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How to Write a Peer Review

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When you write a peer review for a manuscript, what should you include in your comments? What should you leave out? And how should the review be formatted?

This guide provides quick tips for writing and organizing your reviewer report.

Review Outline

Use an outline for your reviewer report so it’s easy for the editors and author to follow. This will also help you keep your comments organized.

Think about structuring your review like an inverted pyramid. Put the most important information at the top, followed by details and examples in the center, and any additional points at the very bottom.

peer review and presentation

Here’s how your outline might look:

1. Summary of the research and your overall impression

In your own words, summarize what the manuscript claims to report. This shows the editor how you interpreted the manuscript and will highlight any major differences in perspective between you and the other reviewers. Give an overview of the manuscript’s strengths and weaknesses. Think about this as your “take-home” message for the editors. End this section with your recommended course of action.

2. Discussion of specific areas for improvement

It’s helpful to divide this section into two parts: one for major issues and one for minor issues. Within each section, you can talk about the biggest issues first or go systematically figure-by-figure or claim-by-claim. Number each item so that your points are easy to follow (this will also make it easier for the authors to respond to each point). Refer to specific lines, pages, sections, or figure and table numbers so the authors (and editors) know exactly what you’re talking about.

Major vs. minor issues

What’s the difference between a major and minor issue? Major issues should consist of the essential points the authors need to address before the manuscript can proceed. Make sure you focus on what is  fundamental for the current study . In other words, it’s not helpful to recommend additional work that would be considered the “next step” in the study. Minor issues are still important but typically will not affect the overall conclusions of the manuscript. Here are some examples of what would might go in the “minor” category:

  • Missing references (but depending on what is missing, this could also be a major issue)
  • Technical clarifications (e.g., the authors should clarify how a reagent works)
  • Data presentation (e.g., the authors should present p-values differently)
  • Typos, spelling, grammar, and phrasing issues

3. Any other points

Confidential comments for the editors.

Some journals have a space for reviewers to enter confidential comments about the manuscript. Use this space to mention concerns about the submission that you’d want the editors to consider before sharing your feedback with the authors, such as concerns about ethical guidelines or language quality. Any serious issues should be raised directly and immediately with the journal as well.

This section is also where you will disclose any potentially competing interests, and mention whether you’re willing to look at a revised version of the manuscript.

Do not use this space to critique the manuscript, since comments entered here will not be passed along to the authors.  If you’re not sure what should go in the confidential comments, read the reviewer instructions or check with the journal first before submitting your review. If you are reviewing for a journal that does not offer a space for confidential comments, consider writing to the editorial office directly with your concerns.

Get this outline in a template

Giving Feedback

Giving feedback is hard. Giving effective feedback can be even more challenging. Remember that your ultimate goal is to discuss what the authors would need to do in order to qualify for publication. The point is not to nitpick every piece of the manuscript. Your focus should be on providing constructive and critical feedback that the authors can use to improve their study.

If you’ve ever had your own work reviewed, you already know that it’s not always easy to receive feedback. Follow the golden rule: Write the type of review you’d want to receive if you were the author. Even if you decide not to identify yourself in the review, you should write comments that you would be comfortable signing your name to.

In your comments, use phrases like “ the authors’ discussion of X” instead of “ your discussion of X .” This will depersonalize the feedback and keep the focus on the manuscript instead of the authors.

General guidelines for effective feedback

peer review and presentation

  • Justify your recommendation with concrete evidence and specific examples.
  • Be specific so the authors know what they need to do to improve.
  • Be thorough. This might be the only time you read the manuscript.
  • Be professional and respectful. The authors will be reading these comments too.
  • Remember to say what you liked about the manuscript!

peer review and presentation


  • Recommend additional experiments or  unnecessary elements that are out of scope for the study or for the journal criteria.
  • Tell the authors exactly how to revise their manuscript—you don’t need to do their work for them.
  • Use the review to promote your own research or hypotheses.
  • Focus on typos and grammar. If the manuscript needs significant editing for language and writing quality, just mention this in your comments.
  • Submit your review without proofreading it and checking everything one more time.

Before and After: Sample Reviewer Comments

Keeping in mind the guidelines above, how do you put your thoughts into words? Here are some sample “before” and “after” reviewer comments

✗ Before

“The authors appear to have no idea what they are talking about. I don’t think they have read any of the literature on this topic.”

✓ After

“The study fails to address how the findings relate to previous research in this area. The authors should rewrite their Introduction and Discussion to reference the related literature, especially recently published work such as Darwin et al.”

“The writing is so bad, it is practically unreadable. I could barely bring myself to finish it.”

“While the study appears to be sound, the language is unclear, making it difficult to follow. I advise the authors work with a writing coach or copyeditor to improve the flow and readability of the text.”

“It’s obvious that this type of experiment should have been included. I have no idea why the authors didn’t use it. This is a big mistake.”

“The authors are off to a good start, however, this study requires additional experiments, particularly [type of experiment]. Alternatively, the authors should include more information that clarifies and justifies their choice of methods.”

Suggested Language for Tricky Situations

You might find yourself in a situation where you’re not sure how to explain the problem or provide feedback in a constructive and respectful way. Here is some suggested language for common issues you might experience.

What you think : The manuscript is fatally flawed. What you could say: “The study does not appear to be sound” or “the authors have missed something crucial”.

What you think : You don’t completely understand the manuscript. What you could say : “The authors should clarify the following sections to avoid confusion…”

What you think : The technical details don’t make sense. What you could say : “The technical details should be expanded and clarified to ensure that readers understand exactly what the researchers studied.”

What you think: The writing is terrible. What you could say : “The authors should revise the language to improve readability.”

What you think : The authors have over-interpreted the findings. What you could say : “The authors aim to demonstrate [XYZ], however, the data does not fully support this conclusion. Specifically…”

What does a good review look like?

Check out the peer review examples at F1000 Research to see how other reviewers write up their reports and give constructive feedback to authors.

Time to Submit the Review!

Be sure you turn in your report on time. Need an extension? Tell the journal so that they know what to expect. If you need a lot of extra time, the journal might need to contact other reviewers or notify the author about the delay.

Tip: Building a relationship with an editor

You’ll be more likely to be asked to review again if you provide high-quality feedback and if you turn in the review on time. Especially if it’s your first review for a journal, it’s important to show that you are reliable. Prove yourself once and you’ll get asked to review again!

  • Getting started as a reviewer
  • Responding to an invitation
  • Reading a manuscript
  • Writing a peer review

The contents of the Peer Review Center are also available as a live, interactive training session, complete with slides, talking points, and activities. …

The contents of the Writing Center are also available as a live, interactive training session, complete with slides, talking points, and activities. …

There’s a lot to consider when deciding where to submit your work. Learn how to choose a journal that will help your study reach its audience, while reflecting your values as a researcher…

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What is the Purpose of Peer Review?

What makes a good peer reviewer, how do you decide whether to review a paper, how do you complete a peer review, limitations of peer review, conclusions, research methods: how to perform an effective peer review.

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Elise Peterson Lu , Brett G. Fischer , Melissa A. Plesac , Andrew P.J. Olson; Research Methods: How to Perform an Effective Peer Review. Hosp Pediatr November 2022; 12 (11): e409–e413. https://doi.org/10.1542/hpeds.2022-006764

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Scientific peer review has existed for centuries and is a cornerstone of the scientific publication process. Because the number of scientific publications has rapidly increased over the past decades, so has the number of peer reviews and peer reviewers. In this paper, drawing on the relevant medical literature and our collective experience as peer reviewers, we provide a user guide to the peer review process, including discussion of the purpose and limitations of peer review, the qualities of a good peer reviewer, and a step-by-step process of how to conduct an effective peer review.

Peer review has been a part of scientific publications since 1665, when the Philosophical Transactions of the Royal Society became the first publication to formalize a system of expert review. 1 , 2   It became an institutionalized part of science in the latter half of the 20 th century and is now the standard in scientific research publications. 3   In 2012, there were more than 28 000 scholarly peer-reviewed journals and more than 3 million peer reviewed articles are now published annually. 3 , 4   However, even with this volume, most peer reviewers learn to review “on the (unpaid) job” and no standard training system exists to ensure quality and consistency. 5   Expectations and format vary between journals and most, but not all, provide basic instructions for reviewers. In this paper, we provide a general introduction to the peer review process and identify common strategies for success as well as pitfalls to avoid.

Modern peer review serves 2 primary purposes: (1) as “a screen before the diffusion of new knowledge” 6   and (2) as a method to improve the quality of published work. 1 , 5  

As screeners, peer reviewers evaluate the quality, validity, relevance, and significance of research before publication to maintain the credibility of the publications they serve and their fields of study. 1 , 2 , 7   Although peer reviewers are not the final decision makers on publication (that role belongs to the editor), their recommendations affect editorial decisions and thoughtful comments influence an article’s fate. 6 , 8  

As advisors and evaluators of manuscripts, reviewers have an opportunity and responsibility to give authors an outside expert’s perspective on their work. 9   They provide feedback that can improve methodology, enhance rigor, improve clarity, and redefine the scope of articles. 5 , 8 , 10   This often happens even if a paper is not ultimately accepted at the reviewer’s journal because peer reviewers’ comments are incorporated into revised drafts that are submitted to another journal. In a 2019 survey of authors, reviewers, and editors, 83% said that peer review helps science communication and 90% of authors reported that peer review improved their last paper. 11  

Expertise: Peer reviewers should be up to date with current literature, practice guidelines, and methodology within their subject area. However, academic rank and seniority do not define expertise and are not actually correlated with performance in peer review. 13  

Professionalism: Reviewers should be reliable and objective, aware of their own biases, and respectful of the confidentiality of the peer review process.

Critical skill : Reviewers should be organized, thorough, and detailed in their critique with the goal of improving the manuscript under their review, regardless of disposition. They should provide constructive comments that are specific and addressable, referencing literature when possible. A peer reviewer should leave a paper better than he or she found it.

Is the manuscript within your area of expertise? Generally, if you are asked to review a paper, it is because an editor felt that you were a qualified expert. In a 2019 survey, 74% of requested reviews were within the reviewer’s area of expertise. 11   This, of course, does not mean that you must be widely published in the area, only that you have enough expertise and comfort with the topic to critique and add to the paper.

Do you have any biases that may affect your review? Are there elements of the methodology, content area, or theory with which you disagree? Some disagreements between authors and reviewers are common, expected, and even helpful. However, if a reviewer fundamentally disagrees with an author’s premise such that he or she cannot be constructive, the review invitation should be declined.

Do you have the time? The average review for a clinical journal takes 5 to 6 hours, though many take longer depending on the complexity of the research and the experience of the reviewer. 1 , 14   Journals vary on the requested timeline for return of reviews, though it is usually 1 to 4 weeks. Peer review is often the longest part of the publication process and delays contribute to slower dissemination of important work and decreased author satisfaction. 15   Be mindful of your schedule and only accept a review invitation if you can reasonably return the review in the requested time.

Once you have determined that you are the right person and decided to take on the review, reply to the inviting e-mail or click the associated link to accept (or decline) the invitation. Journal editors invite a limited number of reviewers at a time and wait for responses before inviting others. A common complaint among journal editors surveyed was that reviewers would often take days to weeks to respond to requests, or not respond at all, making it difficult to find appropriate reviewers and prolonging an already long process. 5  

Now that you have decided to take on the review, it is best of have a systematic way of both evaluating the manuscript and writing the review. Various suggestions exist in the literature, but we will describe our standard procedure for review, incorporating specific do’s and don’ts summarized in Table 1 .

Dos and Don’ts of Peer Review

First, read the manuscript once without making notes or forming opinions to get a sense of the paper as whole. Assess the overall tone and flow and define what the authors identify as the main point of their work. Does the work overall make sense? Do the authors tell the story effectively?

Next, read the manuscript again with an eye toward review, taking notes and formulating thoughts on strengths and weaknesses. Consider the methodology and identify the specific type of research described. Refer to the corresponding reporting guideline if applicable (CONSORT for randomized control trials, STROBE for observational studies, PRISMA for systematic reviews). Reporting guidelines often include a checklist, flow diagram, or structured text giving a minimum list of information needed in a manuscript based on the type of research done. 16   This allows the reviewer to formulate a more nuanced and specific assessment of the manuscript.

Next, review the main findings, the significance of the work, and what contribution it makes to the field. Examine the presentation and flow of the manuscript but do not copy edit the text. At this point, you should start to write your review. Some journals provide a format for their reviews, but often it is up to the reviewer. In surveys of journal editors and reviewers, a review organized by manuscript section was the most favored, 5 , 6   so that is what we will describe here.

