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“This Manuscript Was a Complete Waste of Time”

Reviewer Etiquette Matters

Durning, Steven J., MD, PhD; Sklar, David P., MD; Driessen, Eric W., PhD; Maggio, Lauren A., PhD

doi: 10.1097/ACM.0000000000002697
From the Editor
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Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Editor-in-chief, Academic Medicine.

Maastricht University, Maastricht, the Netherlands.

Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Disclaimer: The views expressed in this article are those of the authors and do not necessarily represent the views of the Uniformed Services University, the Department of Defense, or other federal agencies.

Editor’s Note: The opinions expressed in this editorial do not necessarily reflect the opinions of the AAMC or its members.

The peer review of manuscripts submitted to journals is a form of high-stakes assessment. The acceptance or rejection of a manuscript can have major consequences for a researcher’s career and emotional well-being.1,2 Thus, journal editors are committed to continual improvement of the peer review process and dedicate significant time and effort to assist peer reviewers.3–5 Many authors, however, have experienced the sting of a negative peer review report, especially if reviewer comments contain little nuance, are crudely phrased, or take aim at the researcher as a person. When the reviewers’ comments to authors contain overly critical or personally disparaging language, those effects can be magnified. Finding the right balance between useful feedback and overly critical comments can be difficult, and in our own experience as authors, PhD supervisors, and journal editors, we have observed that negative comments can cross the line at times.

Editors depend on the honest assessment of manuscripts by expert reviewers, and sometimes such assessments are negative. In this editorial, we address reviewer comments that are more harshly phrased than needed—that is, they lack etiquette. Instead, we offer recommendations for writing constructive reviews that inform the authors about the quality of their work and offer directions for improvement.

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When Criticism Is Not Constructive

Harsh comments from reviewers can be damaging to individual authors and to the field of health professions education (HPE) for a variety of reasons. First, such comments provoke strong emotional reactions and can be very upsetting to receive, regardless of whether one is new to the field or is an established researcher. Second, overly harsh reviewer comments are often not constructive and provide little guidance on how to improve the manuscript. Effective feedback provides directions for improvements. Third, after receiving harsh reviewer comments from a journal, authors may choose not to submit to the journal again nor to serve as one of its peer reviewers. Fourth, less experienced researchers may think that one negative experience is indicative of the entire process of peer review in HPE and replicate harsh review practices in their own work. Finally, peer review comments that lack etiquette could be so discouraging to authors that they abandon a potentially publishable article or even choose to stop conducting research in HPE.

We have little empirical data about the prevalence in HPE of reviewer comments that lack etiquette, but as journal editors, PhD supervisors, and authors we sometimes experience peer reviewer comments that are out of alignment with the guidelines of effective feedback. For example, below are a handful of harsh comments we have received from peer reviewers of our own work.

This work is poorly written and ill conceived.

This study was a complete waste of time and resources. Why would anyone investigate this?

I don’t understand why this work was conducted. This manuscript was a complete waste of time.

This manuscript is inadequate. It is not scholarly.

I know this study team and it’s surprising that they have submitted a paper that is so poorly put together—it reads like a draft.

Why do scholars who are often familiar with the principles of effective feedback write reviews that do not meet these principles? Time pressure could play a role. Reviewing a manuscript, which on average takes five hours,6 often occurs on top of the responsibilities of an HPE scholar’s already-busy university and service life. If a manuscript appears to have major flaws, the busy reviewer may be resentful about using his or her limited time to review it.

Another possibility is the expertise phenomenon. Experienced scholars sometimes forget that authors who are new in the field lack the knowledge that those with more experience have accumulated over time. This can cause misunderstanding or irritation about omissions in manuscripts submitted for review. HPE is a multidisciplinary field, and some of the submissions to HPE journals come from authors with a different scholarly tradition. The “problems” with these submissions may simply reflect the different traditions.

We suspect that some harsh reviewer comments are a result of the idea that harsh reviewing is part of scientific culture: the peer reviewer as the guardian of sound scientific research. Harsh comments could represent a spirited defense of scientific ideals that appear to be under attack. Finally, another possible explanation is that harsh reviewing reflects current culture more broadly, where disagreements become a battle for superiority rather than a quest to find true scientific answers. The ease and ubiquity with which users can write reviews of books on Amazon or restaurants on Yelp—with little or no parameters for providing feedback—may reinforce review practices that lack etiquette.

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Recommendations for Writing Constructive Peer Reviews

Although we hope that overly critical reviewer comments are already rare in HPE scholarship, we would like to eliminate them altogether by encouraging our community to find the right balance between useful, constructive criticism and abusive language. Thus, we offer the following recommendations that we hope will be helpful.

