Research integrity is the cornerstone of academic medicine. The basic principles of research integrity are ethical writing, honest authorship, and formal peer review [1, 2]. Peer review is the academic evaluation of scholarship by scientists in the same field (peers) that aim to ensure scientifically valid and ethical research [3, 4]. The principles of peer review are largely based on professionalism and academic attitude. Although peer review has been considered the standard to evaluate research, it has problems, bias, flaws, and limitations that should be addressed and optimized [5]. Currently, in the demand for abundant publications on researchers, it may be easy to get attracted by predatory journals inviting to submit a paper in the gold open access route that requires the author to pay a fee if the paper is published. In this publication factory, the journals will publish almost anything for a fee, with a short or without a peer review; therefore, effortless and useless publications will be increasing. Other journals have notorious high rejection rates. Although the high number of submissions justifies a high rejection rate, this reflects another bias of the peer-review process; the reviewers are encouraged to reject manuscripts in most cases in order to preserve this quality measure, and solely manuscripts that find favour within the reviewers get published [5,6,7,8].

Peer review is considered a biased process with identified defects; it is a compromise between the likelihood of accepting a bad paper (type I error) and the likelihood of rejecting a good paper (type II error). Although peer review is supposed to reduce type I errors, it also increases the chances of a type II error. Minimizing the likelihood of a type I error will lead to very few papers being accepted for publication but may also result in a number of good papers being rejected from publication [9]. When the risk of a type I error is high, peer review measures should be more rigorous, and the process should be finalized within one to two months to avoid publication of outdated research [9,10,11]. Peer review is the core of the editorial process and the basis of the publication system. It is expected to detect fraud, identify bad science, assess technical details and methodology, and improve the presentation of results with the optimal writing style of the paper [12]. A demanding, rigorous, constructive, and objective peer review is the best method to validate the quality of the accepted papers, and the solution to avoid drawbacks in medical writing and publishing. Even with its inherent limitations and biases, eliminating peer review is unwise. Improving the peer review reduces the risk of publishing research that does not provide new knowledge, or that has substantial flaws [9, 13]. The present editorial note aims to communicate to the readers of the journal a unified set of criteria for the best peer reviewers and to list the methods to optimize the process.

The best peer reviewers

According to the International Committee on Medical Journal Editors (ICMJE), peer reviewers are experts involved in the evaluation process who are able to timely respond to invitations, submit unbiased and constructive comments, and keep confidentiality [14]. The roles and responsibilities of the peer reviewers have been listed in the updated recommendations of the Council of Science Editors (CSE), where ethical conduct is viewed as a premise of quality [15]. The Committee on Publication Ethics (COPE) further emphasizes editorial strategies that ensure transparent and unbiased reviewer evaluations by trained professionals [16]. The World Association of Medical Editors (WAME) prioritizes selecting the best reviewers with validated profiles to avoid substandard or fraudulent comments [17]. Accordingly, the Sarajevo Declaration on Integrity and Visibility of Scholarly Publications encourages peer reviewers to register with the Open Researcher and Contributor ID (ORCID) platform to validate and publicize their academic activities [18].

Peer reviewers without biases, self-interest, and conflicts are supposed to ensure that journals publish high-quality science by evaluating manuscripts and offering suggestions for improvement [5]. However, finding experienced peer reviewers, seniors, and experts is time-consuming and difficult. Moreover, not all reviewers evaluate personally; they could be assisted by a resident or a junior research fellow or a staff member leading to a debatable result. Differences between peer reviewers’ skills and experience could generate inconsistency [5,6,7,8]. Very few individuals have had formal training and assessment methods for reviewing [19, 20]. The variability of the reviewers is a major weakness of the process and generates the subsequent disparate quality of evaluations. Additional challenges are the limited formal training and assessment methods for review compared to other research topics. Moreover, the evaluation of peer reviewers is difficult and incorporates a lot of biases related to authors’ and reviewers’ gender, nationality, native language, and personal and institutional preferences [6, 21, 22]. Specific criticisms associated with peer reviewers include difficulty in identifying the appropriate peers to serve as qualified reviewers, suffering bias and conflicts of interest between authors and reviewers, tolerating inconsistent results, and being slow and expensive. Often, peer reviewers, especially those suggested by the authors, are viewed suspiciously by the scientific community [12]. Last, inaccurate reviews and occasionally rude or unprofessional and inappropriate comments remain significant problems [5]; in a study, more than half of 1106 anonymous respondents reported receiving at least one unprofessional review, and a majority of those said they had received multiple problematic comments including comments tended to personally target a scientist, lacking constructive criticism, or being unnecessarily harsh or cruel [23, 24].