As you write your review, consider starting with a brief summary of the work that identifies the main topic, explains the basic approach, and describes the findings and conclusions. 12 , 17   Though not universally included in all reviews, we have found this step to be helpful in ensuring that the work is conveyed clearly enough for the reviewer to summarize it. Include brief notes on the significance of the work and what it adds to current knowledge. Critique the presentation of the work: is it clearly written? Is its length appropriate? List any major concerns with the work overall, such as major methodological flaws or inaccurate conclusions that should disqualify it from publication, though do not comment directly on disposition. Then perform your review by section:

Abstract : Is it consistent with the rest of the paper? Does it adequately describe the major points?

Introduction : This section should provide adequate background to explain the need for the study. Generally, classic or highly relevant studies should be cited, but citations do not have to be exhaustive. The research question and hypothesis should be clearly stated.

Methods: Evaluate both the methods themselves and the way in which they are explained. Does the methodology used meet the needs of the questions proposed? Is there sufficient detail to explain what the authors did and, if not, what needs to be added? For clinical research, examine the inclusion/exclusion criteria, control populations, and possible sources of bias. Reporting guidelines can be particularly helpful in determining the appropriateness of the methods and how they are reported.

Some journals will expect an evaluation of the statistics used, whereas others will have a separate statistician evaluate, and the reviewers are generally not expected to have an exhaustive knowledge of statistical methods. Clarify expectations if needed and, if you do not feel qualified to evaluate the statistics, make this clear in your review.

Results: Evaluate the presentation of the results. Is information given in sufficient detail to assess credibility? Are the results consistent with the methodology reported? Are the figures and tables consistent with the text, easy to interpret, and relevant to the work? Make note of data that could be better detailed in figures or tables, rather than included in the text. Make note of inappropriate interpretation in the results section (this should be in discussion) or rehashing of methods.

Discussion: Evaluate the authors’ interpretation of their results, how they address limitations, and the implications of their work. How does the work contribute to the field, and do the authors adequately describe those contributions? Make note of overinterpretation or conclusions not supported by the data.

The length of your review often correlates with your opinion of the quality of the work. If an article has major flaws that you think preclude publication, write a brief review that focuses on the big picture. Articles that may not be accepted but still represent quality work merit longer reviews aimed at helping the author improve the work for resubmission elsewhere.

Generally, do not include your recommendation on disposition in the body of the review itself. Acceptance or rejection is ultimately determined by the editor and including your recommendation in your comments to the authors can be confusing. A journal editor’s decision on acceptance or rejection may depend on more factors than just the quality of the work, including the subject area, journal priorities, other contemporaneous submissions, and page constraints.

Many submission sites include a separate question asking whether to accept, accept with major revision, or reject. If this specific format is not included, then add your recommendation in the “confidential notes to the editor.” Your recommendation should be consistent with the content of your review: don’t give a glowing review but recommend rejection or harshly criticize a manuscript but recommend publication. Last, regardless of your ultimate recommendation on disposition, it is imperative to use respectful and professional language and tone in your written review.

Although peer review is often described as the “gatekeeper” of science and characterized as a quality control measure, peer review is not ideally designed to detect fundamental errors, plagiarism, or fraud. In multiple studies, peer reviewers detected only 20% to 33% of intentionally inserted errors in scientific manuscripts. 18 , 19   Plagiarism similarly is not detected in peer review, largely because of the huge volume of literature available to plagiarize. Most journals now use computer software to identify plagiarism before a manuscript goes to peer review. Finally, outright fraud often goes undetected in peer review. Reviewers start from a position of respect for the authors and trust the data they are given barring obvious inconsistencies. Ultimately, reviewers are “gatekeepers, not detectives.” 7  

Peer review is also limited by bias. Even with the best of intentions, reviewers bring biases including but not limited to prestige bias, affiliation bias, nationality bias, language bias, gender bias, content bias, confirmation bias, bias against interdisciplinary research, publication bias, conservatism, and bias of conflict of interest. 3 , 4 , 6   For example, peer reviewers score methodology higher and are more likely to recommend publication when prestigious author names or institutions are visible. 20   Although bias can be mitigated both by the reviewer and by the journal, it cannot be eliminated. Reviewers should be mindful of their own biases while performing reviews and work to actively mitigate them. For example, if English language editing is necessary, state this with specific examples rather than suggesting the authors seek editing by a “native English speaker.”

Peer review is an essential, though imperfect, part of the forward movement of science. Peer review can function as both a gatekeeper to protect the published record of science and a mechanism to improve research at the level of individual manuscripts. Here, we have described our strategy, summarized in Table 2 , for performing a thorough peer review, with a focus on organization, objectivity, and constructiveness. By using a systematized strategy to evaluate manuscripts and an organized format for writing reviews, you can provide a relatively objective perspective in editorial decision-making. By providing specific and constructive feedback to authors, you contribute to the quality of the published literature.

Take-home Points

FUNDING: No external funding.

CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no potential conflicts of interest to disclose.

Dr Lu performed the literature review and wrote the manuscript. Dr Fischer assisted in the literature review and reviewed and edited the manuscript. Dr Plesac provided background information on the process of peer review, reviewed and edited the manuscript, and completed revisions. Dr Olson provided background information and practical advice, critically reviewed and revised the manuscript, and approved the final manuscript.

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  • What Is Peer Review? | Types & Examples

What Is Peer Review? | Types & Examples

Published on December 17, 2021 by Tegan George . Revised on June 22, 2023.

Peer review, sometimes referred to as refereeing , is the process of evaluating submissions to an academic journal. Using strict criteria, a panel of reviewers in the same subject area decides whether to accept each submission for publication.

Peer-reviewed articles are considered a highly credible source due to the stringent process they go through before publication.

There are various types of peer review. The main difference between them is to what extent the authors, reviewers, and editors know each other’s identities. The most common types are:

  • Single-blind review
  • Double-blind review
  • Triple-blind review

Collaborative review

Open review.

Relatedly, peer assessment is a process where your peers provide you with feedback on something you’ve written, based on a set of criteria or benchmarks from an instructor. They then give constructive feedback, compliments, or guidance to help you improve your draft.

Table of contents

What is the purpose of peer review, types of peer review, the peer review process, providing feedback to your peers, peer review example, advantages of peer review, criticisms of peer review, other interesting articles, frequently asked questions about peer reviews.

Many academic fields use peer review, largely to determine whether a manuscript is suitable for publication. Peer review enhances the credibility of the manuscript. For this reason, academic journals are among the most credible sources you can refer to.

However, peer review is also common in non-academic settings. The United Nations, the European Union, and many individual nations use peer review to evaluate grant applications. It is also widely used in medical and health-related fields as a teaching or quality-of-care measure.

Peer assessment is often used in the classroom as a pedagogical tool. Both receiving feedback and providing it are thought to enhance the learning process, helping students think critically and collaboratively.

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Depending on the journal, there are several types of peer review.

Single-blind peer review

The most common type of peer review is single-blind (or single anonymized) review . Here, the names of the reviewers are not known by the author.

While this gives the reviewers the ability to give feedback without the possibility of interference from the author, there has been substantial criticism of this method in the last few years. Many argue that single-blind reviewing can lead to poaching or intellectual theft or that anonymized comments cause reviewers to be too harsh.

Double-blind peer review

In double-blind (or double anonymized) review , both the author and the reviewers are anonymous.

Arguments for double-blind review highlight that this mitigates any risk of prejudice on the side of the reviewer, while protecting the nature of the process. In theory, it also leads to manuscripts being published on merit rather than on the reputation of the author.

Triple-blind peer review

While triple-blind (or triple anonymized) review —where the identities of the author, reviewers, and editors are all anonymized—does exist, it is difficult to carry out in practice.

Proponents of adopting triple-blind review for journal submissions argue that it minimizes potential conflicts of interest and biases. However, ensuring anonymity is logistically challenging, and current editing software is not always able to fully anonymize everyone involved in the process.

In collaborative review , authors and reviewers interact with each other directly throughout the process. However, the identity of the reviewer is not known to the author. This gives all parties the opportunity to resolve any inconsistencies or contradictions in real time, and provides them a rich forum for discussion. It can mitigate the need for multiple rounds of editing and minimize back-and-forth.

Collaborative review can be time- and resource-intensive for the journal, however. For these collaborations to occur, there has to be a set system in place, often a technological platform, with staff monitoring and fixing any bugs or glitches.

Lastly, in open review , all parties know each other’s identities throughout the process. Often, open review can also include feedback from a larger audience, such as an online forum, or reviewer feedback included as part of the final published product.

While many argue that greater transparency prevents plagiarism or unnecessary harshness, there is also concern about the quality of future scholarship if reviewers feel they have to censor their comments.

In general, the peer review process includes the following steps:

  • First, the author submits the manuscript to the editor.
  • Reject the manuscript and send it back to the author, or
  • Send it onward to the selected peer reviewer(s)
  • Next, the peer review process occurs. The reviewer provides feedback, addressing any major or minor issues with the manuscript, and gives their advice regarding what edits should be made.
  • Lastly, the edited manuscript is sent back to the author. They input the edits and resubmit it to the editor for publication.

The peer review process

In an effort to be transparent, many journals are now disclosing who reviewed each article in the published product. There are also increasing opportunities for collaboration and feedback, with some journals allowing open communication between reviewers and authors.

It can seem daunting at first to conduct a peer review or peer assessment. If you’re not sure where to start, there are several best practices you can use.

Summarize the argument in your own words

Summarizing the main argument helps the author see how their argument is interpreted by readers, and gives you a jumping-off point for providing feedback. If you’re having trouble doing this, it’s a sign that the argument needs to be clearer, more concise, or worded differently.

If the author sees that you’ve interpreted their argument differently than they intended, they have an opportunity to address any misunderstandings when they get the manuscript back.

Separate your feedback into major and minor issues

It can be challenging to keep feedback organized. One strategy is to start out with any major issues and then flow into the more minor points. It’s often helpful to keep your feedback in a numbered list, so the author has concrete points to refer back to.

Major issues typically consist of any problems with the style, flow, or key points of the manuscript. Minor issues include spelling errors, citation errors, or other smaller, easy-to-apply feedback.

Tip: Try not to focus too much on the minor issues. If the manuscript has a lot of typos, consider making a note that the author should address spelling and grammar issues, rather than going through and fixing each one.

The best feedback you can provide is anything that helps them strengthen their argument or resolve major stylistic issues.

Give the type of feedback that you would like to receive

No one likes being criticized, and it can be difficult to give honest feedback without sounding overly harsh or critical. One strategy you can use here is the “compliment sandwich,” where you “sandwich” your constructive criticism between two compliments.

Be sure you are giving concrete, actionable feedback that will help the author submit a successful final draft. While you shouldn’t tell them exactly what they should do, your feedback should help them resolve any issues they may have overlooked.

As a rule of thumb, your feedback should be:

  • Easy to understand
  • Constructive

Prevent plagiarism. Run a free check.

Below is a brief annotated research example. You can view examples of peer feedback by hovering over the highlighted sections.

Influence of phone use on sleep

Studies show that teens from the US are getting less sleep than they were a decade ago (Johnson, 2019) . On average, teens only slept for 6 hours a night in 2021, compared to 8 hours a night in 2011. Johnson mentions several potential causes, such as increased anxiety, changed diets, and increased phone use.

The current study focuses on the effect phone use before bedtime has on the number of hours of sleep teens are getting.

For this study, a sample of 300 teens was recruited using social media, such as Facebook, Instagram, and Snapchat. The first week, all teens were allowed to use their phone the way they normally would, in order to obtain a baseline.

The sample was then divided into 3 groups:

  • Group 1 was not allowed to use their phone before bedtime.
  • Group 2 used their phone for 1 hour before bedtime.
  • Group 3 used their phone for 3 hours before bedtime.

All participants were asked to go to sleep around 10 p.m. to control for variation in bedtime . In the morning, their Fitbit showed the number of hours they’d slept. They kept track of these numbers themselves for 1 week.

Two independent t tests were used in order to compare Group 1 and Group 2, and Group 1 and Group 3. The first t test showed no significant difference ( p > .05) between the number of hours for Group 1 ( M = 7.8, SD = 0.6) and Group 2 ( M = 7.0, SD = 0.8). The second t test showed a significant difference ( p < .01) between the average difference for Group 1 ( M = 7.8, SD = 0.6) and Group 3 ( M = 6.1, SD = 1.5).

This shows that teens sleep fewer hours a night if they use their phone for over an hour before bedtime, compared to teens who use their phone for 0 to 1 hours.

