H Ford, they/them/theirs, Manuscript Editor, JAMA Network
There is a particular type of online pedant whose view of the English language has the effect of invalidating strangers’ sexual and gender identities. Much physical and digital ink has been spilled discussing the validity of the singular “they” when referring to a single gender-unknown subject of discussion and as an intentional personal pronoun.
I will not relitigate this issue here, but it should suffice that the AMA Manual of Style (sections 11.12.2 and 7.2.3.2, specifically) concurs with the Chicago Manual of Style, the AP Stylebook, and historical use (eg, Shakespeare and Emily Dickinson) in permitting the singular they.
Now with that said, let’s talk about respecting our queer friends, family, colleagues, and authors by using the honorific Mx! According to Merriam-Webster, the first use of the gender-neutral honorific Mx was in the 1970s, but its widespread use has only gained momentum within the past 5 to 10 years.
It can be helpful to compare Mx with Ms, another relatively recently developed honorific. Although the very first publication of the honorific Ms was in a 1901 article and was likely more focused on expediency of the address than the linguistic and sociopolitical ramifications of defining a woman by her social status, most people’s understanding of Ms is rooted in Gloria Steinem’s eponymous magazine (https://www.nytimes.com/2009/10/25/magazine/25FOB-onlanguage-t.html).
Mx is an honorific that affords the same respect to nonbinary and gender-nonconforming people that has traditionally been given to gender-conforming individuals who do not hold advanced degrees. As awareness grows of the existence of gender identities outside the male/female binary, more people every day feel comfortable publicly identifying as nonbinary, genderqueer, and agender.
The widespread use of Mx signals acknowledgment of and respect toward these individuals. Yet there is a broader application of the honorific Mx that we haven’t fully considered, one that is as practical as it is gender inclusive. Just as the title Ms allowed us to ask why a woman’s marital status affected how she was addressed, Mx should allow us to ask why a person’s gender should matter to any respectful form of address.
For these reasons, JAMA Network now offers Mx as a salutation for submissions to all of its journals!
As editors and writers, we occupy a unique position in the process of the legitimization of nascent linguistic terms. Let’s use that power for good!
Today is the start of Peer Review Week, an annual global event celebrating the essential role that peer review plays in maintaining scientific quality. This year’s focus is on trust in peer review, and this post addresses the evolving transformation of the peer review in scientific publication.
Peer review continues to develop, albeit slowly, in terms of models and methods, with increasing calls for openness and transparency. There are 3 common forms of peer review:
Double-blind review: Authors’ and reviewers’ identities are hidden from each other in an attempt to minimize bias.
Single-blind review: Authors identities are revealed to all, but reviewer identities are not revealed to authors (also known as anonymous review)
Open review: Author and reviewers are identified are revealed and various levels of the process and outputs may or may not be made public
Types of open review, with increasing levels of openness, include the following:
Level 1: Reviewer and author identities are revealed to each other during the peer review process
Level 2: Indication of editor and/or reviewer names on the article
Level 3: Posting of peer review comments with the article, signed or anonymous
Level 4: Publication of peer review comments (signed or anonymous) with authors’ and editors’ responses, decision letters, and submitted and revised manuscripts
Level 5: Publication of the submitted manuscript after a quality check and inviting public discussion from the community
A recent look at the types of peer review used by some top-ranked general medical and science journals shows that most journals use single-blind review, with some allowing reviewers to choose to sign their reviews. For example, JAMA has a single-blind review process and offers reviewers the option to sign their reviews that are shared with authors, and copies of reviews are shared with other reviewers.
JAMA also has an editorial collaborative process, called editorial review before revision, during which senior editors, a manuscript editor, and an editor with expertise in data display collaborate to provide guidance to the authors on all that is needed during revision to reach a favorable final decision.
However, these processes are not public. A short video that explains an inside view of the editorial and peer review process at JAMA is available.
JAMA Network
The BMJ has a fully open review process with the following published with all research articles: all versions of the manuscript, the report from the manuscript committee meeting, reviewers’ signed comments, and authors’ responses to all comments from editors and reviewers. Nature publishes reviewer names and comments and author rebuttal letters; however, authors and reviewers can opt out of the open review process. And eLife has a mixed model with reviewers’ names revealed to each other during the review process; decision letters, anonymous reviewer comments, and author response letters published with the article; and an option for reviewers to sign their reviews.