Although there are no universally accepted criteria for acknowledging the best peer reviewers, it is apparent that they should be active researchers with extensive experience in the subject and have a significant list of relevant and recent publications [25, 26]. Ideally, the reviewers should have equal scholarly ranks and credentials with the authors. The best reviewers should provide comments to guide authors on how to correct mistakes, discuss study limitations, and highlight their strengths. It is recommended that reviewers avoid engaging in the authors’ research and refrain from recommending additional tests and data collection, as these may complicate the research and delay publication [5, 26]. A rigorous peer review is a method against predatory publishing practices, while a short peer review may point to the absence of quality evaluation and apparently predatory publishing practices. A fake peer review is another form of misconduct in the medical publishing of articles without quality checks. Fake reviews are generated by manipulating authors and commercial editing agencies with full access to their own manuscripts and peer review evaluations in the journal editorial manager systems [27]. Assigning independent reviewers and requesting their ORCID IDs may overcome this issue [26, 28].

As previously emphasized, best peer reviewers should be objective, instructional, and informative; provide critical comments to help the editor make his decision and the authors to improve their manuscript; indicate the novelty and significance of the work and if/how it adds to the current literature; identify major flaws in the study hypothesis, materials and methods, techniques, approaches, and statistics; denote statements requiring clarifications; give details for areas to be improved and list changes to be made; write formal but clear to be understood by authors whose native language is not English and avoid complex or unusual words; number the points and refer to pages, paragraphs of sections, or lines in the manuscript; and review all sections of the manuscript including the citations and illustrations [5, 6]. Best peer reviewers should be polite, honest, clear, responsible, and reliable to the authors; should accept promptly and not turn down an invitation for review; return the peer review on time to avoid delays; provide confidential comments to the editor if he/she detects any misconduct such as plagiarism, unattributed work, unethical procedures, or duplicate publication; and disclose potential conflicts of interest [5, 6, 29]. For editorials, letters, and perspectives, the review process should take no more than two weeks by the editors (a rapid rejection policy is welcome if necessary), and some manuscripts such as opinion notes may not require peer reviews as these manuscripts contain normative statements which can be debated by scholars [9].

Given the wide availability of in-journal editorial office services, reviewers’ comments on language typing and syntax errors are categorized as minor [2, 5, 26]. Language problems should be brought up only if they make the paper difficult to understand; but this should be done politely and can be communicated with confidential comments to the editor [29,30,31]. Native English-speaking authors have an advantage in paper writing and reviewing. It is always a matter of huge respect that non-native English speakers can conduct themselves so well in a foreign language both for journals and in meetings. Peer reviewers should not make assumptions about the quality of a paper based on the authors’ nationality and affiliations. Instead, they should focus on the research and communicate to the Editor if the English is so poor that the paper cannot be reviewed or he/she cannot provide feedback on the science [32]. The use of English as the scientific common language began only 400 years ago and continued to expand after the World War with its linguistic advantages including relatively simple and genderless grammar, and the increasing military, economic, and technological clout of the USA. Today, English is the official language of most scientific events and international and indexed academic journals [33]. However, although a common language facilitates international scientific communication and creates a monolingual repository for publications and data; overlooking non-English studies can result in large gaps within global databases [34, 35]. Additionally, non-English speaking authors often publish in lesser-known journals or in regional journals making their research less visible. Depending on scientists with higher English proficiency increases the risk for authorship-related misconduct (fraud) practices [2, 36] and can be a source of anxiety and emotional burden [36, 37]. In the future, multilingual science and publishing are anticipated to promote contributions in different languages.

