How a journal handles a submitted manuscript
Between submission and decision a manuscript is in the journal's hands: the editorial office screens it, the editor chooses reviewers who assess it, and the editor decides what becomes of it. The journal's instructions say in advance who will review and how final the decision is, and authors and reviewers meet all of it through the journal's submission system.
From submission to decision
A manuscript is published when the author has submitted it for consideration, an editor invites its publication and the author accepts. Along the way come peer review, editing changes and sometimes a major revision or two, and after the negotiated changes the author and the editor must both say yes.
The usual steps in submission and peer review at a medical journal run in this order:
- The author submits the manuscript.
- The editorial office carries out quality checks.
- A staff editor is assigned to the manuscript.
- The staff editor assigns referees.
- The referees review the manuscript.
- The staff editor makes a recommendation to the executive editor.
- The executive editor decides whether the manuscript is to be published.
- The author is told the decision.
The author establishes an identity on the journal's manuscript tracking system and sends the manuscript online, where it is assigned an identification number. The author may also be asked for additional data, such as release forms or the identity of an archival author, who will be responsible for maintaining the study's records.
The editor and the author
Author and editor have compatible goals and need one another: the author wants the work in print as soon as possible, and the editor needs high-quality articles for publication, in most cases each month. The editor stands between the author and the reviewers, so must be able to deal with authors who are disappointed or angry; with other authors the problem is that they are tardy or sloppy, and a good editor can handle all of these problems with tact and grace. Editors, like peer reviewers, must be honest, ethical, unbiased, responsible and detail-oriented. They must also be literate, knowledgeable and compulsive about deadlines, since most journals must be published every month and some more often. The editor is the author's contact during the publication process, so it is important to establish a good working relationship early.
The editor's initial screen
Once the manuscript is in, the editor or an assistant editor looks it over quickly to see whether it merits peer review. It moves on to peer review only if the editor believes it suitable for the journal in both subject matter and quality. One editor looks first at the title, the abstract, the tables and the figures, then asks what holes the manuscript fills, or what is unusual about the case.
A manuscript outside the journal's field or carelessly prepared, or one the editor finds libelous, blasphemous, hopelessly incomprehensible or totally irrational, is returned at once as not appropriate for consideration. This summary dismissal is called a desk rejection. Editors, who are prominent scientists or clinicians, read and reject roughly 20% to 60% of submitted manuscripts at this stage. The author hears this first decision relatively quickly. A desk rejection usually comes within three days to two weeks.
The editor's initial screen and peer review test different things. The initial screen covers the journal's scope and the type of article, adherence to the journal's guidelines, readiness and readability for peer review, and compliance with ethical guidelines. It is also a gatekeeping judgement about novelty and likely citation: editors may estimate an article's likelihood of being cited at least as often as their average article, often try to raise the impact factor each year by publishing prestigious research by prominent authors, and may balance the number of manuscripts sent for review on a topic so that each issue carries a variety. At this stage editors also choose and contact the reviewers. Peer review then tests scientific accuracy, novelty and timeliness, and scientific and clinical rigour: the rationale and significance, the completeness of the methods, the rigour of the experimental design and the appropriateness of the analyses, the clarity of the results, fair balance in the discussion and support for the conclusions. It returns comments and questions that guide the authors in improving the manuscript.
Peer review
Peer review is the process by which other experts critically review the work. One journal's assistant editor writes that its editors would love to receive manuscripts that are perfect when first submitted, but such papers rarely exist, and that the peer-review system is intended to select the most worthwhile papers and nudge them toward that elusive perfection. Having the work professionally scrutinised by other experts, and judged by them an accurate representation of the subject, is in the author's interest, and it can be an added safety precaution when the work gives clinicians guidance on treatment, particularly where it discusses specific drug doses and dosing frequencies. The peer-review system used today was devised in 1665 by the founding editor of the Philosophical Transactions of the Royal Society in London. The process has changed little in decades.
Choosing the reviewers
A manuscript that survives the screen goes to referees the editor selects, at least two and most often three. The editor sends the title and abstract to several potential reviewers and perhaps a statistician, and some of them decline. The editor's choice of reviewers is probably more intuitive than scientific. The editor may not be an expert in the author's field and has to do some research to find people with suitable knowledge and expertise. Some editors appreciate suggestions for suitable reviewers, which may matter particularly for a textbook or a book chapter.
Editors choose as reviewers well-recognised authors of high-quality articles with sufficient expertise in the therapeutic area or field. Reviewers may be assistant to full professors, researchers, clinicians, policymakers and sometimes industrial scientists. Many are senior academicians and investigators, and all are volunteers.
