In 2021, JTD reviewers continue to make outstanding contributions to the peer review process. The following reviewers are highlighted and commended for their professional effort and enthusiasm in reviews. Let us take this chance to express our heartfelt gratitude for their tremendous effort and valuable contributions to the journal and to the scientific process!
Robert Van Haren, University of Cincinnati, USA
Christopher W. Seder, Rush University Medical Center, USA
Oliver Reuthebuch, University of Basel, Switzerland
Khosro Hekmat, University of Cologne, GermanyFebruary, 2021
Calvin S. H. Ng, Chinese University of Hong Kong, China
Kenji Tsuboshima, Nissan Tamagawa Hospital, Japan
Joon Bum Kim, University of Ulsan, Korea
Bart De Geest, KU Leuven, Belgium
Akimasa Morisaki, Osaka City University, Japan
Teruaki Mizobuchi, Chibaken Saiseikai Narashino Hospital, Japan
Piotr Gabryel, University of Medical Sciences, Poland
Ulrik Sartipy, Karolinska Institutet, Sweden
Tomasz Marjanski, Medical University of Gdansk, Poland
Anthony W. Kim, University of Southern California, USA
Paul C. Tang, University of Michigan, USA
Kei Suzuki, Boston Medical Center, USA
Christopher Towe, University Hospitals Cleveland Medical Center, USA
Katsuhiro Okuda, Nagoya City University, Japan
Jeffrey Brian Velotta, University of California San Francisco, USA
Jin Yong Jeong, Catholic University of Korea, Korea
Abby White, Brigham and Women’s Hospital, USA
Amer Harky, Liverpool Heart and Chest Hospital, UK
Lieven Depypere, KULeuven, Belgium
Chang Young Lee, Yonsei University, Korea
Norihisa Shigemura, Temple University, Japan
Shigeki Suzuki, Keio University, Japan
Joseph Seitlinger, University of Lorraine, France
Makoto Endoh, Yamagata Prefectural Central Hospital, Japan
Dritan Useini, RUHR-University Hospital Bergmannsheil, Germany
Gonzalo Varela, Institute for Biomedical Research of Salamanca, Spain
Hitoshi Igai, Japanese Red Cross Maebashi Hospital, Japan
Dragan Subotic, University Hospital Zurich, Switzerland
George Rakovich, University of Montreal, Canada
Yoshiyuki Takami, Fujita Health University, Japan
Ravi K. Ghanta, Baylor College of Medicine, USA
Jacquelyn A. Quin, Harvard Medical School, USA
David Shersher, Cooper University Healthcare, USA
Takeo Nakada, Jikei University, Japan
Thierry P. Carrel, University Hospital Zurich, Switzerland
Jimmy T. Efird, Cooperative Studies Program Epidemiology Center, USA
Antonio Alvarez, University Hospital Reina Sofía, Spain
Benoit J. Bibas, University of São Paulo, Brazil
Sehoon Choi, University of Ulsan, Korea
Robert Van Haren
Dr. Robert Van Haren specializes in thoracic surgery, with an emphasis on benign and malignant disease of lung, esophagus, and airway. He completed his surgical training at University of Miami/Jackson Memorial Hospital in Miami, Florida, followed by thoracic surgery fellowship at MD Anderson Cancer Center. While in training, he completed a clinical research fellowship and obtained a Master’s Degree in Public Health at the University of Miami. His current research efforts focus on improving outcomes after surgery for lung and esophageal diseases. To connect with Dr. Van Haren, you may follow him on Twitter @rvanharen.
Dr. Van Haren regards peer review as an important part of scientific discovery and reporting. The process allows experts in the field to review a manuscript and provide constructive feedback, which improves the quality of research and further advances the field. He says, “Reviewers should make suggestions that will improve the quality of the manuscript whether it is the organization of the manuscript, study design, or additional analysis to strengthen results. Reviewers should also be aware of their own biases when they review a manuscript in order to provide a fair review.”
The burden of being a scientist and doctor is heavy enough, but Dr. Van Haren keeps motivating himself to review regularly, “It takes time to review manuscripts, but after some practice the process can be done efficiently. I enjoy the process because it keeps me current with ongoing research and exposes me to novel research methods.”
From the reviewer’s perspective, Dr. Van Haren stresses that authors should follow reporting guidelines when writing papers, “Reporting guidelines are important and should be given more emphasis. They can help provide consistency in reporting of data. This makes it easier for the scientific community to interpret the results of the study, which ultimately will further scientific discovery.”
Christopher W. Seder
Dr. Christopher W. Seder is an associate professor of surgery and the cardiothoracic surgery program director at Rush University Medical Center in Chicago, Illinois, USA. After graduating from the Michigan State College of Human Medicine, Dr. Seder trained in general surgery at William Beaumont Hospitals, in Royal Oak, Michigan. During this time, he dedicated a year to investigating lung and esophageal cancer at the University of Michigan. He completed his cardiothoracic surgery training at Mayo Clinic, in Rochester, Minnesota.
Dr. Seder’s interests include all aspects of benign and malignant lung, mediastinal, chest wall, and esophageal disease. His academic interests include investigating blood-based tumor markers to identify lung cancers at the earliest stage, outcomes research, and resident education. He has been awarded the L. Penfield Faber Teaching Award for excellence in education multiple times for his efforts in this regard.
In Dr. Seder’s opinion, peer review promotes quality research, limiting the potential for unrecognized biases and inappropriate analyses. Since clinicians may base their treatment decisions on the results of publications, the bar for publication must be kept reasonably high. Therefore, it is important for reviewers to remain impartial to the authors, critical of the methodology, and knowledgeable in the topic being examined.
Often is the burden of a scientist and doctor overwhelming, limiting the time Dr. Seder could have on peer review, “I do it nights and weekends. I believe it is important to our field and that we have a responsibility to the patients of today and tomorrow. Thus, we must find time to contribute quality peer reviews.”
From a reviewer’s point of view, Dr. Seder thinks it is necessary for retrospective studies to apply for institutional review board approval, “There is potential risk to patients, even in a retrospective review, and the patients PHI (protected health information) must be protected.”
Oliver Reuthebuch currently serves as a Professor at University of Basel and a Co-Director at Clinic for Cardiac Surgery, University Hospital Basel, Switzerland. Graduating from the University of Tübingen, Germany, he completed two fellowships, one at Rose Medical Center, University of Colorado, USA, another at Clinic for Cardiac and Vascular Surgery, University Hospital Zurich, Switzerland. He then became the senior head physician at Clinic for Cardiac Surgery, Triemli Hospital in Zurich, Switzerland, and later on the head physician at Clinic for Cardiac Surgery University Hospital Basel.
His current focuses of research include minimal invasive cardiac surgery, aortic and mitral valve surgery, Ozaki Reconstruction, off-pump CABG, MIDCAB, thoracoscopic cardiac surgery, surgical therapy of atrial fibrillation, lone AFIB and development of training models. He is an active member of the German Society for Cardio-Thoracic Surgery, European Society for Cardio-Thoracic Surgery, Swiss Society for Cardiac Surgery, and a founding member of the German Society for Computer- and Robot-Assisted Surgery.
We are happy to have the following interview with Dr. Reuthebuch, who will talk about his thoughts and insights as a reviewer on peer review and academic writing.
JTD: Why do we need peer review?
Dr. Reuthebuch: Peer review is a method to ensure qualified and correct scientific publications in the academic field by reviewing manuscripts through experts in the field of the respective science. Nowadays it is of utmost importance to implement such a scrutinized filter that enables the scientific community to absolutely rely on published data. By this meticulous process, a scientific assertion only then has the potential to become an accepted and comprehensive statement.
JTD: What should reviewers bear in mind while reviewing papers?
Dr. Reuthebuch: Scientific research is a very competitive entity. It is of importance that the reviewer tries at its best to read and review the submitted manuscript as fast and as comprehensive as possible. Besides this, the reviewer has to retain his/her neutrality and therefore should accept that the authors, institutions or even countries of publishing should be blinded. On the other hand, the reviewer should kind of accept to declassify his/her own personal data to potentially avoid bias. The reviewer should accept to only pass an expert opinion in field of his profound knowledge. The reviewer also should take meticulous notes, preparations and precautions before agreeing to review for a journal to avoid predatory publishing.
JTD: What is fascinating about peer reviewing?
Dr. Reuthebuch: Peer reviewing is fascinating because reading submitted articles is highly informative. This is due to the actuality and topic of the papers but also the international distribution of the authors, who are potentially spread over the world. Thus, the reviewer comes into contact with interesting or even extraordinary mindsets he/she would otherwise not be able to obtain. Beside that, the reviewer may become member of a group of scientists out of which new ideas can be developed.
JTD: Is it necessary for retrospective studies to apply for institutional review board approval?
Dr. Reuthebuch: No matter whether scientists are initiating a retrospective or prospective study – each time the data of the patients are required. Hence, in Switzerland it is of utmost importance to have the individually signed general consent available, as well as the institutional review board approval and the ethical committee approval. By law we have to follow these guidelines. Though in the setting of a retrospective study this ductus may appear a bit overstated, it helps to remain in accordance to the patients’ wishes and thus leads to save, commonly accepted and legally sound research.
Prof. Khosro Hekmat is a German Board Certified Cardiothoracic Surgeon. He is currently a Professor of Cardiothoracic Surgery and the Director of the Thoracic Surgery Program at the University of Cologne, Germany. During 1998 - 2006, he was an Attending Surgeon at the Department of Cardiothoracic Surgery, University of Cologne, Germany. In 2005, he obtained the German Board Certificate for Surgical Intensive Care. He was an Attending Surgeon at the Department of Cardiac Surgery, University of Ulm, Germany (2006 - 2007), and a Professor of Cardiothoracic Surgery, University of Jena, Germany (2007 - 2011).
Prof. Hekmat’s research areas include first logistic scoring system for intensive care cardiac surgical patients (http://www.cardiac-icu.org/), pulmonary metastasectomy and multimodal therapy of lung cancer. You can get to know more about Prof. Hekmat and his research through his homepages: 1. The CASUS 2. Herzchirurgie Uniklinik Köln
In Prof. Hekmat’s opinion, a healthy peer review system involves a dedicated editorial board and ideally 4 reviewers for each manuscript. A limitation of the existing system is that many reviewers are unmotivated. To remedy this problem, he suggests addressing and inviting more young scientists. Even though reviewing papers is non-profitable and anonymous, he is motivated to review in order to be ahead of others in research.
Calvin S. H. Ng
Dr. Calvin S. H. Ng is Professor in Thoracic Surgery and Honorary Consultant Surgeon at Prince of Wales Hospital, The Chinese University of Hong Kong. He is a pioneer in Single Port (Uniportal) VATS in the Asia-Pacific region. His recent interest has been the use of hybrid operating room (HOR) for image-guided surgery and procedures. His team is at the forefront of developing HOR applications in single port VATS lung surgery, and image-guided electromagnetic navigation bronchoscopy (iENB) for diagnostic and therapeutic purposes such as tumour ablation. Dr. Ng’s other research interests include molecular biology of lung, magnetic actuated surgical endoscopes, organoids and nanoparticles in cancer therapy. For more information about Dr. Ng’s biography, please visit his page.
To Dr. Ng, peer review is an important process in publishing, as it helps ensure integrity scientific rigor behind the article that tries to answer relevant scientific question(s). The approach to the problem, ethics, design of the study, analysis and interpretation should all be part of the reviewing process by experienced and knowledgeable reviewers.
Dr. Ng believes that reviewers should keep firmly in mind the following rules: One of the first considerations would be whether to accept to review the article in the first instance by gauging if the topic you are reviewing falls within your expertise, so that a fair review is possible. Another pitfall that should be avoided is to introduce bias into the review process because of certain pre-existing opinions that the reviewer has.
Even though peer reviewing is not profitable, Dr. Ng encourages all reviewers to keep up their hard work, “In the end, I think we owe it to our patients that published scientific research is of the highest standard and integrity. Results and conclusions from studies may be used for drug development, instigate change in clinical management and support further research. An added bonus is that by being a reviewer you are often kept updated on the latest developments in your specialty.”
Finally, Dr. Ng has a few words for authors: I think following well-established reporting guidelines when writing papers can help the authors, the reviewers and editors assess the article more efficiently and fairly, as well as improve the overall standard of the article.
Dr. Kenji Tsuboshima currently serves in the Pneumothorax Research Center and Division of Thoracic Surgery at Nissan Tamagawa Hospital, Japan. His areas of research are focused on spontaneous pneumothorax and cystic lung diseases. He is currently concerned with two major issues: 1) Although thoracic surgery for spontaneous pneumothorax has been less invasive, he is striving to ultimately revise pain and cosmetic problems. As a solution, he performs uniportal video-assisted thoracic surgery. 2) Pathophysiology of primary spontaneous pneumothorax (PSP) and rare lung diseases with pneumothorax such as thoracic endometriosis (TE), lymphangioleiomyomatosis (LAM), Birt-Hogg-Dube syndrome (BHDs) and so on has not been fully resolved. He hopes to conduct more research on the pathophysiology of these diseases. For more information abour Dr. Tsuboshima, please visit his personal page here.