  1. Recognize that a main purpose of your review is to help authors improve the quality of their manuscript.3 Consider setting a constructive tone by summarizing the key points of the paper and its strengths at the outset of your review. We believe that a reviewer can seriously challenge the science of a paper without using belittling language to do so.
  2. Ensure that your review continues to challenge the substance of the authors’ ideas through specific and directed feedback intended to improve the quality of the manuscript. To achieve this, your feedback should be specific and contain clear suggestions for improvement. Use the principles of effective feedback when writing your review. A number of resources exist to assist with providing feedback.7
  3. Use the confidential comments field judiciously. Typically, journals provide an opportunity to convey comments to the editor that the author will never see. This is a place where you can provide frank comments that would not necessarily help the author improve the work but might help the editor decide whether to publish the submission.
  4. Put aside your review for one day and re-read it before submitting it to make sure you can support the language you have used. Sometimes temporary experiences or emotions can influence the tone of reviewer comments. Taking a break from the review and reading it with fresh eyes later can help you identify and remove unnecessary or inappropriate comments.
  5. Share your review with one or more colleagues before submitting it to the journal. Asking for feedback on your own work can help you understand how a review might be received, especially if you are in doubt.
  6. Organize a community of peer reviewers for manuscripts in your department or institute. Review each other’s work prior to submitting it to journals, and mentor junior reviewers. We recognize that the problem with harsh reviewer comments is not limited to one group; however, faculty development efforts targeted at junior faculty could be particularly helpful because these scholars may lack experience in writing HPE reviews. We have found that the exercise of group peer review sometimes identifies overly harsh comments or language and helps reviewers understand how to correct them.
  7. Review the scientific work of others using the same care and effort that you appreciated from the peer reviewers of your own work. Reflect on peer review comments you have previously received. Consider which reviewer comments have been most helpful to improving your work, and aim to emulate these.

Peer reviewers need not shoulder the total responsibility for eliminating harsh review comments in HPE. Editors can assist reviewers in several ways. They can carefully read reviews and judiciously edit those that lack etiquette by eliminating harsh words. They can then provide feedback to the reviewer to let him or her know what changes have been made and why. If the reviewer continues to write reviews that lack etiquette, the editor can decide to remove the reviewer from the journal’s reviewer pool. Even before the review process begins, editors can make sure that those submissions sent for peer review are high quality and have a real possibility of acceptance. This approach shows respect for reviewers and their time. Finally, some journals and some reviewers are exploring the possibility of “unblinding” the peer review process by requiring reviewers to be identifiable to authors. Although such a move might cause reviewers to think twice about using harsh language, it might also inhibit frank and honest reviews if reviewers feel vulnerable to potential retaliation by signing their reviews.

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Concluding Remarks

Peer reviewers should carefully consider the language they use in their reviews and the impact of their words on authors. We are asking reviewers to be thoughtful with their word choice, writing reviews in a way that will enable authors to improve the quality of their manuscripts without feeling belittled. We also believe that the scholarship of peer review is an important area for future investigation. Specifically, future research should rigorously explore the impact of interventions to address reviews that lack etiquette.

Steven J. Durning, MD, PhD

Uniformed Services University of the Health Sciences, Bethesda, Maryland.

David P. Sklar, MD

Editor-in-chief, Academic Medicine.

Eric W. Driessen, PhD

Maastricht University, Maastricht, the Netherlands.

Lauren A. Maggio, PhD

Uniformed Services University of the Health Sciences, Bethesda, Maryland.

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References

1. Horn SA. The social and psychological costs of peer review: Stress and coping with manuscript rejection. J Manag Inq. 2016;25:11–26.
2. Day NE. The silent majority: Manuscript rejection and its impact on scholars. Acad Manag Learn Educ. 2011;10:704–718.
3. Durning SJ, Carline JD. Review Criteria for Research Manuscripts. 2015.2nd ed. Washington, DC: Association of American Medical Colleges.
4. Azer SA, Ramani S, Peterson R. Becoming a peer reviewer to medical education journals. Med Teach. 2012;34:698–704.
5. Eva KW. The reviewer is always right: Peer review of research in medical education. Med Educ. 2009;43:2–4.
6. Ware M. Peer review in scholarly journals: Perspective of the scholarly community—Results from an international study. Inf Serv Use. 2008;28:109–112.
7. Lefroy J, Watling C, Teunissen PW, Brand P. Guidelines: The do’s, don’ts and don’t knows of feedback for clinical education. Perspect Med Educ. 2015;4:284–299.
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