Peer Review by Early Career Psychiatrists: An Opportunity for Development

Peer Review by Early Career Psychiatrists: An Opportunity for Development

Anne F. Gross, MD; Ilse R. Wiechers, MD, MPP; and Theodore A. Stern, MD

Dr Stern is Editor in Chief of Psychosomatics

Have you ever wondered what peer review is and why it is important? The following discussion will explain the peer review process, elaborate on the steps necessary for writing an effective review, and explore the reasons why early career psychiatrists should take part in this process.

Early career psychiatrists are often asked to serve as peer reviewers for psychiatric journals. When this invitation is received, the psychiatrist might not know what peer review is or why serving as a reviewer is important. Peer review is a process that helps to determine the originality, validity, and significance of an academic article. The process usually involves the participation of 2 to 4 experts (eg, editorial board members, authors of articles on related subjects, and coworkers of experts). Peer review is essential to academic medicine; it helps to ensure scientific rigor and avoidance of bias. Although the review time for journals varies, a rapid turnaround makes it more likely that important results get into print in a timely fashion.

As the early career psychiatrist embarks on the process of peer review, it is crucial to know the steps necessary for an effective review, specifically what questions the editor wants answered and why. Questions often posed by the editors include, Was the abstract useful? To answer this question, the reviewer should note if the abstract was substantive, structured, and brief. Typically, an abstract provides headers that include background (addressing what is known about the subject and why the study was completed), objectives (telling what the authors hoped to learn), methods (explaining how the study was conducted), results (stating what was found), and conclusions (summarizing the findings and providing implications for practice).

Additional questions for the reviewer include, Was the purpose of the article stated succinctly? Was the hypothesis clear? The reviewer should also comment on whether the authors provided a context for their work (eg, the prevalence and severity of the problem in question, with a brief introduction of prior research and identification of conflicting views).

The reviewer should also comment on the appropriateness of the methods. A good review will comment on how the study was completed (eg, Did the authors describe the study design [prospective, retrospective, controlled]? How were subjects recruited [consecutive, randomized, selected]? What were characteristics of the sample? What were the inclusion and exclusion criteria? What was the study setting? What variables and instruments were used? Were institutional review board [IRB] approval and informed consent obtained?)

A thoughtful discussion of the "Results" and the "Conclusions" sections of the article should follow, reporting on whether the results are clearly stated and whether the discussion is informative and comprehensive. It is useful for the reviewer to answer questions, such as, Did the authors agree or disagree with prior investigators? Were the strengths and limitations of the study presented? Were the clinical implications of the study discussed? In addition, the reviewer must determine if the conclusions were valid or went beyond the results provided, if the findings were new or merely replicated those of other studies, if the bibliography was relevant and current, if the proper citation and reference style for the journal was used, and if the article was appropriate for the journal. If the opinions of a statistician are necessary, this should be stated. If a literature review was submitted, covering the following questions is helpful: Did the authors introduce the topic, provide relevant history of the subject, critically review the literature (help the readers understand how past work can be understood in the present context), discuss a differential diagnosis, review the pathophysiology, present the significant findings and treatment alternatives, and summarize the key points? Finally, the peer reviewer must recommend acceptance, revision, or rejection of the article and suggest improvements or an alternative journal for subsequent submission of the manuscript.

Some editors will pose the above questions in a checklist, which allows the reviewer to respond with simple yes/no answers. While the above elements are important for the review process, they are not sufficient for an effective review. Unless the author is provided with both general and specific comments, he or she will not know how to revise the paper. For example, noting that the "Methods" section was flawed but failing to provide specific comments is unhelpful to the author. However, if the reviewer writes, "No mention was made about IRB approval," the author can respond, eg, "IRB approval was obtained" or "was waived." Examples of helpful general comments include statements about a passive writing style, use of interesting language, use of abundant qualifying statements, and grammatical errors. Specific comments that can be addressed to the editor or to the author are also encouraged. Numbering each point makes it easier for the author to provide responses to the editor. Peer reviewers should avoid making hostile comments and instead focus on providing constructive feedback.

Before the early career psychiatrist agrees to participate in the peer review process, he or she might wonder: What is in this for me? Involvement in the peer review process facilitates skills in editing, reviewing, and writing, and it helps to establish a national reputation for the developing psychiatrist. The peer review process can also provide the novice reviewer with a sense of accomplishment, knowing that one has contributed to a scholarly work.

Fledgling psychiatrists engaged in the peer review process also have the opportunity to learn from senior clinicians, to see what experts want included in journals, and to learn how successful writers and investigators pose academic questions and discuss topics thoughtfully. Through the mentorship that surrounds the peer review process, mentees obtain exposure to academic organizations, which puts them in touch with "thought leaders" across the country. Junior reviewers are encouraged to go over their reviews with the mentor and/or the editor of the journal, thus receiving feedback on their review and further improving their skill.

Although peer review may offer a challenge to the early career psychiatrist, it also offers many rewards, such as development of writing and editing skills, enhancement of scholarly works, satisfaction, and exposure to academic medicine on a national level.

Author affiliations: Massachusetts General Hospital, Department of Psychiatry, Boston. Financial disclosure: Dr Stern is employed by the Academy of Psychosomatic Medicine as editor of Psychosomatics, is a consultant for Eli Lilly and Janssen, has received honoraria from The British Medical Journal, serves on the speaker/advisory board of Reed Elsevier, is a stock shareholder in WiFi Med, and receives royalties from Mosby/Elsevier and McGraw Hill. Drs Gross and Wiechers report no relevant financial or other relationships. Funding/support: None reported. Corresponding author: Theodore A. Stern, MD, Department of Psychiatry, Massachusetts General Hospital, Warren 605, 55 Fruit Street, Boston, MA 02114 ([email protected]).

doi:10.4088/JCP.09com05635whi

© Copyright 2009 Physicians Postgraduate Press, Inc.