Peer review is an established and hallowed process in academia, dating back hundreds of years. It provides various fields of study with metrics, expectations, and guidance to ensure published work is consistent with predetermined standards.

  • Protects the quality of published research

Peer review can stop obviously problematic, falsified, or otherwise untrustworthy research from being published. Any content that raises red flags for reviewers can be closely examined in the review stage, preventing plagiarized or duplicated research from being published.

  • Gives you access to feedback from experts in your field

Peer review represents an excellent opportunity to get feedback from renowned experts in your field and to improve your writing through their feedback and guidance. Experts with knowledge about your subject matter can give you feedback on both style and content, and they may also suggest avenues for further research that you hadn’t yet considered.

  • Helps you identify any weaknesses in your argument

Peer review acts as a first defense, helping you ensure your argument is clear and that there are no gaps, vague terms, or unanswered questions for readers who weren’t involved in the research process. This way, you’ll end up with a more robust, more cohesive article.

While peer review is a widely accepted metric for credibility, it’s not without its drawbacks.

  • Reviewer bias

The more transparent double-blind system is not yet very common, which can lead to bias in reviewing. A common criticism is that an excellent paper by a new researcher may be declined, while an objectively lower-quality submission by an established researcher would be accepted.

  • Delays in publication

The thoroughness of the peer review process can lead to significant delays in publishing time. Research that was current at the time of submission may not be as current by the time it’s published. There is also high risk of publication bias , where journals are more likely to publish studies with positive findings than studies with negative findings.

  • Risk of human error

By its very nature, peer review carries a risk of human error. In particular, falsification often cannot be detected, given that reviewers would have to replicate entire experiments to ensure the validity of results.

If you want to know more about statistics , methodology , or research bias , make sure to check out some of our other articles with explanations and examples.

  • Normal distribution
  • Measures of central tendency
  • Chi square tests
  • Confidence interval
  • Quartiles & Quantiles
  • Cluster sampling
  • Stratified sampling
  • Thematic analysis
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Research bias

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Peer review is a process of evaluating submissions to an academic journal. Utilizing rigorous criteria, a panel of reviewers in the same subject area decide whether to accept each submission for publication. For this reason, academic journals are often considered among the most credible sources you can use in a research project– provided that the journal itself is trustworthy and well-regarded.

In general, the peer review process follows the following steps: 

  • Reject the manuscript and send it back to author, or 
  • Send it onward to the selected peer reviewer(s) 
  • Next, the peer review process occurs. The reviewer provides feedback, addressing any major or minor issues with the manuscript, and gives their advice regarding what edits should be made. 
  • Lastly, the edited manuscript is sent back to the author. They input the edits, and resubmit it to the editor for publication.

Peer review can stop obviously problematic, falsified, or otherwise untrustworthy research from being published. It also represents an excellent opportunity to get feedback from renowned experts in your field. It acts as a first defense, helping you ensure your argument is clear and that there are no gaps, vague terms, or unanswered questions for readers who weren’t involved in the research process.

Peer-reviewed articles are considered a highly credible source due to this stringent process they go through before publication.

Many academic fields use peer review , largely to determine whether a manuscript is suitable for publication. Peer review enhances the credibility of the published manuscript.

However, peer review is also common in non-academic settings. The United Nations, the European Union, and many individual nations use peer review to evaluate grant applications. It is also widely used in medical and health-related fields as a teaching or quality-of-care measure. 

A credible source should pass the CRAAP test  and follow these guidelines:

  • The information should be up to date and current.
  • The author and publication should be a trusted authority on the subject you are researching.
  • The sources the author cited should be easy to find, clear, and unbiased.
  • For a web source, the URL and layout should signify that it is trustworthy.

Cite this Scribbr article

If you want to cite this source, you can copy and paste the citation or click the “Cite this Scribbr article” button to automatically add the citation to our free Citation Generator.

George, T. (2023, June 22). What Is Peer Review? | Types & Examples. Scribbr. Retrieved February 19, 2024, from https://www.scribbr.com/methodology/peer-review/

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Peer review templates, expert examples and free training courses

peer review and presentation

Joanna Wilkinson

Learning how to write a constructive peer review is an essential step in helping to safeguard the quality and integrity of published literature. Read on for resources that will get you on the right track, including peer review templates, example reports and the Web of Science™ Academy: our free, online course that teaches you the core competencies of peer review through practical experience ( try it today ).

How to write a peer review

Understanding the principles, forms and functions of peer review will enable you to write solid, actionable review reports. It will form the basis for a comprehensive and well-structured review, and help you comment on the quality, rigor and significance of the research paper. It will also help you identify potential breaches of normal ethical practice.

This may sound daunting but it doesn’t need to be. There are plenty of peer review templates, resources and experts out there to help you, including:

Peer review training courses and in-person workshops

  • Peer review templates ( found in our Web of Science Academy )
  • Expert examples of peer review reports
  • Co-reviewing (sharing the task of peer reviewing with a senior researcher)

Other peer review resources, blogs, and guidelines

We’ll go through each one of these in turn below, but first: a quick word on why learning peer review is so important.

Why learn to peer review?

Peer reviewers and editors are gatekeepers of the research literature used to document and communicate human discovery. Reviewers, therefore, need a sound understanding of their role and obligations to ensure the integrity of this process. This also helps them maintain quality research, and to help protect the public from flawed and misleading research findings.

Learning to peer review is also an important step in improving your own professional development.

You’ll become a better writer and a more successful published author in learning to review. It gives you a critical vantage point and you’ll begin to understand what editors are looking for. It will also help you keep abreast of new research and best-practice methods in your field.

We strongly encourage you to learn the core concepts of peer review by joining a course or workshop. You can attend in-person workshops to learn from and network with experienced reviewers and editors. As an example, Sense about Science offers peer review workshops every year. To learn more about what might be in store at one of these, researcher Laura Chatland shares her experience at one of the workshops in London.

There are also plenty of free, online courses available, including courses in the Web of Science Academy such as ‘Reviewing in the Sciences’, ‘Reviewing in the Humanities’ and ‘An introduction to peer review’

The Web of Science Academy also supports co-reviewing with a mentor to teach peer review through practical experience. You learn by writing reviews of preprints, published papers, or even ‘real’ unpublished manuscripts with guidance from your mentor. You can work with one of our community mentors or your own PhD supervisor or postdoc advisor, or even a senior colleague in your department.

Go to the Web of Science Academy

Peer review templates

Peer review templates are helpful to use as you work your way through a manuscript. As part of our free Web of Science Academy courses, you’ll gain exclusive access to comprehensive guidelines and a peer review report. It offers points to consider for all aspects of the manuscript, including the abstract, methods and results sections. It also teaches you how to structure your review and will get you thinking about the overall strengths and impact of the paper at hand.

  • Web of Science Academy template (requires joining one of the free courses)
  • PLoS’s review template
  • Wiley’s peer review guide (not a template as such, but a thorough guide with questions to consider in the first and second reading of the manuscript)

Beyond following a template, it’s worth asking your editor or checking the journal’s peer review management system. That way, you’ll learn whether you need to follow a formal or specific peer review structure for that particular journal. If no such formal approach exists, try asking the editor for examples of other reviews performed for the journal. This will give you a solid understanding of what they expect from you.

Peer review examples

Understand what a constructive peer review looks like by learning from the experts.

Here’s a sample of pre and post-publication peer reviews displayed on Web of Science publication records to help guide you through your first few reviews. Some of these are transparent peer reviews , which means the entire process is open and visible — from initial review and response through to revision and final publication decision. You may wish to scroll to the bottom of these pages so you can first read the initial reviews, and make your way up the page to read the editor and author’s responses.

  • Pre-publication peer review: Patterns and mechanisms in instances of endosymbiont-induced parthenogenesis
  • Pre-publication peer review: Can Ciprofloxacin be Used for Precision Treatment of Gonorrhea in Public STD Clinics? Assessment of Ciprofloxacin Susceptibility and an Opportunity for Point-of-Care Testing
  • Transparent peer review: Towards a standard model of musical improvisation
  • Transparent peer review: Complex mosaic of sexual dichromatism and monochromatism in Pacific robins results from both gains and losses of elaborate coloration
  • Post-publication peer review: Brain state monitoring for the future prediction of migraine attacks
  • Web of Science Academy peer review: Students’ Perception on Training in Writing Research Article for Publication

F1000 has also put together a nice list of expert reviewer comments pertaining to the various aspects of a review report.


Co-reviewing (sharing peer review assignments with senior researchers) is one of the best ways to learn peer review. It gives researchers a hands-on, practical understanding of the process.

In an article in The Scientist , the team at Future of Research argues that co-reviewing can be a valuable learning experience for peer review, as long as it’s done properly and with transparency. The reason there’s a need to call out how co-reviewing works is because it does have its downsides. The practice can leave early-career researchers unaware of the core concepts of peer review. This can make it hard to later join an editor’s reviewer pool if they haven’t received adequate recognition for their share of the review work. (If you are asked to write a peer review on behalf of a senior colleague or researcher, get recognition for your efforts by asking your senior colleague to verify the collaborative co-review on your Web of Science researcher profiles).

The Web of Science Academy course ‘Co-reviewing with a mentor’ is uniquely practical in this sense. You will gain experience in peer review by practicing on real papers and working with a mentor to get feedback on how their peer review can be improved. Students submit their peer review report as their course assignment and after internal evaluation receive a course certificate, an Academy graduate badge on their Web of Science researcher profile and is put in front of top editors in their field through the Reviewer Locator at Clarivate.

Here are some external peer review resources found around the web:

  • Peer Review Resources from Sense about Science
  • Peer Review: The Nuts and Bolts by Sense about Science
  • How to review journal manuscripts by R. M. Rosenfeld for Otolaryngology – Head and Neck Surgery
  • Ethical guidelines for peer review from COPE
  • An Instructional Guide for Peer Reviewers of Biomedical Manuscripts by Callaham, Schriger & Cooper for Annals of Emergency Medicine (requires Flash or Adobe)
  • EQUATOR Network’s reporting guidelines for health researchers

And finally, we’ve written a number of blogs about handy peer review tips. Check out some of our top picks:

  • How to Write a Peer Review: 12 things you need to know
  • Want To Peer Review? Top 10 Tips To Get Noticed By Editors
  • Review a manuscript like a pro: 6 tips from a Web of Science Academy supervisor
  • How to write a structured reviewer report: 5 tips from an early-career researcher

Want to learn more? Become a master of peer review and connect with top journal editors. The Web of Science Academy – your free online hub of courses designed by expert reviewers, editors and Nobel Prize winners. Find out more today.

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  • 08 October 2018

How to write a thorough peer review

  • Mathew Stiller-Reeve 0

Mathew Stiller-Reeve is a climate researcher at NORCE/Bjerknes Centre for Climate Research in Bergen, Norway, the leader of SciSnack.com, and a thematic editor at Geoscience Communication .

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Scientists do not receive enough peer-review training. To improve this situation, a small group of editors and I developed a peer-review workflow to guide reviewers in delivering useful and thorough analyses that can really help authors to improve their papers.

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  • v.2(6); 2022 Nov

Effective Peer Review: Who, Where, or What?

