most beneficial, the appointment form needs to be clear and concise and provide the initial space for the student and tutor to communicate. Hutton et al. (2023) wrote, “Appointment forms are thus one means of narrowing the gap between the kinds of feedback writers often request by default and the valued forms of feedback that consultants are trained to provide. To ensure that consultant feedback is more rhetorically effective and dialogic, even when tied to grammar, writing centers can structure appointment forms to help writers to more explicitly and precisely ‘explain the assignment and concerns in an email or online form’” (p. 68). The NEOMED intake form has evolved to asking the student exactly what they are looking for and will continue to evolve as student feedback is provided yearly. In addition to the intake form, Hewitt & Thonus (2019) posit that, “Conscious use of metaphor in feedback may assist students with the cognitive leap from reading feedback about their writing to using such feedback purposefully in revision” (p. 2). These metaphors in feedback ask students to critically think about the feedback for their writing. Thus, it may be important to look at actual ways of delivering feedback using metaphors and other rhetorical devices.

When the NEOMED Writing Center was created, the original plan was that specialists would be in-person in the Writing Center and students would come for appointments, whether that be in the physical space or synchronous online appointments utilizing ZOOM. Asynchronous appointments were not considered. There are students who prefer to collaborate with the Writing Center in person with academic and research work. But unlike undergraduate institutions, at least half of the NEOMED students are off campus at varying times completing their hospital rotations, and not on the physical campus. Medical students constantly have their noses to their books, their focus solely on their classes, class work, and research, and rarely have 50 minutes to come to the Writing Center or meet synchronously. When asked to prioritize studying, clinical time, or time for the Writing Center, students will usually choose studying.

The Key to Asynchronous Feedback: The Screenshare

In this paper, screenshare and screencast are synonymous. Asynchronous writing center feedback is defined as providing video feedback to the student. At NEOMED, the Writing Center Specialist reviews the paper submitted in the workflow or through email. Then, the specialist creates comments, edits, and other written suggestions, often using track changes. Finally, the specialist records a 5–10-minute video discussing the comments made as well as other pertinent information. Sometimes, the video is created in real time, which gives the student a synchronous feel. Anson et al. (2016) wrote, “Screencast programs allow teachers to adopt oral, digitally mediated forms of response that enable them to voice their assessments of students’ writing while they point out specific textual features that are related to students’ development as writers. This technology has important implications for providing response in academic settings as well as in business and industry” (p. 379-380). In the graduate writing center, students struggle finding the time to visit the writing center in person. Yet, they still need some of the positives to in-person work. Anson et al. (2016) suggested that “screencast technologies seemed to account for students’ face-related needs (belonging, respect, and autonomy) and hence mitigated the predominant face-threatening potential of the evaluative space” (p. 380).

One of the crucial parts of the screenshare experience is for the writing center specialist to have their camera on as they provide comments for the students. This provides credibility for the student and adds to the importance of the video. In online classes, students who did not have access to the teacher or classmates via video claimed it “reduced their educational experience” (McBrien et al., 2019). It was reported that being able to see the person on the other side of the online experience created a “more complete picture” of teachers and students in the online meeting (Falloon, 2011). Schwenck & Pryor’s (2021) research study showed, “Students want to ‘see’ their classmates and need to see them to engage as a cohort. They also need to see each other to connect and form necessary relationships. Engagement and connectedness cannot happen when cameras are off and in-person students are forced to stare at blank screens” (p. 5). While screen sharing builds the credibility and experience of the student, it is important to do so with the camera on.

Research has shown that, “Screencast technology has the potential to facilitate new discussions about digitally mediated identity formation and relationship building—not only in student–teacher or mentor–mentee relationships but also in other relationships in which feedback interventions play an important role in professional development and learning” (Anson et al., 2016, p. 380) This includes the graduate writing centers where relationships and collaborative experiences are so important. The graduate student is developing professionally. Through the screenshare, the writing center specialist can be part of that journey by visually explaining what the written comments cannot as seen in Lee & Thompson’s (2012) research. They argue that screencast video feedback is stronger for in-depth explanatory feedback in a student-tutor relationship and provides more credibility for the tutor to the writer than written comments.

It is important to note that as the NEOMED Writing Center screen share feedback continues to be provided for its students and as it evolves, it will be important to investigate the best ways a specialist can perform on the video. Wang et al. (2022) suggests that “understanding the video-watching behaviors of students over time is crucial to provide timely instructional support for improving both teaching and learning” (p. 4). Currently, the specialists do not have a set structure for the screenshares. That is a project for the future that will be crucial to the success of the center. There is evidence that the written comments are not as important as the verbal, which could create a screen share only collaborative response.

NEOMED and Collaboration

When the NEOMED Writing Center was not getting the traction expected in the first week, Lunsford’s (1991) seminal scholarship on collaboration was considered as they wrote about the advantages of it in the writing space:

Collaboration aids in problem finding as well as problem solving.
Collaboration aids in learning abstractions.
Collaboration aids in transfer and assimilation; it fosters interdisciplinary thinking.
Collaboration leads not only to sharper, more critical thinking (students must explain, defend, adapt), but to deeper understanding of others.
Collaboration leads to higher achievement in general (p. 94).

