A Practical Guide to Peer Review in Pharmacy Practice

With the increasing rate of journal article submissions, peer reviewers are needed now more than ever.¹ Journal editors utilize peer reviewers’ expertise to critique the quality of submissions to screen for publication suitability. Despite the long-standing and high need for peer reviewers, this skill is typically acquired through on-the-job experience and is not typically taught within graduate curriculum.^1,2 This Field Insight is designed to educate readers on the why, the how, and the what-happens-next of the peer review process to encourage more pharmacists and clinicians to participate in this highly necessary and valuable activity within our community.

Why Peer Review?

Peer review is often presented as an unpaid service, but we implore you to view it as an opportunity. Yes, peer review is a service to the pharmacy and medical community. It is also an opportunity for professional growth. Peer review can improve the quality of one’s own writing and research skills, increasing the likelihood of being published in the future.³ When one submits future research manuscripts, reviews from peers during the publication process can help strengthen knowledge of ways to improve the structure, content, or integrity of the piece.³ You are more aware of the process and expectations, as well as more skilled at interpreting reviews and responding adequately.

Continuous professional development is key in pharmacy practice. Conveniently, conducting peer reviews helps reviewers stay up to date on current research and pharmacy practices.¹ Furthermore, the peer review process is an act of service that invests in others’ success and helps develop a community of support. By devoting time and attention to a meaningful review, you hope that in the future the same consideration will be done for you.¹

A How-To Guide for Peer Review

Individuals who would like to become peer reviewers but are unsure of how to start can begin by reviewing the websites of frequently read journals in their area of practice to see whether there is an option to volunteer or by emailing the editor to inquire. Be cautious about accepting peer review for an unknown or potentially predatory journal, as such journals can contribute to misinformation in medicine and do not support scientific discovery through vetted processes.⁴

When an article is first submitted, it is typically reviewed by screening staff and an editor to assess its general suitability for the journal. Once a submission is deemed appropriate for further evaluation, content experts are asked to review the manuscript, typically through email, with the article’s abstract attached. Importantly, peer reviews are confidential and should not be shared with other individuals.^2,5 Further, it would be unethical for reviewers to use manuscript content for generating personal research ideas.² Additionally, if a peer review is unblinded and there are any known or potential conflicts of interest, reviewers are required to disclose those with the journal (eg, work colleagues, stock interests, etc).²

As a potential reviewer, there are 2 initial questions that must be answered: 1) Is the manuscript within your scope of practice?² Skim the article to see whether you have the appropriate knowledge to fairly and accurately evaluate it. And 2) Do you have the time to complete the review?² A review typically takes several hours to complete and is generally due within a few weeks.^2,5 If the answer is no to either of these, respond promptly to the journal and consider proposing names and email addresses of alternative reviewers.² If you are able to accept, further details, such as the full manuscript and any required reviewer forms, will be provided. Of note, we encourage pharmacists to involve learners, such as students and residents, as well as new practitioner colleagues, in the process; however, it is imperative to request permission from the journal first to maintain the confidentiality expected of this process.⁵

To effectively complete a review, first conduct a general read-through of the manuscript without taking any notes.^1,5 Begin to discern the rationale, methods, and overall results to identify any major flaws in the manuscript. Upon a second run-through, annotate and critically evaluate the article with detailed comments. It is often suggested to perform the more detailed read a few hours after the quick read to prevent burnout and view the manuscript with a fresh perspective.^5,6 Of note, the ultimate goal of peer review is to determine the originality, usefulness, and publishability of a manuscript—it is not to correct grammatical errors.^5,7 Your role is to critique the scientific merit, methods, and implications for practice. If there are overt errors that impede the readability of the article, a general comment to the editor and authors can be included in your review; however, detailed edits of grammar, syntax, and style should not be included in your review.^1,2,5

Every part of the manuscript should be evaluated, including the title, abstract, introduction, methods, results, figures, tables, legends, conclusions, and even the references.⁵ Consider whether the title is accurate and the abstract contains all key information. When reading tables and figures, assess whether they add new information and support the paper.² Other considerations include depth of the background and discussion, proper statistical analysis, appropriate conclusion statements, and contemporary and complete referencing.⁵

The typical review structure includes separate comments to the editors and the authors.^2,5,7 For the editors, always start with a brief summary of the paper (rationale, aims, methodology, results) in a few sentences. Then, list the main areas of improvement as a summary of the detailed critique you are providing to the authors separately. Journals will often ask reviewers for a recommendation on publication from one of the following categories: “accept,” “accept with minor revisions,” “accept with major revisions,” or “reject.”^2,5,7 Rarely, there may be an option for “reject and resubmit” without guarantee of acceptance.² A manuscript that is accepted without revisions is highly unlikely.⁵ This is generally utilized during rereview of a previously revised manuscript. Revisions could be classified as minor if the manuscript is nearly publishable with only a few adjustments, typically not requiring rereview. These are items the reviewer feels authors can easily adjust or clarify and are unlikely to require substantial time. In contrast, major revisions require substantial edits, potentially including further data collection or reanalysis, and rereview by peer reviewers before acceptance or rejection is determined based on the quality and impact of the changes.² The option to reject should not be taken lightly. Reasons for rejection could include inherent study design flaws that cannot be corrected, lack of impact, ethical concerns, and a journal/topic mismatch.^2,5 It is important to note that these comments are confidential to the editor and will not be seen by the authors.^5,7 Ergo, while your critique can be direct, it is critical to remain professional and objective in all commentary.