One of the earliest demonstrations of open and collaborative peer review was launched in 2001 by Copernicus Publications, an open-access publisher of scientific journals. These journals use a 2-stage process:
“In the first stage, manuscripts that pass a streamlined access review are immediately posted as preprint in the respective discussion forum. They then undergo an interactive public discussion, during which the referees’ comments (anonymous or attributed), additional community comments by other members of the scientific community (attributed), and the authors’ replies are posted. In the second stage, the peer-review process is completed and, if accepted, the final revised papers are published in the journal.”1
Many studies have compared the quality of single-blind, double-blind, and open review. Early randomized trials2,3 found no differences in the quality of double-blind, single-blind, or open review. But some studies have found differences, such has higher quality for blinded review,4 higher quality for signed reviews,5 and higher quality for open review.6 And some studies7,8 have identified biases that may be better managed with double-blind review (eg, bias toward gender, geography, institutions, and celebrity authors). However, no study has yet compared the quality of published articles that have undergone these different types of peer review.
“The predominant system of editorial review, where the names of the reviewers are unknown to the authors, is a perfect example of privilege and power (that of the reviewer over the fate of the author’s manuscript) being dislocated from accountability….to the fellow scientist who wrote the manuscript. For that reason alone, we must change our practices. ….The arguments for open peer review are both ethical and practical, and they are overwhelming.”9
There have also been numerous studies demonstrating the feasibility of each type of peer review. However, some studies have found that double-blind review is not always successful and have reported rates of failure to ensure blinding ranging from 10% to 40%. Other studies have found that reviewers who are asked to sign their reviews may be more courteous or positive in their recommendation, may take longer to complete their reviews, and may be more likely to decline invitations to review.
Support for open review, with options, continues to evolve. In a 2016 OpenAire survey of 3062 academic editors, publishers, and authors,10 60% indicated that open peer review (“including making reviewer and author identities open, publishing review reports and enabling greater participation in the peer review process”) should be common in scholarly practice, but they had some concerns. For example, 74% responded that reviewers should be able to choose to participate in open review, and 67% reported being less likely to review if open review was required.
The Nature journals have been experimenting with various models of peer review, and in 2016, Nature Communications announced that about 60% of its authors agreed to have their reviews published.11 In 2019 and 2020, Nature journals began offering “transparent peer review” with options for authors and reviewers to opt out.12
Elsevier conducted a pilot of open review from 2014 to 2017 in 5 journals, with reviews published.13 During this pilot, younger and nonacademic scholars were more willing to review and provided more positive and objective recommendations. There was no change in reviewer willingness to review, their recommendations, or turn-around times. But, only 8% of reviewers agreed to reveal their identities with the published reviews.
Thus, the key to successful transformation to open peer review and maintaining trust in the process may be offering options to authors and reviewers. Whichever model is used, journals should clearly and publicly describe their processes (eg, in Instructions for Authors) and continue to evaluate and test ways to improve the peer review process for authors, reviewers, and editors.–Annette Flanagin, Executive Managing Editor and Vice President, Editorial Operations, for JAMA and the JAMA Network, and Executive Director of the International Congress on Peer Review and Scientific Publication
*Note: Portions of this post have been presented at several meetings.
Justice AC, Cho MK, Winker MA, Berlin JA, Rennie D; PEER Investigators. Does masking author identity improve peer review quality? a randomized controlled trial. JAMA. 1998;280(3):240–242. doi:10.1001/jama.280.3.240 https://jamanetwork.com/journals/jama/fullarticle/187758
van Rooyen S, Godlee F, Evans S, Smith R, Black N. Effect of blinding and unmasking on the quality of peer review: a randomized trial. JAMA. 1998;280(3):234–237. doi:10.1001/jama.280.3.234 https://jamanetwork.com/journals/jama/fullarticle/187750
McNutt RA, Evans AT, Fletcher RH, Fletcher SW. The effects of blinding on the quality of peer review: a randomized trial. JAMA. 1990;263(10):1371–1376. doi:10.1001/jama.1990.03440100079012 https://jamanetwork.com/journals/jama/fullarticle/380957
Walsh E, Rooney M, Appleby L, Wilkinson G. Open peer review: a randomised controlled trial. Br J Psychiatry. 2000;176(1):47-51. doi:10.1192/bjp.176.1.47
Bruce R, Chauvin A, Trinquart L, et al. Impact of interventions to improve the quality of peer review of biomedical journals: a systematic review and meta-analysis. BMC Medicine. 2016;14(85). https://doi.org/10.1186/s12916-016-0631-5
Lerback J, Hanson B. Journals invite too few women to referee. Nature. 2017;541(7638):455–457. doi:10.1038/541455a
McGillivray B, De Ranieri E. Uptake and outcome of manuscripts in Nature journals by review model and author characteristics. Res Integr Peer Rev. 2018; 3(5). https://doi.org/10.1186/s41073-018-0049-z
Rennie D. Freedom and responsibility in medical publication: setting the balance right. JAMA. 1998;280(3):300–302. doi:10.1001/jama.280.3.300
Ross-Hellauer T, Deppe A, Schmidt B. Survey on open peer review: attitudes and experience amongst editors, authors and reviewers. PLOS One. 2017;12(12): e0189311. https://doi.org/10.1371/journal.pone.0189311
Bravo G, Grimaldo F, López-Iñesta E, et al. The effect of publishing peer review reports on referee behavior in five scholarly journals. Nat Commun. Published online Junary 18, 2019. https://doi.org/10.1038/s41467-018-08250-2
In the 10th edition of the AMA Manual of Style, writers and editors were instructed to remove US fellowship designations and honorary degrees (PhD[Hon]) but to keep non-US designations, such as the British FRCP or FRCS and the Canadian FRCPC. The idea was that many of these non-US designations were attained through a series of qualifying examinations.