While it was initially unclear how a collaborative relationship would work in the graduate writing center, it was essential to try. This is when the in-house editing service model started to move in. How does the undergraduate model of hands-off, reading papers aloud, content over grammar, and teaching the student fit into a graduate medical school whose students are completing the high stakes writing of CVs and personal statements in hopes of surviving the Match, the National Resident Matching Program (NRMP), which pairs graduating medical students with residency programs based on a computerized algorithm, and getting a job after graduation? In a genuinely collaborative relationship, both parties contribute equally, eliminating any power imbalance. For many graduate students, the labor that was needed was that of an editor. Yet, the undergraduate model clearly approaches the session as tutor-tutee, where the tutor has the information, and the tutee learns by doing. Grammar and punctuation are put aside for the greater good of content and educating the student. This did not work in the graduate writing center. It became clear that the writing center was doing some of the work an in-house editing service would do (McNeill, et al. 2024). Thus, partly solving the issue of fixing the grammar that writing center theory pushes against.

The undergraduate model is often like teaching a student to fish instead of giving them a fish sandwich. Whereas the graduate model that evolved through the pilot program could be more of a collaborative experience and does not approach the session as only a teaching experience. The education of the student is important, but that does not take away the need for sentence level editing. In the NEOMED model, students are fed first and then, through the screen share videos and in-person sessions, are shown why the fish was cooked that way. The need of students is two-fold: A final product that is worthy of residency applications and the education to become a better writer. Unlike the undergraduate writing center that prides itself in content as the only foci, the NEOMED Writing Center models for students strategies that include grammar, punctuation, and format editing. NEOMED Writing Center staff realized the specific needs of healthcare graduate students at NEOMED were unlike the needs of the undergraduate student. Many medical students have not focused on writing for many years. In fact, early in the development process, Brian asked a first-year medical student how much writing they did in undergraduate school, the student laughed, “We worked in groups anytime writing was involved. We always had one student who wanted to do the writing. The last time I wrote anything in school was my junior year in high school.” It was then that Brian realized that this center would be more than just content driven education, it is the job of the writing center specialist to engage in editing practices and to teach the student the intricacies of sentence structure, APA or National Library of Medicine (NLM) formatting, and organization of the CV. When this was realized, the Writing Center grew quickly. By applying the Lunsford (1991) collaboration model to a 2022-2024 graduate school writing center, utilizing asynchronous sessions, and replying using screen share videos, nearly 2,000 student tutoring sessions were held during the pilot program, with 66% sessions held asynchronously.

The Graduate Model

What works for the students of NEOMED and its writing center specialists may be different for other writing centers. Here is the outline of the model:

Asynchronous

Students submit manuscripts to workflow or via email.
The specialist completes formatting, grammar, and punctuation edits.
The specialist provides revision comments and shares the document with the student via email or the workflow.
The specialist records a screenshare video, with the camera on, discusses the comments made and offers additional information.
Students are provided access to the video through a shared software system.
Students are invited to revise and resubmit for an additional asynchronous session.

Synchronous Online

Students make an online appointment with the specialist via the workflow using ZOOM software.
Students are asked to submit the text in the workflow to be discussed in the synchronous online meeting.
If available, the specialist reads and comments on the document to be discussed in preparation for the meeting.
The meeting is held, and the comments are discussed live. Students are asked at the beginning of the session how they want the session to work, and the specialist tries to follow those instructions.
Students are invited to make revisions and resubmit for an asynchronous session.

In-Person

Students make an in-person appointment with the specialist via the workflow.
Students are asked to submit the text in the workflow to be discussed at the in-person meeting.
If available, the specialist reads and comments on the document to be discussed in preparation for the meeting.
The meeting is held in person in the common room of the Writing Center. Comments are discussed live. Students are asked at the beginning of the session how they want the session to work, and the specialist tries to follow those instructions.
Students are invited to make revisions and resubmit for an asynchronous session.

Asynchronous sessions are scheduled for 50 minutes, with the last 10 minutes to create a screenshare video that walks the student/faculty through the comments made on the paper unless the asynchronous session is connected to a synchronous session. Typically, a specialist will provide comments in both the workflow CHAT and directly on the manuscript using track-changes and comments. Once these comments are made, a video is created and then the manuscript is shared with the writer, along with the video. A link to both the video and the manuscript is placed in the workflow CHAT. Access to the workflow is given to both specialists and the director of the NEOMED Learning Center, who oversees the writing center. Writers are then given freedom to ask questions using CHAT or email, make another asynchronous appointment once the revisions and edits are completed, or make a synchronous appointment as they continue through the writing process. Many students use both synchronous and asynchronous appointments for the same manuscript. Often, the student meets synchronously with the writing center specialist and then submits the changes for an asynchronous session. That said, many of the COM professional writing (CV/personal statements) appointments are done solely asynchronously because the writer is completing rotations in hospitals during their training at the same time as writing these documents.