Peer review is widely viewed as one of the most critical elements in assuring the integrity of scientific literature ( Baldwin, 2018 ; Smith, 2006 ). Despite the widespread acceptance and utilization of peer review, many difficulties with the process have been identified ( Hames, 2014 ; Horrobin, 2001 ; Smith, 2006 ). One of the primary goals of the peer review process is to identify flaws in the work and, by so doing, help editors choose which manuscripts to publish. It is surprising that one of the persistent problems in peer review is assessing the quality of the reviews. Both authors and journal editors expect peer review to detect errors in experimental design and methodology and to ensure that the interpretation of the findings is presented in an objective and thoughtful manner. In traditional peer review, two or more reviewers are asked to evaluate a manuscript on the basis of the expectation that if the two reviewers agree on the quality of the submission, the likelihood of a high-quality review is increased. Unfortunately, studies have not consistently confirmed a high degree of agreement among reviewers. Rothwell and Martynn (2000) evaluated the reproducibility of peer review in neuroscience journals and meeting abstracts and found that agreement was approximately what would be expected by chance. Similarly, Scharschmidt et al. (1994) found similar results in the evaluation of 1,000 manuscripts submitted to the Journal of Clinical Investigation, where clustering of grades in the middle resulted in an agreement being “…only marginally…” better than chance. These observations suggest that we cannot rely on the agreement of reviewers to be an indication of the quality of the reviews. Another potential way to evaluate the quality of reviews would be to assess the ability of reviewers to detect errors in submissions. It is generally accepted that detection of intentional fraud is beyond the scope of typical peer review, but we do expect reviewers to detect major and minor errors as a primary function of the traditional peer review system ( Hwang, 2006 ; Weissman, 2006 ). Schroter et al. (2008) evaluated the ability of reviewers to detect major and minor errors by introducing errors into three previously published papers describing randomized controlled clinical trials. Reviewers detected approximately three of the nine errors introduced in each manuscript. Unfortunately, reviewers who had undergone training in how to conduct a high-quality peer review were not significantly better than untrained reviewers. Similar results have been reported by Godlee et al. (1998) and Baxt et al. (1998) . Baxt et al. (1998) did report that reviewers who rejected or suggested revision of a manuscript identified more errors than those who accepted the manuscript (decision: 17.3% of major errors detected [accept], 29.6% of major errors detected [revise], and 39.1% of major errors detected [reject]). It is almost certainly true that the extent of the failure to recognize errors in submitted manuscripts may differ among scientific disciplines and journals. It also however seems likely that these observations do have some applicability to journals such as JID Innovations . It is critical that both authors and editors are cognizant of these limitations of peer review in their assessment of reviews. These findings compel journals to continue to work to develop new strategies to train and evaluate reviewers. The findings also suggest that factors beyond the failure to detect objective mistakes in a manuscript may be playing a role in the discrepancy in reviewers’ evaluations. One area of ongoing concern in the peer review process is the role of reviewer bias in assessing the scientific work of colleagues ( Kuehn, 2017 ; Lee et al, 2013 ; Tvina et al, 2019 ).

Bias in the peer review process can take many forms, including collaborator/competitor bias, affiliation bias based on an investigator’s institution or department, geographical bias based on the region or country of origin, racial bias, and gender or sex bias ( Kuehn, 2017 ; Lee et al, 2013 ; Tvina et al, 2019 ). All of these forms of bias present the risk that a decision of the reviewer will not be based solely on the quality or merit of the work but rather be influenced by a bias of the reviewer. We and other journals routinely seek to avoid selecting individuals to review work from their own institutions and ask all reviewers to declare any potential personal conflicts of interest. All these methods require either the editor or the reviewer to identify a bias and fail to address the issue of implicit or unconscious reviewer bias. The dominant method currently utilized for peer review is the so-called single-blind review, in which the identity and affiliations of the authors are known to the reviewers, whereas the identity of reviewers remains unknown to the authors. This has led to concern that knowledge of the identity of the authors and their institutions may be the source of significant reviewer bias, especially implicit bias, in the evaluation of manuscripts. Double anonymized peer review (DAPR), also known as double-blind peer review, has been suggested as a way to address this issue ( Bazi, 2020 ; Lee et al, 2013 ). Studies have compared single-blind with double-blind reviewing and reported that there is no significant difference in the quality of the reviews ( Alam et al, 2011 ; Godlee et al, 1998 ; Justice et al, 1998 ; van Rooyen et al, 1998 ). Although these studies looked at measures such as the number of errors detected, acceptance rate, and distribution of initial reviewer scores, they were not designed to address specific sources of bias such as authors’ gender, institution, or geographic location. Other studies have been undertaken to directly address the issue of bias in the peer review process. Ross et al (2006) compared the acceptance of abstracts submitted to the American Heart Association’s annual scientific meeting during a period when the reviewers knew the identity and origin of the authors (i.e., single-blind review) with when this information was not known by the reviewers (i.e., double-anonymized peer review). They found a significant increase in acceptance of non‒United States abstracts and abstracts from non-English speaking countries when the reviewers were unaware of the country of origin of the abstracts ( Ross et al, 2006 ). They also found a significant decrease in the acceptance of abstracts from prestigious institutions when the reviewers were unaware of the institutions where the work was done. In a similar study, Tomkins et al. (2017) found that papers submitted to a prestigious computer science meeting were more likely to be accepted if they were from famous authors, top universities, and top companies. Okike et al. (2016) documented similar results for manuscripts submitted to the orthopedic literature. They submitted a fabricated manuscript that was presented as being written by two prominent orthopedic surgeons (past Presidents of the American Academy of Orthopedic Surgeons) from prestigious institutions. When reviewed in the traditional single-blind fashion, which included the identity of the authors, the manuscript was accepted by 87% of the reviewers. By contrast, when the identity of the authors was unknown, the manuscript was accepted by 68% of the reviewers ( P  = 0.02) ( Blank, 1991 ). A study conducted at The American Economic Review found that authors at near-top-ranked universities experienced lower acceptance rates when authorship was anonymized ( Blank, 1991 ). Of interest, they also found that for women, there was no difference in the acceptance rate between the double-anonymized and single-blinded reviews; however, for men, the acceptance rate was lower with double-anonymized reviews.

These studies provide strong evidence that knowledge of who and where the study was performed can impact the acceptance of abstracts and manuscripts. This conflicts with the goal of the review process to base our judgments on the quality of what the results demonstrate. It is difficult to estimate how much this may affect the fate of a manuscript at JID Innovations . We do not have evidence that our review process has been impacted by bias as is reported in the studies discussed. However, neither can we state with certainty that such bias is not a factor in the reviews we receive. One of the goals of JID Innovations is to be a truly open-access journal available to all investigators in skin science from around the world. We have sought to be an outlet for studies that challenge existing paradigms or that may report negative results. We want to be seen as providing fair and objective reviews for all authors, regardless of where they work or who they are. If we are to achieve this goal, it is imperative that the who and where of a specific manuscript do not negatively impact the evaluation of the what. We want young investigators, investigators at less prestigious institutions or from less well-known laboratories, and investigators from any country around the world to be confident that their work will be judged by what they report and not by the who and the where.

To be true to this mission, JID Innovations will be initiating DAPR starting in October 2022. This is not being done because we are aware of any issues of bias with our current process of peer review but because we realize that the absence of proof is not proof of absence. As a part of this process, authors will be asked to remove identifying material from manuscripts at the time of submission in preparation for the review process ( https://www.jidinnovations.org/content/authorinfo ). As a result, primary reviewers will see only the what of the manuscript. We realize that this process involves extra work for both the authors and our staff, but we feel the benefits will outweigh this small cost. Indeed, in other journals that have taken this step, surveys have shown that both authors and reviewers ultimately prefer double-anonymized reviews ( Bennett et al, 2018 ; Moylan et al, 2014 ). We realize that achieving 100% anonymization of a manuscript is nearly impossible. Studies have shown that the rate of successful anonymizing, where the reviewers cannot discern the authorship of a manuscript, ranged from 47 to 73%. It is however interesting that even with this rate of success in the anonymizing process, a meta-analysis of trials of double- versus that of single-blind peer review has suggested an impact, with lower acceptance rates with double-anonymized peer review ( Ucci et al, 2022 ). More work clearly needs to be done to assess the value of the DAPR process, and we will be monitoring our results carefully.

The institution of DAPR in JID Innovations will assure our authors that the what of their manuscript is our focus. It does not matter who you are or where you are from. It will also emphasize to our reviewers that our focus is on the what. We will be carefully monitoring the results of this new policy and plan to report back on our experience. We also welcome your feedback on your experience as a reviewer and author for JID Innovations ; send your comments to us at [email protected] .

Finally, this decision should be seen not as the end of our efforts to improve the peer review process but merely as a first step. We will continue to work to improve all aspects of the peer review process for JID Innovations . We firmly believe that the use of double-blind -anonymized peer review will bring us closer to ensuring to our authors and readers that the work that is published by JID Innovations has been selected on the basis of what the paper reports and not on who performed the studies or where they were located.

Conflict of Interest

The author states no conflicts of interest.

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  • The work should clearly communicate the content without calls for clarification.
  • If written for the general public, simplification of terms and provision of background information would allow attendees to easily grasp the concepts and research results being reported. 
  • If written for fellow scholars and researchers, the content would presume no need for topic education is necessary, that terminology is consistent with the subject area, and research reporting would be at the level of scholarly writing.
  • The work should be free of grammatical and punctuation errors.
  • Numbers and data, if used, should be presented in a manner which makes understanding easy to achieve.

Ask yourself:

  • Does the content wording and use of terms match the intended audience?
  • Is evidence presented logically and use appropriately?
  • Is the work clearly and succinctly organized?
  • Are discussions and research results of subjects, either individual or groups, presented in an objective and respectful manner?
  • Are sensitive topics and issues presented with thoughtfulness and courtesy?
  • Works submitted for publication in traditional print resources should follow the publisher’s guide to submissions, especially criteria involving relevant value to the readers.
  • Works submitted for publication in an electronic format – web site, digital, PDF, etc. – should be cognizant of the type of format and the format’s strengths in appealing to the reader by use of technology, programming, and audio or video motion.
  • Is the work suitable to the audience targeted?
  • Does the work present an appropriate and suitable style?
  • The work should clearly state the purpose of the work, the goals that were designed, the results that occurred, any differences between the goals and the results, and the importance of the research results to the audience or area of interest.
  • The author should demonstrate scholarship in the field by the quality of supporting evidence, research method, research results, and interpretation of those results.
  • Is the work objective in its content and presentation?
  • Are conclusions reached without predeterminations and outside influence?
  • Is there sufficient evidence, both in terms of amount and substance, to effectively support the outcome?
  • Does the work provide new evidence or research results that would be of interest to the field, practitioners, and scholars?

Blogs, Listservs, and Social Media

Electronic presentations are a great way to gage collegial ideas and opinions about the topic you have selected to pursue.  These formats can be done at varying and convenient times.

  • Online brevity is the best – adopt Twitter’s 140 character limit, and select words carefully.
  • Use simple statements.
  • Seek feedback and comments.

Exhibits consist of a visual display of a collection, program, initiative, or body of work (i.e. paintings, drawings, prints, posters, photography, sculpture, ceramics, video, installation, multi-media).

  • Include a general statement of purpose and statements to provide an intellectual context both for the collection as a whole and for its individual pieces.
  • Be prepared to respond to comments and questions.

Facilitated Discussions

Facilitated discussions involve the arranging of attendees into groups, such as tables or round chair setup, and provide topics for discussion.  Topics can be the same for all attendees and groups, or vary by group.

  • Provide a brief introduction – remember that you are not the presenter, and the discussions are the purpose of this event.
  • Develop discussion points, topics, and questions well in advance by polling registered attendees.
  • Be willing to accept ad-hoc discussion topics relevant to the content.
  • Provide for adequate Q&A and open comment time at the end.
  • Ensure that the majority of time allotted for the event is reserved for discussion and report-back.
  • Record group report-back’s on flip charts or other method, so that attendees may view the report-back comments as they are read out, and receive a written copy after the event.
  • Foster collegial conversational exchange.
  • Mingle among the groups or tables to see if attendees are participating, but avoid becoming involved in their discussions.

Keynote Address

The keynote address is perhaps the most challenging presentation.  What you say and how well you communicate your ideas, research, findings, and experience sets the tone for the event.  High level competency and established experience are the minimum content goals.  See Oral Presentations for additional guidance.

  • Presentation much be absolutely relevant to the event.
  • This is a stand-alone presentation.
  • Be prepared to “wow” the audience with a dynamic content, excellent slides, well developed public speaking skills, and inspiration.
  • Professional credibility is presumed.

Oral Presentations

Oral presentations involve the presentation of a paper or research project with or without visual aids.  This is an excellent opportunity to share research findings with colleagues, seek comments, listen to advice, and facilitate discussion and comment.

  • Focus on the purpose, methodology, challenges, and findings of the research.
  • Report laboratory and data results, if applicable.
  • Clearly provide the reason that motivated research interest and commencement.
  • Disclose the strengths and weakness of the research process, and what was learned from failures.
  • PowerPoint presentations should be well done.  See PowerPoint Use in Presentation for more details.
  • Subject mastery is presumed.
  • Expect questions and comments that indicate doubt or disagreement, and respond collegially.
  • Include a Q&A section at the end of the presentation.
  • Provide contact information.

Panel Discussions

Panel discussions involve a limited number of panelists, usually 3-5, presenting and discussing their views on a scholarly topic and responding to audience questions.

  • Select speakers from different perspectives to give balanced presentations.
  • Before finalizing speaker selection, discuss panel content and purpose to ensure that potential speakers understand the purpose of the panel discussion.
  • Ask panelists to state their points concisely and clearly, mindful of the limited time for each panelist.
  • Anticipate questions from both the audience and panelists.
  • Defer comment and questions from the audience to panelists.
  • Provide ample time for individual presentations, statements, general discussion, and Q&A.

Peer Review Publications

Poster sessions.

Posters present a visual display of work on poster boards. Presenters should be able to provide a scholarly introduction to their work and be prepared to entertain the viewers’ questions.

