February 16, 2023
Writing a manuscript for a journal can be an arduous task. It can be time consuming and often the fate of the publication and study lies in the hands of a few reviewers. It is quite disappointing for an author to get a paper rejected after months and sometimes years dedicated to a particular study. However, scientific journals must rely on expert reviewers to ensure peer-review and high-quality standards. In my experience as the Co-Editor in Chief for Resources in Surgical Education (RISE), an Associate Editor and on the Editorial Board for two other peer-review journals, and as a reviewer for 12 journals, I have noticed that different reviewers tend to focus on different aspects of the study. My observation has been that most “rejected” manuscripts fall along a continuum between “able to be fixed within a reasonable turn-around time” or those with fatal flaws.
Intended Audience: All surgical educators who participate in Surgical Education Research.
Objectives: After reading this article, the reader will be able to:
The title of the study is the first thing the reader will see about the work. An engaging title will help capture the attention of the reader and help them decide if the article is worth pursuing. It is essential that the title is not misleading and should accurately reflect the content and the breadth of the research. Think of the title as the shortest possible abstract for your study. It should be clear, use appropriate key words, and outline the importance of the study. Reviewers tend to get cranky when the title is not representative of the study.
The abstract is arguably the most important component of a paper as it will determine whether or not a potential reader chooses to read the full text. The abstract covers each and every component of the study and should report precise data that matches the data in the manuscript. Reviewers will look for a clear picture of why the study was performed, the methodological details, the key findings, and the implications of the study from the abstract.
It is essential to outline both the purpose and the importance of the study in the introduction. In this section, the authors should establish a clear conceptual framework, lay out what is already known on the topic and identify the gap in the literature that the study is trying to address. The literature review provides a theoretical and methodological framework for the problem under study. Key references should be selective and used only if they help the reader to understand the literature gap and establish a clear relationship between what is already known about the problem and the specific research question. Unanalyzed references that do not relate to the research question should not be included.
The purpose and the importance of the study should be clearly articulated, and specifically how the work is relevant to potential readers. It is common for reviewers to ask the question, “So what?” when reviewing a manuscript. Therefore, it is essential that authors clearly define the problem statement and how the current study is addressing the problem identified. Readers should be provided with sufficient information to understand the problem and see how the current study contributes to field. Reviewers tend to reject papers when there is an insufficient or poorly stated problem statement, the overall importance of the study is not clear, and/or the authors fail to make a compelling case for the research.
Another reason why articles are rejected is due to poor methodological rigor. First and foremost, the authors need to describe the study in sufficient detail to allow the study to be replicated by another researcher. Enough detail should be provided for the reviewers to make a well-formed decision about the appropriateness of the methods based on the research question. During the research design phase, the authors should make every effort to control possible confounding variables and/or biases that may impact the results. The variables or outcome measures need to be clearly described and directly related to the problem of the study.
Reviewers will also expect that any measurement instruments used are clearly described and justified, including the psychometric qualities. Instrument psychometrics can be reported directly within the methods section or by reference to previous validation publications. It is also helpful to insert an example of the instruments used in the Appendix.
The subjects of the study and how the subjects were sampled/recruited must also be clearly outlined and described. The sampling procedure should be clearly explained, and the authors need to provide a convincing argument as to how the results from the actual sample are able to be generalized to other settings and populations. If a convenience sample was used, the author must address and justify this decision. In addition, the data collection procedure should be clearly described along with the setting in which the study took place. The data analysis procedures should be appropriate and stated in precise terms, avoiding generalized descriptions.
The Methods section of a manuscript is essential in that it outlines and communicates the research design to the reader. Reviewers will look to see that the methods are appropriate for the stated research question(s), the data analysis is appropriate given the problem the authors are trying to address, and the research is appropriate without any particular weaknesses. Quite often, manuscripts will be rejected even when the authors have implemented the appropriate design and data collection methods but have not described the study in sufficient details to make this clear to the reader.
The Results section should only report the results of the study; this is not a place to present opinion. The results should be consistent with the methods used and should provide a clear answer to the research question. Results need to be presented clearly with precise and specific data. Tables and figures are an efficient way to present complex or extensive data. They should provide a summary of the information and be easily read and understood. Data that is presented in the tables and figures should not be repeated in the text; instead, tables should be labeled appropriately for the data to stand on its own. Authors should be careful to avoid over or under-representation of the results, inaccurate or incomplete data reported, and the use of incomplete or inaccurate tables or figures.
An effective discussion section describes and interprets the major findings and implications of the study and outlines for the reader why they are important. Authors should cover all debatable aspects of the study and contextualize the results within the literature. All findings and implications should be clearly stated and related back to the conceptual framework that was introduced in the introduction. Negative results can be just as useful as positive ones in terms of learning and advancing the field. Reviewers will look to see if the study adds to the existing literature in a meaningful way.
It can be difficult to highlight the implications of the study without overinflating the findings; authors should always be careful that the implications and benefits reported are consistent with the data obtained. In addition, authors must discuss the limitations of the study along with an explanation for any surprising or inconclusive results. All generalizations made from the data should consider the limitations of the study and potential confounding variables should always be discussed. Reviewers will look to see that the conclusions presented are supported by the data from the study.
The discussion should be directly related to the current study and data obtained. It is not appropriate to state opinions about the topic in general or sidetrack readers into a different topic. The discussion should be centered on the research study at hand and any relevant and pertinent studies from the literature. Reviewers will get annoyed when authors provide unwarranted speculation and/or discuss tangential issues not directly related to the results.
The authors should end the discussion section with a concluding paragraph that re-states the research question or hypothesis and major findings of the study and reminds the reader what contribution the study has made to the existing literature. In this paragraph, the authors should state and/or suggest the future directions for the research.
A solid and methodologically strong research study may get rejected by reviewers if the manuscript is poorly written and difficult to follow or understand. Reviewers will also look to see that the various sections of the article are clearly identified, and the content corresponds with the section heading. For example, a common mistake is to introduce new methods or parts of the discussion in the results section. Abbreviations should be consistent throughout the text and tables. There should never be any spelling errors. Authors need to understand that good writing/grammar is as important as good science. “When it comes to clarity- the reader is always right!”.1
Another reason for rejection is that the topic is not novel or relevant to the readers. The paper must be original and answer the question of, “So what?”. Reviewers will decide if its suitable for publication if they learned anything new that is important to the field. Along these lines, the literature review should be thoughtful, up-to-date, and contain a thorough review of pertinent articles. The number of references should be reasonable and only contain articles that are related to the study. Reviewers will look to see that the references cited were clearly understood by the author. Authors must keep in mind that the reviewers may know the references related to the topic inside and out and will be looking to ensure a thorough review.
Lastly, reviewers will expect that the study has undergone approval from the Institutional Review Board (IRB), that all conflicts of interest are addressed and that this is not a duplication publication. In addition, they will look to see that there was no “salami slicing" (i.e., submitting the smallest publishable unit from a larger study) and that references to previous findings are accompanied by proper literature citations. Any evidence of these issues is in direct violation of publishing ethics.