For me, following this rule usually meant copying and pasting the designation into an online search engine to find the associated country and then explaining to the authors in a query why some designations were removed while others were allowed to remain.
With the 11th edition, fellowship designations will be removed altogether from the byline. The emphasis will now be placed on academic degrees (which means even honorific addresses like knighthood won’t appear in the byline).
Like the 10th edition, we will continue to publish academic degrees (eg, MD, MBBS, PhD, MS) in bylines as well as licensing and certifications (eg, RN, ELS). We hope this updated style rule will keep byline presentations fair and consistent. –Iris Y. Lo
When you pick up a book you haven’t yet read, do
you immediately turn to page 1 and begin reading? Or, do you check out the front
cover design to see if the book looks interesting? What about the back cover?
Most stories are broken down in many ways to
hook the audience. It’s fairly standard that a book has a promotional blurb on
the front cover, a tagline, a 1-sentence summary on the back, a slightly longer
summary on the back, and, yes, more promotional blurbs on the back and inside
the front cover. Perhaps you learned of the book through a social media post or
through a review. What grabs your attention may not grab someone else’s, so
breaking a story down in various ways makes it appeal to a larger audience.
The same can be done with scientific research
articles. The main text typically follows the IMRAD format (introduction,
methods, results, and discussion) to clearly and fully tell the story. The
authors detail why they performed the research, how they did it and among whom,
what they found, and what it means.
That story is condensed into an abstract, a brief summary that allows readers to determine whether they may find the full article interesting or useful. Should an abstract be too long or technical to pull a reader in, an article can have an even briefer key points section. This could be a bulleted list of important findings or, as in the JAMA Network journals, a list of the question, findings, and meaning of the research.
For social media, perhaps a single summary
sentence is needed to fit the constraints of a character limit. For readers who
prefer a more visual summary, especially through social media, a visual
abstract can be useful. These are eye-catching depictions of the research,
often using icons and very brief wording.
Twitter, JAMA (JAMA_current), January 17, 2020.
Medical editors may be tasked with reviewing,
editing, or even writing some of these pieces. In doing so, a few tips might be
helpful.
First, make sure the shorter piece is consistent
with the main article. Numbers should match and any data in the shorter piece
should be included in the main article.
Second, make sure the trimmed text doesn’t
overstate the study’s results. For example, “This study suggests that X is
associated with Y” is different from “X affects Y.”
Third, make sure the most important information
is emphasized: “This [study type] examines [primary outcome] in [population].”
Fourth, remember the audience. The short items
should be able to draw someone in to read the more technical information in the
main article.
A journal article may be the culmination of an investigator’s life’s work or the end of a trial that has cost millions of dollars, which may make an article’s 1-sentence blurb seem measly. However, a patient may search social media to find information on a rare disease, and a post could bring the patient to the full article. A physician may scan key points to see if an article looks interesting enough to read fully. A student could review abstracts to find articles that are helpful for a research project. An investigator might use the full article to replicate the study or as a springboard for further research.
Each breakdown serves a purpose, promoting the right information to the right audience.–Shannon Sparenga
When I was completing my thesis during graduate school, one of my most frustrated moments came right at the end of the process while preparing my final manuscript for submission. The school required thesis manuscripts to have a uniform title page, with all the information sized and spaced just so. They provided a template to work from, but somehow, when I converted my finished file to a PDF, one of the signature lines for my advisor’s name kept coming out a fraction of a centimeter too short.
