Peer reviewer trainingpart I:
What do we know about peer review?
Dr Trish GrovesDeputy editor, BMJ
What do editors want from papers?
• Importance• Originality• Relevance to readers• Usefulness to readers and, ultimately, to
patients• Truth• Excitement/ “wow” factor• Clear and engaging writing
Peer review
• As many processes as journals or grant giving bodies
• No operational definition--usually implies “external review”
• Largely unstudied till 1990s
• Benefits through improving what’s published rather than sorting wheat from chaff
What is peer review?
• Review by peers
• Includes: internal review (by editorial staff) external review (by experts in the field)
BMJ papers
• All manuscripts handled by our online editorial office at http://submit.bmj.com
• The website uses a system called Benchpress
• Reviewers recruited by invitation, through volunteering, and by authors’ suggestions
• Database also includes all authors
• We monitor reviewers’ workload for BMJ
• We rate reviewers’ reports using a 3 point scale
BMJ peer review process I
• 7000 research papers, 7% accepted
• approximate numbers at each stage:– 1000 rejected by one editor within 48 hours
– further 3000 rejected with second editor
– within one week of submission 3000 read by senior editor; further 1500 rejected
– 1500 sent to two reviewers; then 500 more rejected
– approx 1000 screened by clinical epidemiology editor and more rejected
BMJ peer review process II
• 400-500 to weekly manuscript meeting attended by the Editor, an external editorial adviser (a specialist or primary care doctor) and a statistician..
• …and the full team of BMJ research editors, plus the BMJ clinical epidemiology editor
• 350 research articles accepted, usually after revision
• value added by commissioned editorials and commentaries
BMJ peer review process III
• always willing to consider first appeals--but must revise the paper, respond to criticisms, not just say subject’s important
• perhaps 20% accepted on appeal• no second appeals; always ends in tears;
plenty of other journals
What we know aboutpeer review
Research evidence
Peer review processes
• “Stand at the top of the stairs with a pile of papers and throw them down the stairs. Those that reach the bottom are published.”
• “Sort the papers into two piles: those to be published and those to be rejected. Then swap them over.”
Some problems
• Means different things at different journals • Slow• Expensive• Subjective• Biased • Open to abuse • Poor at detecting errors• Almost useless at detecting fraud
Is peer review reliable?(How often do two reviewers agree?)
NEJM (Ingelfinger F 1974)• Rates of agreement only “moderately better than chance”
(Kappa = 0.26)• Agreement greater for rejection than acceptance
Grant review • Cole et al, 1981 – real vs sham panel, agreed on 75% of
decisions• Hodgson C, 1997 – two real panels reviewing the same
grants, 73% agreement
Are two reviewers enough?• Fletcher and Fletcher 1999 - need at least six reviewers,
all favouring rejection or acceptance, to yield a stats significant conclusion (p<0.05)
Should we mind if reviewers don’t agree?
• Very high reliability might mean that all reviewers think the same
• Reviewers may be chosen for differing positions or areas of expertise
• Peer review decisions are like diagnostic tests: false positives and false negatives are inevitable (Kassirer and Campion, 1994)
• Larger journals ask reviewers to advise on publication, not to decide
Bias
Author-related• Prestige (author/institution)• Gender• Where they live and work
Paper-related• Positive results• English language
Prestigious institution bias
Peters and Ceci, 1982
Resubmitted 12 altered articles to psychology journals that had already published them
Changed:• title/abstract/introduction - only slightly• authors’ names• name of institution, from prestigious to unknown
fictitious name (eg. “Tri-Valley Center for Human Potential”)
Peters and Ceci - results
• Three articles recognised as resubmissions
• One accepted
• Eight rejected (all because of poor study design, inadequate statistical analysis, or poor quality: none on grounds of lack of originality)
How easy is it to hide authors’ identity?
• Not easy
• In RCTs of blinded peer review, reviewers correctly identified author or institution in 24-50% of cases
Reviewers identified (open review) – results of RCTs
Asking reviewers to sign their reportsin RCTs made no difference to the qualityof reviews or recommendations made
• Godlee et al, 1998• van Rooyen et al, 1998• van Rooyen et al ,1999
Open review on the web
Various experiments and evaluations are underway…
What makes a good reviewer? – results of RCTs
• Aged under 40
• Good institution
• Methodological training (statistics & epidemiology)
What might improve the quality of reviews?
• Reward/credit/acknowledgement?
• Careful selection?
• Training?
• Greater accountability (open review on web)?
• Interaction between author and reviewer (real time open review)?