  • Include both charts and pictures.
  • Develop an eye catching format and design.
  • Brevity works best, both for what is on the poster and for answering visitors.
  • Have a one-sheet handout for the main take-away points, including your contact information.
  • Have business cards available.
  • Be prepared for many repeats of your 60-second verbal summary.
  • Expect fast and furious turnovers.
  • Balance the content – not too sparse but not too detailed and complex.

PowerPoint Use in Presentations

Using PowerPoint or any slide programmed should be viewed as a supplemental visual tool for many types of presentations.  They should not be treated as “the” presentation.

  • Don’t read from the slides.
  • Look at the screen as little as possible.
  • Present from knowledge and experience, not from the slides.
  • Slides should be limited in numbers and complexity.
  • Charts, graphics, pictures, and other inserts should be simple and visually clear.
  • Sound, video, and images add value, if content relevant.
  • Use bullet points. PowerPoint slides do not need full sentences, and should never have a paragraph full of information.
  • Use images effectively. You should have as little text as possible on the slide. One way to accomplish this is to have images on each slide, accompanied by a small amount of text.
  • Slides provide focus and guidance, not full details.
  • Never put your presentation on the slides and read from the slides.

Workshops consist of a brief presentation followed by interaction with the audience. The purpose of a workshop is to introduce the audience to your subject and involve them in using a skill or technique.  Learning objectives and anticipated outcomes should be clearly stated.

  • Content should be timely and relevant.
  • Content should be take-away – attendees should be able to leave the workshop, go back to their jobs, and begin brainstorming ideas, developing strategies, and implementing projects soon.
  • Go short on theories and long on how-to methods.
  • Develop learning objectives and anticipated outcomes, and build content around these goals.
  • Develop an agenda that more resembles a syllabus.
  • Select preparation materials, such as articles and documents to read before the workshop.
  • Include data but do not overwhelm attendees with too much or complex data.
  • Provide a bibliography or list of suggested readings.

Academic Presentation Formula

Newbies are strongly encouraged to follow this formula.  Later and with experience, deviation from the formula is more feasible.

  • Introduction/Overview/Hook
  • Theoretical Framework/Research Question
  • Methodology/Case Selection
  • Background/Literature Review
  • Discussion of Data/Results
  • Q&A, if permitted

The Audience Is Ready to Listen

Avoid presenting too much information about what is already known, and provide this information, if needed, in the introduction.  Only discuss literature and background information that relates directly to the topic and research results being presented.  Keep this portion of the presentation to five minutes or less.  More time will be needed for the presentation of the research results and audience questions and comments.

Practice Practice Practice

Practice the presentation from start to finish before delivering the presentation – several times.  Repeated practicing provides delivery confidence, efficient time management, and better speaking skills.  Make sure the presentation fits within the time parameters. Practicing also makes it flow better.

Keep To the Time Limit

If the time allotted for the presentation is ten minutes, prepare ten minutes of material.  Regardless of the amount of time provided, a little or a lot, finish within or at the end of the allotted time.  Practice the presentation with a stopwatch to ensure complicity.

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Article Contents

1. introduction, 2. definition(s) of peer review, 3. the ‘deficit model’ of peer review, 4. a potential basis for theories of peer review, 5. practices (i.e. process): activities in peer review, 6. deriving procedures from practices: types of peer review, 7. peer review in context, 8. peer-review procedures producing quality and legitimacy, 9. implications for science and politics, 10. peer review as a mechanism of government of science, 11. conclusion, acknowledgements, conflict of interest statement., peer-review procedures as practice, decision, and governance—the road to theories of peer review.

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Martin Reinhart, Cornelia Schendzielorz, Peer-review procedures as practice, decision, and governance—the road to theories of peer review, Science and Public Policy , 2024;, scad089, https://doi.org/10.1093/scipol/scad089

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Peer review is an ubiquitous feature of science with three interrelated roles: first, as a mechanism to assess quality through expert judgement (process); second, to decide on the distribution of scarce resources, e.g. publication space (outcome); and, third, to self-govern science (context). This is poorly reflected in public and academic debates, where attention is focused on alleged deficits. Moving beyond a ‘deficit model’, we, first, divide the peer-review process into eight different practices, which, in combination, can make up a wide variety of peer-review procedures. Second, we claim that peer review not only provides evaluative decisions, but, more importantly, also provides the legitimacy for these decisions. Thus, an encompassing theoretical view of peer review should integrate process, outcome, and context. Such a view could start by theorizing peer review as a form of government, not unlike democracy, grown historically around concerns for legibility, responsibility, and responsiveness akin to the Mertonian norms.

Peer review is an ubiquitous feature of science dating back to the 17th century. As the basic and most adequate form of quality control, peer review seems irreplaceable to most scientists. Despite its central importance and long history, peer review is mainly discussed with respect to its deficiencies. Public debates have the tendency to either accept peer review as the gold standard for scientific knowledge or to focus on some of its deficiencies and implying that serious reform is needed. Little is said about the merits of peer review and the mechanisms that make it work. As a consequence, attempts to reform or improve peer review primarily aim at eliminating or alleviating such deficiencies. Concentrating on the shortcomings offers only a limited understanding of how peer review works, and measures to address deficiencies may have significant and negative unintended consequences as a result. In light of the many current calls for reform in how quality is controlled in science (responsible research and innovation, translation, reproducibility, misconduct, Coalition for Advancing Research Assessment), a more comprehensive understanding of how peer review works is urgently needed.

Some of this focus on deficiencies has carried over into the research literature. Peer-review research started as a reaction to public criticism, most notably with political concerns over cronyism, exemplified by the work of Cole and Cole in the 1970s ( Cole, Rubin and Cole 1977 ; Cole and Cole 1981 ; Baldwin 2018 ). By and large, it has retained a focus on perceived deficits and ways to improve on them up to the present. As such, it is perfectly attuned to the need in public debates for evaluative judgements and quick guides for action. However, the field has, at the same time, become bigger and more diverse, so that the time may have come to challenge the premises of the deficit model and ask for a more encompassing understanding of peer-review processes. Despite the large number of empirical studies, a more generalizable discussion of how peer review works as a procedure for quality control and what useful theoretical renderings of this process might look like is still missing ( Hug 2022 ). Such a discussion is sorely needed to move the field from primarily evaluative to more scientific perspectives ( Hirschauer 2004 ).

Instead of providing a fully fledged theory of peer review, our goal in this paper is a preliminary one. We, first, argue for a more comprehensive definition of peer review as a social phenomenon and relate it to the existing literature. We, second, elaborate on common premises of conceptualizations of peer review in existing (empirical) research, on which theories of peer review can be built. We argue, third, that a common understanding includes peer review as a procedure to assess quality, peer review as a mechanism to decide on scarce resources, and peer review as an instrument for (self-)governance in science. The primary focus in the literature has been on peer review as a decision mechanism, from where we expand on what it means to conceptualize peer review as a procedure for quality assessment and as an instrument for governance. Based on a simple typology, we conclude by integrating these three understandings and suggesting the main theoretical concerns that future theories of peer review may consider. These concerns result from the claim that the success of peer review is predicated on it combining issues of scientific quality with issues of political legitimacy that remain inseparable for any empirical analysis.

If peer review is considered any procedure in science that is used to allocate scarce resources by invoking expert judgement on the epistemic qualities of an object, then peer review is a highly diverse phenomenon with a long history. Objects can be papers, books, research projects, people’s careers, funding programmes, or organizations. Epistemic qualities can be disciplinary, interdisciplinary, or even transdisciplinary. Expert judgment can be individual, collective, or even algorithmic. And scarce resources can be publication space, funding, careers, attention, and prestige. 1 As such, peer review encompasses many, if not most, of the institutionalized procedures of evaluation in science: journals, books, conferences, funding, professorships, and a myriad of institutional and programme evaluations ( Jasanoff 1990 ). Such a definition should cover most of the diversity of peer review as a social phenomenon.

As a definition of peer review, this is more encompassing than the everyday usage of the term and more encompassing than how most of the literature frames the phenomenon. 2 It is generally seen as self-evident that peer review differs with respect to what objects are reviewed (e.g. papers versus funding proposal) or with respect to the institutional setting (e.g. journals versus funders versus universities). 3 We think it worth to reconsider the self-evidence of separating multiple forms of peer review analytically for historical and theoretical reasons, as we explain below. A simple example to see that less encompassing definitions are limiting are the recurring claims of a shortage of reviewers. Addressing such an issue requires including all forms of peer review in the analysis because reviewers are typically active in more than one form of peer review and a shortage of reviewers may be due to how the demand for reviewers varies across multiple forms of peer review. 4 The historic origins of peer review can be traced back to the scientific associations, such as the Royal Society, from the 17th century ( Barnes 1934 ; Webster 1967 ; Zuckerman and Merton 1971 ; Lock 1985 ; Kronick 1990 ; Biagioli 2002 ; Spier 2002 ). 5 These initial forms of evaluative witnessing ( Shapin 1994 ) and selecting were mostly informal and local. Even though they spread alongside the growth of the science system, peer review only evolved into an ubiquitous feature of science in the second half of the 20th century ( Jasanoff 1985 ; Guston 2000 ; Baldwin 2018 ).

The rise of peer review must be regarded in the context of increased and more specific public funding for research after the Second World War ( Jasanoff 1990 ; Guston 2000 ). Baldwin’s (2018) account is highly instructive here as she pinpoints the moment in US-American politics in the 1960s and 1970s when referring to peer review became taken for granted: on the one hand, when public spending on research had to be justified and, on the other, when the quality of research had to be publically ensured. From that point on, peer review became the procedure that regulated the boundary between science and politics, and more generally between science and society ( Guston 2000 , 2001 ; Weingart 2001 ). It became successful in this role, not because there was convincing evidence that peer review would be the best procedure, either epistemically or politically, to regulate science. Rather, it became a matter of course because it represented the consensus between political and scientific actors. The history of how peer review proliferated to become the normal procedure, also in journals or institutional evaluations, remains to be written, but the political consensus around research funding after allegations of financial mismanagement and of cronyism will play a central role. As such, peer review itself only became a contested issue when allegations could be made that it has serious deficiencies. Since then, public debates about peer review have little to say about its merits and much about its flaws.

The list of alleged flaws and deficits is long and has changed little over the last 40 years: conservatism, corruption, bias, lack of transparency, inefficiency, ineffectiveness, low reliability, low validity, overburdened reviewers, and much more ( Reinhart 2012 : p. 50ff, Eve et al. 2021 : 8). It seems that these recurring allegations have less to do with how peer review actually works and more with how important peer review has become. Whatever the overarching contested issue is at the time—interdisciplinarity, translation, responsible research and innovation, reproducibility, misconduct, etc.—peer review is always part of the debate. Due to its centrality, it must at least be either part of the cause or part of the solution for such problems. Whatever the problem, it is due to the deficits of peer review, and the way forward lies in peer review reform or in alternatives to peer review. At least, this is how these public debates always seem to play out. We call this the ‘deficit model’: peer review is only of interest when problems arise then calls for urgent changes follow. The way peer review actually works, however, is taken for granted and requires no immediate action. 6 Along the lines of a famous quote by Winston Churchill, the perennially recurring slogan for the deficit model can be summed up as: peer review is the worst form of quality control, except for all the others.

It seems then that these public debates are only secondarily about peer review. If they were primarily about peer review, one would expect the script for such debates to change over time according to the current state of research on peer review. The question of whether one of the proclaimed deficits is actually prevalent could be resolved through research, e.g. whether there is gender bias or not, and the debate should change accordingly. It seems that this is not happening, even though the number of empirical studies on peer review has been growing considerably ( Batagelj, Ferligoj and Squazzoni 2017 ; Grimaldo, Marušić and Squazzoni 2018 ). Gender bias is still a contested issue both publicly and in the research literature ( Squazzoni et al. 2021 ). The fact that 40 years of research have not convincingly shown that these deficits are real and problematic—not just in single cases, but for peer review in general—prompts us to explore theoretical options beyond the deficit model.

We think that this state of affairs has at least three causes. First, most empirical studies employ a case-study approach (e.g. of one journal or one funder), and comparative work is very rare. Second, most studies have relatively small sample sizes and the robustness of results suffers accordingly. Third, most studies follow the deficit model in that they primarily test for one (or several) of the alleged deficits of peer review and thus fail to give a comprehensive view of peer-review procedures. 7 The first two causes would be easy to overcome if there were more access to data from journals, funding organizations, and governments. Despite national transparency and accountability laws and more researchers attempting to gain access to data, the field has seen only minor progress on this front, and it still seems that limited access to data will be a central issue for the foreseeable future. The third cause, however, is more difficult to overcome and little progress has been made here.

