1. Article goes to journal where it is logged in and screened by a technical editor.
2. If within the basic scope of the journal, close to being understandable in English, and basically follows the format of the journal, it is sent to the Editor-in-Chief of the journal.
3. The editor will either handle it as the primary editor or send it to an associate editor who may or may not be especially knowledgeable about the specific research topic. Journals with associate editors often have 1 to 10 of them who serve as the primary editors for manuscripts. They will review any difficult decisions with the editor in chief, but the workload for major journals is huge and associate editors are generally fairly autonomous.
4. The primary editor (henceforth, editor) will look at the article briefly, especially the abstract and decide if the article merits further scientific review. This review is based on the topic does it really fit the journal, the scientific method is it up-to-date, etc? For clinical studies, the editor will consider the study design. For example, some journals do not publish many or any retrospective reviews. Finally, the editor may do a scan of the literature to see if this study is novel or if the authors have published some of it before.
5. If the paper is deemed very unlikely to be acceptable for publication for any reason, most commonly it just isnt novel or important enough for that journal, the editor will send it back to the author with a rejection letter. The letter may briefly describe the reason or simply say that the study would not be likely to clear peer review. Total time from submission for this process is often about a week or two. Appealing a rejection like this is essentially futile for the authors. Move on and resubmit elsewhere. Remember that the editor is doing you a FAVOR here with the quick rejection. If they send out for peer review a paper that they have already decided wont be accepted, they are delaying you by a month or more on resubmission of the paper elsewhere. Journals have relatively fixed numbers of papers they can accept. The editors cant accept all papers even all of the good ones. So, sending out for peer review a paper that is, for example, a case report or a retrospective review that the editor knows wont be something they can accept for this journal is not being nice to the authors. You can think of analogies here to the med school admissions process
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6. If the paper is deemed worthy of peer review, the editor will select the reviewers. This is the key step of the whole process. If the authors have suggested reviewers, these will be seriously considered. In general, the reviewers suggested by authors are not more positive to papers than non-suggested authors. If the authors have given the name of someone they do not want to be a reviewer, the editor probably wont send it to them. But, they can send it to anyone they want, with the understanding that the editor has been warned of a potentially biased review. Certainly any editor brings their own scientific biases into selecting reviewers and that is inevitable. Clearly, the editor can select reviewers that they think will be easier/harder, etc. In general though, editors are seeking the most knowledgeable and unbiased reviewers they can find. They also are going to look at the reviewers history with their journal. Is the reviewer usually on-time with reviews, do they accept review assignments or complain?
7. Peer review occurs by the reviewers. This is the LONGEST step of the process. If the reviewers initially chosen by the editor decline to do the review, then the editor may need several tries to find reviewers. In general, it is considered nice to review a paper within 2 weeks of receiving it. But this often doesnt happen. A range of 2 to 6 weeks is common. Some journals are notoriously slow. The editors can prod reviewers, but cant force anything since being a reviewer is a voluntary, unpaid task. Reviewers are usually scientists and physicians with patients to see, their own papers to write, and grants to prepare. A thorough peer-review can take 2-20 hours for a reviewer and that is totally unreimbursed time. Peer reviewers are making a significant effort and sacrifice to look at YOUR science. Keep this in mind. A brief review is not a favor. A thorough review is best, even if it seems like a lot of work to rewrite the paper. In a sense, a good peer reviewer is acting as a mentor. Of course, some reviews are unkind and inaccurate, but most are pretty accurate and well-done.
8. The reviews are sent back to the editor who must make a decision. With some variation on the theme, one of three decisions is possible:
a. Accept the paper (very rare to be accepted at this point for original science papers)
b. Accept the paper if the author can respond appropriately to the reviewers comments/criticisms.
c. Reject the paper
Of these, within the middle category, there can be various ways by which the editor can indicate the likelihood of ultimately accepting a paper and convey this information to the authors. The editor could send the author a decision letter saying This is the best thing every written about the topic, but answer the reviewers about why you did X,Y and Z before I can accept it. They could send the author a letter saying This is awful, but maybe we are missing a key point, so look at what the reviewers say and tell us why they are wrong. Or, most commonly, theyll simply say Respond to the reviewers and well relook at it.
9. The editor will send this letter back to the authors, potentially adding their own personal comments and/or note some technical issues (e.g. please double space) that need to be fixed on resubmission. The editor may point out the most important points they need to have answered or they may provide some commentary to help the author with the revision. Pay very close attention to what the editor says in their letter. It is not inappropriate to communicate with the editor directly on these points, although this is uncommonly done. You may not, as the author, gain direct access to the reviewer except for those journals that do open review (few at present time).