To Dr. Tsuboshima, peer review can ensure the fairness and evaluation of scientific papers. It is important for authors and reviewers to discuss various issues or questions so that the papers will be more understandable, leading to a higher level in the quality of the research.
“My motto of reviewing is to make progress together with other researchers wishing for the development of medicine.” In Dr. Tsuboshima’s opinion, reviewers are required to be generous. If there is a valuable novelty in any incomplete papers, reviewers are responsible for discussing enough and leading ones to better contents. A reviewer becomes always a researcher as well as an author in a sense.
“This is entirely a hard problem for me,” says Dr. Tsuboshima when he is asked how he manages to review under heavy daily workload, “However, I always find ways to make time by efficiently conducting daily clinical practice and systematically researching on regular basis. When an extra review task is requested, I try to start the task immediately. A reviewer can comment with enthusiasm and an author can get an early response.”
On Conflict of Interest (COI) disclosure, Dr. Tsuboshima claims that it is an important information that can influence the scale and conclusion of a research. Therefore, he believes that COI disclosure is necessary for assessing the quality of the papers.
Joon Bum Kim
Dr. Joon Bum Kim, MD, PhD, is an Associate Professor in Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. He is an awardee of Evert A. Graham Memorial Traveling Fellowship of the American Association for Thoracic Surgery (AATS) in 2014 – spent the fellowship year at Massachusetts General Hospital, Cleveland Clinic and Hermann Memorial Hospital at Houston.
His major areas of interest are 3-D printing based open repair of thoracoabdominal aorta, minimally invasive-valve surgery, minimally invasive open aortic repair including valve-sparing root surgery and arch reconstruction, and surgical ablation of atrial fibrillation.
He serves as the Editorial Board Member of (1) Journal of Thoracic Disease, (2) Journal of Thoracic and Cardiovascular Surgery, (3) Journal of American College of Cardiology-Asia, (4) Asian Cardiovascular and Thoracic Annals, (5) Journal of Chest Surgery and (6) Journal of Korean Medical Science.
As the editorial board member and reviewer of JTD, Dr. Kim would like to say a few words to encourage all the other reviewers who have been devoting themselves to advancing scientific progress behind the scene: “From the beginning level as an author myself, nobody has taught about scientific writing more than journal reviewers with respect to all aspects of scientific researches. With full appreciations to my teacher reviewers, I have also tried to repay for those valuable lessons as a reviewer. As such, the peer review process I believe is such invaluable experience for all members of our research community.”
Bart De Geest
Dr. Bart De Geest is a Professor of Medicine in the Department of Cardiovascular Sciences at KU Leuven, Leuven, Belgium. He obtained his M.D. degree summa cum laude with congratulations of the jury in 1993, his Ph.D. degree in 1998, and his license to practice Internal Medicine in 2001. Since 2001, he has been the principal investigator of the Lipoproteins and Gene Therapy Group in the Centre for Molecular and Vascular Biology at KU Leuven. His research interests include gene transfer technologies, high-density lipoproteins (HDL), familial hypercholesterolemia, gene therapy for metabolic diseases, clinical prediction models, and heart failure. He is in particular interest in HDL-targeted interventions for treatment of heart failure with preserved ejection fraction (HFpEF).
JTD: Why do we need peer review?
Dr. De Geest: Peer review is intended for quality control in academic publishing. Research that has not gone through the peer review process in general is not as reputable and may be flawed. Whereas peer review may indeed increase the quality of scientific papers, it is equally important to realize that the peer review process is no guarantee for the accuracy and precision of data and for the absence of erroneous interpretations in published studies. Importantly, the publication process in several scientific areas is going to be impacted by the ideological and philosophical position of the editorial board and/or of the reviewers. Moreover, the scientific publication process may certainly be influenced by groupthink, which is the desire of authors and/or reviewers for conformity with established viewpoints within academia or in other words the desire not to disrupt harmony within the scientific community. In addition, a specific problem for both authors and referees is confirmation bias whereby data are interpreted selectively or whereby data that do not support a hypothesis are simply ignored. Taken together, the peer review process in general improves the quality of scientific papers but is insufficient and is not an endpoint. Peer review certainly does not eliminate the need for each individual reader to have sufficient factual knowledge and methodological skills to evaluate a manuscript. My experience is that medical students uncritically consider peer review to constitute a magic bullet that makes peer-reviewed papers automatically trustworthy.
JTD: What are the qualities a reviewer should possess?
Dr. De Geest: A reviewer should be completely independent and should never consider the authors as friends, enemies, competitors, or allies. In reviewing papers, a reviewer consistently applies the same standards with regard to quality of study design, quality of raw data, quality of data analysis, and reasonable interpretation of data. Ideally, a reviewer has extensive experience in different disciplines and has a thorough knowledge of basic science, clinical medicine, statistics, epidemiology, and modelling. In analyzing a manuscript, the reviewer must also investigate that there is no discrepancy between the factual data and the interpretation of the factual data. An old proverb most often gratuitously attributed to Mark Twain states: ‘Never let the truth get in the way of a good story.’ This should certainly not be applied to academic publishing.
The reviewer should have attention for detail, carefully analyze the consistency of the data, and also assess the scientific and clinical relevance of the study. T.S Eliot wrote in 1934: ‘Where is the Life we have lost in living? Where is the wisdom we have lost in knowledge? Where is the knowledge we have lost in information?’ Data may obscure information, information may obscure knowledge, and knowledge may obscure wisdom. This point is especially relevant in this era characterized by a plethora of data and plethora of information.
The reviewer may give a confidential advice to the editor, but never with the intent to directly steer the decisions taken by the editor. There should never be a discrepancy between the comments to the authors and the confidential comments to the editor.
JTD: Would you like to say a few words to encourage all the other reviewers who have been devoting themselves to advancing scientific progress behind the scene?
Dr. De Geest: The goal of reviewing papers should not be academic visibility. Peer review should be an invisible activity, reflecting intellectual curiosity and the pursuit of objective truth. One of the critical philosophical presuppositions to science is the existence of an external, orderly, knowable, and intelligible world. One also presupposes that humans have a rational nature and that they can know and judge external reality. Aristotle defines in Metaphysics 1011b25 truth as: ‘To say of what is that it is not, or of what is not that it is, is false, while to say of what is that it is, and of what is not that it is not, is true. Thomas Aquinas defines truth as ‘Veritas est adaequatio rei et intellectus” (Truth is the equation of thing and intellect)’. Truth does not require sensational headlines, unique selling propositions, buzzwords, window dressing, …but sets free. So-called ‘scientific consensus’ is certainly not a criterion of truth. In contrast, ‘scientific consensus’ can be a serious impediment in the pursuit of truth. Peer review is an intellectually stimulating activity in which the individual reviewer makes a difference.
JTD: From a reviewer’s perspective, do you think it is important for authors to follow reporting guidelines?
Dr. De Geest: Checklists are an instrument but nothing more and certainly not a goal in itself. There is a trend for always increasing bureaucracy and legalism in science and a disproportional emphasis on the ‘process’ rather than on the actual result. Simply following a set of rules is not a surrogate marker of good science. Checklists are no substitute for the intellect of authors and peer reviewers. If e.g. the STROBE guidelines are analyzed, one can only conclude that the items listed in the checklist are acceptable but at the same time quite evident. However, the requirement to fill out the checklist implies significant additional administrative work for authors because the authors are expected to indicate for each item where information can be retrieved in the paper. From a practical point of view, who is ever analyzing the accuracy of the answers in this checklist? It is dubious whether checklists have a real incremental value in academic writing and in the peer review process.
Akimasa Morisaki, MD, PhD, is Junior Associate Professor of Cardiovascular Surgery, Department of Cardiovascular Surgery, Osaka City University, Graduate School of Medicine, Osaka, Japan. He is a specialist in cardiovascular surgery, and thoracic and abdominal endovascular surgery in Japan. For more information about Dr. Morisaki and his research, please visit his personal page or Research Gate.
JTD: Why do we need peer review?
Dr. Morisaki: The Internal Committee of Medical Journal Editors defined peer review as the critical assessment of manuscripts submitted to journals by experts who are usually not part of the editorial staff. The role of peer review is mainly a screening by verifying a suitability of the manuscripts for the journal by expert reviewers. Then, peer review includes an important meaning to ensure high quality and appropriate study by evaluating originality, and significance of the hypothesis, accuracy of the methods and data in the scientific manuscript. The authors also can improve the quality of manuscript as referring to a suggestion from the peer reviewers. Additionally, peer review system would prevent biased opinions and decisions by multiple reviewers. The peer review system eventually would connect to rise in status and quality of the journal.
JTD: What reviewers have to bear in mind while reviewing papers?
Dr. Morisaki: I think that reviewers have to review with a fair eye because a subjective assessment has a possibility of wrong judgement of the manuscript. And also, reviewers should understand the current trend of researches and have extensive knowledge in his/her expertise.
JTD: Why do you choose to review for JTD?
Dr. Morisaki: I have reviewed for many other journals. JTD is a highly professional journal with quick response and publication of manuscripts. I think that JTD corresponds with my field of expertise greatly.
JTD: Is it important for authors to complete Conflict of Interest (COI) forms recommended by ICMJE?
Dr. Morisaki: Yes, it is important for authors to complete COI forms, because COI disclosure eliminates biases and enables a fair and transparent assessment of the proposed research. COIs have a potential for creating bias and exerting undue influence on the judgement and actions of the researchers, especially on financial conflicts.
Dr. Teruaki Mizobuchi currently serves as a Director of the Department of General Thoracic Surgery, Chibaken Saiseikai Narashino Hospital, Chiba, Japan. He obtained his M.D. in Chiba University School of Medicine in 1996, and completed his Ph.D. (Doctorate of Medical Science) at Graduate School of Medicine, Chiba University, Department of General Thoracic Surgery in 2003. Recently, he is focusing on the studies of lung cancer surgery especially in reduced port video-assisted thoracic surgery, intractable pneumothorax surgery such as Birt-Hogg-Dubé syndrome, Lymphangioleiomyomatosis, catamenial pneumothorax, and so on. For more information about Dr. Mizobuchi, please visit here.
To Dr. Mizobuchi, the peer-review process should be carried out in a fair and upright manner. In the opposite direction, because of fairness, an appropriate peer review is necessary, “My motto for reviewing papers is ‘be honest’. Of course, scientific fairness, ethical codes, and fundamental human (and animal) rights should be respected and protected. Moreover, even if I am not a true expert on reviewing a manuscript, deepening knowledge of the field on the manuscript helps me become the eligible reviewer. Do not neglect your efforts. Keep pursuing your knowledge. That’s pretty important.”
As a reviewer of Journal of Thoracic Disease (JTD), Dr. Mizobuchi has a great experience working with the journal as it has been taking up the most up-to-date issues, especially minimally invasive video-assisted thoracic surgery. He looks forward to collaborating more closely with JTD in the near future.
Piotr Gabryel, MD, currently serves in the Department of Thoracic Surgery at Poznan University of Medical Sciences, Poznan, Poland. He is a Member of Polish Society of Cardiac and Thoracic Surgeons, European Society of Thoracic Surgeons, and European Respiratory Society. His research is focused on lung cancer surgery, enhanced recovery after surgery, indocyanine green fluorescence and pulmonary metastasectomy. Recently, he is studying the influence of COVID-19 on diagnosis and treatment of patients with lung cancer; role of nutrition-related factors in predicting short- and long-term outcomes of minimally invasive lung cancer surgery; relation of surgical approach - including thoracotomy and various types of VATS approach and the outcomes of treatment of NSCLC; and outcomes in extended resections of lung cancer.
In Dr. Gabryel’s opinion, peer review is important for everyone involved in this process: for science, for authors, for the journals, and for reviewers. For science, because it enables the selection of the most interesting research articles, which will significantly affect the state of both theoretical and - even more important in the case of a health care practitioners (most of all – doctors, nurses, and physiotherapists) - practical knowledge. Peer review allows authors to look at their research through the eyes of other people involved in a given field of medicine. If the reviewer’s work focuses not only on the evaluation of the article, but also contains comments that can improve its quality, the authors receive valuable information that allows them to improve both the reviewed text and future research work. When it comes to medical journals, the peer-review process by specialized reviewers allows for the selection of up-to-date, well-written articles for publication that may impact the medical community. This can contribute to maintaining and increasing the quality of the journal. Finally, peer-reviewing allows the reviewer himself/herself to gain new medical knowledge, look critically at his/her own research work, and perhaps see directions for new research.
There are some key qualities that Dr. Gabryel thinks reviewers should possess. First of all, they must have extensive medical knowledge in the field from which they review scientific research. They should know the theoretical basis of writing scientific articles, and have knowledge of research methodology and statistics. Reviewers should be able to critically look at the results presented in the article and the way it is written, and at the same time provide suggestions that could improve its quality. At the same time, reviewers must remember that the authors are people, members of the global medical community, who, regardless of the quality of the article, should always be given due respect.
From the reviewer’s perspective, Dr. Gabryel sees the need for all scientific research, including retrospective studies, to apply for institutional review board (IRB) approval. This would allow them to maintain appropriate ethical standards and correct any errors in this regard.
“Reconciling the different roles in life - a doctor, father, scientist, amateur athlete, and peer reviewer of scientific journals - can seem difficult. However, with the support of loved ones and proper organization of time, it makes everything possible,” says Dr. Gabryel.