How the review is conducted
Review may be completely open, single-blind or double-blind: in single-blind review the authors are not told the reviewers' names, and in double-blind review neither side is told the other's. In most cases, but not all, the paper the reviewers receive does not carry the author's name, which goes only on the title page, and the title page is generally not sent to the reviewers. Even when the names of authors and institutions are absent, a reviewer working actively in the field can often deduce the source from the topic, the methods and even the writing style.
Each referee prepares a report that usually has two parts, one for the editor only and one for the authors. A volunteer reviewer spends five hours on average reading and critiquing a manuscript and writing the review. A reviewer with a concern about ethical behaviour sends a confidential note to the editor, who can take it up with the corresponding author and, if necessary, contact the author's institution.
How long review takes
Reviewers are often given 10 to 21 days. Peer review can last months, depending on how many reviewers were selected and what their own schedules are like. If no decision has come within a reasonable time, such as 6 to 8 weeks from submission, it is a good idea to contact the journal. Some journals let authors track a manuscript's status, as the New England Journal of Medicine does through the author dashboard of its manuscript system.
The editor's decision
Peer review is one more point at which a manuscript may be rejected or accepted. When all the reviews are in, the editor makes the decision and lets the author know. The editor makes the final decision, based on the recommendations of the peer reviewers or of any editorial board the journal may also have. The decision rests strongly on the peer reviewers' recommendations, but it is not a vote: editors are paid to make judgements, and they make the final call. The editor weighs the reviewers' comments for the authors, their confidential comments for the editor and their recommended outcomes, and decides on immediate acceptance, an opportunity to resubmit after minor or major revisions, or rejection, sending the decision to the corresponding author in a decision letter. Immediate acceptance is very rare. Manuscripts are seldom accepted without any requested changes, and an editor will rarely publish one exactly as it was submitted.
After accepting the work, an editor usually asks the authors to revise it, perhaps in response to the reviewers' suggestions, and may offer to publish it in a different format, such as a considerably shorter article, a letter to the editor or a brief report. When authors revise in response to a decision letter, the editor examines their responses and the revised manuscript to judge whether they address the editor's and the reviewers' issues, and may send a major revision back to the same reviewers, before sending a decision letter of acceptance or rejection.
What journals require of review
From 2007 to 2009 the AMWA Journal's instructions for contributors stated that manuscripts were reviewed by the editor and at least two additional reviewers and that the editor's decisions were final.
In 2007 a conference panelist reported that many top-tier journals, Archives of Physical Medicine and Rehabilitation among them, were requiring an external statistician, even one paid by the author of the article, to review industry-sponsored research, and would not otherwise publish the manuscript.
The submission system from the users' side
Timeliness is a marketable product in publishing: authors want their manuscripts reviewed and published as quickly as possible, readers want the most up-to-date information, and journals want to attract highly skilled and experienced authors. Fluidity and ease of use in a journal's submission and review processes help it recruit and retain authors and reviewers.
Mayo Clinic Proceedings moved its manuscript registry and review from paper to a commercial web system in January 2005. The change greatly improved staff productivity and effectiveness, but how authors and reviewers perceived it remained largely unknown. In 2009 the journal surveyed the 1,688 people with active accounts in the system, and 462 (27%) completed the survey. Of the 462 respondents, 37% were primary authors, 31% coauthors, 82% reviewers and 6% editorial board members, so many held at least two roles. The journal concluded that, in the selected aspects the survey investigated, its authors and reviewers were in general highly satisfied with the web-based submission and review processes and with the services they received through the system. Navigating the system and accessing records was easy for 94% (374 of 400), and 99% (396 of 402) found the tasks required of each role clearly represented. The number and frequency of email reminders were adequate for 96% and 95% respectively.
Of 411 respondents, 72% said they did not routinely access the user instructions and tutorials available within the system. The system is designed to perform every task for every user's role from submission to publication, but from the user's side the process is more complex than the paper one it replaced. Difficulty with it may come from unfamiliarity with the basic principles or processes for performing these tasks. Because 72% did not routinely use the instructions and tutorials despite the potential for frustration, it appeared to the editorial office that it could do a better job of communicating the value of the system's resources to users who run into problems.
The journal's decision letters carried a "quality review" section in which editorial-office staff gave recommendations to help authors address formatting and information deficiencies that would hinder final acceptance and publication. Of 194 respondents, 188 (97%) found those items helpful when revising a submission and 6 found them unhelpful. Respondents rated turnaround times similar to those of other journals they had published with, and 32% (66 of 205) called them better. As authors, they generally judged the journal's reviewer comments better than those of other journals.
The journal concluded from its survey that the right tool helps a task get done on time and efficiently, but the human element and common courtesy in dealing with authors, reviewers and editorial board members remain extremely important.