Author + information
- Lauren B. Cooper, MDa,∗ (, )
- Naveen Bellam, MDb,
- Muthiah Vaduganathan, MD, MPHc,
- JACC: Heart Failure Fellows
- aDuke University Medical Center, Department of Medicine, Durham, North Carolina
- bThomas Jefferson University Hospital, Department of Medicine, Philadelphia, Pennsylvania
- cBrigham and Women’s Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts
- ↵∗Reprint requests and correspondence:
Dr. Lauren Cooper, Cardiovascular Diseases, Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina 27715.
The peer review process is fundamental to contemporary scholarship and academic success. Active participation in the peer review and editorial process is a general expectation and building block to an academic career. Although peer review is considered an essential skill in academic medicine, few formal programs teach trainees how to give meaningful and effective feedback. Fellowship may be the first time that physicians are asked to participate in the peer review process, often when they are asked to review a paper by a mentor or are directly assigned a review by an editor or associate editor. With little or no prior peer review experience, fellows may have limited resources to guide the overall process. Although published data are available detailing what constitutes a “great” review, feedback from a mentor may be limited, and real-time, practical teaching of the peer review process is rare (1). Teaching this skill requires iterative feedback and back-and-forth interactions between the fellow and an experienced reviewer in an environment that is conducive to advancing the learner's skillset.
The American College of Cardiology (ACC) and the JACC family of journals have placed great emphasis on training the next generation of clinical investigators and peer reviewers. As described by Dr. Valentin Fuster, “there is a delicate, painstaking process in selecting appropriate future academicians and bestowing upon them the proper balance of responsibility and guidance, which are both integral to foster the strongest cardiovascular investigators and educators. However, the single most important component of making this process successful is a strong engagement with a mentor rather than a premature independence” (2). The ACC includes a robust mentorship program for fellows, and ACC members serving on journals from academics and private practice alike serve as role models in engaging career pursuits from various vantage points. The JACC family of journals includes fellows and early career investigators in a variety of roles, including continuing medical education development and social media content, in addition to the JACC Fellow-in-Training & Early Career Page (3).
In accordance with the JACC journals’ emphasis on mentorship, the JACC: Heart Failure Fellows Program, established in 2013, is designed to shape and hone peer review skills as a part of its overall mission. Cardiology fellows are nominated and mentored by an associate editor of the journal to participate in this program. The stated goals of the program have been reviewed previously (4). The JACC: Heart Failure Fellows Program utilizes a number of different strategies to develop peer reviewing skills, including individual learning, 1-on-1 mentorship, and group-based discussion. This provides a structured environment to learn, practice, and receive timely feedback on peer review.
An integral component of the program is a quarterly Journal Club session, in which the participating fellows and JACC: Heart Failure associate editors and editors jointly discuss a single manuscript in a group setting after individual reviews have been submitted by each fellow (Table 1). In a conference call, each fellow presents his or her view on the strengths and weaknesses of the paper, taking into consideration the methodology, the authors’ interpretation of the results, and the scientific importance, which mimics a real-world editorial board discussion. Additionally, fellows discuss the rationale on whether the data would meet criteria for incorporation into guidelines. The editors then offer feedback on the fellows’ evaluation of the study, why they selected the paper, and how the paper fits into the larger landscape of published scientific data. This multistep approach to developing peer reviewing allows for the fellow to utilize these skills once he or she becomes an independent reviewer.
There are also opportunities for the fellows to attend the JACC journals’ editorial meetings at Scientific Sessions, in which they learn important aspects of the JACC journals’ vision and statistics. From a fellow’s perspective, this forum provides a critical understanding of how a journal functions and how editors make key decisions. Exposure to high-level interactions among senior peer reviewers and editors helps contextualize the fellow’s work and provide benchmarks and targets for future reviews. The knowledge gained from understanding the peer review and editorial processes may provide valuable insight for the fellow’s academic pursuits.
High-quality peer review is more important now than ever before, as many academic leaders are scrutinizing the current review process and looking for ways to improve it (5). Journals face a number of other challenges as the way in which knowledge is disseminated advances (6). Training of the next generation of peer reviewers and journal editors is essential not only to ensure the publication of high-quality, accurate, and relevant science, but also to equip the next generation of academic cardiologists with the skills to address the challenges facing journals and the peer review process.
The JACC family of journals offers unique and invaluable opportunities for trainees and early career investigators. As Dr. Fuster advocates, “One of the most important missions for fellowship programs anywhere in the world should be to develop future academic leaders in cardiovascular medicine by promoting clinical excellence and productive careers in scientific investigation in basic, translational, or clinical areas of interest” (7). The methods developed by JACC and the JACC: Heart Failure program may serve as a model for development of similar peer review educational programs with other specialty and subspecialty interests. This may best be carried out in the context of a journal, to pair fellows, senior peer reviewers, and editors with similar interests to real-time academic research. Although the development and implementation of these programs are certainly time and resource intensive, we believe that further structured emphasis on the peer review process is worthwhile and should be a major facet of the development of the next generation of academic cardiologists.
- Thomas F. Lüscher, MD ()
RESPONSE: Why Do We Need Peer Review?
It is said that Henry Oldenburg (1618 to 1677), the long-time secretary of the Royal Society, introduced the peer review system when he was the editor of Philosophical Transactions (1). As a theologist, he did not feel competent enough to assess all of the papers submitted to his journal as to their suitability for publication. Furthermore, he could not publish everything he had received. To select the best papers, he therefore began to send them to his colleagues with particular knowledge in the field and relied on their judgment about the value of the papers he had received. Today, most scientific and medical publications have implemented this system.