Ulrik Sartipy is a cardiac surgeon at the Department of Cardiothoracic Surgery, Karolinska University Hospital and an adjunct professor at the Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. His main research interests include clinical epidemiology and heart disease. His group performs nationwide population-based register studies in several cardiovascular research areas, such as coronary artery disease and aortic valve replacement. His clinical field is adult cardiac surgery. He is the lead pulmonary endarterectomy surgeon at Karolinska University Hospital. He specializes in minimally invasive aortic valve replacement and surgical myectomy for hypertrophic obstructive cardiomyopathy. For more information about Dr. Sartipy, please visit here.
To Dr. Sartipy, a healthy peer review system is characterized by an unbiased and fair evaluation of manuscripts throughout the process; starting with the initial evaluation by the editorial board, selection of reviewers, reviewers’ assessment of the merits and weaknesses, and finally the editor’s decision, sometimes based on conflicting advice. Peer review does not exist on its own, it is part of an integrated system, and all components must function properly for the system to stay healthy and promote sound science.
Dr. Sartipy further points out that reviewers have a great responsibility because they help editors understand if a study is performed with a sound methodology, if the data are presented clearly, and if the analysis and interpretation is adequate. By accepting an invitation to review a manuscript, a reviewer should be prepared to devote enough time to provide a thoughtful evaluation of the manuscript and provide a report before deadline. Reviewers should always be respectful and constructive in their criticism, and high-quality reviewer reports include comments that help the authors to improve the quality of the paper. He says, “Please be the reviewer that you yourself would be happy to receive a report from – a reviewer who has taken a serious look at your work, identified flaws, and provided suggestions for improvements.”
From the angle of a reviewer, Dr. Sartipy urges authors to disclose Conflict of Interest (COI) for their studies. Transparent reporting of all potential COI is fundamental for authors. COIs have the potential to compromise objectivity, and thus in the worst case completely invalidate research.
“Reviewing is a privilege, and an invitation to perform a review is a sign of confidence from the editors that you are qualified to assess the work of your peers within the scientific community. Peer review is an integral tool for ensuring the quality and high standard of scientific research. Reviewing is rewarding because your skills are not only reviewing, but also producing. Science will improve over time,” says Dr. Sartipy.
Dr. Tomasz Marjanski is Associate Professor of Thoracic Surgery, Medical University of Gdansk, Poland. He completed his medical degree at Medical University in Gdansk. He defended his Ph.D. thesis in the field of general thoracic surgery in 2009. Later that year, he was awarded Young Investigator’s Award during the annual congress of the European Society of Thoracic Surgeons (ESTS). He has established his clinical skills during clinical visits and short fellowships at the University of Pisa, Italy; New York Presbyterian Hospital, USA; Atrium Medisch Centrum Parkstad, the Netherlands; Marmara University Hospital, Turkey; and Princess Margaret Hospital, Canada. He received three ESTS scholarships for minimally invasive surgery trainings in France, and national board certification in general thoracic surgery. He is a member of the ESTS and International Association for the Study of Lung Cancer.
Dr. Marjanski’s clinical and scientific interest is concentrated on novel adjuvant and neoadjuvant lung cancer treatment protocols involving surgery. The recent implementation of immunotherapy into the treatment of advanced lung cancer enriches the armamentarium of preoperative treatment which poses a valuable option for thousands of patients. Another field of interest is the risk reduction policy in lung cancer surgery. Implementation of low tech exercise tests has the potential to identify patients who may benefit from personalized perioperative care. Currently, Dr. Marjanski is involved in a clinical practice based in a university hospital with a full spectrum of specialties. To connect with Dr. Marjanski, you may visit his Facebook page here.
In Dr. Marjanski’s opinion, the main condition for a good review is to spend enough time on it. Reviews, as a rule, are directed to specialists in a given field. Most often, there are no problems with the substantive evaluation of the submitted text. On the other hand, the global reach of current scientific publications makes it almost impossible to unethically downgrade submitted manuscripts. On the contrary, the main limitation of the peer review is the time disparity. There is no doubt that the reviewer spends much time less on a text that has often been written for years. This forces reviewers and editors to take special responsibility for their decisions. Conceivably, a higher number of reviewers would increase the quality of decisions.
Speaking of research data sharing, Dr. Marjanski believes that it should be decided by authors as it may be regulated by additional rules. Recent General Data Protection Regulation (GDPR) restrictions make this area particularly fragile. Therefore, this should be decided individually, not as a routine.
“Finding the time to do a review is not easy. Nevertheless, I believe that peer-review is at the core of academic activity. Therefore, we are committed to contributing to today's science by working for scientific publishers. I try to do reviews over a period of several days in approximately 1-hour sessions in order to return to the same manuscript several times,” says Dr. Marjanski.
Anthony W. Kim
Dr. Anthony W. Kim is a general thoracic surgeon, Professor of Clinical Surgery, and Chief of the Division of Thoracic Surgery at the Keck School of Medicine of the University of Southern California in Los Angeles, California, USA. His clinical practice focuses on the surgical therapy for all types of thoracic malignancies as well as benign thoracic diseases. He incorporates the entire spectrum of approaches ranging from the minimally invasive approaches of thoracoscopic and robotic thoracic surgery to the open approaches for both straightforward and complex operations. His clinical research interests include studying thoracic oncology at the population level using large datasets. He also has ongoing collaborations with translational scientists on a wide range of projects for the purposes of facilitating discoveries that can be brought from the bench to bedside. He also is an active participants in a number of international clinical trials including serving several committees for these studies. Lastly, he is highly regarded as a mentor and teacher to innumerable students, residents, fellows and other faculty in the clinical and research arenas. For more information about Dr. Kim’s research, please follow @FightOnThoracic on Twitter.
JTD: What role does peer review play in science?
Dr. Kim: The peer review process is incredibly important to advancing the science and understanding in our specialty. It provides many surgeons and scientists the opportunity to determine if a submission is worthy of publication owing to considerations including but not limited to rarity, novelty, comprehensiveness, strength of science as well as whether it is interesting to the audience at-large. It also provides the opportunity to inform other surgeons and scientists about wonderful ideas who perhaps may adopt, include, or modify in their own work. Through this process, there is then another opportunity to evolve research further. The peer review process also allows for the honest feedback and rewards those surgeons and scientists who conduct high-caliber studies and describe their work well. Lastly, in and of itself, the review process is an outstanding way in which education continues as often times, studies incorporate context that established the foundation for a study, an excellent source of review, and then allows for the learning of concepts and ideas that has the potential to be more mainstream with time. After all, we are all in this field to serve our patients and our discipline through learning.
JTD: What do you regard as a constructive/destructive review?
Dr. Kim: A constructive review is one in which the reviewer identifies and provides recommendations that enhances the central message for a manuscript that has the potential to be published. Everyone who submits a manuscript in some fashion believes there are unique aspects to their manuscript. Furthermore, each submission represents a significant effort. With that in mind, a destructive review is one that does not offer an opinion where a manuscript can be improved. Even if a manuscript is deemed not acceptable for publication, a good review will have points of enhancement for the authors so they can build upon their current work. A good review will then lead to a version of the manuscript that can be submitted and published elsewhere.
JTD: What is so fascinating about peer reviewing?
Dr. Kim: There are two components about peer reviewing that are fascinating. The first is that it affords anyone who is invited to review equal stature at the proverbial review table. Therefore, the review process is an invitation to be a formal expert in the domain in which most surgeons already are an expert clinically. The invitation is the opportunity to demonstrate expertise in a realm in which the surgeon routinely demonstrates facility in the day-to-day clinical activities. The other fascinating aspect is the concept that most reviewers understand which is that of fairness. In order to have one’s manuscript reviewed fairly, they too must participate in the review process of other authors. Most authors and reviewers seem to understand and respect the integrity of this process.
JTD: From a reviewer’s perspective, do you think it is necessary for authors to follow reporting guidelines when writing papers?
Dr. Kim: Reporting guidelines provide excellent structure especially for the review process and because of a baseline standardization in reporting, it is important for authors to follow them. The surgical scientific community should also appreciate though, that on a few occasions, adhering to every aspect may not serve the authors of a study well or may not do justice to a scientific report about which the data is being written. Because of these circumstances, reviewers and readers should understand that these guidelines are just guidelines and not immutable rules. Guidelines were conceived and implemented to lend themselves to a certain degree of uniformity in reporting. As long as the authors provide sound and robust justification for moving outside of certain aspects of any set of guidelines, it is reasonable to do so for the sake of advancing knowledge. In the end, the role of the surgeon and scientist is to push the envelope and this advancement may mean moving slightly outside the confines of a rigid set of guidelines. In many ways that is how science has progressed.
Paul C. Tang
Dr. Paul C. Tang currently serves at the Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, MI, USA. He was trained in cardiothoracic surgery at Duke University Medical Center and completed a PhD in cardiovascular immunology at Yale University. He has a clinical focus on surgery for patients with heart failure performing ventricular assist device implantation, extra-corporeal membrane oxygenation and heart transplantation. He also has expertise in thoracic aortic disease including valve sparing root replacement and Ross procedures. His translational science research deepens our understanding of the pathophysiology of primary graft dysfunction in donor hearts and facilitates the development of therapeutic strategies to improve cardiac function following preservation. He also conducts clinical research on valvular heart disease in the setting of mechanical circulatory support and uses OMICs techniques (e.g. RNA Sequencing, proteomics) to investigate responses to ventricular assist device therapy. You may connect with Dr. Tang on Twitter @PaulTangMD.
To Dr. Tang, peer review is critical for promoting high quality, accurate and informative publications that ultimately benefits his specialty and the patients who receive care. The peer review process provides vital expert input for authors who submit their research as well as reviewers who assess their investigations. This allows the prioritization and dissemination of the most impactful research to the global community.
There are some qualities that Dr. Tang thinks a reviewer should possess. Reviewers should have deep expertise in the field in the subject being evaluated for publication. This ensures valuable input regardless of the acceptance or otherwise for the manuscript. Objectivity as much as possible should be practiced by reviewers to promote advances in the field and they should ensure the best knowledge is being disseminated. Blinding of reviewers to the institution and authors will facilitate this goal.
From Dr. Tang’s perspective, it is important for retrospective studies to apply for institutional board review so access to patient information for research purposes are kept track of. The application process itself serves as an important reminder to researchers of their ethical duty to protect patient confidentiality at multiple levels. This process is very important for promoting patient and public confidence in integrity of the medical research process. It helps promote our continued access to clinical information to improve patient outcomes through medical investigations.
“I believe serving as a reviewer is the responsibility of content experts to help the specialty move forward. It serves as a valuable avenue for authors to receive critical input for which I have benefited from myself. The manuscript evaluation process is also an important mechanism for reviewers to impact a field that they are passionate about,” says Dr. Tang.
Kei Suzuki, MD FACS, currently works in the Division of Thoracic Surgery, Department of Surgery, Boston Medical Center, Boston, MA, USA. He is board certified in thoracic and general surgery, with clinical interest in robotic surgery and research interest in early detection and prognostication of lung cancer as well as socioeconomic disparity in the screening and treatment of lung cancer patients. He is the site director for the Joint Lung Cancer Trialist’s Coalition Stablemates Trial, which is investigating the efficacy of wedge resection versus radiotherapy for stage I lung cancer patients. He has obtained several funding for his research, which includes study of immune response in stage I lung cancer as well as investigating factors to improve the yield of lung cancer screening.
Dr. Suzuki did his general surgery residency at Beth Israel Medical Center in New York. During his general surgery residency, he spent 2 years in the Adusumilli Lab at Memorial Sloan Kettering Cancer Center in New York, where he dedicated time investigating immune response in stage I lung adenocarcinoma. He then completed cardiothoracic surgery fellowship at Presbyterian/Memorial Sloan Kettering Cancer Center in New York. Upon graduating, he joined Boston Medical Center in 2017 and has been on faculty since.
To Dr. Suzuki, peer review is essential in maintaining high quality and integrity of the work we publish, which in turn is necessary to advance the field. He believes that it is important to recognize that no study is perfect and that every study has limitations. As such, it is important for reviewers to critique appropriately while providing constructive criticism to help improve the quality of each paper. “I think the review process is an underappreciated part of what we do as clinician/scientist in providing sound research that will change our everyday practice in improving patient care,” says Dr. Suzuki.
Dr. Christopher Towe has been a member of the Department of Surgery at University Hospitals Cleveland Medical Center, USA since October 2014 after surgical training in New York City at Weill Cornell Medical College and New York University. He was promoted to Associate Professor in 2020. He is a board certified cardiothoracic surgeon, and practices general thoracic surgery at Cleveland Medical Center and Parma Medical Center. His areas of clinical interest include lung cancer, chest wall surgery and reconstruction after trauma. His research interests include risk models and large database analysis. He serves on committees at the Society of thoracic surgeons and at the Chest Wall Injury Society. Outside of the hospital, Dr. Towe enjoys spending time with his family outdoors and cooking.
