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: William A. Norcross, MD, clinical professor of family medicine, UC San Diego School of Medicine

The critical review of manuscripts is an important component in the advancement of new knowledge and, to be perfectly honest, I think it’s fun. Here’s how I go about the process of ensuring that reviewing remains fun.

Those rascally editors always seem to know what interests me and often hook me like a hungry trout. However, I do read the abstract carefully to ensure I am able to make some contribution, and I check the list of authors. It is unfortunate to spend several hours working on the review only to discover that the fourth author is your cousin. I also look at my calendar and make certain I can comfortably do the work lest the review become rushed and the quality suffer.

The first thing I do after I accept the invitation is to print out the manuscript. I apologize to the forests of America for this profligate use of paper. I take the manuscript everywhere I might read something. I read it through, casually, at least two or three times, to get the feel of it. It is amazing how much you can learn just from that.

If I feel comfortable with the manuscript—the writing style, the authors’ depth of familiarity with the subject, my knowledge of the subject—I may dive right into the review. If I find the manuscript puzzling or unsettling in any way, I may put it down and pick it up again a few days later, my thinking being that perhaps the problem is me and not the manuscript.

I do my review in the way the manuscript is written, and, by now, remember, I’ve read it two or three times. There is one exception, the abstract, which I think is best left for last. You can only know whether the abstract is of good quality once you have analyzed the entire manuscript.

Consider if the title accurately describes what the manuscript is about. You would be surprised at how often this is not the case. It’s important that the reader be able to accurately select those articles from the table of contents that are of importance.

The introduction should tell us: how well the authors know the subject, why the study was done, how the work adds to existing knowledge, and how well the authors can write. Almost invariably, I will review one or two articles referenced in the introduction to be certain that the claims are valid and that I understand the place of the manuscript in the existing literature.

The methodology is the most important part of any manuscript. Almost all other sections can be remediated and improved, but a flawed methodology, like a torpedo amidships, sinks the paper every time. A common flaw is for authors to make claims beyond those that can be supported by the methodology. While not a fatal error, it usually requires that the authors rein in their discussion to accommodate the limitations of their methodology and results.

In areas of statistical analysis, I simply state my limitations and suggest that the editors include someone with this competency in their review process.

In the results, I look for clarity, simplicity if possible, and a sensible display of the results. In general, authors do this well.

The discussion is critical for a good manuscript, and discloses, more than any other section, the scholarship and integrity of the authors. I am very impressed when authors suggest limitations that have not occurred to me. On rare occasions, I find the authors to be excessive in their self-criticism, and I will include this in my review. The discussion, however, is not only a place to discuss limitations but also a platform to relate what is likely valid in the manuscript, what the reader should glean from it, how it might justifiably affect the reader’s practice or thinking. And it should plant the manuscript fairly within the extant literature.

A good reviewer must have the gumption and diplomacy to honestly and sensitively describe the manuscript’s strengths and weaknesses. One must be able to give helpful feedback in an objective and supportive way, and that can be done even when the decision is to reject the manuscript. Research and scholarly writing is very hard work, and I recognize how much effort goes into every manuscript. Everyone profits from a careful review.