10. The authors must decide if they are willing to revise the manuscript based on the reviewers and editors comments. They must respond with a revised manuscript, specific rebuttals, and a very nice letter that ALWAYS starts with (give or take a few words) We appreciate the reviews sent to us regarding our paper. We have enclosed our revised manuscript in which we have responded to each comment by the reviewers. Do not ever, ever send a hostile letter back to the journal. Even if you (or the PI) decide not to revise the paper for that journal, you may submit to that journal a different paper sometime and dont want to make enemies.
After your first Nobel Prize you can become a prima donna and blast the reviewers for their ignorance of your brilliance. For now, eat crow and respond nicely to each point the reviewers make, even the ones that are clearly based on a lack of understanding of what youve done and written. That doesnt mean you MUST agree with the reviewers and make EVERY change they suggest. You can decide not to make any given change the reviewer wants. But, you must explain to the editor clearly why you disagree with the reviewer. Remember the reviewer will see this again, especially if you pick a battle here. If the reviewer wants small changes that you dont think are worth it, generally, do what the reviewer wants. Save the battles for key issues. If there are (as there almost always are) multiple authors on your paper, make sure that the co-authors see both the revised manuscript and your letter of response before submitting these. Above all, ALWAYS respond professionally to EVERY point in EVERY review. Dont just ignore a comment by any reviewer give a response to everything that is said. Please, remember to keep it polite and collegial. The reviewer could be your future boss, colleague, or mentor. Express your anger at the unfairness of the review to your friends and teddy bear.
11. The editor will look at the authors response and make a new decision. The choices are:
a. Accept the paper
b. Accept the paper IF the authors make a few more small changes
c. Send the paper BACK to the original reviewers to see if they agree or at least will accept the authors responses
d. Reject the paper.
12. In theory, the cycle of 7 through 11 can be repeated a few times. In general, it is not done more than twice (two revisions) except in rare circumstances or related to some trivial changes that lead to a third or fourth revision. Typos and the like can usually be handled after acceptance. It is uncommon for an unsolvable conflict between author and reviewer to exist. Usually reviewers will accept the authors answers but may ask for some hedge words or explanations of the limitations of the study in return. These types of trade-offs make editors satisfied that a balance of perspective has been achieved. In the uncommon situation of a true stalemate, it is up to the editor to make a decision. Dont worry, they wont be afraid to do it. But, they would much rather that the author and reviewer are in reasonable agreement. As a last resort, the editor may offer the reviewer the option of writing an editorial commentary or a letter to the editor in rebuttal of a paper. This is unlikely to occur for studies done by post-docs and junior faculty.
13. Eventually, the paper is accepted by the editor and the author is sent a letter that includes the phrase Your manuscript has been accepted. At this point, and not before then (e.g. not when the letter says we expect to accept or if you respond to these minor issues we will accept) can the authors list the paper as In Press on their CV.
14. The manuscript as accepted is now sent to the publisher and leaves the hands of the editorial office. Whether it is technically edited by hand, by computer, by the journal, or by the publisher for grammar, style and spelling is highly variable, but somehow it will get edited and your typos fixed. It is the publisher that will determine when the paper actually appears and send out page proofs.
15. About 2 months before the paper appears in the written journal, you will be sent, usually electronically as pdf files, what are called page proofs. This is the paper as it will look in the journal with everything except the actual final page numbers since they dont know them yet. You will be given 48 hours to review these. It really behooves you to spend a few HOURS poring over these. Have someone who isnt familiar with the paper do this too. Amazing how often tables are messed up (data columns transposed!), words and sentences deleted, etc. Much better to catch these mistakes now than after publication and be forced into a correction. You cannot rewrite anything in the paper now except for making corrections of mistakes. You could be asked to pay if you insist on substantial changes. Your paper could be delayed as well. Rarely, if you ask to make a real change, the editor could be informed and decide if they agree to this change. Be cautious here. Fix actual mistakes but dont try to change what youve written based on more recent data, new publications in the field, etc.
16. Finally, the paper is published. If an on-line version was published earlier, it will usually be replaced with the final version which will now appear in pubmed as a final version.
17. Congratulations! Now, just do this another 20-50 times and youre ready to be promoted!
journal, but about good primary journals that reject more papers than they accept and that practioners, physicians and scientists often read to keep up with a field. Of course, there are variations in the theme and details of the process. However, like medical education, there are more things in common than different between these journals.