Considering the abundance of public debate and research, it is surprising that there is very little theorization of peer review. Peer review is frequently introduced as playing ‘a key role’ in science without much qualification as to what this key role implies. Most authors treat the role of peer review and thus its theoretical relevance either as self-evident or as pertaining to a deficit. 8 Whether a deficit relates in an important way to what the role of peer review is in theory is rarely discussed. As a consequence, there seems to be a need for specific rather than general claims as to what the role of peer review is and how such claims help in determining what research questions can be deemed relevant. Overcoming the deficit model will therefore require making explicit (and testable) claims about the role of peer review that relate to the general sentiment that peer review is ‘one of the fundamental conditions of possibility of academic knowledge and the construction of its value’ ( Biagioli 2002 : 11). In addition, such theoretical claims may also help explain why the deficit model has become the most prevalent folk theory of peer review.

In summary, the empirical literature on peer review makes it difficult to draw generalizable conclusions about peer review, as individual studies focus on just one case, or say little about their theoretical (i.e. generalizable) framework, or follow a deficit model, often implicitly. Similar criticism has been voiced earlier, e.g. by Hirschauer (2004) ; Lamont (2009) ; Reinhart (2012) , or Hug (2022) , and still seems relevant today. We think the way forward is to use a more inclusive definition of peer review, which, as explained above, comprises ‘any procedure in science that is used to allocate scarce resources by invoking expert judgement on the epistemic qualities of an object’; for this allows for more comparability between individual studies and to work towards more explicit theoretical models that allow for more generalizable insights. Historically, these premises can be justified by recognizing that peer review has been a changing and diverse phenomenon, both diachronically and synchronically, and by recognizing that the legitimacy and success of peer review is predicated on its role at the nexus of science and society, i.e. science and politics.

While the deficit model informs much of the public discussions on peer review, e.g. in editorials, it also provides a frame for the research literature that is mainly focused on finding out whether everyday criticism of peer review has some validity. Public debates and research literature seem perfectly attuned: one proclaims a serious deficit at the heart of science (conservatism, bias, inefficiency, etc.), while the other sets out to prove or disprove the critics empirically. However, since this back and forth is not anchored in theoretical debates, the potential for generalizable understanding remains limited. Why and how peer review works beyond its deficits as a procedure for quality control and (self-)governance has been a peripheral topic at best ( Neidhardt 2016 ). To move beyond the predominant focus on the decisions and outcomes of peer review and beyond the deficit model with its evaluative orientation ( Hirschauer 2005 ; Sabaj Meruane, González Vergara and Pina-Stranger 2016 ), we fall back on very basic assumptions about the role of peer review.

In a very general sense, peer review does not just consist of outcomes, but rather these outcomes are produced by a process within a certain context. Abbott (2016) provides a perspective that binds these three elements (process, outcome, and context) together in a highly abstract theoretical fashion. We concretize the two underdeveloped elements for the case of peer review by drawing on the work of Stefan Hirschauer (for process) and Friedhelm Neidhardt (for context). An ethnographic perspective reveals that a series of interrelated practices make up a peer-review procedure, such as various forms of reading, editorial discussions, or joint revising of texts ( Lamont 2009 ; Mallard, Lamont and Guetzkow 2009 ; Hirschauer 2010 ; Pontille and Torny 2015 ; Horbach and Halffman 2019 ; Eve et al. 2021 ). A contextualizing perspective indicates functions peer review fulfills beyond decisional outcomes; it legitimizes these decisions to a diverse set of audiences (first among them scientists themselves and actors in science policy) and, as a result, also legitimizes itself as an institution to (self)govern science ( Neidhardt 2016 ; Guston 2000 ; Jasanoff 1985 ; Horbach and Halffman 2018 , Forsberg et al. 2022 : 1–36). To relate these processual aspects of peer review to their legitimate context, Niklas Luhmann’s concept of ‘legitimation by procedure’ (1983) is helpful as it allows decisions to be analysed not as self-evident because they represent the truth, but instead as acceptable because they are recognized by a community of stakeholders.

In a more vernacular language, these three elements (process, outcome, and context) can be summarized as three interrelated claims about the role of peer review, which can also be found either implicitly or explicitly in much of the empirical literature: peer review is a mechanism used to assess quality based on expert judgement; peer review is a decision mechanism used to decide on scarce resources, such as publication space, funding, or employment; peer review is an instrument for self-governance in science ( Reinhart 2012 : 189ff).

In order to understand peer review as a process, it is necessary to first consider the actual practices that make up a peer review procedure. Even though peer review comes in many forms and even though ethnographic descriptions of a variety of processes are rare, a limited number of frequently occurring practices can be discerned. We propose differentiating between at least eight such practices that occur as purposeful activities. As individual elements, they can be found in many peer-review procedures, and by combining them, they can be used to describe most procedures, ranging from very simple to very complex ones. 9

5.1 Postulating activities

The submission of a manuscript, a grant proposal, or a job application is a request for approval of the related claims. These claims can be on publishability, on funding, or on hiring. We call these the postulating activities and they create the imminent cause for setting in motion a procedure that evaluates and decides on such postulates.

5.2 Consultative activities

The reviewing by experts is often seen as the core element of peer-review procedures. They can be performed remotely, e.g. when external reviewers write their review, or on site, e.g. when designated reviewers present their assessment orally in face-to-face meetings. We call these consultative activities as they represent the evaluations from expert advisors. These evaluations (and the experts) are often directly linked to debating or decision-making activities (see below); however, we treat them separately because they are often separate also in practice.

5.3 Decision-making activities

The primary outcomes of peer-review procedures are decisions to accept or reject postulates. These decisions are based on decision-making activities that are informed, e.g. by grades, rankings, reports, presentations, or discussions and that are mostly separated from consultative activities (e.g. when a panel discusses the scientific merit of postulates individually and then moves on to rate or rank them comparatively).

5.4 Administrative activities

Administrative activities are usually provided by organizations that use peer review, such as journals or funding organizations, and are carried out by their representatives such as editors, editorial managers, or staff of funding agencies. They include subsidiary tasks such as receiving and distributing postulates, setting dates and agendas, general communication between all the parties involved but can also include more substantial tasks such as searching and selecting reviewers. To define administrative activities as a distinct practice accounts for the organizational framework in which most peer-review procedures are embedded (journal, funding agency, universities, etc.).

5.5 Debating activities

We define debating activities as the processes in which the reviews, notes, and evaluations that contribute to the assessments are exchanged, commented, and discussed. The debating practices take place, for instance, in editorial boards, reviewing panels, or appointment commissions and can contain written reviews, memos, speaking notes, numerical votes, or oral contributions.

5.6 Presenting activities

We refer to processes as presenting activities in which the postulating authors or applicants for grants or jobs introduce themselves and present their proposal and answer questions. In these activities, the postulators are involved directly in the evaluation process. This happens mostly in more complex and multi-stage peer review, such as job applications, personalized grants and collaborative project funding, for instance, in the case of on-site visits and inspections.

5.7 Observing activities

We classify these activities as the processes in which the assessment is monitored in order to control procedural compliance with regard to the respective tasks, rights, and duties of each role, its course, and the overall objective. These activities often require the results to be documented or reported to the decision-making authorities.

5.8 Moderating activities

The regulated procedure as such requires moderating activities that accompany and, if needed, explicate and (re)explain the processes. The more complex the procedures are, the more the interplay between different activities needs to be explicitly concerted and aligned throughout, for example, by introducing and guiding participants in the procedure. This can also mean chairing the meeting during discussions.

The different activities correspond to specific tasks and responsibilities, some executed by different, some handled by the same persons but in separate phases of the procedure. To be specific, the postulating authors or applicants themselves are never involved in consultative or decision-making activities in relation to their own proposals, but are potentially involved in the evaluation of other postulates. Depending on the procedure, consultative and decision-making activities can be carried out one after the other by the same person, or they can be strictly separated. In the latter case, it is often the report created during the observing activities that provides the basis for the decision on the results of the consultation and discussion.

The great variance in peer-review procedures in terms of effort and complexity is also due to the fact that all of the activities mentioned above can be carried out by multiple people, but hardly any of them necessarily require more than one person. Postulates can be submitted and presented collectively or individually according to preference, disciplinary convention, or funding. The administrative, moderating, and observing activities are presumably assigned according to the number of postulates, the narrow or broad thematic scope, the length and complexity of the procedure, and the available resources. In the course of consultation, multiple reports are usually required in order to obtain a variety of perspectives, but this requirement is not always met. Therefore, only the debating activities, in which different opinions are debated and weighed against each other, are necessarily collective. In the case of journal editors, who sometimes still decide alone on the acceptance and rejection of manuscripts, their activities remain collective to the extent that their decisions are founded on expert reviews.

Building on this, we can now discern different types of peer-review procedures, by asking which activities need to be present at the least for a procedure to be called peer review and how complex procedures can get, when combining many of these activities.

At a minimum, a peer-review procedure requires a postulating activity, a consultative activity, and a decision-making activity in which the postulate is accepted or rejected. This may be seen as an edge case, however, because the frequent practice of sending a manuscript to colleagues, who then make comments, whereupon the author decides on how to proceed with the manuscript, contains all three activities in a minimal form. The question, thus, arises as to whether a basic understanding of peer review must include an administrative activity, in which postulates are received and their processing is initiated and coordinated. As mentioned above, as an instrument for self-regulation in science, peer review is always embedded in an organizational framework, in which administrative activities take place (see Neidhardt 2016 : 271; Reinhart 2012 : 150–155). In light of this, we define a minimal peer-review procedure as containing four activities: postulating, administrative, consultative, and decision-making.

The spectrum’s other pole is marked by a maximum procedure, which can be found in the application for long-term funding or large-scale research collaborations. Here, more elaborate peer-review procedures are used, which, in addition to the four basic elements also contain debating, presenting, observing, and moderating activities. The maximum peer-review procedure is thus composed of all eight elements (see Table 1 ).

Combination of activities in peer-review procedures from minimum to maximum.

The variety of peer-review procedures can be seen as the result of the many possible combinations and variations of these eight elements. This, however, raises the question as to why so many combinations, and thus variants, of peer review are needed. A naive understanding of scientific self-governance would assert that peer review is all about expert judgement and, thus, the only relevant aspect is finding the best peers who will ‘know quality when they see it’. From such a view, the many variations of peer-review procedures seem unnecessary. Moving beyond the deficit model and recognizing the procedural differences, however, prompts us to ask about the context in which peer review is used and which functions it fulfills, either with individual elements or combination of elements. Stefan Hornbostel (2016) suggests that evaluation procedures in science can fulfill six different functions: the knowledge function , in which the evaluation provides information on the nature, effect and efficiency for the participants; the control function , which ensures compliance with target values and auditing procedures; the dialogue function , which serves to stimulate self-understanding and communication processes; the legitimation function for decisions and accountability; the evidence function , in which meta-analyses are carried out in order to make evidence-based decisions; and the public function , which is constitutive for ratings and rankings ( Hornbostel 2016 : 245).

We assume that all peer-review procedures serve multiple or even most of these functions in one way or another. Furthermore, individual elements of procedures may serve more than one function over different procedures or even within the same procedure. We see these six functions as a heuristic to move away from common sense understandings of peer review and to emphasize the move beyond the deficit model where quality and legitimacy are the result of process, outcome, and context. As such, we suggest some frequent combinations of elements and functions to move towards the more general question as to how they produce quality and legitimacy.

With respect to quality, the knowledge function is often served by a combination of postulate, consultative reviewing, and discussions in presenting and debating activities. This can go hand in hand with the dialogue function when the postulate is accompanied by presenting activities and a Q&A session, continued and deepened in debating activities (e.g. in panel or board sessions), and resulting in feedback to those who submitted a postulate. Knowledge about the scientific quality of postulates must be explicated in peer-review procedures, providing the basis for a dialogue about quality. The close relation between knowledge and dialogue has prompted Hirschauer to address peer review primarily as a communicative process.

With respect to legitimacy, the control and legitimation functions are decisive. Control is exercised by means of publicly accessible information on opportunities for publication, funding, and jobs, including the respective rules such as who is eligible to postulate or what the relevant quality criteria will be. As this is public information, it serves as the basis for accountability towards the relevant scientific communities as well as towards further stakeholders, e.g. in politics. In addition, elements of administration, moderation, and observation provide control and legitimation as internal and organized parts of peer-review procedures. Control, legitimation, and public functions of peer review connect internal and external aspects of how procedures produce legitimacy. This close relation has prompted Reinhart to address peer review primarily as an organized or organizational process ( Reinhart 2012 : 123ff).

