Most emergency medicine (EM) residents read academic blogs.1,2 These blogs provide an accelerated, convenient option for reading about medical innovations and decision making, for accessing physicians’ and others’ personal reflections, and for accessing published literature on conditions and treatments. Blog popularity arises in part from flexible publication formats and open accessibility online.
Contributors to peer-reviewed academic journals have criticized the credibility of blogs and other open online educational resources, citing a lack of traditional prepublication peer review.3 The traditional peer review processes, while conferring credibility, pose barriers to learners interested in publishing.3–5 In particular, the potential for strongly worded and critical reviews, and the lack of open dialogue between authors and reviewers, may discourage new authors.6 Authors are sometimes left feeling bullied and without an avenue for recourse.7 We worry that authors, especially junior authors, may discard many hours of work upon receiving a rejection and/or not pursue academic publication and peer review in the future.
Still, because credibility was identified as a key component of perceived quality in a recent review,4 academic blogs have responded. The editorial staff at the prominent EM blog Academic Life in Emergency Medicine, for example, developed an open expert prepublication peer review process5 for its learning materials. Other blogs have followed suit.
BoringEM is a multiauthor EM blog founded in 2012 that has recently been incorporated into a larger blog, CanadiEM.org. CanadiEM creates content produced predominantly by medical learners (i.e., medical students, interns, and residents). In 2014, more than 350,000 viewers accessed BoringEM, and it is ranked 12th of 156 EM and critical care blogs using the Social Media Index, an impact metric for blogs and podcasts in the areas of EM and critical care.8 The CanadiEM editorial team comprises two senior editors (B.T., T.C.) and two junior editors (E.P., S.L.-G.). All four staff members have blog-writing and editing experience. The two senior editors hold peer review and editorial positions at other academic blogs, serve as peer reviewers for major EM and/or medical education journals, and have each published 30+ peer-reviewed articles.
Acknowledging that readers could perceive CanadiEM’s commitment to publishing material created by learners as a threat to credibility, the editorial team developed a collaborative prepublication peer review process called “coached peer review.” The purpose of CanadiEM’s innovative coached peer review process is to promote positive and professional relationships between authors and reviewers such that they work collaboratively to publish online medical education resources that are rigorously vetted and edited to enhance credibility. This process aims to meet the unique needs of its learner–authors.
CanadiEM’s prepublication coached peer review strategy emphasizes a nonjudgmental editorial process. The goal of coached peer review are to improve learners’ medical knowledge, as well as their writing and editorial skills, by providing learner–authors with feedback from attending physicians who serve as reviewers and editors. The focus of these interactions is to improve the quality of the article, rather than determine whether it should be accepted or rejected for publication. The CanadiEM philosophy is that all learner–authors’ submissions—given enough time, attention, and revision—are ultimately publishable. This learner-centered editorial philosophy encourages and supports fledgling writers and helps them develop component skills of the CanMEDS framework (within, specifically, the medical expert, scholar, professional, communicator, and collaborator domains).9
The coached peer review process (Figure 1) begins either when an editorial team member recruits a learner–author to write about a topic of interest, or when a learner–author contacts CanadiEM directly, citing interest in a particular subject. The editorial team guides the learner–author through topic refinement using an internally developed curriculum map. After the learner–author completes an initial draft, she or he can suggest an external reviewer (i.e., “staff reviewer”) who is an expert on the topic, or a member of the editorial team will assign such an expert. In addition to this external review, all articles undergo review by an internal editor. The internal editor is a junior or senior member of the editorial team and serves as a peer reviewer and copy editor. The internal editor reads for style, grammar, flow, and clarity. The expert staff reviewer is an attending physician who provides content expertise and clinical context. Once the external review is complete, editors, staff reviewers, and learner–authors send the draft back and forth amongst themselves until everyone is satisfied with the finished product. Finally, the article is published on the blog concurrently with an open commentary (dubbed “Reviewing with the Staff”) written by the expert staff reviewer.
Submitted pieces vary in length, depth, and initial quality, and needs for editorial coaching vary widely. Each mentoring experience entails a series of e-mails exchanged among learner–author, internal editor, and staff reviewer. Editors and staff reviewers provide learner–authors with individualized feedback during each round of reviews via tracked changes. Sometimes multiple sets of revisions and rewrites are required to ensure that the final product meets the expectations of internal editors before it can be sent to the expert staff reviewer. Internal editors aim to ensure not only the quality of the written piece but also that the time and knowledge of the staff reviewers are used effectively. All suggested revisions are reviewed and accepted by the learner–author who, alongside the editor and expert staff reviewer, plays an active role in preparing the draft for expert review and publication. Should disagreements occur, the editorial team and learner–authors resolve them through discussion and consensus building. Formatting is customizable to the needs of the individual articles and aligns with content delivery needs.
The identities of the internal editor and the expert staff reviewer are fully disclosed, and informal discussion is encouraged. A sense of collaboration and accountability develops between the learner–author and editing team members as they build rapport with one another.
We developed and piloted coached peer review in July 2014, and fully implemented it in August 2014. Between July 2014 and March 2015, 10 learner–authors authored 24 articles for our academic blog. Fifteen physicians participated as expert staff reviewers. We recruited the staff reviewers through online searches and our own professional networks.
To assess the experience and satisfaction of learner–authors and expert staff reviewers, we conducted a mixed-methods survey of these two groups between February 16, 2015, and June 14, 2015. The study population included medical student and resident learner–authors and physician staff reviewers.