To Dr. Towe, a robust peer review system is one in which all parties are striving for research excellence. For the system to work, both the author and reviewer need to share the common goal of advancing science and improving patient care. Furthermore, both the author and reviewer need to be humble. Changes in the status quo require significant burden of “proof”, and this may be difficult for authors to accept, especially those with circumstantial evidence. On the other hand, reviewers must be ready to accept changes to medical dogma when presented with compelling evidence. This too may be difficult, especially when the changes challenge long-held beliefs.
“The role of reviewer is not to be taken lightly,” says Dr. Towe. He reckons that reviewers must have a sessile knowledge of the current medical literature and a keen understanding of modern analytic and statistical techniques. They must both be deeply invested in evidence-based practice and willing to accept new ideas and approaches to old problems. The reviewers’ role is to facilitate publication. Authors often needs guidance and mentorship to improve their manuscript, and this is an excellent opportunity to provide that.
There are a variety of tools to assist with writing and reviewing a manuscript. As an author and reviewer, Dr. Towe typically feels that the “checklist” style tools (such as STROBE and CONSORT) do not effectively communicate problems with a manuscript. As an officer, he believes that manuscript should be concise, and written in a way which does not require a standardized format to be understood. In terms of reviews, he vastly prefers a manuscript review style which is conversational and collaborative. For example, rather than accusations that the authors have “omitted key references”, he believes reviewers should cite relevant papers and suggest that adding those would “strengthen the conclusions”. Again, the role of the reviewer is to improve the manuscript, not to tear it down.
“The practice of academic medicine is complex. There is never enough time for patients, research, and other administrative duties. I believe acting as a reviewer is important both as a service to the medical literature at large, and also as a part of a personal mission to stay current with topics in thoracic surgery. Activity as a reviewer not only helps others in the field gain recognition, but gives me insight into others’ research ideas and concepts. I feel that all of this is invaluable,” says Dr. Towe.
Dr. Katsuhiro Okuda currently serves as an Associate Professor of the Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. He is focused on the surgical and molecular target therapy for thoracic malignant tumors including lung cancer and thymic epithelial tumors. Recently, he has been particularly focusing on research on the clinical and scientific usefulness of minimally invasive surgery for thoracic malignancies. For more information about Dr. Okuda, please visit here.
To Dr. Okuda, peer review is an essential and quite important process of checking the importance, accuracy and need of each special field. Before delivering the articles to readers around the world, it is a process of neutrality and transparently examining whether there is any incorrect information, fraud, or simple mistakes.
Seeing the significance of peer review, it is therefore of utmost importance for reviewers to spend enough time and do a fair peer review. To Dr. Okuda, it is necessary to peer review with a critical eye, but also necessary to have a flexible idea so that good thoughts and results can be judged as good, even if they differ from the reviewer’s opinion. Reviewers should thoroughly investigate any questions during the peer review, and point out issues from a different perspective from the authors, and try to play a role in brushing up the articles.
From a reviewer’s perspective, Dr. Okuda stresses the importance for authors to follow the reporting guidelines, as there is a time limit for reviewers. If the authors write according to the guidelines, it will be possible for reviewers to review efficiently. The review time will be shortened and the authors will be able to obtain the results faster. Thus, it will be beneficial to the authors eventually.
“Peer review is a time-consuming task that takes much responsibility, but it often gives me quite novel things and new ideas. So I try to keep the time of peer review for self-development, instead of treating it as a work task. Peer reviewing a good journal can be very helpful in writing better articles for myself,” says Dr. Okuda.
Jeffrey Brian Velotta
Dr. Jeffrey B. Velotta is a general thoracic surgeon at Kaiser Permanente Northern California, Oakland, CA, and Assistant Professor of Surgery at the University of California San Francisco (UCSF) School of Medicine. After graduating from the George Washington University School of Medicine, Washington, DC, he completed his general surgery training at the University of California Los Angeles (UCLA) Medical Center, Los Angeles, CA. During his residency years, he completed a postdoctoral fellowship in Cardiothoracic Surgery at Stanford University under the mentorship of Dr. Robert Robbins and Dr. Michael Fischbein. He completed his Cardiothoracic surgery training at the Brigham and Women’s Hospital, Harvard Medical School. Dr. Velotta’s clinical and research areas of focus are on thoracic surgical outcomes, specifically looking at the role of regionalization in lung and esophageal cancer as well as mesothelioma. Recently, he has been awarded a major Division of Research grant studying the incidence and outcomes of lung cancer in never smoking female patients, specifically looking into ethnic differences on a population and molecular level. Dr. Velotta prides himself on his role as a surgeon educator and mentor and believes it to be highly rewarding to teach the next generation of medical students and residents. Please visit his page here for more details.
To Dr. Velotta, peer review is an extremely important aspect of scientific literature. There is so much information out in the digital age and clinicians and medical personnel need to read literature that has been appropriately reviewed and vetted by experienced researchers and clinicians in that given field. In other words, journals that are reputable are vital and possess accurate scientific knowledge because of their rigorous peer review process. In addition, the peer review process is an anonymous, non-biased review of the literature and can focus on the research at hand and not be influenced by the corresponding authors. Dr. Velotta believes that the peer review process allows clinicians and researchers to appropriately evaluate and comprehend the articles they read on a daily basis and can impact their practice in a positive way.
“A constructive review is one that does not let one’s own personal clinical or scientific thoughts judge the merit of the article,” comments Dr. Velotta. To him, a suitable review should be one that focuses on the science at hand and is critical of the information being read. A reviewer should use his/her clinical expertise to help guide the discussion and comments of the article being reviewed but not fully impart that on to the review process itself.
As a reviewer, Dr. Velotta stresses the importance and necessity for authors to complete the Conflict of Interest (COI) forms recommended by ICMJE. In his opinion, the literature review and writing process should be based on the research and not have any financial or personal gain involved. Otherwise, it would be difficult to interpret the data from these research studies where COI was not divulged. When it is reported as a conflict, it allows the reader and reviewer a more accurate assessment of the literature they are evaluating. COI can indeed affect research at times, but as long as the reviewer is aware of this in advance, they can take appropriate steps to ensure that the data being presented is indeed accurate and non-biased.
“I believe this is an invaluable service for reviewers such as myself to continue to review the literature in my field. It keeps me educated on the most current literature but can also assist the hard working editors with additional insight on all scientific research. If we did not have reviewers constantly assessing the new research that comes out, we would not be able to advance the medical field, thus I am very appreciative of being able to be a part of this vital process,” says Dr. Velotta.
Jin Yong Jeong
Dr. Jin Yong Jeong is the Professor of Thoracic and Cardiovascular Surgery at Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. He was the President of Korean Society for Phlebology from 2015-16, and the President of Korean Society for Thoracic & Cardiovascular Surgery (Kyeongin Branch) from 2017-19. His research is focused on lung cancer surgery, esophageal cancer surgery, robotic thoracic surgery, chest wall surgery, hyperhidrosis surgery, and varicose vein surgery. Recently, he is involved in projects related to robotic pulmonary resections including lobectomy, segmentectomy, and sleeve lobectomy; robotic esophagectomy for esophageal cancer; pectus excavatum and the functional changes of the thoracic organs including heart, lung, and spine; minimally invasive repair of pectus excavatum with using needlescope and Crane technique; predictive procedure for compensatory hyperhidrosis before sympathectomy in patients with severe primary hyperhidrosis; and endovascular ablation and stripping in varicose veins.
Peer review in science, according to Dr. Jeong, is essential to ensure that the authors’ work can be understood and shared by many other scientists. In scientific research, papers are written based on the original ideas of authors, but when authors conduct or describe their research in a way that only they themselves can do, other scientists might not be able to understand their work or refer to it in other research. Therefore, peer reviewers should understand what the authors are trying to describe in their research so that other scientists would not have difficulties in reading the authors’ writings. In addition, peer reviewers should make sure that the authors describe their background knowledge, research methods, results, discussion, tables and pictures, and references properly according to the author instructions presented in the journal.
Nonetheless, the qualities of reviews vary most of the time. How to ensure a review is constructive? To Dr. Jeong, a constructive review would politely suggest concrete opinions based on scientific knowledge of other papers so that the authors can improve the quality of their paper. Importantly, the review must be done within the time limit.
“The research quality of manuscripts submitted to JTD is high. Also, if the manuscripts are related to my research field, I can better understand the authors’ research. It would be worthwhile to review and help improve the quality of these papers effectively,” says Dr. Jeong.
Dr. Abby White is a surgeon for the Division of Thoracic Surgery at the Brigham and Women’s Hospital, USA, with special interests in thoracic oncology, lung cancer in women, mediastinal disorders, esophageal cancer, and minimally invasive thoracic surgery. She is also an Assistant Professor of Surgery at Harvard Medical School which she regards as a priority and privilege to teach medical students, residents, and fellows daily. Her research is focused on clinical outcomes, with specific interests in signet ring cell esophageal cancer, segmentectomy for non-small cell lung cancer, as well as treatment of locally advanced and recurrent lung cancer. Her most recent project evaluated the role of segmentectomy vs lobectomy for early stage lung cancer. She is married to Kris and they are about to have their 4th boy, all six years old or under. Congratulations!
In Dr. White’s opinion, a robust peer review system relies on experts (3-5 per manuscript) within a given field to filter and prioritize studies for publication by thoroughly vetting the validity of the study, its conduct and the findings. Such a system also improves the quality of the manuscripts deemed acceptable for publication.
Nonetheless, the existing peer review system has its shortcomings, according to Dr. White. It is cumbersome to implement, with many nuances to expertise and topics, even within a specialty field. Also, the existing process can be slow, as it is often “volunteer” work that goes above and beyond a busy clinician’s schedule. To improve the current situation, Dr. White suggests connecting reviewers to CME credit to encourage timely responses as well as compensate for the time spent, but as it is now, is too varied and cumbersome for most to take advantage of it. Also, it would be helpful to standardize review forms and include opportunity for both objective and subjective feedback; Scoring can also ensure that each paper is getting the scrutiny it deserves.
“The quality of research we put out there is only as good as the scrutiny and feedback it undergoes to get there. I want to give the same time energy and effort to the manuscripts I review as I would want my own research efforts to receive. It is exciting to see what problems people are tackling, what questions they are asking in their field and how they are approaching them,” says Dr. White.
Dr. Amer Harky is a speciality trainee in cardiothoracic surgery at Liverpool Heart and Chest Hospital, Liverpool, United Kingdom. He is a graduate of Hawler Medical University in Iraq and has entered the UK Cardiothoracic specialty training program since 2017. He has been a member of Royal College of Surgeons since 2015 and holds MSc in advanced surgical practice / type A aortic dissection. Furthermore, he is a member of Liverpool Centre for Cardiovascular Science (LCCS), Liverpool Aortic Biomechanics and Biochemistry Research Group and an honorary research fellow at the University of Liverpool. Dr. Harky’s research work can be accessed through his ResearchGate profile or through his twitter account @HarkyAmer.
In Dr. Harky’s opinion, peer review is an important aspect of any scientific data analysis. The reliability of the data does not only lie with the authors, but also the reviewers and their perspective in understanding and comprehending such information. Reviewing process is an important tool to ensure the data is sound, results are appropriate and bias free or at least limited to lowest level.
“Reviewers, including myself, always look at aspects of any paper that can help the scientific community by adding additional value through the presented research. As a reviewer, I find reading these papers very interesting and rewarding. Therefore, following a structured guidelines is of paramount to make this process smooth and easy,” says Dr. Harky.
Dr. Lieven Depypere is consultant general thoracic surgeon in the Department of Thoracic Surgery of the University Hospitals of Leuven and Assistant Professor at the KULeuven, Belgium (Department of Chronic Diseases and Metabolism; Laboratory for Pulmonary Diseases and Thoracic Surgery (BREATHE)). He had his surgical and general thoracic training in Leuven and did clinical fellowships in Marseille (France) and Guangzhou (China). In 2016, he became European Board certified thoracic surgeon (FEBTS) and in 2017, he became European board certified esophagogastric surgeon (FEBS/OG). He earned his PhD title in 2019 with a dissertation titled “Impact of multimodality therapy in esophageal cancer on disease, patient and treatment”. Dr. Depypere performs lung resections, lung transplantations and esophageal surgery for benign as well as malignant diseases. His special research interest goes to the vagus nerve and to curative esophageal cancer treatment and its multimodal aspects. Further interests in thoracic surgery fields are education in thoracic surgery and non-intubated thoracic surgery. You may visit Dr. Depypere’s profiles through LinkedIn and ORCID.
The problem of the existing system, according to Dr. Depypere, is the lack of direct interaction between authors and reviewers in order to come to the best result. The final goal of the reviewing process is to improve the manuscript to the highest possible quality, but with the existing system it takes a lot of time for the manuscript to go back and forth between authors and reviewers. It should be possible to organize a more interactive system with direct communication between authors and reviewers, still being anonymous.
Speaking of the anonymity in the review process, Dr. Depypere reckons that the goal is to deliver the best possible research manuscript and not to help some friends or to stop competitors. Therefore, reviewers not only have to be experts in the field and be aware of the latest literature, but also remain neutral in any circumstances.
With regard to research data sharing, Dr. Depypere is fond of the data sharing form used in JTD which he believes can stimulate researchers to share their data for reproducibility and reliability. He explains, “researchers are not obliged to share all their data with JTD and the public, which is a good thing – research is very competitive in most branches and sharing all data is not always possible. JTD allows authors to share parts of their data in coherence with good clinical practice, but at the same time takes into account the real life competitive nature of our domain.”
