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How to Do a Peer Review: Part Two

by Sarina Schrager, MD, MS, Family Medicine Editor-in-Chief, and Jose Rodriguez, MD, FAAFP

The Title 
The title of a manuscript is the first area that we expect reviewers to evaluate.  Many people use catchy titles to capture readers’ attention in their papers.  However, because many readers only look at the title when deciding whether to read a paper, we suggest that the title should describe the paper’s content and, if applicable, the study’s results.  For example, if a paper uses medical student focus groups to evaluate a lecture, that is what the title should say. If the curriculum is about social media, the title could be something like “Follow me,” which doesn’t really describe what the paper discusses but is somewhat catchy.  So, you could suggest, “Follow me: an evaluation of an undergraduate course about social media.” Or, “Follow me: medical student focus groups rate social media course.” You can also comment if the title is too long.  Many people like to use colons in their titles, but if the title is too long, it is easy to lose track of what it says. The title is often the only part of the paper that is read. If it doesn’t catch the reader’s attention, they won’t look up the abstract. When possible, highlight the main finding in the title.  Instead of “An evaluation of a novel teaching method,” you could say, “Novel teaching method associated with higher resident satisfaction” or something like that.

Abstract  
If the title is catchy or describes a topic that the reader is interested in, they will go on to the abstract.  For many people, the abstract is the only thing they read. So, an abstract must be clear, well-written, and accurately describe what the paper is going to say. Abstracts, by their nature, are short, usually 150-250 words, and are structured with four sections:  background/objectives, methods, results, and discussion.  A strong abstract makes a brief case for the gap this study aims to fill, then describes how the authors addressed the research question.  We want reviewers to comment on whether the abstract is well written, clear, and accurately describes the study. We also want reviewers to let us know if the main findings are captured in the abstract.

Introduction
Often, when you are chosen as a reviewer, you are a content expert and know the literature on a given topic.  In that case, you will know if an author leaves out essential papers.   It is common for authors to write introductions that are too long because they don’t want to leave anything out.  It is your job as a reviewer to evaluate whether important background articles are included, but the author doesn’t make any detours (i.e., start talking about a peripheral topic).  Writing experts coach authors to start broad in the introduction and narrow the focus, so that the last sentence presents the paper’s research aims and explains how it fills a gap in the literature.  As a rule, the introduction should be about the same length as the other sections of the paper. An excellent guide to writing introductions is this paper by HG Welch: https://cancer.dartmouth.edu/sites/default/files/2019-05/papertrail.pdf. When new authors struggle with writing the introduction, we will often refer them to this paper. Essentially, it outlines how to write a three-paragraph introduction using the questions:

1. What is the global problem?
2. What is the specific issue?
3. How does this paper help?

Methods 
The methods section of a research paper should clearly describe the “how” of the study.  What did the researchers do?  We want enough detail so that someone at a different institution could replicate the study if needed.  If you did pre- and post-evaluations of an educational intervention, what questions did you use, when did you administer the surveys, etc.?  Reviewers want to see a statistical assessment and a justification for the researchers’ choice of statistical methodology.   Reviewers do not want to see any results in the methods section.  Does the methodology of this study make sense to answer the stated research question? Is the methodology based on any theoretical models?  The methods section must describe how the authors got the information that will be shared later in the results section of the paper. Everything in the methods section should map out well to the results section. If the authors do not say how they got the data in this section, they should not report it in the next section. This is also true for the abstract.

A note about statistics: most reviewers will not be expert statisticians (the editors may choose a reviewer who is if the paper needs it).   Most quantitative studies will include basic statistics.  If the authors use some statistical test that you have never heard of, they will need to explain why in the methods section.  All methods sections should have a detailed description of how the data was analyzed (whether quantitative or qualitative).

Results
While the methods section describes what you did, the results section describes what you found.  One common mistake that reviewers often see is the lack of specifics around surveys.  How many people received the survey?  How many people responded?  What is the response rate?  Do you know anything about the people who didn’t respond  (i.e. demographics)?  Findings from the research should be described either in text (in the results section) or in a table.  Some people use the text in the results section to give a high-level overview of the results and highlight key findings, then put the actual data into a table.  Tables traditionally do not count toward a word limit, so they are a great way to add more content without using many words. Reviewers should comment on whether the methods described can produce the results reported. Look for areas where the results are not reflected in the methods and vice versa. The Welch article listed above can be very helpful in crafting methods and results sections as well.

Make sure to read Part 3 of this blog series where we will discuss what to look for in the discussion section, in tables and figures, and in references.

How to Do a Peer Review: Part One

by Sarina Schrager, MD, MS, Family Medicine Editor-in-Chief and by Jose Rodriguez, MD, FAAFP

As journal editors, we fundamentally believe in peer reviewing. Peer review helps make published papers higher quality. Objective experts and peers often see areas in a manuscript and research study that the authors and editors did not elucidate. Journals in general (and Family Medicine specifically) have a hard time finding peer reviewers. Doing a peer review takes time, is unpaid, and often feels like one more thing for already overwhelmed faculty. On behalf of the editorial team of Family Medicine, we are writing a series of blog posts about why we think you should sign up to be a peer reviewer (Family Medicine), how your expertise can contribute to the mission of the journal, and step-by-step instructions on how to construct a valuable peer review.