The Goals of Peer Review
The peer review system was introduced to help readers obtain the best scientific information (i.e., data they can rely on in their daily practice or use for their research projects). To achieve this goal, unsuitable papers are rejected by the editor, others are improved after 1 to 2 revisions on the basis of suggestions from reviewers, and very few are accepted as is (2).
Editors have to rely on peers, but who is a peer? The American College Dictionary defines a peer is a person of the same civil rank or standing, an equal before the law (3). In science and medicine, this would be a colleague of reputation on the basis of his experience and knowledge: in short, an expert in the field.
Obviously, the system only works if the peers are reliable and competent. For an editor, a reliable peer provides an unbiased and objective assessment. The peer review system should not be abused to get rid of competitors or to favor friends. A competent peer must have experience in the field. Most importantly, the mindset of a peer should be constructive. The review process should make deserving papers even better or near perfect.
How to Become a Good Peer
There are 2 characteristics of a good peer: an unbiased, constructive mindset, and expertise in a given field. Mentoring young academicians to become respected peers is certainly essential—without them the future is at stake. Mentors are role models, physicians, and scientists respected for their achievements, persons who do what they preach. Reviewing starts with proper reading, and reading also has to be learned. Journal Clubs, as outlined by Cooper and colleagues, are the forum where young fellows learn to review papers and ask themselves: Is the question important? Is it novel? Is the design of the study appropriate? Are the methods state-of-the-art? Is the statistical analysis well performed? Do the conclusions match with the results? The next step is assisting a peer, but this is only helpful if the mentor gives feedback to the fellow. We learn from our mistakes, and we grow with advice from those who are experienced. A good mentor mentions in his review: This review has been written together with Dr. Jonathan Miller, a promising fellow in our department. Then, the editor might consider the fellow in the future.
As we grow into the role of an independent peer, we must be conscious of the hurdles. As Thomas Kuhn (4) stated, we must be aware that we work within paradigms in normal science and that we might be blind to findings of importance that do not fit with our expectations. Thus, we must be open-minded as peers, ready to accept findings that we did not anticipate.
How Good is the Peer Review System?
As anything in life, the peer review system is not perfect. Indeed, what can be said about the peer review system has been said by Churchill about our political system: “Democracy is the worst form of government, except for all those other forms that have been tried from time to time” (5). No doubt, on occasion, seminal observations have been neglected, and prejudices, rivalry, and jealousy have delayed or hindered discoveries, but overall, peer review makes science better. It forces authors to properly plan their projects and to be careful, precise, and honest when carrying them out (6); it provides expert advice on how to improve a good paper further; and eventually, it provides better science to our readers.
It is the responsibility of a good editor to invite reviewers with experience in the field of the submitted paper. To do so, he or she must have an updated database with precise profiles of his experts—and they must provide the information to ensure this. Importantly, he or she has to invite not only 1, but rather 5 reviewers to obtain 3 reviews in time. Indeed, research showed that 3 reviews allows for better decisions than only 1 or 2 (2). The editor also must be prepared to ask another expert if ratings of the received reviews are too divergent to allow for a fair decision.
Finally, a family of main and specialty journals, as introduced by Circulation, JACC, and the European Heart Journal (7), allows for the transfer of papers that are more suited for a specialty journal, when papers are too technical for a broad readership or too preliminary for a high visibility in the main journals. Also, here the peers are important and can give guidance to the editor as to where a given paper might be best suited.
What the Editors Expect
What is a good reviewer in the eyes of an editor? First, a good reviewer declares any interest, be it personal, financial, or institutional, and declines an invitation if these conflicts might interfere with his or her assessment (8) or if the topic of the paper is outside his or her area of expertise. Obviously, the reviewer should refer the editor to papers that have been previously published, if he or she questions the novelty of the findings. Conversely, the reviewer confirms that he or she did not find similar papers in a search of the published data when declaring novelty. He or she detects inconsistencies in the data, if present; assesses the suitability of the methodology used; and recommends statistical analysis where appropriate. The reviewer then gives an overall priority as to its suitability for eventual publication or transfer to a subspecialty journal.
What is most remarkable about peer review is that busy, high-standing experts work voluntarily and without compensation to provide advice for the good of science and medicine. They even accept reminders, apologize if they are late, and usually do their very best to provide balanced and constructive recommendations. I do not know any other field that has maintained this spirit in a time of economized life. Let us maintain this academic spirit and ensure that the next generation of physicians and scientists lives along these lines.
- ↵Oldenburg H. The Correspondence of Henry Oldenburg. Hall AR, Hall MB, editor and translator. 13 volumes. Madison and Milwaukee: University of Wisconsin Press, 1965–1986.
- Lüscher T.F.
- ↵The American College Dictionary. Random House, New York, 1948, page 894.
- Kuhn T.S.
- Churchill W.S.
- Lüscher T.F.
- Lüscher T.F.,
- Gersh B.,
- Brugada J.,
- Landmesser U.,
- Ruschitzka F.,
- Serruys P.W.
- Lüscher T.F.
The JACC: Heart Failure Fellows include: F.A. Ahmad, MD, A.D. DeVore, MD, N.E. Ibrahim, MD, J.P. Kelly, MD, S.S. Mitter, MD, M.A. Psotka, MA, MD, A. Sharma, MD, J. Svetlichnaya, MD.
- American College of Cardiology Foundation
- DeMaria A.N.
- Fuster V.
- Fuster V.
- O'Connor C.
- Smith R.
- Krumholz H.M.
- Fuster V.