The time a paper is reviewed until the moment a final decision is made is always a time of apprehension and uncertainty for the authors. Who are the people who are examining my work? Are they qualified enough? Will they understand what I have written and tried to demonstrate? And above all, will they offer constructive criticism and recommend acceptance—or at least revision—to the editor making the final decision?

It will help authors to live through these difficult weeks if they understand the review process better. After all many authors have also experienced the other side in the past as reviewers for a journal. But there is no doubt that the whole peer review process is confusing and messy.

First of all who are the so-called peers? Wikipedia defines a peer as “someone equal in such respects as age, education or social class” [1]. However, according to the Merriam–Webster dictionary peer review is “a process by which something proposed (as for research or publication) is evaluated by a group of experts in the appropriate field” [2]. Obviously there is a difference between someone equal in education and an expert in the appropriate field. Behind the mask of an anonymous reviewer, there might be a junior fellow from the same field or a senior professor.

Second although the whole peer review is structured—selection, invitation, review, and recommendation—it is still a messy process full of uncertainties. Did the editor select the right peers? Were they knowledgeable enough? Did they take enough time to fully understand the paper? Did the various reviewers come to the same conclusion?

One thing to keep in mind is that the reviewers are the first members of a hopefully large audience. If reviewers do not understand or appreciate a manuscript, it is very unlikely that the general readership of the journal will take a better view of the paper.

The selection of reviewers is the responsibility of the editor managing the submission and is of utmost importance. Sometimes authors are invited to suggest reviewers, even then there is no way for the authors of knowing whether the editor has followed the suggestion, and if so whether the suggested reviewers have given a positive review. When the editor has to select reviewers, he or she is confronted with several options: should she choose reviewers whom she knows personally or select them randomly from an anonymous database? Experienced editors tend to rely on trusted and proven reviewers—reviewers who reliably give good reviews in a timely fashion—and also aim for a balance of younger and more experienced reviewers. In an international journal, it will also make sense to choose reviewers from different geographical regions. In very small fields and particularly for basic science manuscripts, it can be difficult to find reviewers because the pool of potential experts is small.

Many authors feel that the choice of reviewers influences the eventual decision on their manuscript, and this is certainly true. Editors can be biased, and when they lean toward rejection or acceptance of a manuscript, they might subconsciously—or consciously—invite someone whom they know to share their view. Of course a good editor will always try to hold his or her own bias to a minimum but, it can never be ruled out completely.

The International Urogynecology Journal uses a single-blinded review process. This means that the reviewers know the names of the authors and where the paper comes from but the identity of the reviewers is not revealed to the authors—and also to the other reviewers. Blinding the authors to the reviewers has proven impractical since the identity of the institution and thus the names of potential authors could often be deduced from the manuscript and from references to previous work. On the other hand, it is felt that the anonymous review process gives the reviewer greater freedom in expressing her or his views and criticizing a manuscript. After all next time around, it could be one of the authors who is called to review a paper or a grant application of the reviewer.

When a reviewer accepts the invitation to review a manuscript, he or she must be sure that there is no conflict of interest with the authors of the manuscript or their institution. This could be personal or professional relationships or competing interests, but there are no strict guidelines for this kind of conflict of interest. It is the responsibility of the reviewer to decline the invitation if he or she feels that something might interfere with a balanced evaluation of the submission.

A reviewer is expected to read and evaluate the manuscript and to provide the editor with two types of comments and a recommendation as to the final disposition. The first comments should be confidential comments for the editor only. These comments will not be forwarded to the authors so the reviewer can be quite open to express his or her views to the editor. The second part of the comments will be the comments for the authors. These comments should explain to the authors what the reviewer thinks of their work and which changes and improvements he or she would suggest. The recommendations for the final disposition (acceptance, revision, rejection) are meant for the editor only and must not be part of the comments to the authors.

A good review is clearly structured into general and specific comments. The general comments should summarize what the paper is in one sentence and should state positive and negative things about the paper. The specific comments address the different sections of the manuscript (abstract, introduction, methods, results, and discussion) pointing out missing aspects or suggesting changes and improvements. The remarks should be consistent: it does not make sense for the reviewer to praise a paper in the general comments and then criticizing it harshly in the specific comments.

Authors naturally are very sensitive to what a reviewer says and how he or she says it. Authors have a right to expect that reviews do not contain impolite or even abusive remarks. In such cases it is the duty of the editor to edit the “comments to the authors” and to delete inappropriate passages.

On the positive side, reviews can be extremely valuable. The author gets candid feedback from someone knowledgeable in the field of his or her work. The peer review process is a rare opportunity where the result of one's work is evaluated and discussed by people from outside the inner circle of the research group. Everyone wants to hear praise, but critical comments can be very valuable when developing new study protocols and they are a great learning experience for fellows or researchers at the beginning of their careers.

In summary reviewers must take their task seriously, and authors should appreciate the time and expertise given by the reviewers. Reviewers get the opportunity to learn about new research and are giving back what they themselves have received from their peers at earlier stages in their careers. Authors must be grateful for the critical evaluation of their work which can make their work better and help them in their careers. If we look at the review process in this way, everyone will benefit.