Why Was I Asked to Do This Review?
We often hear from early-career faculty that they don’t feel qualified to conduct peer reviews because they aren’t “experts.” Our Associate Editors aim to include a diversity of viewpoints in each manuscript. So, they may ask an expert to comment on the methodology or the statistics. But we also want input from our readers. Yes, you may not be a content area expert, but if you are a reader of the journal, your opinion is valuable. If you didn’t understand some of the paper, then other readers may also not understand. You should feel empowered to include comments to the editor about which aspects of the paper you feel qualified to comment on. I will often state, “I am not a statistician, but the numbers do not make sense to me.” If it doesn’t make sense to you, it may not make sense to others, so we want to know!

Getting Started
If you do not know where to start, go to the reviewer page on the journal’s website. There is a lot of material about how to do a peer review. Alternatively, you can ask a senior colleague or mentor for help. If you feel comfortable doing the review, then the first step is to read the paper. Most people recommend reading the paper through to the end the first time and not getting bogged down with comments or questions.

The first questions to ask yourself after you read the paper the first time are: 

1. Did this make sense?

2. Does it add to the field?

3. Does it matter?

4. Is it written well?

Often, we don’t notice if a paper is written well, but we do see if it is written in an unclear manner or if there are typos or grammatical errors. Those errors, while easily corrected, usually signal that the manuscript needs more work.

The Second Time Through  
After you have done a full read of the paper and answered some general questions to yourself, it is time to reread it. This time, when you read it, we want you to focus on all the details. We want reviewers to pay attention to the details of every section of the paper. The following two blogs will go section by section with descriptions of what to look for and how to provide feedback.

How to Organize Your Review
This is a matter of personal preference. Some reviewers organize their reviews by section. So, they start the review with comments on the title and continue with comments on the abstract, the introduction, the methods, the results, the discussion, the tables, the conclusion, and the references. Other reviewers prefer a more “free form” review, using bullet points or a numbered list to capture all the comments for each section. But, bottom line, we want reviewers to carefully assess all these sections of the paper. As editors, we must see in your review that you read the paper. A one-sentence review that is general, like “this was a great paper” or “this paper is not acceptable,” without comments on each section or other specific evaluative statements, is not helpful in the evaluation of a paper.

Tone and Goal of the Review
The overall goal of any peer review is to make the paper better. As such, we ask that you frame your feedback in a constructive manner and avoid disparaging comments. SS once had a reviewer say, “if the authors had only read the literature, they wouldn’t have made this mistake.” A better way of phrasing that same sentiment would be, “I suggest that the authors review these papers to get a different perspective on the subject.” These two phrases say essentially the same thing, but one is much more respectful. Remember, academic family medicine is a small community. Treat the authors as if they knew it was you writing the review, and keep your comments constructive and respectful.

The next two blogs will review how to evaluate specific sections of the paper in your review.

Crafting Narratives for Publication

By Sara Shields, MD
associate editor
,
Family Medicine

You’ve had a defining clinical, teaching, or learning experience in your role as a family physician educator, clinician or student.  Someone suggests that you write about it. Here are some pearls for crafting your reflective piece in hopes of publication in a journal like Family Medicine that accepts such narrative work.

  • What story are you trying to tell? Just as with any written piece, consider first your content. What are your key themes (keeping in mind that any word limit may mean focusing on just one theme)?  Consider the readership of the journal—how would a medical student on a family medicine rotation respond to your story? How would a seasoned family medicine faculty member?
  • Avoid judgment–In general, an effective narrative piece is a personal story that shares a particular learning point, but does so without editorializing or requiring references.  How can your writing avoid judgment even as you elucidate and emphasize what you hope the reader will learn with you in your story?
  • Focus on the writing–In narratives, the “methods” of your writing enrich your themes and help them resonate for your readers.  The term “methods” refers to the craft of the writing—how are you using language to move your meaning along?  While avoiding redundancies or complicated phrasing is important, your writing may “sing” more to your readers with careful use of specific literary devices such as metaphor, alliteration, rhythm, or repetition of key words.  No matter whether you are choosing prose or poetry, remember the adage “show, don’t tell” –how can you describe people or events in ways that invoke the reader’s sensory or emotional response rather than simply stating what happened?
  • Every word matters–Especially for formats with strict word counts such as 6 word stories or 55 word essays, every word needs to move your story along. 
  • Circle back to the meaning—When looking at every word,do not lose sight of the totality of the essay.  Does this piece make sense overall?  Does it still say what you want it to say?
  • Do your homework–If your themes seem like they are common in narrative work (e.g. a physician’s experience of their own illness), you may want to look for similar pieces and think about how your story offers new angles or reflections compared to other similar work.  What can you contribute that may be new or surprising for readers?
  • Ask a friend or colleague to read your story–Consider asking someone to read your work before submitting it, to help assess both the content/themes and your storytelling style.  Do these readers resonate with your language?  Your themes?
  • You may need permission__If you describe a patient or learner scenario with enough detail, you may need to get their permission to submit your story for possible publication.
  • Don’t lose yourself–Be authentic; challenge yourself to dig deeply into both personal and professional lessons from your story.   How can you help the reader to consider multiple perspectives?

Reference: Walling A, Shapiro J, Ast T. What Makes a Good Reflective Paper? Fam Med 2012;45(1):7-12.