“The peer reviewing process is absolutely needed to ensure the quality of published scientific research. Therefore, I would like to thank all researchers who are devoting (mostly parts of their free) time to a proper reviewing process. Maybe something to remember for all authors who ever will write a manuscript for possible publication: your manuscript will be read by multiple reviewers and editors in order to even improve the quality of what you have been working on for so long. Remember that reviewing is also hard work that deserves respect. On the other hand, I would like to encourage authors to become reviewers, because it keeps you up to date with literature and gives you extra instruments to improve your own publications,” says Dr. Depypere.
Chang Young Lee
Dr. Chang Young Lee currently serves as an Associate Professor at Severance Hospital, Yonsei University College of Medicine in Seoul, Korea. His main areas of research and surgeries include lung cancer, thymoma/thymic carcinoma and tracheal disease, on which multidisciplinary research (along with oncology, radiology and pathology) have been carried out recently. He visited Toronto General Hospital and studied image-guided surgery under the help and instruction of Dr. Yasufuku for two years. Based on this experience, thoracoscopic segmentectomy using preoperative simulations and ICG has been conducted for early lung cancer patients.
To have a peer review system that is healthy and robust, Dr. Lee stresses that each paper should be evaluated by experts, preferably more while having a large pool of experts. Besides, if sufficient time is allowed for each review, better-quality review will be possible. On the other hand, reviewers should also have a balanced experience in surgery, writing papers, research and attending academic conferences. And with a sense of criticism, efforts should be made to find out and correct something wrong of even a good paper.
We are moving forward to new norm where research data are shared. However, to Dr. Lee, this concept of data sharing is still unfamiliar to many surgeons and researchers. In order to encourage this, publishers should actively provide incentives, even when initially sharing limited periods or limited numbers of data. As an incentive, we can consider exempting publication fee, shortening review period or quick publication, etc.
“Being a reviewer, I am happy to meet the latest, unpublished article first. This allows me to keep track of the latest research trends. And the shortcomings of the articles that have not been published serve as an opportunity for new research to me,” says Dr. Lee.
Dr. Norihisa Shigemura, MD, PHD, is currently a Professor in Cardiovascular Surgery at the Temple University Lewis Katz School of Medicine and the Surgical Director of Lung Transplantation and Lung Failure, Japan. His daily practice involves the care of the sickest patients with advanced lung failure. Many of these patients would not survive without transplantation or an extraordinary level of care and mechanical support including artificial lungs. His research and clinical interests are both focused on improving outcomes and also developing new therapeutic strategies for the patients with advanced lung failure by using not only surgical techniques and/or evolving technologies but also regenerative medicine, stem cell therapy, and tissue engineering. To this end, he has published consistently over 150 publications in many top-notch science journals.
Dr. Shigemura is an active teacher of residents and fellows and has also taught the colleagues by lecturing nationally and internationally on surgical techniques used in lung transplantation, management for highly complicated patients with advanced lung failure, pre- and post-transplant. As a physician-scientist, he also has extensive experiences with strong passion and consistent research focus on innovating new organ preservation techniques in the lab by using small animal models for the last decade. Dr. Shigemura has developed ex vivo lung perfusion (EVLP) systems for rodents and validated EVLP protocols in rodent models while he was the first to publish these innovative techniques. He also subsequently established an EVLP system for human lungs while he was at University of Pittsburgh, and in 2014 he performed the first clinical lung transplantation using lungs that were maintained on EVLP prior to transplant.
Providing positive and educational feedback, according to Dr. Shigemura, is the key thing a reviewer should keep in mind. Sometimes reviewers may encounter really poor-quality studies. Even for them, however, instead of rejecting them immediately, reviewers can think about how the studies can be improved with their additional advice by respecting the authors’ time and efforts. With this borne in mind, reviewers can also actually learn how to better organize a good study.
From a reviewer’s perspective, Dr. Shigemura recommends authors to follow reporting guidelines (such as STROBE, CONSORT and PRISMA) during preparation of their manuscripts. Given that an increasing number of online reports and reviews continue to be published every day through evolving multimedia channels in addition to the standard peer-reviewed journals, it is getting more relevant to comply with the reporting guidelines in particular for the systematic reviews so that they can duly catch up with the most recent updates, avoid selection bias as well as overlapping work, and eventually maintain the high quality of the studies that will contribute to advancing the medicine.
“Reviewing manuscripts is a time-consuming volunteering work; however, it deserves our time and efforts so that we will also continue to learn and progress toward a higher goal as a physician-scientist in this evolving world of medicine,” says Dr. Shigemura.
Shigeki Suzuki currently serves at the Department of General Thoracic Surgery, Sagamihara Kyodo Hospital; and Division of Thoracic Surgery, Keio University School of Medicine, Japan. He engages in daily medical care centered on respiratory surgery, especially lung cancer surgery. In clinical research, he is also conducting research on minimally invasive surgery for early lung cancer, extended surgery for advanced lung cancer or salvage surgery. For more information, please visit his homepage here.
A healthy peer review system, to Dr. Suzuki, is one that is fair, constructive and swift, featuring reviewers who possess the attitude to give advice to improve the content, rather than just to deny. Also, a good system has to be transparent, which makes data sharing crucial. By creating a database on a global scale, even retrospective trials may provide meaningful evidence, whilst having personal information carefully managed.
Speaking of how to deal with the heavy burden of a scientist and doctor while doing peer reviewing, Dr. Suzuki says, “Having patients as the top priority, I carry out review tasks with a research mind in the intervals of the day-to-day practice.”
Dr Joseph Seitlinger is a thoracic surgeon at the University Hospital of Nancy, University of Lorraine, France. His research area is focused on thoracic oncology and minimally invasive surgery. His recent research projects include organoid formation from tumor tissue and drugs testing, and clinically the development of electromagnetic endobronchial navigation and resident training in his department. You may get to know more about Dr. Seitlinger through LinkedIn here.
Science is fast-moving, and it is often difficult to be up-to-date with the literature. To Dr. Seitlinger, peers are the best judges of the potential clinical impact of a study to be published. Peer review helps to improve the quality of the work, by asking relevant questions or by contributing to the discussion, always in a constructive way. Thus, he believes peer review is the best way to evaluate scientific work.
Being a reviewer, Dr. Seitlinger says it is not always easy to stay objective, “I can’t imagine that I am objective every time. I try to reread my reviews several times and imagine myself working in another hospital (in terms of equipment, patients and social insurance).”
The use of reporting guidelines has become prevalent in academic writing in recent years. Dr. Seitlinger reckons that they help to give a framework for writing, especially when starting out, and thus authors should follow the guidelines more closely. Nevertheless, he is not fond of writing a scientific paper in a too mathematical way. Medicine is an art, and it is not compulsory to follow systematically the writing recommendations.
Finally, there are a few words Dr. Seitlinger would like to say to encourage all the other peer reviewers: “Reviewing allows you to stay up to date on the scientific knowledge of your specialty, and to have a critical look at the practices of others but also your own. However, it is necessary to move on to writing in order to participate fully in the advancement of scientific progress.”
Makoto Endoh serves as a general thoracic surgeon at Yamagata Prefectural Central Hospital, Yamagata City, Japan. He has trained and studied all aspects of respiratory surgery with Prof. Hiroyuki Oizumi, who is a pioneer of thoracoscopic segmentectomy, at Yamagata University since 2000. They have worked together to solve problems and expand the indications for thoracoscopic sectional resection, especially for small lung cancer (JTD2018). From 2014 to 2015, he studied at the National Cancer Center Hospital in Tokyo, where he learned surgical techniques from Dr. Shun-ichi Watanabe. Since 2016, together with Dr. Satoshi Shiono at his current hospital, he has joined the Japan Clinical Oncology Group (JCOG) and has registered a number of clinical trials to improve outcomes in lung cancer. His current research interests include the development of surgical techniques for small lung cancers, the development of induction immunochemotherapy for advanced lung cancer, the treatment of malignant airway stenosis and respiratory intervention, and strategy for surgical treatment of acute thoracic empyema.
Dr. Endoh considers peer review as an essential part of scientific discovery and reporting. In this process, experts in the field can review the manuscript and provide constructive feedback to improve the quality of the study and further develop the field. Reviewers should make suggestions to improve the quality of the manuscript, including manuscript composition, study design, and additional analysis to enhance the results.
On the other hand, through peer review, reviewers can also gain new medical knowledge, critically view their research results, and find new research directions. In view of this, Dr. Endoh thinks peer review can make progress with other researchers who wish for the development of medicine.
Dr. Endoh further draws attention to the significance of Conflict of Interest (COI) disclosure, which he believes is an important information that influences the scale and conclusions of a study, and assists to evaluate the quality of the treatise.
“Journal of Thoracic Disease (JTD) is a highly specialized journal, with quick response and manuscript publication. I think JTD has a great deal of support in my area of expertise,” says Dr. Endoh.
Dr. Dritan Useini is a cardiac surgeon at the Department of Cardiothoracic Surgery, RUHR-University Hospital Bergmannsheil, Bochum, Germany. He is a member of German Society of Thoracic and Cardiovascular Surgeons. During his residency at the Department of Cardiac Surgery, University Hospital Rostock, Germany, he completed the doctoral thesis with regard to the homing potential of the human CD 133 stem cells in-vivo analysis and obtained the M.D. degree at the University Rostock in 2013. His current research area is transcatheter heart valve therapies with focus on aortic valve, aortic diseases, minimally invasive valve surgery and cardiac tumors. Parallel to his daily clinical engagement, he currently works at obtaining the postdoctoral Ph.D. degree at RUHR-University Bochum. More information of Dr. Useini can be accessed through the following platforms: ResearchGate, Publons and ORCID.
A healthy peer-review system is paramount for promoting high-quality research. According to Dr. Useini, choosing appropriate reviewers for the appropriate field is of utmost importance, limiting so unknown knowledge disparities and other undefinable potential biases, which may influence the editor decisions. Even though a quick peer-review process is desirable for publication, limited time for the review process may pose negative influence, taking into account the high level of engagement of the clinicians. Another point of importance for a healthy peer-review process is to standardly include a statistical review process so as to improve the end point of the medical science – the accuracy.
Speaking of how biases can be minimized during review, Dr. Useini explains, “As a reviewer, I concentrate on giving my best at the points of the paper where my expertise provides extended amount of knowledge. So I can ensure minimal potential bias. Investing a proper amount of time and dedication during the review process is of great relevance as well.”
Data sharing policy has evolved to a standard and mandatory requirement during the submission process. In Dr. Useini’s opinion, publicly data sharing may have a dual effect. While making research studies more transparent, there may be a risk of misinterpretation, resulting in negative scientific effects. He reiterates that in most cases these are patient’s data, thus etic regulations must be taken into account.
In spite of the anonymity and unprofitability of being a peer-reviewer, Dr. Useini is constantly motivated to review, “The love for research is my no.1 reason. The review process keeps me abreast of new research ideas, technologies and developments. It also gives me the opportunity to be a part of decisions which will improve the medical science to a next level. Even though reviewing is often anonymous and non-profitable and represents a kind of virtual biotope of the science, it is a wide underground way which in the last instance leads to promotion of the health status of our patients.”
Dr. Gonzalo Varela is currently a Research Advisor at the Institute for Biomedical Research of Salamanca, Spain. He is the former Professor of Surgery, School of Medicine (1994-2017) and Chief of Thoracic Surgery (1994-2014) at Salamanca University, and Medical Director of Salamanca University Hospital (2015-2017). Dr. Varela has always been interested in patient safety, achieving the best results with the least possible surgical aggressiveness. For this, it is essential to have reliable and well-analyzed data series that allow an accurate estimation of the surgical risk and a decision-making always oriented to the greatest effectiveness of the treatment with the minimum complications or, better, with none. Most of his posts touch on these topics. Because of this interest, he has collaborated from the beginning, as a member of the Committee, in the creation of the ESTS Database. From the teaching point of view, he is interested in helping younger surgeons to develop a constructive critical spirit and to know how to propose feasible innovative projects. For more information, please visit Dr. Varela’s research page here.
A good review, according to Dr. Varela, underlines the values of the manuscript under review and helpa the authors to improve in terms of scientifical soundness and clarity of communication. Reviewing means encouraging further writing. Sometimes suggesting small changes in methodology can render a mediocre paper in a much better one. On the contrary, a destructive review underlines defects but never suggests improvements.
Reviewing often increases workload, but to Dr. Varela, reviewers must consider that other colleagues are also reviewing their papers and dedicating time to improve their scientific production. He adds, “The time when I was a surgeon, manager, professor, associate editor, and father-of-five was exciting indeed. Receiving papers to review from different journals is a great honor, but you need to organize yourself. First, you must select well-fitted manuscripts in your expertise area and kindly decline others hardly related to. Honestly declaring if the deadline for the review fits your schedule is paramount and, if not, proposing an alternative date is usually accepted by the editor. Then you must organize yourself scheduling time along the week to do the job. If not, reviewing always goes to the bottom of daily activities, and it will be postponed. In such cases, the quality of reviews will not be as good as desired.”
