the hidden academic

There is something that most of us “academic types” do that often goes unrecognized, and is almost always undervalued. However, it is a big part of my life, and I thought you might enjoy learning about it. Of course you might think it’s total nonsense, and that’s OK too. Just bear with me for a few moments.

Are you trying to guess what I am thinking? What this post is about?

It’s about reviewing manuscripts that have been submitted for possible publication in medical and scientific journals.

This is the story of PEER REVIEW

Have you ever wondered how a paper goes from the authors’ concept, to actual publication? This graphic gives you an idea of the process. Many of the detailed steps have been omitted to make it simple enough for me to create. The real point is, that no matter who the authors are, no matter their reputation or fame, the process is basically the same in order to be published in a “peer-reviewed” journal. Depending upon the quality of the journal and how often it’s papers are quoted by others, the acceptance rate for an individual manuscript can be highly variable. But many of the highly regarded medical  journals accept fewer than 20% of the submitted papers. It is the reviewers who determine whether any submitted manuscript will make it into print in that particular journal. Each journal has its own set of reviewers (although within any given specialty field, reviewers may overlap considerably between different publications). They are bound by the listed criteria for that journal and expect the authors to follow the “instructions for authors” for that particular journal.

The editorial staff ensures that the paper is read by reviewers who are considered experts in the field that the paper discusses.

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Reviewers are expected to read the paper, including tables, figures and references. They then provide a detailed critique which is eventually sent back to the authors. In addition, each reviewer will make a recommendation regarding publication—is this manuscript worthy of publication in this journal?--to the editor, not to the authors directly.  They may also send information or comments to the editor regarding the paper, and whether they might have concerns about how the research was conducted, or any other issues. When I undertake a manuscript review (about 10-20 times a year) I endeavor to put myself in the authors’ shoes. Why did they write this paper? Was this a project that they meant to publish, or did they just happen upon the information or data and decide to write about it? Does it answer an important question in the field? Does it add new knowledge to the field that will be helpful for physicians treating real patients (I don’t tend to review purely scientific papers since I am not a basic science researcher, but those would have other criteria). Do I understand how the research was conducted? Do I understand the statistical evaluation? Did they use appropriate statistical techniques given the nature of the data? Will the readers of this journal understand it? Is the reader given enough information upon which he or she can relate the paper to their own practice? If not, what additional information is needed? Have the authors made appropriate conclusions based upon the data they had, and the statistical evaluation they described?

And probably the most important question to ask is “So what?” If I can’t answer the “so what?” question after reading the manuscript (at least twice), then it is very unlikely that I will recommend publication.

Reviewers may or may not be allowed to see the names of the authors or their institution of origin. If they are given the names and institution, they must recuse themselves if an author is a close friend or relative (or potientially a significant competitor). Authors are almost NEVER able to see the names of the reviewers of their manuscript. They will receive one letter  signed by the editor-in-chief of the publication.The letter tells the authors whether or not the vote was for publication, and incorporating all the comments from the individual reviewers; generally identified by number, but not by name. Reviewers of peer-reviewed publications are volunteers. We are not paid to do this work. Yet this work is critically important. And that’s why we do it. It is part of the desire to give back. Part of the need to keep our profession intact. Despite the process, there have been occasional failures, as evidenced by journals occasionally having to retract certain conclusions by authors subsequently proven to be fraudulent. We must be very careful about the information published in clinical medicine journals. It must be true, to the best of any one’s ability to know what the truth is. YOU must have faith in it. YOU must have faith in this system.  Your doctor or other health care provider may base their choice of treatment for YOU on the words found in one of these papers. It is critical that those words be correct, and the final judgments sound. I would love to hear your impressions, your comments, your questions about this part of medicine that very few people actually observe.

Recent Comments

I think of accountability and responsibility that volunteers take to themselves when dealing with the words of others.
I did not consider this type of work much before, but seeing what is involved, amidst an already full workload is inspiring.
Imagine having to put your blog before such a process to get published?
I am glad that freedom to do both exists in our systems and lives.
Alice, this is a refreshing change from the usual.
More power to you... :) Billy

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About Dr. Ackerman

Alice Ackerman, MD, MBA, FAAP, FCCM is the Chair of the Department of Pediatrics at Carilion Clinic and Professor and Founding Chair of Pediatrics at the Virginia Tech Carilion School of Medicine. Dr. Ackerman is recognized nationally as an expert in pediatric critical care.

She has been at Carilion Clinic since June of 2007. Her primary goals are to enhance the health care of children in the Roanoke Valley and Southwest Virginia, and is actively working to do this both as physician in chief of the children's hospital, as well as through involvement with many state-wide initiatives.

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