Acad Psychiatry 30:263-264, June 2006
doi: 10.1176/appi.ap.30.3.263
© 2006 Academic Psychiatry
A Cautionary Tale: On Becoming an "Unmasked" Reviewer
Ruth E. Levine, M.D., University of Texas Medical Branch, Department of Psychiatry, Galveston, TX
To the Editor: I was excited, and more than a little nervous, that November morning as I flew into New York. I was an invited guest at a committee of psychiatric educators. I believed no one on this committee, with the exception of my friend, the chair, had any idea who I was. But I knew nearly all of them. They were leaders in the field: deans, department chairs, officers in APA and other organizations and I had heard many of them speak at national meetings. I was honored by the invitation to join the group and anxious to make a good impression.
The first order of business, after introductions, was the review of a manuscript that the committee had prepared at previous meetings and submitted to Academic Psychiatry. The manuscript had received three reviews. Two had recommended immediate acceptance. The third and most critical review had recommended "acceptance with revisions." The task of the committee for that day would be to review the recommendations and revise the manuscript.
When I saw the review, I blanched. I had seen this manuscript before! I was the author of the critical review. I quickly scanned what I had written. Was I sufficiently respectful? Suddenly, every word became magnified in importance.
"The subject ... is an important one and the suggestions that the authors make are sound."
Thank goodness I had started with a compliment!
"... However, there is a disappointing lack of empirical grounding in their suggestions."
Why did I use the word "disappointing"? It is so subjective! I chastised myself for not having worded that better. As the review proceeded, I read the suggestions I'd made that were both helpful and irritating.
"What would have been constructive would be suggestions based on a survey ..."
Why did I recommend a survey? Developing a survey requires changing methods, a process most authors are not interested in or prepared to consider when revising a manuscript. I seldom find reviews in which my methods are criticized as helpful or constructive. I had become one of those reviewers I disliked!
Eventually, I redeemed myself with some genuinely useful suggestions.
"This article could be strengthened most easily by the addition of some concrete examples. ... For example ..."
I was relieved that I had given some practical tips for improving the manuscript, particularly when I saw the committee members eagerly discussing ways to revise the draft that were based on my advice. I was impressed with how seriously they took my suggestions. These colleagues, for whom I had so much respect and admiration, seemed to believe they were required to modify their manuscript according to my suggestions. I began to appreciate the gravity of the review.
No one could ever accuse me of having a poker face. While I was in the midst of debating with myself whether or not to reveal my "secret," a particularly perceptive colleague across the table asked, "Ruth, did you write the review?" I had to admit that I was responsible for prompting revision of the manuscript. Then, a remarkable thing happened. As the group started making changes to the paper, they kept returning to me to ask, "Ruth, what do you think? Do you suppose this will work?" I wanted to say, "Look guys, I’m not the editor of Academic Psychiatry; I was just a reviewer. I didn't even spend much time on it ... it looks really good to me now ... I’m sorry if I caused you guys any trouble." Of course, I did not voice any of those comments.
In a recent survey of peer reviewers, most acknowledged a strong desire to participate in the scholarly evaluation of manuscripts but a lack of formal training. Only 14% of respondents had received training in reviewing, though 66% said they would like such training (1). An interesting finding was that nearly three-quarters of respondents said they would be happy to sign their reviews in the interest of "transparency." Nevertheless, when this same pool of reviewers was actually given the opportunity to sign their reviews for the journal Medical Education, most rejected the opportunity. One can only speculate on the discrepancy between what these reviewers said and what they actually did. I wonder if the lack of training might have left some reviewers feeling insecure with the quality of their reviews. Others might have been concerned about the potential repercussions associated with rejecting a colleague’s manuscript.
There are several excellent resources to assist in the process of peer review (2–4). In addition, one can always call upon a journal editor to help, particularly when concerns about confidentiality preclude consultation with a colleague. Overall, what seems most important in being a good reviewer is taking the time to perform a conscientious and respectful evaluation of the manuscript. In a JAMA article entitled, "What makes a good reviewer for a medical journal?" the authors were surprised to discover that reviewer characteristics really did not make that much difference in determining the quality of a review. Those who were actively involved in research, occupied academic positions, and were members of the editorial board performed no better than those who were not. The only characteristics that proved important were having training in epidemiology or statistics and spending a longer time on the review (up to 3 hours) (5).
I’d like to think that my experience, harrowing as it was, turned out well. The committee was happy enough with my contribution to invite me to become a "full" member. And I learned a valuable lesson. Whenever reviewing a manuscript, it is instructive to imagine that one might have to sit with the authors afterward. Being mindful of the gravity of each review, and how it influences the writing of a manuscript, never can be underemphasized. Approaching a review in a thoughtful and conscientious manner and spending a reasonable amount of time on the task are essential. Keeping reviews respectful and practically useful will definitely be a high priority of mine in the future!
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REFERENCES
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- Snell L, Spencer J: Reviewers’ perceptions of the peer review process for a medical education journal. Med Educ 2005; 35(1): 90-97
- Roberts LW, Coverdale J, Edenharder K, et al: How to review a manuscript: A "down to earth approach." Acad Psychiatry 2004;28(2): 81-87
- Bordage G, Caelleigh AS: A tool for reviewers: "review criteria for research manuscripts." Acad Med 2001; 76(9): 904-908
- Bland C, Caelleigh A, Steinecke A: Reviewer’s etiquette. Acad Medicine 2001;76(9): 954-955
- Black N, Van Rooyen S, Godlee F, et al: What makes a good reviewer and a good review for a general medical journal? J Am Med Assoc 1998; 280(3): 231-233
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