Conflicts of interest (COI) are common and do not necessarily mean wrongdoing, but in some cases, the credibility of a manuscript and hence the journal publishing it is undermined when COI are suspected. Unfortunately, some examples of biased papers came recently to newspapers damaging the credibility of medical journals. In Dr. Varela’s opinion, financial ties to the industry are not the only relevant conflicts to disclose in scientific papers. Some other interests are frequently biasing the results; In some cases, the authors tend to overemphasize the relevance of specific surgical techniques simply because his or her clinical income comes mainly from the promoted technique. Sometimes personal or institutional relationships have positive or negative influence on the results. Editors, helped by reviewers, have a responsibility for investigating if the results of a clinical report are biased or, in some cases, manipulated by the authors.
“The Journal of Thoracic Disease is one of the youngest dealing with chest diseases and it is closely related to my expertise topics. It has quickly grown its Impact Factor, up to around 3 thanks to carefully selected manuscripts. I have cooperated with AME Publishing Company in some projects, and I believe the technical and scientific quality of their products is high,” says Dr. Varela.
Dr. Hitoshi Igai is an Assistant Director at Japanese Red Cross Maebashi Hospital, Japan. He is a Board Certified Surgeon of Japan Surgical Society and Japanese Association for Chest Surgery. Dr. Igai’s interests include all aspects of benign and malignant pulmonary, pleural, chest wall, and mediastinal disease. His current research focuses on minimally invasive surgery, especially uniportal VATS or pulmonary segmentectomy. He has published over 110 papers for those topics. Recently, Dr. Igai is conducting a research project “efficacy of infrared thoracoscopic pulmonary segmentectomy with intravenous indocyanine green administration using preoperative simulation” at his institution. Moreover, he is a principal investigator of two nationwide retrospective studies including “current status of spontaneous hemopneumothorax” and “current status of primary and secondary spontaneous pneumothorax” conducted by The Japanese Society for Pneumothorax and Cystic Lung Diseases. Dr. Igai’s full profile can be accessed here.
During the review process, an objective review is the most important thing to ensure the scientific value of a manuscript. When Dr. Igai reviews a manuscript, he usually examines whether there are other previous reports dealing with similar contents. Only after reading them can he evaluate the manuscript objectively. Abundant knowledge about the topic can make sure a review is objective.
The existing peer review system is not perfect, according to Dr. Igai. An appropriate reviewer for a manuscript is not always selected, which sometimes causes inappropriate judgement. Therefore, a candidate as a reviewer in a journal should be strictly registered with his or her specialization.
Speaking of the role of institutional review board (IRB) in original studies, Dr. Igai reckons that the primary aim of having an IRB is to avoid the risks and disadvantages correlated with the safety or privacy for the enrolled patients caused by the prospective or retrospective studies. IRB can assess whether those studies are appropriately conducted. Therefore, without IRB, the involved patients might suffer from risks and disadvantages by inappropriately conducted studies.
“Many manuscripts are submitted to JTD, some of which are very interesting and with content about novel treatments. I am very happy and honored to read those excellent manuscripts as a reviewer. Moreover, this is a good opportunity to know what other researchers or clinical doctors are trying to study, especially about minimally invasive thoracic surgery, which is my specialization,” says Dr. Igai.
Dr. Dragan Subotic currently works at the Clinic for Thoracic Surgery, University Hospital Zurich, Switzerland. He was the Head of Thoracic Surgery in the Clinic for Thoracic Surgery in Belgrade in 1996, and was nominated Director of that clinic in 2013. He was elected Professor of Surgery at the University of Belgrade School of Medicine in 2008. From 2008-2011, he was a member of the Thoracic domain of the EACTS. For many years, he participated in the activities of the Surgical Assembly of the ERS and served as Assembly Head during 2013-2016. In 2017, he moved to Switzerland and worked 2 years in the University Hospital in Basel. Dr. Subotic’s field of interest is in general thoracic surgery, excluding esophageal surgery.
JTD: What makes a healthy peer review system?
Dr. Subotic: In my opinion, prospective clinical trials, multicentric and randomized studies should be reviewed by a minimum of 4 reviewers. If one recognized authority/ opinion leader in a particular field is included, the number of reviewers could be reduced. The reviewers should sufficiently reference themselves, but unfortunately, there are not too many thoracic surgeons. I am sure that each associate editor for a particular research area knows at least several competent colleagues who could do the task properly. Strict adherence to the rules by reviewers is mandatory for an objective review. The quality of the review is monitored by associate editors who are at the same time in charge of appeals from authors in case of any doubts concerning the review objectivity.
JTD: What reviewers have to bear in mind while reviewing papers?
Dr. Subotic: First of all, reviewers should always be aware of the efforts a particular team invested in the submitted study, especially for original research papers. Thus, each of the submitted papers is a potential contribution for practice and as such deserves a certain time investment from the reviewers. It is the reviewer’s responsibility to keep abreast of the state-of-the-art in a particular field, in order to assess whether the paper brings something really “new or innovative”.
Second, as we all are practicing surgeons, we should be fully aware of the importance of the studies that “only confirm” the existing pool of evidence. In particular research areas with limited evidence, any single contribution may be valuable. Many active surgeons with a good and broad activity, who are interested and motivated to publish their data, are not in a situation to participate in prospective or randomized studies.
Last but not least, reviewers should recognize the potential of a paper to become a valuable contribution. Even if the paper does not fit the journal requirements, mostly when the structure, style and grammar are suboptimal, reviewers should focus on the core of the content and suggest corrections, unless the research methodology comes into question. For example, reviewers can suggest an additional analysis from the already existing data in order to clarify some unclear points. With detailed point-by-point comments and suggestions, the paper could be significantly improved. It is the part of the reviewer’s work that I find most challenging.
JTD: Peer reviewing is often anonymous and non-profitable, what motivates you to do so?
Dr. Subotic: This is a good question. Yes, peer reviewing is anonymous by definition, but for those who invited you to be a reviewer, you are not anonymous. This invitation means that your work was once recognized by somebody who had the confidence that you would be able to do that correctly. And from the moment you accepted the invitation for the first time, it simply becomes a part of your activity. Furthermore, performing a review is a way of sharing experience with others. Even though the process is confidential, it is always beneficial to both sides – everybody can learn something from it.
JTD: What is the role of institutional review board (IRB) in research studies?
Dr. Subotic: The practice varies broadly throughout the world. In my opinion, the optimal situation would be to have an IRB as a first step towards approval of the planned research through the regional ethic committees (organized by the corresponding governmental bodies), verifying not only ethical, but also the methodological aspect of the research. The primary role of any review board should be to give the appropriate ethical and methodological frame and to facilitate the work. However, this process should not be too complicated and time consuming, in which case it becomes disincentive and counterproductive.
Dr. George Rakovich is Chief of Thoracic Surgery at Maisonneuve-Rosemont Hospital, affiliated with the University of Montreal School of Medicine, Montreal, Canada. He also holds a Master’s degree in medical education. His clinical practice spans the field of thoracic surgery, but his interests are focused on advanced minimally invasive techniques and anatomic sublobar resection in particular. He is also interested in integrative multispecialty approaches for individualizing the treatment of patients with complex lung nodules. In partnership with Ecole Polytechnique Montreal Engineering School, Dr. Rakovich has developed a research program investigating pulmonary and parenchymal resection staple line biomechanics, and he is currently developing a project with the Department of Psychology at Concordia University in Montreal to study visual perception in surgical planning and surgical skills training. He has served on the editorial boards of several journals including the Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, as well as Current Challenges in Thoracic Surgery. You may connect with Dr. Rakovich on LinkedIn.
JTD: Why do we need peer review?
Dr. Rakovich: Reviewers provide a breadth of experience and perspective that is an invaluable resource for editors to help them make informed decisions about the quality and relevance of submissions. Having worked as an associate editor, I have relied on reviewers, and I know first-hand how much of a difference a thorough, expert review can make. But beyond that, in many ways a review can be seen as a process of quality improvement, rather than the pursuit of an editorial decision. Interestingly, this process requires a partnership of sorts between individuals who are otherwise complete strangers. Feedback can help authors reflect on and improve their submissions. The editors and reviewers can then accompany the authors through successive iterations of their manuscript until acceptance, or perhaps provide a new perspective and suggestions that allow the authors to submit successfully elsewhere. As an author, some of the most helpful reviews that I received were of this kind. There is no doubt that a thorough, insightful review will make an author feel that their work is being truly recognized.
JTD: What do you consider as an objective review?
Dr. Rakovich: It is always important to remember that the source of the manuscript, whether the institution or the authors, and their relative notoriety or obscurity, has little bearing on the quality of the content, which should be allowed to speak for itself. One should listen to what the text has to say with an open mind. Sometimes, we may be influenced by our own local practice preferences, or the received wisdom in our field, and may thus be either quick to endorse manuscripts that espouse our own biases or brush off new or different ideas. Also, English may be the default language of scientific writing, but many authors are not native English speakers, and in spite of their best efforts shortcomings in grammar and syntax may sometimes mask what they are really trying to say. It is important for the reviewer to recognize when this does not bear on the actual quality of the content, and when necessary to provide pointers or encourage English-language proofreading. Obviously these are not easy tasks and they require some degree of insight, but as with everything else, improvement only comes with experience and the effort put into to each review.
JTD: What is so fascinating about peer reviewing?
Dr. Rakovich: Acting as a peer reviewer is a unique opportunity to participate in the process that shapes knowledge, thought, and practice in the field of medicine. Obviously, most submissions will not end up as seminal, transformative publications (although some might, which is indeed a compelling thought!), but every submission nonetheless is the result of someone’s invested time and effort and every submission, whether ultimately published or not, has something to say. Therefore, I don’t think there is any such thing as a “small” or “trivial” submission (or a “small” or “trivial” journal, for that matter), and every single one calls on the reviewer’s due diligence. Also, new submissions provide a window into current areas of clinical interest and research in one’s field, and really, the reviewer is in a unique position to be among the first to appreciate this work! For me, it is particularly satisfying to have the opportunity to contribute constructive feedback and suggestions that help improve a paper towards acceptance for publication. And there is no doubt that participating in the review process has helped me improve my own scientific writing skills.
JTD: Is it important for authors to disclose Conflict of Interest (COI)?
Dr. Rakovich: Reporting COI is very important. Whether we recognize it or not, as physicians, we regularly interact with medical products, devices, and companies. While such interactions are obviously essential to the progress of medical research and practice, they also may influence us in ways that we do not immediately appreciate. In itself, revealing potential COI is a way for authors to recognize such potential bias, and it also allows the readers to make an informed judgement as to the content and conclusions of published work.
Dr. Yoshiyuki Takami is currently a Professor at the Department of Cardiovascular Surgery in Fujita Health University School of Medicine, Japan. His areas of research include Intraoperative Graft Flow Measurement in Coronary Surgery, Mechanical Circulatory Assist, Centrifugal Pump, Aortic Surgery, Valve Surgery, Cardiac Surgery in Hemodialysis Patients, and Infection In Cardiac Surgery. You may check out Dr. Takami’s profile here.
One of the limitations of the existing peer review system, according to Dr. Takami, is the burden of reviewers. To solve this problem, he suggests having preferential treatment for reviewers. To pay reviewers may be one idea. Reviewers will be paid regardless of whether the paper is published or not. Instead of paying in a single peer review, it will be distributed according to the total number of articles published over a period of time. It is expected that a better research environment will be built by using the rewards obtained from peer review for research expenses and paper purchase expenses. Remuneration may also make reviewers aware that it is an important task. As a result, researchers will less likely decline requests for peer review.
Ensuring a review is objective and free of bias is of utmost importance. Dr. Takami reckons that the objectivity of a review is purely an academic consideration. During review, he purely focuses on examining the academic significance and the correctness of the scientific analysis of the manuscript.
“The burden of being a researcher and professor is heavy, but I usually allocate time to review on weekends,” says Dr. Takami.
Ravi K. Ghanta
Dr. Ravi K. Ghanta is an Associate Professor of Surgery at the Michael E. DeBakey Department of Surgery Baylor College of Medicine (BCM) in Houston, Texas, USA. He is also the Chief of Cardiac Surgery at the Ben Taub General Hospital and Staff Cardiac Surgeon at the Texas Heart Institute / Baylor St. Luke’s Medical Center. He has a long standing interest in cardiothoracic surgical education and is the Associate Program Director for BCM’s Cardiothoracic Surgery Residency Program. Dr. Ghanta is a graduate of Cornell University with a degree in Applied Physics and Harvard Medical School. He completed his training in Surgery and Cardiothoracic Surgery at the Brigham and Women’s Hospital in Boston, Massachusetts under the mentorship of Drs. Lawrence Cohn and David Sugarbaker. As a Surgeon-Scientist in the BCM Laboratory for Cardiac Regeneration, Dr. Ghanta focusses on utilizing immunomodulation to facilitate repair after ischemic injury. In addition, his outcome research focusses on utilizing machine learning and artificial intelligence to predict surgical risk and improve outcomes. You may connect with Dr. Ghanta through Twitter @DrRaviGhanta.
A healthy peer review system, in Dr. Ghanta’s opinion, provides a comprehensive evaluation of a manuscript to provide expert opinion on scientific methodology with the goal of producing an impactful contribution to the medical literature. Reviewers should ascertain the potential impact of the manuscript and pay careful attention to the hypothesis and the methods used to evaluate the hypothesis.