In-person and synchronous online sessions are also scheduled for 50-minute slots. For a synchronous appointment, whether online or in-person, the writing center specialist and writer sit down at the same table. The writer is asked to submit the document prior to the 50-minute session, if possible. This is so the specialists can acclimatize themselves to the document and make copies, if necessary. This sharing of the document can also be done via email at the beginning of the session. Writing center specialists encourage writers to have the document on their computer so the writer can engage in writing during the session. The specialists begin every synchronous session with the question, “What are you looking for in this session?” This acclimates the writing center specialist to the goals of this appointment and helps direct the session, along with identifying the perceived strengths and weaknesses of the text. Once the goals are laid out, the next question is, “What are you writing?” This helps the specialist get to the meat and potatoes of the manuscript. CVs and resumes have a traditional template to use. The Writing Center in partnership with Student Affairs collaborated to create a template for the COM and COP students to make it easier for individuals to create their CV and for writing center specialists and individuals working in Student Affairs to edit. Most students use these templates and simply copy and paste their own information into it, saving them time and helping ease their stress when it comes to document formatting.

Pilot Program Results

In the third week of the pilot program, six student sessions were held: one in-person, one via meeting software, and four asynchronously. While, initially, asynchronous appointments were not being considered, it became evident in the post-COVID scholarship, and some pre-COVID research, especially in graduate writing center research, that asynchronous appointments were able to provide the collaborative experience the writers needed (Denton, 2017; Bell et al., 2022; Severino & Prim, 2016). Professional organizations like the Online Writing Center Association, that “is dedicated to supporting professionals and students who research or implement online writing support services,” promote asynchronous work throughout the writing center scholarship. From the beginning, the NEOMED Writing Center looked for ways to pragmatically pivot to the desires of the students and faculty writers. Through oral and written feedback, after the third week, the Writing Center staff saw that asynchronous sessions needed to be added to the offerings.

During the pilot program, there were 1,957 total Writing Center appointments. 71% of the students came from the COM, 21% from the COGS, and 8% were from the COP. During this time there were 1,299 asynchronous sessions, 336 in-person sessions, and 322 synchronous online sessions utilizing ZOOM meeting software. Eleven in-person and synchronous online workshops were held over two years and many asynchronous workshops were recorded for the students to access in their own time. Over 350 students and faculty were active participants in the workshops. The Bitonte College of Dentistry first cohort starts in 2025, and the Writing Center is preparing for those students in many ways, including developing specific collaborative curriculum.

In terms of assessment, the Writing Center has continuously engaged in assessment practices to justify the writing center’s budget and sustainability. NEOMED’s Envisio (a data distribution software) is updated quarterly with data summarizing the number of sessions, the modes of these sessions, and the overall satisfaction of the students. After each session, students were emailed a survey to complete. These surveys were not mandatory, and while the response rate for individual sessions and workshops was a little more than 10%, the results showed the important part of the co-curricular experience that the Writing Center became for these students at NEOMED. In a survey response of 105 students who participated in an individual session with a writing center specialist, 93 (89%) gave the highest rating of satisfaction, stating their objectives were completely achieved. Seven students stated their objectives were partially achieved. One student stated their objectives were not achieved and four did not respond. For the in-person workshops, 35 students completed a survey, with 31 (89%) stating the workshop was “excellent,” three (9%) stating the workshop was “very good,” and one stating that the workshop was average. All 35 students stated that their questions were answered, and 22 (63%) of the students in the survey submitted a document to be reviewed by the Writing Center. Students were asked to provide a narrative assessment that considered the most beneficial aspect of their writing center experience.

Many of the 70+ responses centered around the idea, “The feedback was timely and the manner in which it was delivered was very helpful,” and that, “Reaching out was simple and easy via email and the Writing Center Specialist was quick to respond with a scheduled timeline for the review. He had my CV back on the date he said with excellent suggestions to improve upon the document.” The students really appreciated the asynchronous sessions too, writing, “I really appreciated being able to have my work checked via email. With a busy schedule in medical school, I was worried I would not have time to fit in an appointment.” Most valuable to a Writing Center collaborative model is summed up as, “The Writing Center Specialist was very helpful, and he genuinely cares.” Finally, what was a general theme in many of the narratives was the appreciation for the screenshare videos produced for the asynchronous sessions. Students wrote, “They were very flexible and put in a lot of effort to help me out at the last minute. They even created a video that walked me through the changes.” Giving students the feeling that they matter is key for a successful writing center in a medical university.

The NEOMED Writing Center engages in curricular and co-curricular support by focusing on helping NEOMED students, faculty, administration, and staff create transformational leaders through writing, communication, and collaboration. This is our pledge to the community of graduate writers. As the Writing Center continues to grow, it is essential that the three pillars of the graduate writing center continue to be the foundation: asynchronous work, in a collaborative environment and through screen share videos. By combining the needs for in-house editing services and the writing center, NEOMED has created a space for its graduate students to be the most successful and happy.

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