Publication Decision

Caelleigh, Addeane S.; Shea, Judy A.

Academic Medicine:
Review Process and Publication Decision: Chapter 1

    The publication decision is the last step of the review process. Journals vary in the processes they use for making publication decisions, and each journal should make public how its particular process works. Admittedly, it is neither feasible nor desirable to detail the intricacies and unique responses to individual submissions, so the way many journals make the process public is to publish a description of it, often annually, within a succinct summary of their review process. It is important that every communication of a publication decision include a specific and clearly stated appeal process for authors who are dissatisfied with the outcome. For many journals, the publication of the description of the review process coincides with publication of their submission requirements and annual statistics (e.g., number of manuscripts submitted, acceptance rate).

    The principal actor in the publication decision process is the editor. While few editors may defer to reviewers' comments for the publication decision—uncharacteristically, one survey of North American medical journal editors did find that almost half of the editors responding based their decisions solely on reviewers' comments1—most journal editors rely on reviewers' comments for advice and reserve the final decision for themselves. This is a major area of consensus among health professions journals and the leading journals of most fields and disciplines. Reviewers make recommendations to editors—they do not have votes. (Journals' instructions to authors will often have statements spelling out the general basis for decisions.)

    This is a good place to clarify the use of the term “editor” as a singular noun. While this applies to the organizational and decision-making structure at some journals, it is important to realize that the exact organization of a journal may vary, and several people may have decision-making responsibilities. For example, each section of a journal may have a separate editor who functions and makes decisions independently. Other journals are structured such that associate editors are assigned their “own” manuscripts, and they make publication recommendations that are discussed and decided among the larger group of many associate editors. Most journals have editorial boards, but in general these bodies function as overseers to monitor the activities of the journal from a distance and are seldom involved in daily activities. Clearly, one of the most important ways in which journals vary is in setting the policy that specifies exactly who has decision-making authority. Is it an individual, or a group?

    The decision about whether or not to publish a manuscript that has been sent out for review is rarely obvious. Occasionally reviewers may agree that a manuscript should not be considered further—that it clearly should not be published. Very rarely will reviewers unanimously agree that a manuscript clearly should be published directly as written. Most often, reviewers recommend some middle strategy (e.g., revise) or they offer conflicting recommendations for and against publication. Regardless of the agreement among reviewers, however, the editor must make the publication decision.

    How does an editor make a decision after reading the reviews—how does he or she balance the recommendations, the pros and cons, from reviewers? The editor must consider each reviewer's opinions, suggestions, and comments and then combine the input from several reviewers before reaching a decision. Are all reviewers' comments given equal weight? Probably not. Those from known experts are weighed more heavily. Remember that the editor often knows the general field well but is not and cannot be expected to be a subject expert for every manuscript. Also, reviews that are constructive, more than a couple of sentences long, and original in the issues that are mentioned receive special attention. In short, an editor is looking for a review that is thoughtful, helpful, and specific.

    It is important to note, too, that the editor must balance reviewers' suggestions (arguably the most important single part of the process) with many other factors. A manuscript's originality (or its characteristics at the opposite end of the spectrum, redundancy) is one very important consideration. Depending on the manuscript's topic, either feature may be desirable. Other issues that weigh in the decision include length (sometimes short is good; sometimes long is better), a topic's relevance, and what the journal has published recently. These issues are often secondary to the external reviews, which are primarily concerned with quality, but they can be important either to justify a publication decision or to direct future revisions. If an excellent article is rejected because it is too similar to one that was just published, steps can be taken to make sure that the author hears both points: excellence but redundancy. Similarly, an editor can work with an author to shorten or expand a manuscript.

    In sum, the decision-making process is highly complex, multifactorial, and unique for each paper. It is subjective, but it is neither capricious or uninformed. In many ways, a paper is in competition with all other good papers being processed at the same time. Often the editor must make only a few selections from a large potentially publishable field. This is a very important point that may be overlooked—a manuscript that is generally quite acceptable may be rejected primarily because it is not quite as “strong” (e.g., interesting, methodologically sound, different) as are current competitors. Outside of stating how many reviewers are typically requested and making public the review form that they use, there is little about the process that can be succinctly generalized except to say that reviewers' suggestions are taken seriously. Reviewers' comments are almost always the most important ingredient in the process. If the comments agree, they are usually followed. Unfortunately, agreement is rare, and it is in these instances that editors must rely on their judgment, built from experience.

    So, the editor makes a decision. (In reality, the decision is often not an absolute—some magnitude of revision of the manuscript is required. Those negotiations are discussed in the next article in this chapter.) The final step in the process is that “the decision” is conveyed to the author in writing. Several parts of this process are relevant to reviewers and, again, journals differ in how they handle it. Are the reviewers' comments forwarded to the author? If so, are they sent as received or does the editor pick and choose among the comments and compile them in the decision letter? Do the reviewers see a copy of the letter sent to the author? Do they have the benefit of seeing the other reviewers' comments? If particular comments from a reviewer are unusual (e.g., highly technical), will the reviewer be asked to interact directly with the author?

    Finally, editors make decisions in other ways that are not so obviously tied to the review process. Journals differ in their involvement in editorial work. Some journals publish a paper more or less as it was submitted once the author adequately addresses queries (see “Presentation and Documentation” near the end of this chapter). In such a case, poorly written papers about good studies are unlikely to make the cut. Other journals go to great lengths to restructure a manuscript to improve it, highlighting some parts and minimizing or removing the others. Some editors will review each manuscript with an eye towards identifying the usable “kernel.” Negotiations with the author determine how much a manuscript can ultimately change, or what part of it can be published. In sum, while journals have well-defined policies and flow charts designed to support efficient and fair publication processes, decisions about any one manuscript have to be viewed within the larger context. Editors are usually more than willing to communicate the important elements in any particular decision, either in writing or verbally, to an author.

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    1. Wilkes MD, Kravitz RL. Policies, practices, and attitudes of North American medical journal editors. J Gen Intern Med. 1995;10:443–50.
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    National Research Press. Part 4: Responsibilities. In: Publication Policy. 〈〉. Accessed 6/5/01.
    Siegelman SS. Assassins and zealots: variations in peer review. Special report. Radiology. 1991;178:637–42.
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    Section Description

    Review Criteria for Research Manuscripts

    Joint Task Force of Academic Medicine and the GEA-RIME Committee

    © 2001 Association of American Medical Colleges