Survey questions appear in Supplemental Digital Appendix 1 at http://links.lww.com/ACADMED/A356. Three members of our editorial team (D.S., E.P., and T.C.) developed the questions and pilot tested them with the other two members (B.T., S.L.-G.). Questions focused on understanding participant demographics and contrasting the coached peer review process with the traditional peer review processes used by most medical journals and with other online educational blogs.
We e-mailed an anonymous survey link to the blog’s learner–authors and staff reviewers, offering no incentives for participation. The survey used in this Innovation Report received an exemption from the Hamilton Integrated Research Ethics Board, which deemed the survey a quality assurance project.
We made every effort to adhere to guidelines set by the Standards for Reporting Qualitative Research. Two authors (D.S. and E.P.) performed qualitative analyses of the narrative responses by identifying themes, using an interpretive descriptive approach. After each author reviewed the responses independently, we compared and discussed our findings. We resolved disagreements by consensus after consulting with a third author (T.C.).
Respondent demographics and satisfaction
Of those surveyed, 10/10 (100%) learner–authors and 12/15 (80%) staff reviewers responded. The overall feedback from learner–authors and staff reviewers was uniformly positive.
Most learner–authors (7/10; 70%) and staff reviewers (11/12; 92%) participating in the survey had been involved, either as authors or reviewers, in traditional peer review processes. Of these, 15/18 (83%) rated our coached peer review process as superior. Specifically, all seven learner–authors agreed that coached peer review was superior: 2 (29%) rated it “better,” 4 (57%) rated it “significantly better,” and 1 (14%) rated it “the best” compared with traditional peer review. Of the 11 staff reviewers, 8 (73%) rated coached peer review superior to traditional peer review: 5 of these 11 (45%) rated it as “better,” and 3 (27%) as “significantly better.”
Comparison to traditional peer review
When compared with traditional peer review, learner–authors and staff reviewers valued (1) the speed and ease of publication; (2) the friendly, collegial, and nonconfrontational review process; (3) the opportunity to improve the quality of publication instead of receiving an outright rejection; (4) the increased transparency relative to blinded peer review; and (5) the increased speed of knowledge dissemination relative to the production process of typical journals. The negative aspects of our editing process that learner–authors and external expert staff reviewers identified included (1) too many back-and-forth revisions between authors and reviewers; (2) too many reviewers/editors assigned to an author; and (3) copy-editing periods that were longer than anticipated.
Because of CanadiEM’s editorial stance (i.e., that all submissions are ultimately publishable), some learner–authors felt there were “too many back-and-forth revisions.” During our initial period (July 2014–June 2015), only one author declined to revise a post after a second round of revisions, so this perception from the learner–authors surprised us. We believe the sequential reviewing process may have contributed to the perception, held by some learner–authors and expert staff reviewers, of prolonged review. This perception may have originated from the 30% of learner–authors who did not have prior experience with traditional peer review.
Comparison to other academic blogs
When compared with peer review processes for other academic blogs, learner–authors and expert staff reviewers valued (1) an involved editing team that was invested in the final published product; (2) clearly defined editing processes; (3) improved confidence in creating the written piece with appropriate guidance; and (4) the fast response times from experienced reviewers.
The outcomes we have reported above are congruent with the coached peer review goals of promoting collegiality, collaboration, and quality improvement.
A transparent, collegial, and supportive peer review model like ours has the potential to support the development of the next generation of scholars. Our expert staff reviewers and learner–authors report strong engagement in this purposeful collaborative process. Because our staff reviewers are geographically diverse, the coached peer review may facilitate professional networking, aiding learner–authors in establishing connections outside of their institutions. Although there are differences in the process and content for publishing in traditional academic journals compared with academic blogs, we hope that our process serves as a starting point for learners as they pursue traditional peer review avenues later in their careers. We hope that their positive experiences with coached peer review will encourage them to pursue publication in traditional academic journals with increased confidence.
The time investment required to participate in coached peer review makes it challenging to implement and scale. Although we did not solicit information about barriers to participation, it is possible that the substantial investment of time required and lack of academic credit will limit growth of such editorial processes.10 We hope that the benefits of improving the accuracy and quality of academic blog posts through this process adequately justify the increased time investment required. We have found that having champions at a number of geographical locations is helpful for the sustained recruitment of learner–authors and staff reviewers—and for expediting turnaround time for reviews. Having learner–authors identify their own coaches also facilitates the process because a natural mentorship relationship may already exist. The survey had a small sample size, and as the number of participants increases, challenges that were not identified within this sample may become apparent.
Future research goals include measuring, through blog quality scores, how the credibility of CanadiEM is affected as a result of the coached peer review process. We also plan to determine the educational value of the process for learner–authors, expert staff reviewers, and readers. Measures tracking the educational value of this process may include evaluation of the level of coaching required by returning learner–authors on subsequent submissions.
We hope to encourage the adoption of our coached peer review process by other academic blogs. We believe this will improve the credibility of online educational resources and provide additional outlets for the development of learners’ academic writing skills. We hope to determine—once better methods for measuring the quality of blog-based medical education resources are available—whether the coached peer review results in higher-quality resources than nonreviewed content. We will also explore the adoption of certain aspects of coached peer review in traditional peer-reviewed journals. Finally, we may be able to track our cohort of learner–authors and compare them with their peers to see if they were more likely to become prolific in their academic writing.
In sum, innovations in editing processes in the digital world, such as CanadiEM’s coached peer review process, can contribute to upholding rigorous academic standards while also facilitating learner engagement and comfort in the academic publication process.