The various types of peer-review procedures ranging from more minimalist to rather maximalist procedural forms thus reflect different functional demands from different stakeholders, such as the readers, the scientific community, the citizens as taxpayers, academic colleagues, university staff, scholars, and students. Hence, the complexity of peer-review procedures and their elaborate design are also determined by the variegated pressures for legitimacy. This can be further predicated on the sustainability of staffing or funding, the amount of financial resources allocated, or the reputation of the funder, journal, or position.

The manifold practices and functions that make up the diverse sets of peer-review procedures demonstrate that determining the quality of scientific work is only part of the role played by peer review. Equally important is that these procedures also provide legitimacy for these judgements on quality. That is, in essence, what procedures do in general ( Luhmann 1983 ). Separating the quality and the legitimacy aspects is impossible in practice because of the processual nature of peer review. However, our typology of practices makes it possible to address how different peer-review procedures combine these elements and thus produce combinations of quality and legitimacy that are context specific.

With regard to ensuring quality, those procedures that ascribe great importance to consultative reviewing (e.g. journals) derive their quality assurance and legitimacy to a large extent from the competent written expert opinions and their subsequent discussion. Those procedures that provide considerable time and space for presenting and debating activities (e.g. panel assessments) complement the legitimacy based on written expert judgement and also draw legitimation from discursive and deliberative elements. If observing activities are also highly developed, standards such as compliance with procedural requirements to ensure equal treatment and avoid bias are also invoked as legitimation-relevant features. In this respect, it is also instructive to see who guarantees that a procedure unfolds as fairly and impartially as possible. This task is often performed by representatives of the organizations. If observing activities overlap heavily with administrative activities, legitimacy through procedure is presumably very pronounced and generally weighty. If observing activities overlap strongly with consultative and debating or even decision-making activities, it is questionable whether the separation of roles can be maintained without assigning them to separate people. Otherwise, the allegation might be raised that these activities are not effective and, thus, are ‘just for show’.

Concerning legitimation through procedure, we can assert that the more complex and multi-levelled the procedures are, the more pronounced the separation of functions and personnel and the division of labor are, the more legitimacy is based on the procedure itself. As a result, different procedural types of peer review imply different techniques to provide quality assurance and legitimacy because the way in which the different activities are combined affects the way legitimacy is generated through procedure. This is not to say, however, that procedures produce legitimacy irrespective of who participates in them. The power of peer-review procedures to decide on scarce, and thus contested, resources seems to be predicated on scientists playing roles that are seen as key to the procedure. If only other scientists are involved, the scientific community is the central stakeholder, whereas the inclusion of representatives of the funding organizations or other stakeholders are signs that, e.g. science policy or the public are also addressed and affected to some degree.

Our claim at the beginning of this paper was that the deficit model is tied to a mostly implicit theory of peer review that mainly focusses on the results, that is to say the decisions, of procedures. Research questions about peer review thus centre around issues such as reliability, validity, and fairness. What is neglected by such accounts are two commonsensical aspects of peer review that make decisions both possible and relevant: process and context. By exploring these two aspects, we have shown, first, that the processes through which decisions are reached are highly diverse and practically complex. As such, they incorporate a multitude of practices and criteria that are difficult to capture solely from outcomes. We have illustrated, second, that the contexts of peer-review procedures extend beyond scientific communities of shared quality standards and that these extended contexts co-determine the outcomes. By giving equal weight to the process, decision, and context aspects, we conclude that the role of peer review lies in inextricably linking the quality and legitimacy of judgements about scientific work. In other words, peer review is as much about science as it is about politics. Theorizing peer review should therefore start from the notion that the primary role of peer review is to link self-governance and external governance of scientific work.

Starting from this notion, theoretical claims about peer review can be taken in different directions. Some possibilities were mentioned above; e.g. peer review as (boundary) organization or peer review as a communication process. Merton famously linked ‘science and the social order’ through the democratically inspired scientific ethos, which had organized scepticism, i.e. peer review as one of the four norms ( Merton 1938 , 1968 ). Following up on that Mertonian intuition our account here could be used to balance the normative with the processual aspects of peer review. Drawing additional inspiration from Foucauldian perspectives, we can ask: Who governs through peer review and who is governed by it? With reference to the distinct activities and our typology of minimum and maximum procedures, we can discern three spheres in which governance in and of science through peer review calls for legitimation: scientific community, science politics, and society, which respectively encompass scientists, including researchers in humanities and social sciences, politicians, and citizens in general as the populations being governed. Hence, these spheres overlap, for example, in ‘boundary organizations’ ( Guston 2000 ) such as national research agencies or coincide with societal concerns.

In the scientific community , self-governance through peer review is legitimized by safeguarding the professional competence of the assessments, guaranteeing an intersubjective coordination of the judgments between several experts from within scientific communities, and providing a functional separation of roles and division of labor ( Reinhart 2012 : 125, 176, 183). This sphere deals with the creation of legitimation by procedure with regard to quality assessment in the scientific community. Its main concern is the sphere of science policy, representing an already external governing authority given that it assures the legitimacy of the decision. In essence, it consists of making an adequate selection of articles worthy of publication, research projects eligible for funding, or job applicants competent to occupy the position because in this way, the scientific system shows it is capable of making gradual decisions within the disciplinary communities.

The distinction between legitimation addressing the scientific community and legitimation addressing concerns of science policy lies at a procedural level. In both directions, the objective is ‘to do justice to the matter’, i.e. to carry out an evaluation appropriate to the object in question, and this requires the criteria that have been put in place to be explained. For only then can the decision be justified and made plausible by means of outlined criteria—which can include science policy arguments and reasons—both to the scientific community and to actors in science policy.

The governance of the societal sphere involves the justification of peer review as an adequate mechanism of self-regulation in science, in some way supervised externally and governed by science policy actors. This means that peer review also justifies itself and the form of governance it provides to other societal spheres, especially since the logic of other spheres is already making its way into peer-review procedures in the form of publishers pursuing economic interests and public funds or foundations with latent political interests. Thus, the legitimacy of procedures rests on orders of justification ( Boltanski and Thévenot 2006 ) and is always a political issue.

The three spheres of governance for and in which legitimation is generated are linked and refer to each other. For example, trust in peer review as a functioning decision-making mechanism itself can only be maintained if procedural legitimation can be used as a justification in cases of doubt, retraction, or possible misconduct. Inversely, comparing different interpretations and assessments of various dimensions of the evaluation requires weighting and a reduction in complexity, which can only be achieved taking into account specific decisions. Trust in peer review as a functioning mechanism for externally supervised self-regulation in science is therefore based on this reliable decision-making ability. By the same token, the quality of peer review also refers to the extent to which these communication channels between the three spheres of legitimation exist and can be made transparent and plausible if necessary.

Furthermore, the way in which the spheres of governance are linked with each other reveals the sources from which the legitimacy of peer review is derived. The triad of legitimation in peer review refers, first, to legitimacy immanent in science, which is ensured by means of the expert quality assessment of scientific contributions by competent peers. Second, it refers to the jurisprudence in which legitimacy is guaranteed by the neutrality of the judgement. ‘Although peer review is not a legal concept, it is invoked by scientists and academics as the axiom that informs most of their practices. It functions as an article in the tacit “Constitution” of the social system of science (not unlike the way democracy functions in the discourses of modern liberal economies)’ ( Biagioli 2002 : 13, see also end note 2). Third, selection and qualification as a competent peer draws on the political legitimacy of power, which is derived from the forms of representation of the population concerned, legitimized in procedural terms (by election, status, function, education, etc.). This once more reveals the relation to other spheres of society, especially to politics, in whose orders of logic and justification (e.g. academic reputation) the legitimacy of peer review is embedded.

The fact that peer review is as much about science as it is about politics has consequences, which reveal themselves in the way this form of governance is legitimized. It is now evident that the question of legitimizing a form of governance points beyond the realm of science and refers back to political and civic notions of legitimacy. From this perspective, the principles of democratic legitimacy identified by Pierre Rosanvallon (2018) are instructive. Accordingly, democratic legitimacy is based on impartiality, reflexivity, and even proximity to coexistent particularities ( Rosanvallon 2018 : 18). 10 These distinguishable types of legitimacy are linked to three forms of social generality ( Rosanvallon 2011 : 7): legitimacy of impartiality to a ‘negative generality […] by way of detachment from particularity’ ( Rosanvallon 2011 : p. 6); legitimacy of reflexivity to a ‘generality of multiplication […] through multiplication of the expressions of social sovereignty’ ( Rosanvallon 2011 ) and legitimacy of proximity to a ‘generality of attention to particularity […] through consideration of the variety of situations […] marked by concern for concrete individuals’ ( Rosanvallon 2011 ). We can now pinpoint these criteria with regard to the shared concerns of the scientific community, science policy, and civic society as follows: Impartiality comprises a distancing of particular interests with respect to party positions or divergent schools of thought. Transferred to peer-review procedures that comprises the employment of impersonal criteria and the commitment to restrict biases. Reflexivity is a necessary part of any culture of deliberation. It implies the consideration of different forms of knowledge and potential innovation according to multiple forms of expression of the common good. It hence consists in allowing for inquiries and corrections. Translated to peer review, it comprises evaluation, amendments as well as being open to revisions. Proximity entails to immerge into the peculiarity of various cases and multiple existing situations ( Rosanvallon 2011 : 5–8). Since societies conceive themselves as pluralistic, constituted by heterogeneous fractions, more than a simple majority principle is needed in order to achieve legitimacy that can cope with democratic claims, no matter the sphere of governance or governed collective from which they originate ( Rosanvallon 2018 ). With regard to peer review it entails the recognition of different epistemological paradigms with respect to the equivalence of all particular interest groups or research approaches.

This process-oriented approach identifies the nexus of quality and legitimacy as the central theoretical concern in the research on peer review. It has the advantage of being applicable to multiple forms of peer review (journal, grant, recruitment). Within the broad spectrum between minimum and maximum procedures, the different types and variants of peer-review processes can be understood as different modes of governance with regard to their function as an instrument for the (self) governance of science.

We speak of modes of governance because it is a matter of exercising power and agreeing on maxims to build and establish legitimate forms of control, i.e. ‘governmentality’ ( Foucault 2005 ). In the case of peer review, power is exercised in the form of the decision on how scarce resources can be distributed as fairly and effectively as possible regarding scientific goals (furthering knowledge, innovation, and other social benefits) and in view of the diversity of possible paths leading to these goals. Consequently, we comprehend peer review as a mechanism of government because its decisions divide the population of the scientific community into those that govern and those that are governed, thus creating power relations.

From a governmental perspective, these issues of justice are usually discussed in relation to freedom and equality. In this respect, it is worth taking a look at the population of the scientific system in order to conceptualize the relationship of those who govern to those who are governed. First of all, this relationship is characterized by the way it operationalizes the idea of representation. When comparing the scientific community and civic society in this respect, some commonalities and differences are noteworthy: in the scientific community and in civic society those who govern in some way represent those who are governed on principles of impartiality, reflexivity, and proximity. The first notable difference is that the separation between those who govern and those who are governed is less pronounced in the scientific community. Scientists frequently switch between the roles of authors, reviewers, or editors. They are not fixed into either being governed or governing. They acquire first-hand experience in how the execution of power works, both from the view of those that govern and those that are governed. In contrast, citizens in civic society are less often actively involved in governing. They mostly see themselves as being governed by professional politicians. And their relations to these politicians are justified as institutionalized forms of representation. First-hand experience in how the execution of power works is relatively rare and is often limited to the act of voting. The division of labor and separation of roles is institutionalized in representative democracy and made permanent by the professionalization of politics.

Moreover, according to Rosanvallon, three principles structure this relationship: legibility, responsibility 11 and responsiveness. 12 Legibility refers to the reception of information, with interpretative capacities being deployed leading to a comprehensive understanding of and acquaintance with the procedures and mechanisms of governing. These parameters are decisive for understanding how power relations are designed and how power is diffused and executed ( Rosanvallon 2018 : 157–161). In the scientific community legibility comes from actively participating in peer review on both sides of the reviewing process. A democratically literate scientific community means a community that actively comprehends the social world and the mechanisms governing it ( Rosanvallon 2018 : pp. 167–168). Hence, we consider this the prime principle for analysing governmentality in science as it allows for accountability and encompasses responsibility. In this sense, legibility characterizes the way in which the two central requirements of quality and legitimacy of judgement are met and specifically how they are mediated via expertise and representation or participation. As processual know-how, legibility is crucial for enabling competent participation. It can convey empowerment and diminishes the distance to power, its mechanisms, and its art of execution. Hence, legibility can be seen as a key element that allows for contribution to, involvement in, and appropriation of governing principles and thus responsive governance in science. For Rosanvallon, the three forms of social generality, democratic legitimacy, and the structuring principles of legibility, responsibility, and responsiveness underlie his ambition to understand democracy as an inseparable unity of ‘a mode of government and a form of society’ ( Rosanvallon 2018 : p. 205), whereby he draws on Durkheim. Transferring his insight to academia these terms and distinction might lead a way to connect the scientific community to its own modes of government.