Comments for the authors should also include a summary of the manuscript to display understanding of core concepts, as well as a brief overview of the requested actionable feedback.^2,5,6 Reviewers can copy their same statement on the manuscript overview they are sending to editors, as described above, to the authors. Writing comments to the author as a conversation using first-person pronouns rather than third-person pronouns may be perceived as less judgmental and more constructive.⁶ After the initial brief summary, each part of the paper (eg, title, abstract, methods, etc) should have its own section with detailed comments. Best practice is to include the page and line numbers at the beginning of the comment, then lead into specific, actionable feedback.^5,6 Examples of quality feedback are shown in the Table.

TABLE IN WF

Responding to Reviewers’ Comments

As an author, reading the editor’s decision and the reviewers’ comments may elicit a very emotional response.² If the editors request revisions, be sure to adhere to their deadline for resubmission and request an extension if necessary.⁷ This may be needed on manuscripts with numerous coauthors, since all writers must approve changes. A designation of “accept with minor edits” requires only a minute revision.⁷ Any changes suggested should be responded to and revised line by line with explanations for how the suggestions were implemented.² The editors may decide to go through a second peer review process, but this is more likely with requests for major revisions.⁷ The request for major revisions is the most common result of the initial peer review.⁷ Examples of more lengthy revisions include further explanation of methods, additional analysis of data, and redesign of tables/figures.⁷ As with minor revisions, respond to each comment in a respectful manner, detailing how the issue will be fixed.² Submitting an unrevised manuscript to another journal is not recommended, given that the suggested improvements have not been addressed.⁷

Finally, a manuscript may be rejected—either outright or after revisions if the editor feels the revised manuscript did not fully correct the items noted by reviewers. In this scenario, the reason for rejection is important. If the paper does not align with the journal’s audience or purpose, resubmitting to a different journal whose scope better aligns is encouraged.⁷ Manuscripts that are very poorly written or require entire restructuring may be salvageable if the comments suggested by the editors and reviewers are implemented.⁷ Papers that lack statistical strength, possess weak methodology, etc, are more difficult to simply revise; further experiments or data analysis may be required before resubmission.⁷

Occasionally, a reviewer may have overlooked something from the manuscript or the authors disagree with a recommended change.⁸ Either respectfully direct the reviewer toward the section containing the overlooked item and ask whether further clarification is needed, or preemptively make improvements to clarify the manuscript. Did the reviewer miss the item due to poor flow of information or confusing wording? This could represent an opportunity for improvement. Moreover, if you disagree with a reviewer’s comments or cannot implement a suggestion, provide a reason as to why.⁸

For instance, if the reviewer asked for additional data analysis but the Institutional Review Board application is closed, explain this to the reviewer in a respectful manner, and the editor will decide whether this is a pivotal factor in determining publication status. Or, if a reviewer disagrees with a portion of the methodology, such as a measurement tool used, show appreciation for their perspective and direct them toward publications supporting your study’s methods. Again, this represents an opportunity to improve the manuscript and enhance the impact on readers who may have the same questions as peer reviewers.

Receiving major revisions or rejections can be difficult. Upon a brief literature search, there are no recent pharmacy data on the number of submissions required before publication. However, an economics publication from 2004 estimated that authors receive 3 to 6 rejections before acceptance.⁹ Therefore, do not be discouraged if you are requested to make revisions several times or if you have to submit to several journals.

Conclusions

The pharmacy community is one of service and dedication to furthering the profession. Try to approach every peer review as a learning opportunity and a way to stay current with practices, help promote other pharmacists’ work, and thus improve future work. Whether you are reviewing a new manuscript or reading reviewers’ comments, remain respectful and remember that pharmacy is a small world.

References

1. Lovejoy TI, Revenson TA, France CR. Reviewing manuscripts for peer-review journals: a primer for novice and seasoned reviewers. Ann Behav Med. 2011;42(1):1-13. doi:10.1007/s12160-011-9269-x

2. Willis LD. The peer review process. Respir Care. 2024;69(4):492-499. doi:10.4187/respcare.11838

3. Kerig PK. Why participate in peer review? J Trauma Stress. 2021;34(1):5-8. doi:10.1002/jts.22647

4. Elmore SA, Weston EH. Predatory journals: what they are and how to avoid them. Toxicol Pathol. 2020;48(4):607-610. doi:10.1177/0192623320920209

5. DiDomenico RJ, Baker WL, Haines ST. Improving peer review: what reviewers can do. Am J Health Syst Pharm. 2017;74(24):2080-2084. doi:10.2146/ajhp170190

6. Watling C, Ginsburg S, Lingard L. Don’t be reviewer 2! reflections on writing effective peer review comments. Perspect Med Educ. 2021;10(5):299-303. doi:10.1007/s40037-021-00670-z

7. Weinstein R. Surviving peer review. J Clin Apher. 2020;35(5):469-476. doi:10.1002/jca.21822

8. Oldham MA, Kontos N, Baller E, Cerimele JM. JACLP guide for manuscript peer review: how to perform a peer review and how to be responsive to reviewer comments. J Acad Consult Liaison Psychiatry. 2023;64(5):468-472. doi:10.1016/j.jaclp.2023.01.011

9. Azar OH. Rejections and the importance of first response times. Int J Soc Econ. 2004;31(3/4):259-274. doi:10.1108/03068290410518247