The (Re)View from the Other Side

Peer Reviewer Resources

Editor’s Note: The following post is part of a series of Peer Reviewer Resources written by some of Academic Medicine‘s top peer reviewers. Check back each Thursday for the next post in the series. Read more about our Peer Reviewer Resources

By: Grace C. Huang, MD, director of assessment, Shapiro Institute for Education and Research, Harvard Medical School and Beth Israel Deaconess Medical Center, and assistant professor in medicine, Harvard Medical School

The “Invitation to Review” shows up in your inbox, and you briefly consider pretending that it went to your spam folder. Now couldn’t be a worse time. You have manuscripts to revise, and your own reviewers to revile. You can’t get paid (believe me, I’ve tried). You convince yourself you’d rather sit in committee meetings or fill out pre-authorizations for meds. You dread the prospect that, even after pouring your energy into that review, somewhere out there the authors will be cursing your nameless existence and diagnosing psychopathology in your every word choice. You will be labeled an idiot, a narcissist, or the worst thing you could be called in academic medicine…“out of touch.”

Peer review is ultimately at the heart of scholarship. It’s not just about being a good citizen of the educational community. Being a reviewer undeniably makes you a better scholar. Curling up for a few hours with an unprocessed piece of someone’s work leads to one of three possible outcomes, and I have benefited personally from all of them:

  • It’s a flawless manuscript. I get ideas about how I should refine my own work. I am reminded that introductions should be concise and streamlined. I am inspired to revise my tables and figures for highest impact. I vow to use the word “epistemological” in my next paper.
  • It’s a terrible manuscript. I see leaps in logic and glaring biases in measurement. The conclusions are overstated. I see twelve words where one could have sufficed. I repress the fact that the paper could have easily been written by me.
  • It’s a workable manuscript that will grow up to be a great one. I do my part to shape someone’s scholarship so it will help others. I think of a more precise title that will attract attention. I envision an alternate way to frame the discussion to make it more relevant to readers. I recommend a reference that will strengthen the bibliography. I feel important and benevolent (temporarily).

Recognizing that peer review benefits you as much as it does the authors, how do you go about writing a review? Most journals provide reviewers’ instructions, and Academic Medicine’s can be found here. Scholarly review of a manuscript boils down to two things:

  1. Does the work represent a thoughtful investigation of an important problem?
  2. Does the product represent a contribution to the current literature?

Like any assessment person, I have a framework.

Summary – Synthesize the work in your own words. Suppress the urge to be ironic.

Major themes – In this section, it is helpful to make a statement about each of the following sections:

  1. methodology (study design, measurement, validity)
  2. presentation (clarity, organization, consistency)
  3. contribution to the literature (generalizable, additive rather than duplicative)

First, take the time to elaborate on the strengths. Be generous (but not misleading). Authors often only receive negative feedback in peer review, and your words can be soul-crushing, particularly for junior faculty.

Second, address the major areas of weakness, particularly if they fall in the three sections mentioned above. Encourage the authors to confront the flaws in the limitations section if they cannot be rectified.

Specific comments – In this section, provide evidence in the text for the general statements above, plus any other minor points to be addressed. Itemize a finite list of edits that should be made to the paper, using page and line numbers for references. Your comments should be of substance; think word choices and requests for clarification, not typos and mockery of grammatical mistakes. Move beyond mere criticism to give constructive (and actionable) suggestions. For example,

Not helpful: “The methods section is vague.”

Helpful: “Please clarify whether subjects had prior experience with team-based learning.”

Odd as it may seem to make the comparison, peer review is not that different from clerkship evaluations. Your feedback should be specific in identifying weaknesses but should also illuminate the path to improvement. You also should provide the justification for the “grade” you ultimately give the manuscript; otherwise, authors are left with mixed messages.

So, next time you are invited to peer review, consider it not a chore but an opportunity to exercise your skills of critique and a testament to your expertise (not to mention a privileged firsthand look at the emerging literature). Ultimately, refining the work of others will reap benefits as you prepare your own manuscripts.