As IUJ Editors we have been reviewing manuscripts and reading original research manuscripts and their reviews over the last 20 plus years. This has led us to develop expertise on best practices for reviewing a manuscript that we would like to pass along.

An original research manuscript review should do two things: first, help an editor determine the quality of the submission; second, help an author improve their manuscript. We want to debunk a couple of myths; long reviews are not always good and short reviews are not always bad. Putting a lot of comments in a review that are not to the point may lengthen the review but is not helpful. Remember, reviewers are not tasked with a decision of whether the manuscript should be accepted or rejected, and a statement about this should not be included in the review. The editor decides whether the manuscript will be accepted or rejected based on the review content. In addition, some reviewers are confused about the sections that are titled “comments to the authors” versus “comments to the editors.” The comments to authors should include your complete review. Comments to the editors should not include the review, as the editors will have access to what is sent to the author, but should include frank guidance to the editor on the overall impression of the article.

How do we start a review? We first read a manuscript through to get a feel for its overall quality. We then go back and review the manuscript in detail to support thoughts on each section. If the section was done well, we mention that. If there are deficiencies, we discuss those with suggestions as to how things should or could be improved. We then go back and review the manuscript in detail to support our thoughts on each of those sections. Numbered comments are helpful to both the editors and the authors as it is easier to identify the issues and their resolution when the authors revise manuscripts in response to reviewer comments.

We expect the introduction to summarize the topic to be addressed and then briefly review what we know and don’t know about the issue. The introduction should ideally include how this manuscript will help move the science forward. The final sentence of the introduction presents the hypothesis or the aim of the study. The Materials and Methods should allow the reader to reproduce the study and serves as a recipe. Just like a food recipe, if you leave any steps out, you ruin the meal. Materials and Methods sections should be no different. Typically, the last section of the Materials and Methods section should include how the data generated in the study are going to be analyzed.

The results section should start with a statement about the ethical conduct of the research, such as “this study was approved by such and such Institutional Review Board (IRB)” and “all patients gave written consent” or “consent was not required by the IRB”. In addition, authors should comment on whether their study was registered on a clinical trials site such as www.clinicaltrials.gov. Registration is usually required for randomized trials and may ultimately be required for all clinical studies. The Results section first describe the study subjects and then the findings. If any multivariate analyses are performed, they would follow the univariate analyses. Overall, the results should be easy to understand and have a combination of tables/figures and prose that rarely overlap. Tables and figures should explain most data, and the prose should highlight the important findings.

The first line of the discussion should state the main findings of the study. The following paragraph should then explain what the results mean considering previous published findings. Strengths and limitations follow with a short one to three-sentence paragraph summarizing the place this study has in the literature and the conclusion.

One of the biggest mistakes reviewers make is that they get bogged down in correcting grammar. If the grammar is obviously very concerning, simply state that the manuscript needs a significant grammatical review by someone experienced. The secret in publishing is that there is an editorial review done by the publishing house after a manuscript has been accepted which will correct many errors. Another common mistake is that reviewers can be confused by statistical tests or results but don’t mention it for fear of appearing ignorant. If the author isn’t clear in describing what they did and why, it is not the reviewer’s lack of knowledge, but the author’s lack of a clear description, and that should be pointed out. If a reviewer doesn’t understand the statistics, they can request the manuscript be reviewed by a statistician. Reviewers can greatly help authors by explaining that the results don’t make sense and provide specific recommendations about how the data could be better displayed or explained. Lastly, reviewers are often shy about making statements about how authors reported the strength of their conclusions. If the authors are overstating their results (much more common than understating) then a good reviewer should point that out and explain why they feel this way.

Another area of issue in some reviews has to do with reviewers’ concerns about conflict of interest or ethical issues. Reviewers should include those in the notes back to the editors and may include some of the concerns in the comments to authors. Asking authors whether the trial is registered, to explain a conflict with a company that may have supported the research or whether or not patients gave consent are all appropriate for authors’ comments. Some concerns, such as duplicate publication or plagiarism, should be directly addressed by editors and do not belong in a review for authors. Finally, there is no role for strong language or name-calling in reviews. These comments have no role in medical professional discourse.

We hope this editorial can be of some use to our large body of reviewers for the IUJ. We want to thank our reviewers from the bottoms of our hearts because you are the unsung heroes of the publishing process and make up a very important part of why the IUJ is a great publication.