In his 2001 bestseller, Bowling Alone, Robert Putnam decried recent trends of diminishing civic engagement.1 Our communities cannot thrive without people who are willing to vote, run a PTA meeting, or simply attend a pancake breakfast at the local VFD. The scientific community is no different. Without active participation in the scientific process, we have no peer reviewed journals, no grant reviews, and no consensus of best medical practice. We are all bowling alone. Grant funding institutions report a growing workload that is getting more difficult to peer review.2 The volume of reviews, declined review requests, and difficulty recruiting new reviewers are problems shared by biomedical journals and grant funding institutions alike. The Sixth International Congress on Peer Review and Biomedical Publication in 2009 identified some problem areas and some possible solutions within the biomedical review process.
It is not easy to recruit and retain excellent reviewers. A study of the peer review process for the Annals of Emergency Medicine found that the majority of reviewers submitted reviews that gradually diminished in quality over time, as determined by objective measures of performance.3 Although the decline was gradual, these data suggest that reviewers put less effort into their reports over time. Perhaps this is due in part to the reality that peer review is not supported and facilitated by the academic community. A survey of 371 grant reviewers from 22 countries revealed that only 7% were given protected time for peer review, 75% received no academic recognition, and 85% received no training or support in the peer review process.2 I might also suggest that time is a precious commodity, and clinician scientists are already short of it. If peer review is relegated to a small, unsupported minority, existing reviewers may find that the time requirement precludes their continued participation in the process. This will further diminish the quality of biomedical research.
Possible solutions for this peer review dilemma do exist. One strategy that seems promising is a simple system of pairing new peer reviewers with seasoned mentors.4 A randomized controlled trial comparing mentees to controls found that mentoring resulted in more reviews accepted and higher review quality. Another solution involves a commitment from our academic institutions to provide protected time and recognition for those who participate in peer review. For this to work, those of us who are strictly clinicians would need to lend unqualified support to the process to present a unified front. Those of us who are not currently engaged in peer review would need to step forward and share the burden. Shared responsibility will lighten the load and improve the outcomes for everyone. Finally, uniform guidelines and formal training in peer review could help broaden the pool of available reviewers and increase the quality of peer review. As peer review becomes increasingly standardized, the time commitment for individual reviewers would most likely decrease as the process becomes more clear and simple.
A community is the sum of its parts. The scientific community, especially the community that defines and disseminates biomedical evidence, is no exception. We have a profound responsibility not only to our peers, but also to our nation and our world. We must all work together to provide the best possible evidence-based medicine to those whose lives and health depend on sound research. Become an integral part this community when asked to perform peer review of a journal article. Your contribution will strengthen and advance our specialty.
1. Robert D. Putnam. Bowling Alone: The Collapse and Revival of American Community.
New York, NY: Simon & Schuster; 2001.
2. Schroter S, Groves T, Hojgaard L. Surveys of current status in biomedical science grant review: funding organizations and grant reviewers' perspectives. Abstract presented at: International Congress on Peer Review and Biomedical Publication; September 10–12, 2009; Vancouver, BC, Canada.
3. Michael Callaham. The natural history of peer reviewers: the decay of quality. Abstract presented at: International Congress on Peer Review and Biomedical Publication; September 10–12, 2009; Vancouver, BC, Canada.
4. Houry D, Callaham M, Green S. Does a mentoring program for new peer reviewers improve their review quality? A randomized, controlled trial. Abstract presented at: International Congress on Peer Review and Biomedical Publication; September 10–12, 2009; Vancouver, BC, Canada.