Altruism as enlightened self-interest: How helping others through peer review helps you
It is so very hard to write about the value of being a peer reviewer when one is an editor without the effort seeming like a contrived self-supporting means of recruitment. So, let's start with full disclosure: Yes, Medical Education, like every other reputable journal, needs reviewers to help authors strengthen their work and help us curate the best possible periodical. That has never been more true than it is now as the pandemic has seen a rate of submission growth that far exceeds the rate of new reviewer enrolment.1
That said, it is sincerely not the reason I am writing this editorial. I am writing it because I was reminded recently about how big an impact serving as a peer reviewer had on my career and how daunting it can seem to take on the role. My views on peer review are on record,2 so this is not going to be yet another contribution to the endless debate about the utility and fallibility of peer review as a defining quality of scholarship. Rather, this editorial is offered to make a case for why you should engage as a peer reviewer regardless of your views on that debate.
During graduate school in cognitive psychology, my supervisor relayed an admonition he had heard from a colleague: ‘For the first 10 years of your career you are not allowed to say “no”’. In health professional education, I do not think the literal aspect of this advice to be sound (or even actionable) given that people who express interest in education in the health professions are generally not short on requests (and typically want to do more than their flesh will allow). Nonetheless, the spirit of the advice remains true in the sense that what Lee Brooks was telling me was that it is critically important for career success to build a reputation as someone who is both capable and willing to contribute collegially to your professional community. In addition to the implicit good that does, the goal is to have opinion leaders, be they editors, conference organisers, grant administrators or other groups come to recognise your name as an insightful and collaborative scholar, as well as someone who gets things done. In other words, you want to come to mind as someone who can be trusted with the more enticing opportunities when they come along.
With the great fortune of a supervisor whose advice was always worth heeding, I wound up doing a lot of peer-reviewing—at least one manuscript or grant proposal per month for the first decade of my career. I do not think I appreciated early on, however, just how much of the value derived from being a peer reviewer was more than reputational. It is in the decades since Lee uttered the words above that I came to think of engaging in peer review with thoughtfulness, care, an open mind, dialogue and a constructive focus as a significant way for academics to engage in deliberate practice.
The fallacy of the 10 000-hour rule aside,3 Ericsson's well-known model outlines the value of practising extensively and practising well.4 Despite being shown in countless domains to be a critical determinant of expertise development, it is not always clear how one could ‘practice deliberately’ in all of our roles.5 Deliberate practice is a highly structured activity that involves repetition, effort, developmentally appropriate activity and informative feedback; it is undertaken with the intention of performance improvement rather than being a means to achieve immediate reward. I admit that ‘not being immediately rewarding’ is perhaps the aspect of this paragraph that resonates most with many when they think about peer review. Let's take each of the other aspects of deliberate practice in turn, however, to reflect on how one can enable the long-term benefits to outweigh the short-term costs.
Highly structured: Good peer reviews demonstrate careful and considered appraisal of each section of a paper, contemplating not only what was done and whether it appears to have been done well, but why, to what end, and in relation to what is already known about the topic.6 As much as such appraisal should be routine, we are forced to focus much more acutely on the details and consideration of alternatives when we are engaged in peer review and need to comment sensibly on each aspect of a manuscript more so than when we are reading for other reasons.
Repetitive: Even the most productive academics are limited in the number of projects in which they can effectively engage. One cannot participate in as many research studies as a basketball player can take free throws or a pianist can play chords. We still need repetitions, however, to deeply understand the options that make education scholarship go wrong or well; reading other people's work extensively offers a crash course in variety of approach and conceptualisation that one cannot get any other way.
Effortful: It is generally easy to flag up problems inherent in any research study; even those that are technically proficient can be made to seem trite if one adopts a distinct worldview relative to the authors because no single study can address all facets of the complex problems educators face. The real effort for good peer reviewers comes from taking the time and energy to think through and explain your answer to the questions of ‘despite whatever problems I can identify, is there still something of sufficient value in these results to warrant publication priority? and, regardless of that answer, 'how can I explain my perspective most effectively to the authors who lovingly crafted this work?’ The act of answering those questions forces a clarity of thought that remains too vague to be useful if it is not committed to writing in a way that will be sensible to someone else.
