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Accept, Reject, or Revise?
Improving Scholarship by Improving Peer Review

April 2016


Elizabeth S. Karlin, MA, Staff Editor
Academic Medicine
Jennifer Campi, Senior Staff Editor
Academic Medicine
Mary Beth DeVilbiss, Managing Editor
Academic Medicine

Peer review is the assessment (or review) of research by a scholar (a peer) who has expertise in the research topic or possibly the methodology applied. The purpose of peer review—the focus of this article—is to help ensure that the published literature is of the highest possible quality. Reviewers act as a sort of jury, determining if the research is of a quality that deserves dissemination.

For centuries, the peer-review process has remained relatively unchanged: Researchers prepare a manuscript, a report of the study or investigation they have conducted. Next, the researchers send the manuscript to an appropriate journal. Usually, the manuscript undergoes an internal review. A decision-making editor (an editor-in-chief or associate editor) decides whether to reject the manuscript before review or to send it out for peer review. Decision-making editors, journal board members, and even the manuscript authors themselves may suggest reviewers. On average, two or three reviewers are selected from a pool of experts who are often authors themselves.  

This next step in the process—review by a peer—is an essential element of scholarship. Although editors need not (and do not) always agree with or abide by reviewers’ recommendations, they rely on reviewers as a vital source of information about manuscripts. Editors and readers, other scholars, and the people who benefit from advances in science—that is, all of us—rely on peer reviewers to provide insights into research, to outline strengths and weaknesses, to uncover critical flaws, and to illuminate new discoveries.

The most important questions peer reviewers can answer are:

To answer the questions above, peer reviewers should examine the report’s introduction and reference list, the methodology, the results or findings, and the discussion and conclusion. We have provided a few questions and suggestions about each of these immediately below, followed by a description of other resources to help reviewers.


Introduction and references:

Do the authors provide enough background information, based in the literature, for readers to understand the nature of the topic, the context, and the need for the current report? Is the literature the authors cite comprehensive—including both the most current articles as well as foundational research? Is the literature balanced—presenting different perspectives? Do the authors state their purpose, question, and/or hypotheses clearly?


Is the method appropriate for the problem or question the authors hope to study? Have the authors provided enough details to allow future researchers to replicate their study? Is the setting clear? Where and when did the research take place? Who are the research subjects or participants? Did the authors procure all necessary ethical approvals, especially if working with human or animal subjects? Have the authors described their tools and their analyses? Have the authors considered all aspects of the problem?


Do the results reflect the methodology? Do the authors report the findings of all their tools and analyses? Have the authors shown their results to be significant—statistically and clinically?

Discussion and conclusions:

Have the authors considered whether their findings are generalizable to other settings, other subjects? Have the authors considered all of the implications of their findings? Have they shown how their findings will affect science? Have they considered avenues for, or questions to address in, future research? Have they discussed any limitations and the effects of those limitations on their conclusions?

Although the questions in the preceding paragraphs will help guide reviewers, here are some additional resources:

And here—enjoying peer review, the benefits of peer review for the reviewers and authors—is where we want to end. In addition to the pragmatic benefits of review, including letters recognizing service, lines on a CV, and sometimes rewards or CME credit, scholars note other reasons for continuing to review one another’s research. Despite the time and effort that quality reviews require, scholars assess manuscripts because doing so allows them the opportunity to learn about the newest discoveries in their field. They are participating in the scholarly process, giving back to the community that has helped them, and advancing science for the benefit of us all.

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