Options to improve peer review

Peer-reviewing is as good as we make it. It is not perfect, does not prevent errors, and does not impede the publishing of bad papers. Yet, it is the best available quality control system for the scientific literature [38]. Currently, there are many options to improve the drawbacks of the peer-review process including interactive models, standardized processes, open peer-review processes, technological advances, and post-publication peer review [9, 13]. Peer review models have evolved from single-handed editorial evaluations to collegial discussions [39]. Editors ask specific review questions and develop templated documents to focus on reviewers’ comments and authors’ replies. Reviewers’ training has been proposed to improve peer review, and scores have been designed to help improve by process evaluation [5, 6, 12]. Publication including open peer-review reports, authors’ responses, and editorial comments, and decisions is a proposed standardized method to optimize peer review and minimize the risks of publishing questionable original research [9]. Peer review is double-blinded most of the time. However, the research community is small and nothing is hidden under the sun. Blinding fails about one-third of the time; researchers can still be identified in a blinded manuscript such as by content or references cited since researchers often cite themselves and their previous work [40]. Additionally, when reviewers are anonymous, their reviews are more common, bad, and rude [5]. Open peer review may be a solution to poor quality and rude reviews. In a study, a sufficient number (76%) of reviewers agreed to have their names revealed to the authors whose papers they reviewed, making open peer review feasible. Non-blinded reviews were at least as good as blinded reviews, and maybe of better quality, however, they were more likely to recommend acceptance of the paper [41]. Importantly, open peer review can provide the reader with an understanding of the thought process leading to the published work, clarify the decisions that led to the publication, and help improve the quality of scientific communications [12, 42]. The idea is to change the status of peer reviewing from a hobby to a mandatory duty of each academic physician, at least those with dignity and ethos. Reviewing should be taught formally to early career researchers, and possibly it should be financially rewarding for the individuals or their institutions [38]. All researchers should do their share in reviewing papers in their field and should do so as they would like others to perform if they were receiving their own papers [5, 6, 38, 43].

Reviewing for International Orthopaedics

SICOT (Société Internationale de Chirurgie Orthopaedique et Traumatologique) and International Orthopaedics are growing. Over the last year, we appreciated an unprecedented rise of submissions to International Orthopaedics [44] and SICOT-J [45] official journals and academic faces of SICOT. The previous year, the volume of received manuscripts increased in a plethoric way and the acceptance ratio was less than 14%. A large number of papers are immediately rejected as being out of the scope of the journal or with a limited interest for the readers of the journal. The high number of submissions places a substantial strain on publishers, editors, and reviewers, creating a challenging problem of balance between the interests of our authors and readers, and the quality standards growth [22].

International Orthopaedics has been and remains a general-interest orthopaedic journal that accepts and publishes interesting, useful, well-written, and presented orthopaedic research [8]; our intention is to keep our readers updated on the major developments in orthopaedic science, as well as to preserve the historical and cultural memory of orthopaedic heritage. We encourage orthopaedic surgeons to read online the pages of International Orthopaedics for quality innovative papers. These are expected to help in clinical and research, and possibly, they might lead to a change in practice.

We acknowledge the amount of time and effort that is required to perform a study and to prepare and submit a paper, and we aim for a constructive, fair, honest, and ethical peer-review process performed in a timely appropriate fashion. More than 1500 scientists currently review for International Orthopaedics and for SICOT-J. They provide pro-bono work consistently with high standards of quality, responsibility, and talent. Their work and commitment are highly noted and appreciated.

We are strong advocates that medical writing should include both medical knowledge and expertise in writing and should have formal rules and standards. As the official journal of SICOT, we publish articles from many countries around the world including articles from authors in developing countries. Linguistic variations can generate misunderstanding for non-native English-speaking authors, reviewers, and editors. The quality is not always the same, but we presume that the authors improve with each written paper, and our aim is to support the spirit of the SICOT where every surgeon could join to learn and improve. As a major general scientific journal, International Orthopaedics has been a catalyst for change and we foresee this continuing in the future. As editors, we support continuous orthopaedic education, and we look forward to reading and evaluating your work.