Speaking of the role of institutional review board (IRB) in research, Dr. Ghanta stresses that seeking IRB approval for any original research should be standard, as it ensures equitable research with appropriate safe-guards. To him, this is the ‘standard of care’ for medical research and cannot be omitted.
“I learn a lot by reviewing manuscripts. It provides a window into the cutting edge of cardiothoracic surgery. It also improves my own research and submissions. I find the process of serving as a reviewer yields dividends to one’s own endeavors, while also providing valuable service to the medical community,” says Dr. Ghanta.
Jacquelyn A. Quin
Dr. Jacquelyn Quin is a full-time staff surgeon for the Cardiac Surgical Service at the VA Boston Healthcare System (VABHS) and an Assistant Professor at Harvard Medical School, Boston, USA. Her clinical and research focus is adult cardiac surgery, and her research interests include clinical outcomes after coronary artery bypass grafting and aortic valve surgery. Dr. Quin participates in large-scale research conducted through Veterans Affairs, including the Randomized On-Off Bypass (ROOBY) and Randomized Endo-vein Graft Prospective (REGROUP) Trials conducted through the VA Cooperative Studies Program. Currently, she is working at looking at long-term outcomes of veterans who underwent aortic valve replacement at VABHS.
“It starts with the recognition that all research is valuable,” says Dr. Quin when she is asked what she considers as a constructive review. Whenever she reviews, the first question she often asks herself is – what question are the authors trying to answer, and how well is the methodology able to do that? She then moves on to give feedback based on what she finds, with the hope that the feedback given will improve the study and/or strengthen the findings.
In contrast, reviews that are not as constructive tend to interject opinion on the value of the research or rate the investigation without offering any feedback on how the study question might be better answered. Dr. Quin explains, “For a review to be truly objective, I believe the reviewer should at least be blinded to the authors and institution conducting the research. Given this is sometimes not the case, it helps to focus on the methodology and whether the discussion is appropriate for the strength of the study findings.”
From the angle of a reviewer, Dr. Quin is fond of the idea of research data sharing, which she believes has many obvious advantages. There is “strength in numbers” – especially if the data collected is sufficiently defined and collected in a manner that makes combining data possible. It also encourages transparency and comradery. In her opinion, the difficulty in data sharing lies in the fact that, in most cases, there are just enough differences in the way the data is defined and collected to make interpretation challenging at times.
“I think that peer review particularly lends itself to individuals who are primarily clinically based as it can be accomplished in multiple settings and is portable. Although it would be ideal if a submission can be reviewed in a single setting, sometimes this is not possible and I believe a review is better if one has time to look at the submission twice,” says Dr. Quin.
Dr. David Shersher is an academic thoracic surgeon practicing at Cooper University Healthcare, Camden, NJ, USA. They are working on a clinical program thanks to the MD Anderson at Cooper system. His clinical interests run the full breath of thoracic oncology from complex minimally invasive robotic pulmonary and mediastinal resections to esophagectomy for esophageal cancer to robotic applications for minimally invasive benign foregut disease. His lab efforts currently focus on translational applications of stem cell technology to improve esophageal anastomotic leaks, as well as testing innovative tools to assist in performing thoracic procedures.
Peer review is one of the most critical aspects of scientific presentation. To Dr. Shersher, without a quality peer review process, we are left with substandard, poorly-focused research that ultimately do not help push forward evidence-based medical progress.
During the review process, we all come to the table with bias. In Dr. Shersher’s opinion, it is critical to be up-to-date with the most current evidence based practice and to apply that to a review. It is this knowledge that can help limit the bias in a review.
Since there may be bias in any paper, Dr. Shersher recommends full disclosure of any potential conflicts of interest. If industry has sponsored the research, this should also be disclosed. With that said, many industry sponsored research papers add value to a journal and should absolutely be considered if full disclosure has been provided.
“Whether I agree with the findings of the paper or not is irrelevant in a quality peer review process. What is really exciting is that my reaction and commentary to a paper may certainly elicit commentary that should invite academic discussion. It is within this academic discussion and watching the evolution of a paper from initial submission to its acceptance that makes the peer review process rewarding,” says Dr. Shersher.
Dr. Takeo Nakada serves as a general thoracic surgeon in the Department of Surgery, Division of Thoracic Surgery, the Jikei University School of Medicine, Tokyo, Japan. He obtained PhD at the Jikei University School of Medicine in 2020. From 2010 to 2012, he received thoracoscopic surgery training at Department of Thoracic Surgical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Japan. From July 2019 to Jun 2021, he served as a general thoracic surgeon at Department of Thoracic Surgery, Aichi Cancer Center Hospital, Aichi, Japan. Recently, Dr. Nakada’s research is focused on surgical simulation using a three-dimensional printed model, role of radiological tools in predicting prognosis of lung cancer surgery, enhanced recovery after surgery, pulmonary function after surgery, and postoperative pain. His research work can be accessed through the following platforms: ResearchGate and Publons.
A healthy peer review system, in Dr. Nakada’s opinion, is essential to assess the validity of literature and derive good insights. Journal editors should select advanced professionals who have good understanding of the study themes and models. Providing constructive comments to authors will help improve the quality of their dissertation and ensure the quality of the published work. Appropriate time spent on peer reviews is also important. Reviewing should not be overly urgent, as reviewers need to fully understand the entire article, review the data, and comment individually.
As a reviewer, Dr. Nakada urges authors to disclose any potential Conflict of Interest (COI), which he believes is essential for a proper evaluation of the literature. What’s more, COI can potentially relate to reviewers as well as authors.
“I like to review for JTD because it has appropriate guidelines, which highly facilitate the review process. The peer-review deadline set is also appropriate. In addition, a wide range of papers on thoracic disease are submitted, providing reviewers with the latest medical insights,” says Dr. Nakada.
Thierry P. Carrel
Dr. Thierry Carrel currently serves a cardiac surgeon at the Clinic for Cardiac Surgery at the University Hospital Zurich, Switzerland. He has performed around 12000 procedures as surgeon, teacher or assistant. He is author of more than 800 peer-reviewed publications, and Associate Editor or member of the Editorial Board of several international journals (EJCTS, JTCVS, JCVS). In 2013, he received the Da Vinci award of the EACTS as best teacher of Europe. In 2015, he was awarded as Honorary Doctor of the University of Freiburg, Switzerland. Between 2018 and 2021, Dr. Carrel was International Member of the Board of Directors of the AATS. In 2014, he founded Corelina, a foundation for the children’s heart that support projects in Switzerland and abroad (Russia, Usbekistan and Marokko) in the field of congenital surgery. His foundation works closely together with the EurAsia Heart Foundation. His main focus of research are organ donors after circulatory death, surgical and hybrid treatments of complex aortic pathologies and congenital heart diseases. More details about Dr. Carrel can be found here.
JTD: Why do we need peer review? What is so important about it?
Dr. Carrel: Scientific findings and discoveries, especially in medicine may have far-reaching implications for individuals and for the society. This is one reason why they imperatively must undergo a process of quality control called “peer review” before they will be published.
Peer review involves subjecting the author’s scholarly work and research to the scrutiny of other experts in the same field to check the validity of the scientific analysis and evaluate its suitability for publication. A peer review helps the editorial board of a journal but also the publisher to decide whether a scientific paper, based on its originality, validity and significance should be accepted or not for publication.
Once a scientific paper is submitted to a journal, it should first undergo a preliminary check known as “desk review”: the check should confirm that the paper is presented according to the guidelines for authors. One major aspect - which has been adopted by a majority of scientific medical journals - is the availability of raw data not only during the process of revision but also after publication.
Following this first check, the editor will decide if the manuscript falls within the journal’s scope and should be sent for peer review or be rejected outright. The next very crucial step is to select several experts who are highly qualified and able to review the work impartially.
These reviewers have multiple goals: 1) they will check whether the research topic has been clearly formulated, and 2) decide if a suitable approach has been taken to address the scientific issues involved. 3) The reviewers will also examine the methodology to determine whether the author’s results can be reproduced, and 4) they will assess the novelty and originality of the findings. 5) Finally, the reviewers will rate the “readability” of the work, assessing how logically the arguments have been constructed and whether the conclusions are well-founded.
Among different journals of the same medical sub-specialty, there may be considerable differences in the level of details with which papers are evaluated. Some journals routinely use anti-plagiarism software, organize separate statistical reviews or examine the submitted illustrations to detect whether they have been manipulated. There is also an increasing number of journals that focus on scientific software or research datasets.
If a scientific project involves patients or animals, the peer review has also to cover all ethical aspects. Nowadays, the protocol of registered trials can be read at ClinicalTrials.gov.
Unfortunately, there are also major criticisms to the peer review process. The evaluation of an academic paper is also affected by the reviewer’s scientific beliefs and by the care and efforts they invest in this work. Recently, cases where reviewers failed to discover serious errors in the author’s methodology have been publicly discussed. The reasons for such failures during the peer review process include reviewers’ heavy workload and poor selection of reviewers by the editorial board. Reviewers must imperatively also declare potential conflicts of interest regarding the work they have to review.
Finally, many open access journals are funded by article processing charges, also known as publication fees. A small number of these journals are unfortunately “black sheep” which provide little or no editorial or publishing services in return for the money they charge.
This type of business practices and quick publication process are often referred to as “predatory publishing”. In several cases, these journals send spam emails which encourage authors to submit their work: such emails often include details designed to tempt authors, such as unrealistically short deadlines by which the journal insists it can complete the peer review process. The majority of these journals that claim to have implemented peer review most probably carry out very superficial assessments, or none at all.
Nevertheless, it is quite clear that peer review will never completely eliminate fraud and get low-quality papers published. However, peer review can help improve the quality of publications – especially if authors are able to view the report and work through the comments.
JTD: What are the qualities a reviewer should possess?
Dr. Carrel: The reviewer is the vital heart of the process, and one of the editor’s primary responsibilities is to create and maintain a high-quality, productive group of reviewers. To do so, journals are concerned with several areas of reviewers’ performances: knowledge, judgment, constructiveness, ability to write clearly, and willingness to work within the journal’s guidelines. In addition, in terms of selecting reviewers for individual papers, editors are responsible for having and enforcing fair policies about how reviewers are selected and natural biases inherent in the review system are avoided as much as possible.
Among several qualities of a reviewer, I would expect the following ones:
- expertise (being a leader in the field of the paper)
- availability and time for an expedient review
- constructivity (providing useful advice that will help the authors to improve their paper)
- to be friendly, specific, honest and polite
Every journal should be concerned about whether the reviewer can make balanced judgments, keep a sense of proportion when assessing the strengths and weaknesses of a research project, apply appropriate standards, and give definite opinions. To give these opinions, the reviewer must be able to express complex ideas clearly—and, if possible, concisely—for both the editor and the author, whose levels of scientific knowledge and needs are not always the same. The reviewer serves as adviser to the editor but also as teacher to the author, especially to the less experienced. In writing critiques, the reviewer should use the criticisms in the review as opportunities to tutor. In reviewing excellent reports by highly experienced researchers, reviewers serve as peer assessors; in contrast, when reviewing weaker reports by younger researchers, they serve very much as teachers. Furthermore, many journals put considerable emphasis on reviewers’ giving constructive criticism to authors and expect the reviewers to give their opinions in a collegial spirit accompanied by suggestions for improvement.
JTD: Why is it important for a research to apply for institutional review board (IRB) approval?
Dr. Carrel: A key goal of IRBs is to protect human subjects from physical or psychological harm, which they may attempt by participating in research projects. The protocol review assesses the ethics of the research and its methods, promotes fully informed and voluntary participation by prospective subjects capable of making such choices (or, if that is not possible, informed permission given by a suitable parent), and seeks to maximize the safety of subjects. It is therefore of paramount importance that IRB approval has to be obtained before starting a research project and this has to be written in the scientific report. Omitting the process of IRB approval would open the doors to biased or even potentially dangerous research without control by independent peers.
JTD: Would you like to say a few words to encourage other reviewers who have been devoting themselves to advancing scientific progress behind the scene?
Dr. Carrel: My personal motivation to review scientific papers is the curiosity about research, the feeling to be connected with the academic medical community worldwide but also the wish to be timely informed about interesting basic and clinical research topics. Finally, I love the “contact” with younger researchers to serve them somewhat as a teacher. I would warmly encourage colleagues from all over the world to participate actively in the review process of medical journals. They may experience a lot and will benefit from numerous valuable scientific information at a very early stage.
Jimmy T. Efird
Dr. Jimmy T. Efird is an Epidemiologist who currently works at the Cooperative Studies Program Epidemiology Center (CSPEC/HSR&D) at the Durham (Duke) VA, USA. He received his doctorate degree from Stanford University School of Medicine. His research interests include cancer research and cardiovascular sciences. His h-index is 57 and he has been cited over 11,000 times.
A healthy peer review system, according to Dr. Efird, is one that is fair, honest, and comprehensive. During peer review, reviewers should always bear in mind one simple but essential rule – “How can one’s review improve the quality of the manuscript”. Often, insights not beforehand recognized by the authors become apparent upon receiving comments from expert reviewers in the field. A careful review also helps to identify awkwardly composed paragraphs and syntax issues that may distract from a manuscript’s important message.