Developmentally appropriate: Wasting time by reviewing articles that are clearly poor fits for your field makes crafting a review an exercise in tedium rather than genuine contemplation. At the same time, if you read nothing but the published literature that has already made it through triaging you will not gain enough exposure to the breadth of issues that can arise or how they present during the ‘not yet ready for dissemination’ stages of one's writing. Seeing the traps others fall into and struggling to find the words to explain why they are problems from your perspective will make your own research and writing better.
Informative feedback: This aspect may be the trickiest and the most powerful for those who use peer-review activity to engage in professional development. How can you get good feedback from such a constrained process? Compare what you have written with what professionals advise should be written (eg using the Wiley-provided resources at the top of our ‘Guidelines for Reviewers’ webpage);6 discuss what you are considering offering to the authors with peers and mentors (while being careful to avoid breaching confidentiality requirements); conduct group reviews to proactively learn what others would say in response to the same submission7; take time after a journal copies you into their decision letter to compare what you wrote to what other reviewers said and what the editors highlighted as the basis for their decision (keeping in mind that the goal is not for all reviews to be homogeneous, but is to reflect the variability of reactions well); treat reviews you have received as an opportunity to reflect (once your revisions are made) on what aspects of the reviews you wish to emulate and what aspects you thought to be non-constructive.
I appreciate that the thought of reviewing other people's work can make one feel like an imposter when they are new to a field. To overcome such hesitation, it is helpful to keep in mind that the editor is ultimately responsible for the decision just as the clinical preceptor is ultimately responsible for patient care when working with trainees—decisions won't be made based on your perspective alone and I am to blame for the mistakes we make, not our reviewers; disclose to the editor that you are new to reviewing and would like some support or that you don't feel qualified to comment on particular aspects of the manuscript if either of those things is true; reach out proactively to the editors of journals that are well-suited to your interests and expertise to offer your service as a reviewer in the domains you feel most comfortable (and tell them what those domains are by carefully setting your account preferences); take advantage of the resources around you for guidance on how to review well, be they conference workshops or local leaders; and, finally, keep in mind that every one of those leaders, regardless of the strength of their current reputation, started with no more experience than you have—expertise is a process, not a threshold you can expect to claim.
If you do not have local guidance in these regards, there are fortunately people around the world who can offer advice. In addition to our editorial team and advisory board, Medical Education has now supported 8 cohorts of editorial interns who spent a year with our editors advancing their knowledge of publishing and reviewing processes. Each joined the internship with the stated intent of sharing what they learned with interested individuals from their geographic regions. You can find a list of all who have completed the internship on the Awards section on our homepage, mededuc.com. For 2021-2022, we are pleased to welcome Roghayeh Gandomkar (Iran), Honghe Li (China) and Anél Weise (Ireland) as the 9th cohort.
The same Awards page also lists the individuals we have celebrated as having made exceptional contributions to peer review for Medical Education. 2020’s winners of the Choice Scholars Awards are Robbert Duvivier (Australia), Lynelle Govender (South Africa), Larry Gruppen (USA), Avinash Supe (India) and Mamta Singh (USA).
And, although not as directly relevant to the act of peer reviewing, I am pleased to announce three successes our peer reviewers enabled: This year's Silver Quill Award, granted to the article that was downloaded most frequently in 2020, goes to Compton, Sarraf-Yazdi, Rustandy and Radha Krishna (Singapore) for their paper entitled ‘Medical students’ preferences for returning to the clinical setting during the COVID-19 pandemic’. The parallel award for Really Good Stuff articles, named the Henry Walton Prize in honour of our longest-serving Editor-in-Chief, goes to Cain, Klink and Yunus (USA) for their work entitled ‘Telemedicine implementation in family medicine: Undergraduate clerkship during the COVID-19 pandemic’. And, last but not least, the Medical Education Traveling Fellowship was re-purposed this year (due to pandemic-related travel restrictions) as a ‘Developing Scholarship Award’ with its inaugural recipient being Amy Wong from Queens University Belfast in Northern Ireland.
Returning to the notion of deliberate practice, I suppose it is good that such effort is typically performed without the expectation of immediate reward because there is little we can offer reviewers beyond Continuing Medical Education credits, acknowledgement in the journal8, 9 and our eternal thanks. What reviewers can offer themselves, however, is a stimulus to grow their expertise, their reputation, and the knowledge that they have made critically important contributions to their chosen field. So, whether you do it for us or for someone else, please do yourself a favour and offer peer review.