This seemingly simple issue—which ultimately turned out to be a problem with an outdated PDF viewer on an administrative assistant’s computer—required multiple rounds of emails between myself, my department head, and the graduate school office, and at one point led to me crouching over a physical copy of the page with a ruler the day before the final deadline, begging the thesis gods for mercy.
I understood the need for a correctly formatted title page, but it was frustrating having to spend so much time on such a small problem after pouring months of hard work into my thesis. So when a recent study by LeBlanc et al in PLOS One found that authors of research articles reported spending a median 14 hours on formatting their manuscript for publication in a peer-reviewed journal, I was surprised, but not without sympathy.
As an editor, I’m often communicating with authors to resolve relatively small questions about style and format: is the header in this table really meant to cover both of these columns? This figure looks good, but can you resend it in a different file format? When you gave this value as 48.5% in the Methods but 48.45% in the Table, was it inconsistent rounding, or is this a different result?
The Instructions for Authors for JAMA Network’s journals (not to mention the AMA Manual of Style) offer guidance on many of these formatting points, from how to format tables and figures to how to present numbers for certain types of data. It may feel overwhelming or frustrating to authors on top of all the work required to write up their study to have to go through all those seemingly small details before their article has even been accepted. But there is a reason these formatting instructions are given to authors before submission.
Chapter 2 of the AMA Manual of Style focuses on manuscript preparation, and the chapter’s introduction makes the point that properly preparing a manuscript according to journal requirements “may enhance the chances of acceptance and expedite publication.” Just like decent grammar and correct spelling allow a reader to focus on a writer’s message without distraction, a cleanly formatted article makes it easier for editors and reviewers to focus on the content of the work and more quickly ensure that certain required elements are present.
And, of course, formatting requirements are ultimately set with the scientific content in mind, with the goal of ensuring all methods, data, and findings are presented clearly, correctly, and unambiguously. For authors wanting to better understand what goes into a properly formatted article (and for some insight into the why behind certain style and formatting requirements), chapter 2 of the style manual is a valuable reference.
The PLOS One article by LeBlanc et al recently made the rounds in some of the online editing circles I follow, and one commonly raised question was how much unnecessary time authors may be spending following out-of-date instructions. With most publications now having their instructions and submission processes moved online—making them able to update their guidelines more efficiently—I wouldn’t imagine this to be a common risk. For example, the JAMA Network journals have their Instructions for Authors updated regularly to reflect any changes in style or procedure and to correct any inconsistencies that may pop up. There’s a “Last Updated” date posted at the bottom of the instructions page so authors can be sure they’re working with the most recent version.
I would also encourage authors to remember that if they do have a question about formatting or something in the instructions for authors, they can feel welcome to email that question to the journal. Someone in the journal office may be able to provide guidance that will help clarify the process. It’s also possible that a question may lead to the correction of an inconsistency in the instructions, which can make things that much easier for other authors down the road.
And as a final tip, to speak from personal experience: it never hurts to make sure your PDF viewer and other programs are all updated.–Kirby Snell
Authors may come alone or in pairs or trios. Or more. Today, more and more frequently, they come as part of a group. There is nothing wrong with group authorship—groups can accomplish great things. But if a group is named in the byline as sole author or in addition to individually named authors, all members of the group are still being presented as authors and all must meet authorship requirements.
This is a point of contention or difficulty for some authors (or some groups), who wish to have only the name of the group in the byline even if only a small number of the members of the group (eg, the Writing Committee) meet the standards of authorship set forth by the International Committee of Medical Journal Editors (ICMJE) and outlined on the authorship forms required by our journals.
What to do? The AMA Manual of Style lists an option to address both concerns: (1) authors who want only a group name to appear in the byline, even if all members of the group do not meet authorship criteria, and (2) journals that want to adhere to the criteria for authorship outlined by the ICMJE. Let’s call this the “asterisk solution.” An asterisk is placed after the group name in the byline, and this links to an asterisked footnote that indicates which members of the group met authorship criteria.
The asterisk solution often is a happy one for both authors and journal editors (and it allows readers to see who the true authors are). But sometimes even the asterisk is objected to. The editors of 3 ophthalmology journals (Archives of Ophthalmology, American Journal of Ophthalmology, and Ophthalmology) found strength in numbers. In August 2010, the 3 editors published a jointly written editorial in each of their journals, outlining the “asterisk solution” policy from the AMA Manual of Style and announcing that they planned to hold firm to this policy in their journals.
Being an author is a form of recognition and can add to one’s reputation. It also represents a responsibility. The asterisk solution bestows recognition and responsibility with a single character.—Cheryl Iverson, MA