On the use of reporting guidelines like CONSORT and PRISMA, Dr. Efird recognizes their importance in strengthening a paper but suggests flexibility on the part of editors when guidelines become arduous to the goals at hand. Nonetheless, he believes that authors ultimately benefit from carefully following these guidelines.
“Peer reviewing is fascinating as it provides reviewers with an opportunity to see cutting edge research,” says Dr. Efird.
Dr. Antonio Alvarez is a consultant thoracic surgeon in the Thoracic Surgery and Lung Transplantation Unit at the University Hospital Reina Sofía, Cordoba (Spain), being member of its Lung Transplant Program from 1993, and having performed more than 700 lung transplants to date. He is Associate Professor of Surgery in the University of Córdoba (Spain) and Investigator of the Maimonides Institute for Biomedical Research (IMIBIC) where he is involved in research programs dealing with lung preservation, ECMO and ex-vivo lung perfusion. His professional interests include lung transplantation, surgical thoracic oncology, minimally invasive surgery and chest wall deformities. He is author of more than 80 publications in peer-reviewed journals, and is member of the Editorial Review Board of several journals including: AME Group journals, Eur J Cardiothorac Surg, Ann Am Thorac Surg, Transplantation, PLOS one, BMC pulmonary Medicine, among others. For more information about Dr. Alvarez, you may visit his pages on ORCID, Publons and LinkedIn.
JTD: What role does peer review play in science?
Dr. Alvarez: Peer review has become an essential component of the academic writing process and has been defined as “the essence of science”. It is the core element of scholarly research and the only way to ensure mistakes and overstatement do not misguide progress in science. If research is published without this process of review and checking, articles of low quality might be published and damage the integrity of that field of research. Therefore, peer review has two main functions: filtering out incorrect information and improving the accuracy and clarity of scientific reports.
JTD: What are the limitations of the existing peer review system? What can be done to improve it?
Dr. Alvarez: The peer review process is generally conducted in one of three ways: open, single-blind, and double-blind reviews. Single-blind review is by far the most common, but this leads to important limitations that should be corrected, because the anonymity of the reviewer poses him or her to a potential bias in assessing papers dealing with issues of conflict of the reviewer’s interests. In addition, as double-blind review is rarely used, papers are judged on the reputation of the author rather than on the quality or originality of the paper. For instance, a US based journal is much more likely to reject non-US papers, regardless of its quality.
Besides, the whole process of peer reviewing is very time consuming. This is especially true for prestige high-impact journals, and much of the decision-making process rests in the hands of editors that in some instances can lead to a misuse of this authority. Editors often are accused of arbitrarily rejecting manuscripts before they reach the peers, arguing journal constraints of space for publication, and this is frustrating for the authors.
Another limitation of peer review is the limited number of individuals that are competent to conduct peer review compared to the vast number of papers that need reviewing. Manuscripts reviewed by inexpert peer reviewers may be published without reaching the minimum standards of quality. This is the reason for the advent of websites dedicated to revealing papers that have been retracted after publishing due to improper peer review (i.e. Retraction Watch website).
In my opinion, there are major points that should be developed to improve the peer review process: recruiting reviewers that are highly knowledgeable in the areas being reviewed, speeding up the reviewing process and promoting clear, effective communication between reviewers and authors, decreasing the rate of publication bias by promoting double-blind peer reviews, and open publication of reviewer comments. In addition, some sort of standardization should be developed in the whole review process to avoid major discrepancies between reviewers of the same manuscript.
JTD: Peer reviewing is often anonymous and non-profitable, what motivates you to do so?
Dr. Alvarez: Certainly, peer reviewing is, in general, an anonymous and non-profitable task, and time consuming. My motivations for peer reviewing are mainly academic. By peer reviewing, I have the opportunity to access the latest developments in my area of knowledge. But most importantly, having duties as a reviewer has facilitated enormously my capabilities as an author. While writing a manuscript, taking the position of a potential reviewer of my own manuscript, I have seen more clearly the potential weak points of the paper, anticipating what the future reviewer might comment on it. Finally, my involvement in peer review is an added value to my curricular activity.
JTD: Data sharing is prevalent in scientific writing in recent years. Do you think it is crucial for authors to share their research data?
Dr. Alvarez: Nowadays, information storage and data sharing have become a normal part of our lives. Historically, researchers have been reporting their findings in scientific journals but the data appearing in the publications are summary data insufficient to have the complete picture of the focus of investigation. However, at present, science is becoming more collaborative and data sharing is being a valuable part of the scientific method allowing for verification of results and extending research from prior results. Therefore, a reader should be able to use the data to reproduce, and thereby confirm, the findings of a paper, or even reuse the data for a new investigation.
Data sharing has many advantages: the re-analysis of data helps certify results which is a key part of the scientific process, different interpretations or approaches to existing data contribute to scientific progress, data availability provides safeguards against misconduct related to data fabrication and falsification, and studies based on analyses of previously published data can achieve just as much impact as original researches. In fact, some journals and societies do share data in form of international registries. For instance, transplant centers providing their data to the United Network for Organ Sharing (UNOS) Registry have access to the whole dataset to analyse a terrific large number of transplant patients, otherwise impossible to accrue for a single Institution.
In my opinion, data sharing should be seen as a normal and essential part of the scientific process, much the way we see peer-review. Although the disagreement of some authors and stakeholders about how to share their data are precluding the wide onset of a data sharing practice, a growing number of journals are establishing methods of sharing data through community-endorsed public repositories. This is to make them available for later access and use by other researchers. I am convinced that data sharing should be a condition of publication in major medical journals. The authors should share a de-identified patient data on which the results are based. This requirement would be a significant step forward in improving transparency in clinical trials.
Benoit J. Bibas
Dr. Benoit Bibas is an attending thoracic surgeon at the Heart Institute (InCor) of the University of São Paulo, Brazil. His research focuses on clinical and surgical aspects of tracheal diseases, such as benign tracheal stenosis, tracheoesophageal fistula, complex laryngotracheal problems, and rigid bronchoscopy for neoplastic airway obstruction. Furthermore, he is interested in predictors for surgical complications, development of clinical trials, databases, and minimally invasive thoracic surgery. He is currently leading a taskforce in the Brazilian Society of Thoracic and European Society of Thoracic Surgeons (ESTS) Surgery that created a joint database regarding clinical and surgical treatment of tracheal diseases. Dr. Bibas has published more than 40 papers in peer reviewed journals, serves as Editorial Board Member of Translational Cancer Research, and as invited reviewer in several peer-review journals. He is an active member of the Brazilian Society of Thoracic Surgery (BSTS), and the European Society of Thoracic Surgeons (ESTS). Dr. Bibas’ profile can be accessed here. You may also follow him on Instagram @drbenoitbibas.
JTD: Why do we need peer review?
Dr. Bibas: The peer review process is a pivotal step of the current scientific activity. It is intended for quality control and improvement of academic knowledge. Research that has not gone through the peer review process could be biased or flawed. And we are at a time where misinformation is widespread. Thus, true scientific information must be highly scrutinized before publication. The goal of peer review is to ensure that the information is consistent, that there are no clear biases and to improve the quality of the published manuscript.
JTD: What are the qualities a reviewer should possess?
Dr. Bibas: The reviewer is currently the mainstay of the scientific publishing process. Thus, I would expect a good reviewer to have certain qualities. I will mention a few of them.
- Open-mindedness: When reviewing manuscripts, especially within our area of expertise, we should not let our prejudices and conceptions guide the reviews. One should read with careful attention and understand that clinical practice varies widely among institutions and countries, and different approaches and techniques might be relevant to the medical community, whether we like it or not, and agree with it or not.
- Impartiality: The reviewer must remain impartial to the authors, or institution, of the manuscript. Many journals do not include the authors in the draft version of the manuscript, but the reviewer may be able to discern, especially if he or she knows, where the manuscript comes from. Remaining impartial is of utmost importance because the goal is to improve each manuscript and publish only what is best for the journal. This is one of the reasons that some journals have 3-5 reviewers for each manuscript. In this manner, we can exclude a review that may be biased.
- Knowledge: A critical part of the peer review activity is based on knowledge of every aspect of the scientific process; from how to write a manuscript, to statistical analysis. Furthermore, the reviewer should be an expert in a determined topic. Thus, the review will be at its best. For instance, as a Thoracic Surgeon, I am capable of reviewing a manuscript about Myasthenia gravis. It is within my area of expertise. Nonetheless, my MAIN area of expertise is airway diseases. In this particular area, I am more in line with the current trends, recent papers and can discuss more deeply the subject of the manuscript. Should I not revise a manuscript that is not my main focus of interest? This is to the reviewer’s decision. Nonetheless, one should always question: Am I qualified to review this manuscript? Will I be able to improve it? If you are in doubt, you should probably kindly thank the editor and say that it’s not in your area of expertise.
- Politeness: No one likes to be criticized, or to have its work criticized. The job of the reviewer is not only to criticize, but to question and point directions. The objective of the review is to have a better manuscript at the end of the process. Yes, the reviewer will criticize, but he or she must find a way to do it without being rude, or arrogant. This is extremely important. If you are reviewing for JTD for instance, in this review you are representing the journal. Always remember this.
- Time: Now, this is extremely important. As an author, I receive good and bad reviews all the time. And by bad, I don’t mean not favorable. I mean reviews that were clearly pointless, had 5 sentences explaining why your article is not good enough. They were probably done the night before the deadline was due. Well, that is not sufficient. A good review requires time. Time to read, understand and then write the review point by point. I often read the manuscript once first. The plan is to have a general idea of the manuscript. I read it again the next day, and I make some notes. Then, I read it a third time. But this time, I am reading and writing the review, starting from the introduction and moving forward, writing down every question or comment that I might have. Finally, I usually summarize the review into major and minor points (strengths and weaknesses). As you can see, this takes some time.
JTD: Is it important for authors to disclose Conflict of Interest (COI)?
Dr. Bibas: It is essential that the authors report their COI. They are common nowadays and should be thoroughly described. Having a COI does not mean the research is biased. Reporting COI adds transparency to the process. If not described properly, COI will undermine the credibility of the authors, and the credibility of the journal itself.
JTD: Would you like to say a few words to encourage all the other reviewers?
Dr. Bibas: I often review manuscripts at night, after my wife and son are asleep. And honestly, the process of reviewing manuscripts is often fun and amusing to me. Especially when I enjoy reading the manuscript, I do not see it as work. And it should not be seen as work, as it is NOT mandatory. The reviewer has a very important role in the decision process of a manuscript. And we should always bear this in mind. The manuscript that you are reviewing could be the result of years of work from someone you don’t know. Plan the review during your week schedule, whenever you feel more comfortable and reserve some time for it. Never let the review to be at the bottom of your “to do list”. Reviewing will improve your writing and make you more conscious about your own writing mistakes and you will also be more capable of properly responding to reviewers in your own papers. It’s a very interesting process. I highly recommend it!
Dr. Sehoon Choi, M.D., Ph.D., is the Associate Professor at Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. He graduated from Seoul National University College of Medicine and received training in the Department of Thoracic and Cardiovascular Surgery at Seoul National University Hospital. After completing a fellowship in general thoracic surgery at Seoul National University Hospital, he joined the faculty of Asan Medical Center, University of Ulsan College of Medicine. Between 2015 and 2016, he was a visiting scholar at Stanford University Hospital under Prof. Joseph Shrager. He is a board-certificated surgeon of Korean Thoracic and Cardiovascular Surgery and Korean Association for Thoracic Surgical Oncology. Lung cancer surgery (especially minimally invasive surgery such as VATS sub-lobar resection, lung transplantation, and pediatric thoracic disease) are among his main scientific and clinical interests. Dr. Choi recently began working with AMC’s simulation center since he has long been interested in resident (or medical student and nurse) education, particularly education using VR, XR, or metaverse.
Peer review plays a crucial role in science, according to Dr. Choi. First, the academic worth of the article can be accurately assessed by performing peer review by experts in the field. Furthermore, appropriately judging the strengths/weaknesses of papers will lead to further research on critical subjects and scientific advancement. In the end, patients and their families will receive better treatment.
To reduce the biases that can undoubtedly arise throughout the peer review process, Dr. Choi reads through the received manuscript twice, once for and once against. He tries to have two opposite views in his thoughts after reading from the position of maximally defending the researcher once and reading extremely critically once. In this way he believes the biases could be minimized.
Data sharing is getting more popular in scientific writing these days. Nonetheless, Dr. Choi holds a skeptical view towards its effectiveness. Data sharing necessitates deidentification, which typically necessitates a significant amount of effort, but the usefulness of the results is low. There are many problems that need to be overcome for data sharing, such as the problem of non-overlapping study periods and the need for additional follow-up, also.
“The most important factor in deciding whether or not to accept a review is whether the study is in my field of interest. Reviewing such a manuscript is an opportunity for me to study the field in which I am most knowledgeable and interested. Also, I examine the references and apply the most accurate expression while writing reviewer comments, and this process is also helpful to improve understanding of the field. Above all, I believe it adds to the advancement of my academic subject, in which I intend to dedicate my entire life,” says Dr. Choi.