Thus, in more detail, 1 cohort received the original version of text 1 and the rewritten version of text 2. 12, 13 The comprehensibility of the 2 examples of biomedical text was tested in the original published form and in the rewritten form. The text samples were extracted from the methods sections of 2 original research papers referenced within the undergraduate curriculum of the students. In the first instance, each of the 2 cohorts of students was presented with 1 sample of text in its original published form, with frequent use of the passive voice, and a sample of text in which the passive voice was replaced throughout the text with the active voice (text available from corresponding author). Hence, the purpose of this study was to compare the comprehensibility of authentic samples of biomedical text expressed in the active and passive voices. In this age of evidence-based care, it is somewhat ironic that the teaching of health sciences literacy remains largely opinion based. 11 To date, however, no experimental studies have challenged the assumption of enhanced comprehensibility for the active voice. On the other hand, it has recently been argued that there are instances in medical writing in which the passive voice is preferable to the active voice, and that sweeping editorial guidelines may be overly simplistic and so do not serve their intended purpose. Even the American Medical Association Manual of Style continues to encourage authors to “use active voice whenever possible,” 9 while the British Medical Journal still advises authors to “use active voice but avoid ‘we did' or ‘we found.'” 10 For example, it is not uncommon to see writers encouraged to favor the active voice over the passive voice-“the doctor treated the patient” versus “the patient was treated by the doctor”-perhaps based on the misconception that the passive voice results in longer and less-comprehensible constructions. However, commonly proposed strategies for comprehensible writing may not be grounded in good evidence. 5 The overabundance of articles on how to write readable medical prose is testimony to this conventional wisdom (eg, see Alexandrov, 6 Bredan and van Roy, 7 and Steen 8). Thus, the more understandable learning resources are, the more efficient the learning process will be. 3 Furthermore, even health sciences students who are so-called native English speakers may be challenged by the vocabulary and writing conventions in their chosen discipline. 1, 2 This is likely as true for chiropractic students as for students in other areas of the health sciences. As increasing numbers of health professionals undergo training in English, it becomes apparent that the language of their chosen discipline may present challenges. Efforts to render such writing more comprehensible are therefore laudable, especially as English becomes the lingua franca of health sciences education and research worldwide. This is natural, given what are often the relatively esoteric themes and the argumentative (in a scientific sense) nature of writings in the health sciences for example, establishing cause-effect relationships from samples of populations. Writings in the health sciences tend to be complex.
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