AcademyHealth Roundtable: How to Publish Without Perishing g MEET THE EDITORS: • • • • • • • Ann Fl A Floodd Par Atwal Gloria Bazzoli Arnold Epstein Brad Gray C i Ki Catarina Kiefe f Alan Monheit Health H lhS Services i R Research h Health Affairs Med Care Research &Review New England J of Medicine Milbank Quarterly M di l C Medical Care Inquiry Outline for Today • Brief intro about typical yp ppeer review process • Roundtable R dt bl reply l tto ttwo questions ti – Hints for success at journal j – Unique ‘feature’ of journal • Q&A ffrom the h audience di Making Peer-Reviewed Publication More User-Friendly Peer review P i iis ‘f ‘friendly’??? i dl ’??? B Butt what h t about… b t * All those rejections! j * Exposing your work to anonymous reviewers! * Perishing P i hi unless l you publish! bli h! It Could Be Worse: Peer Review in the 1500’s • Servetus, Spanish physician, 1509-1553 – Published theory about pulmonary circulation – Burned at the stake by John Calvin It Could Be Worse: Peer Review in the 1500’s • Servetus, Spanish physician, 1509-1553 – Published a theory on pulmonary circulation – Burned at the stake by John Calvin • Galileo, 1564-1642 – Published a book, book Dialogue on Two Chief World Systems – Confined to his home; forced to recant • It used to be: Publish AND Perish! A Overview of the Process: Using HSR as an Example • Often appears to be a “black box” • Understanding the steps can reduce anxiety • AND provide hints for greater success Choosing a Journal • Choosingg a jjournal… – Look where ‘similar’ manuscripts have been published p – Review journals to determine what they publish Look through issues Mission Statement Audience Instructions for Authors Preparing Your Manuscript • After y you choose a jjournal… – Follow its guidelines regarding styles, y , length, g , etc. – Consider whether review-only appendices pp would be useful – Consider any additional material to submit, e.g., g related ppapers p that might be considered duplicative S b i i the Submitting h Manuscript i • NO paper! • Go to ou our webs website te http://hsr.manuscriptcentral.com • Fill out information as an author and potential reviewer • Submit electronic version of manuscript • Use Endnote or other reference system y • Receive acknowledgment What We Do First 500 new ms./yr* 260 external rev/yr* • Assign the manuscript to an editor-in-chief [EIC] – Based largely g y on workload and potential conflicts of interest • EIC reviews to determine whether h h the h manuscript i goes out for peer review * 2010 projected j d regular l issue submissions First Barrier: The Editors Editors’ Review • Most “Editors’ Reject” reflect: – “Lack of fit” with the journal – Very narrow potential audience – Quality, less often a consideration • 2009 at HSR: – ~ 47% of new submissions were reviewed and rejected by editors • Mean time to decision—11 days – Remaining papers are assigned to a Senior S i Associate A i Editor Edi (SAE) Examples of ‘Fit’ for HSR • Mission: To further our vision and values by publishing rigorous state rigorous, state-of-the-art of the art research on healthcare that is widelyy disseminated and meets the highest standards of scientific peer review. • Audience: Disciplinary and multidisciplinary researchers h Methodologists Policy li analysts l Mostly U.S.-based but with ith a global l b l context t t Identifying d if i Reviewers i • Identify >2 reviewers, who as a set have the needed expertise • Identifying willing and appropriate pp p reviewers is difficult • Authors can help by suggesting potential reviewers (with e-mail e mail addresses) • CAN suggest whom not to use What Is a Good Review? • For authors – Cites strengths g and weaknesses with enough g detail – Separates major and minor points – Provides constructive criticism • For editors – – – – – Detail D il to support recommendation d i potential conflicts or biases [not always ‘bad’] previous reviews of ‘same’ manuscript similar works by same authors lack of expertise for evaluating some parts What Is a Bad review? • • • • • • Personal comments or attacks Irrelevant comments No detailed support for judgments Does not disclose conflict of interests Touts own work that wasn wasn’tt referenced Reveals recommendation to authors Waiting for a Decision • Perhaps the most difficult part for authors • Manuscript Central (MC) lets you know k the h current status • MC automatically reminds reviewers about late reviews • The EICs have much more information about where things stand and whom to nudge Reaching a Decision: Both Reviews are ‘In’ In • Reviewers’ comments go to SAE • SAE re-examines i the h ffull ll record d [paper and reviews] and recommends a decision & comments for authors • The EIC who started the process makes the final call • SAE and EIC need to agree • EIC sends letter to the author with decision, special advice from us and reviews Initial Decisions for External Reviewed Papers Only • TIMING: – In 2002: 126 days to 1st decision – In 2009: 58 days! • OUTCOMES at 1st round – Conditional accept – Revise and resubmit o Major revision o Minor Revision – Reject j – TOTAL 0.2% 0 2% 23.4% 20.9% 20 9% 2.5% 29.9% 53.3% Major Revise and Resubmit • Reviewers and editors see significant potential pote t a in the t e pape paper or o the t e topic, top c, but also note important shortcomings • Further, it is not certain that – Authors will be able to address concerns or redo analyses – New results will be interesting enough to publish • Our letter explains the risks involved Revisions and Responses p • Reviewers’ comments may conflict – Editors try to resolve extreme conflicts • Slavish Sl i h revisions ii may be b inappropriate i i – It’s your paper and reviewers and we may have “gotten gotten it wrong wrong” – But, if we did, readers might also be “confused” • Detailed memos explaining how you addressed each point are helpful • Electronic appendices? • Don’t take too long! Improving p g Your Manuscript: p Typical Problems • Important flaws – Literature review misses key studies – Conceptual framework missing or inadequate – Analyses have problems – Poor write up of tables, methods, results – No policy implications or, alternatively, lt ti l oversells ll findings fi di The Next Cycle • Revisions go to SAE • Sometimes S i an immediate decision • Usually back to the reviewers – Especially if major revisions • Then back to SAE and EIC D ii Decisions on First Fi t Revisions R ii • OUTCOMES: OUTCOMES – Accept/Conditional – Reject R j – Revise R i (minor/major) ( i / j ) 48% 6% 45% After Acceptance, p , You’re Not Done Yet • The manuscript goes to Wil Bl k ll our Wiley-Blackwell, publisher, for copyediting di i • Author needs to review, respond to questions, and approve, with a very short turnaround Published Online & In Print • For accepted papers… – Paperless process to publisher too Exception: original signatures on copyright (can be PDF) – EarlyView Publishing (~2 months in 2010) When copyediting done, published online Fully citable (use DOI), available to subscribers on web Referenced in MedLine – Appears pp in print p next avail issue (~4 ( months in 2010)) And Now…Let’s Hear From the Other Editors What criteria should authors use to choose your y journal and prepare their manuscripts for it? What is your mission? Who is your audience? What feature is most 'unique ' to your j journal? l? How can authors successfully orient their manuscripts to this feature?