The scientific community consists primarily of professional scientists and science managers. With regard to forms of participation, it is noteworthy that in both the scientific community and civic society membership is conditional: be it in terms of a minimum qualification to participate competently in the expert evaluation procedures or in terms of citizenship and elective franchise. While democratic government obtains its legitimacy through free, equal, and secret elections of representatives, which are mostly professional politicians, and jurisprudence relies on compliance with the law, court procedures, and the impartiality of judges, the scientific community insists on self-government in the form of self-regulation through peer-review procedures, i.e. organized skepticism.

Bearing in mind these organizing principles we can now imagine benchmarks that have to be taken into account when designing peer-review procedures with a view to their legitimation as a mechanism of self-government. A legitimate execution of governance in decisions about scarce resources should align its procedures to ensure that it is (a) fair in the sense of impartiality, reflexivity, and acceptance of a plurality of paradigms, (b) reliably practical in the sense of functional efficiency as well as reactive and responsive in the way reviewer selection, composition of reviewing panels and evaluating commissions strive to enable ‘representative moments’ and strive for substantial interaction of both sides, and (c) responsible in the sense of accountability because the procedures are legible. In this way, peer review may assert itself as a mediator for moderating external and self-governance, thus managing the deep-rooted entanglement of science and politics in a democratically oriented societal environment.

We do not only claim that there are procedural similarities between peer review in science and democratic governance in society, but that these two are also intimately linked. While much of the literature conceptualizes peer review primarily with respect to its proximal outcomes (e.g. funding decisions), we gave equal weight to the practical process that leads to these decisions and to the scientific and political context in which peer review is practiced. From disaggregating peer-review processes into a combination of at least eight different activities, we were able to argue that a more encompassing definition of peer review is possible and desirable. The benefit of a broader definition of peer review lies not only in allowing for more comparative empirical studies, e.g. comparing journal and funding peer review, but also in rethinking how peer review works as an instrument of government. Our primary claim is, thus, that theoretical conceptions of peer review need to contend with two issues: First, peer review is not just a mechanism to decide on scarce resources in science, but also a procedure to assess quality based on expert judgement and an instrument for self-governance. Second, beyond self-governance, peer review is situated at the interface between science and policy and, as a consequence, provides not just decisions on the quality of scientific work but also provides the legitimacy for these decisions to be accepted within scientific communities and the wider public. We see these two issues as reflected in the aggregate of specific or common-sensical understandings in the empirical literature of what the role of peer review is. By aggregating these views, we hope to have provided the preliminaries to rethink and expand current theoretical discussions about peer review.

We acknowledge the support by the German Ministry for Education and Research (BMBF), grant no. 16PH20012, by the Robert K. Merton Center for Science Studies (RMZ) and the German Centre for Higher Education Research and Science Studies Berlin (DZHW).

None declared.

None of these lists are meant to be exhaustive.

Recent exceptions are Forsberg et al. (2022) defining peer review as ‘a context-dependent, relational concept that is increasingly used to denote a vast number of evaluative activities engaged in by a wide variety of actors both inside and outside of academia’ ( Forsberg et al. 2022 : 4) and Eve et al. (2021) who define the role of peer review as ‘to institute a set of institutional practices that allow for the selection of quality by a group of empowered, qualified experts’ ( Eve et al. 2021 : 5). Horbach and Halffman (2018) limit their understanding of peer review to scientific publishing but not without mentioning that ‘so many forms of peer review exist that some claim we can no longer call it a single system’ ( Horbach and Halffman (2018) : 2). Also see Pontille and Torny (2015) .

A recent series of three interrelated papers from the Research on Research Institute on innovations in peer review ( Woods et al. 2023 , Kaltenbrunner et al. 2022 ; Waltman et al. 2023 ) claim to use an ‘inclusive and broad interpretation’ ( Woods et al. 2023 : 2) of peer review but see little to no reason to justify limiting their ‘meta-summary’ and ‘analytical overview’ to journal peer review. Working with such a limited conceptualization even though addressing generalizable issues is taken for granted just as limiting the analysis to the ‘weaknesses of the peer review system’ is ( Waltman et al. 2023 : 2).

The historical study of peer review at the Royal Society Journals by Fyfe et al. (2020) conceptualizes peer review practices by ‘embedding journals within communities’ ( Fyfe et al. (2020) : 423) to generalize about how reviewing, journals and communities interrelate. These types of studies would benefit, in our view, from extending the definition of peer review because reviewing and communities are not just connected through journals, but also through funding and hiring.

For a dissenting view on determining the historical origins of peer review in line with the convention of the scientific revolution in the 17th century, see Rip (1985) or Laine and Mulrow (2003) .

This echoes the symmetry principle in Bloor (1991) .

Eve et al . ( 2021 : 8) note that ‘much, although by no means all, of this research has been critical of peer-review processes’, but a quick count of the number of studies they mention in this context shows 4 with ‘positive opinions on the process’ and 35 as ‘critics of peer review’. While 90% of all empirical studies being rooted in the deficit model may be a high estimate, we see this as confirmation that a large majority is.

The sparse literature that works with a substantive theoretical approach will be reviewed in the next chapter.

These activities have been identified through empirical analyses of peer reviewing procedures in public research funding. They have been elaborated based on in-depth mixed-method analyses of different funding schemes, namely of the DFG in Germany and the SNSF in Switzerland, including single project funding, funding for collaborative research consortia, and career funding. For more detailed explanations, see ( Schendzielorz and Reinhart 2020 ; Reinhart and Schendzielorz 2021 ).

These three types of legitimacy displace the formerly dominant types of ‘legitimacy as social recognition’ and ‘legitimacy as conformity to a norm’ (see Rosanvallon 2011 : 7). The current three types are never indelibly achieved. Since they are ‘always open to challenge, and dependent on social perceptions of institutional actions and behavior’ ( Rosanvallon 2011 .) they operate as orienting principles that guideline our conception of democratic legitimacy.

To be responsible and to be made responsible as those who exercise power is to be subject to certain procedures of control that limit power. It is related to the possession of power and the possible consequence of those power control mechanisms to step back from it. Responsibility includes both accountability and an examination of capability a ‘test of ability’ ( Rosanvallon 2018 : 173), and is constitutive of public trust in those who govern. ( Rosanvallon 2018 : pp. 172–173). The former refers to the transparent documentation and presentation, justification, and assessment of executive policy actions ( Rosanvallon 2018 : p. 183–186). The latter can be termed as ‘commitment’ ( Rosanvallon 2018 : p.186) and is directed toward the future and refers to the dimension of responsibility that is demonstrated by the extent to which those in power are able to make policy and thus demonstrate their will and ability to change existing states of affairs ( Rosanvallon 2018 : pp. 286–289).

In the case of responsiveness, Rosanvallon is concerned with the revival of social forms of expression in order to enable a ‘true democracy of expression and interaction’ ( Rosanvallon 2018 : 190). He diagnoses a decline in earlier forms of civic expression, such as intensive petitioning, which opened up a form of action for those excluded from the right to vote at the time, the labor unionized form of representation, and collective identities. Currently, the forms of expression that elicit responses from those in power have been reduced to the right to demonstrate, a narrow use of opinion polls as barometers of sentiment, and to atomized variants of expression on social networks. ( Rosanvallon 2018 : 196–202, 258–267) In order to increase responsiveness, he accordingly suggests the development of ‘altered forms of interaction between the governing and the governed’, for example, through the organization of representative moments in ‘ad hoc meetings’ ( Rosanvallon 2018 : p.203) and the establishment of a civil service or a ‘commission for democratic debates’ ( Rosanvallon 2018 : p. 205).

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Weingart   P. ( 2001 ) Die Stunde der Wahrheit?: Zum Verhältnis der Wissenschaft zu Politik, Wirtschaft und Medien in der Wissensgesellschaft . Weilerswist : Velbrück Wissenschaft .

Woods   H. B.  et al.  ( 2023 ) ‘ An Overview of Innovations in the External Peer Review of Journal Manuscripts ’, Wellcome Open Res , 7 : 82.

Zuckerman   H. and Merton   R. K. ( 1971 ) ‘ Patterns of Evaluation in Science: Institutionalisation, Structure and Functions of the Referee System ’, Minerva , 9 : 66 – 100 .

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10 Strategies to Make Peer Review Meaningful for Students

EdTech , Teaching | 0 comments

“A peer review can be a very mysterious process, and certainly a scary one, which is why we need to talk more about how it’s done.”- Wyn Kelley, Lecturer, Literature, MIT

One of the most powerful means of encouraging student engagement and learning is through peer review, or guiding students to both critique and encourage each other as they develop speeches, presentations, and paper drafts. Peer review activities enable students to seek guidance from others, and to gain an objective idea of the quality of their thinking and their ability to organize and present their own thoughts. Peer review, effectively, is what enables students to become better thinkers and communicators.

For some students, it can be difficult to provide concrete, actionable, and descriptive feedback to their peers. As Thomas Levenson, Professor in Writing and Humanistic Studies, MIT notes, many students are uncomfortable critiquing peers. To make sure students know that peer assessment should be constructive, he tells students that “they only get to say, ‘I liked it’ once per class.” It’s important that instructors give students a set of prompts that guide students, and enable them to see how they can be most productive and explicit in giving feedback. Grant Wiggins of Authentic Education , suggests that helpful feedback follows the following 7 criteria. It is 1) goal-referenced; 2) transparent; 3) actionable; 4) user-friendly; 5) timely; 6) ongoing; and 7) consistent. Peer feedback should, above all, provide students with a sense of closure as to where to go next.

Video: “No One Writes Alone” from MIT Video

At Acclaim, instructors from Communication and Public Speaking, as well as Entrepreneurship, Science and Digital Storytelling courses, have shared some of the prompts they send to students as they ask them to give peer evaluations of presentations. The following are 10 prompts for peer review, compiled from assignments across the disciplines; with 5 prompts on content and presentation skills, and 5 on technology:


1. What is the speaker’s main point?

2. How is the speech structured? Does the speaker have a distinct introduction and conclusion? Where does he signpost his argument?

3. How does the speaker use evidence and analysis? Do examples elaborate on facts? Can you tell the difference between broad ideas and details?

4. Is the amount of time the speaker spends on each point proportional to its importance to his argument?

5. How does the speaker engage the audience? Some things to comment on: voice level, tone, level of interest/excitement in subject, eye contact, responses/attitudes towards questions, approachability. How did his movement and gestures coordinate with content?


1. How well did the speaker coordinate his timing with the visuals?

2. Were the visuals relevant to the speech, and if so, how did they enhance it? Did the speaker adequately explain them?

3. Were the visuals clear, independently of the speaker? Voice any ideas about animations or graphics.

4. Did the speaker seem comfortable with the technology he/she used? How does the speaker respond to technological difficulties (if there were any?)

5. Are there any additional visuals that might have helped to enhance the speakers point?

While these prompts can be used in any context, real or online, they can be especially effective when both the presenters, as well as the reviewers, have the “the time to adequately reflect on the content presented and technology used before delivering feedback,” according to Robin Cooper , Professor of Biology and Neuroscience, University of Kentucky. Student feedback, when delivered in written form online, can take the pressure and discomfort off of class communication. Moreover, we’ve found that when students have the chance to review their own recorded presentations, the suggestions of their peers become increasingly actionable. For more great reading and suggestions on peer review and assessment, check out the following resources:

Annie Murphy Paul: “ From the Brilliant Report: How to Give Good Feedback .”

Cynthia C. Choi and Hsiang-ju Ho: “ Exploring New Literacies in Online Peer-Learning Environments ”

Gale Morris, “ Using Peer Review to Improve Student Writing .”

  • Performance Management

Peer Review Examples: Powerful Phrases You Can Use


The blog is tailored for HR professionals looking to set up and improve peer review feedback within their organization. Share the article with your employees as a guide to help them understand how to craft insightful peer review feedback.

Effective employee performance evaluation plays a pivotal role in both personal growth and the maintenance of a productive, harmonious work environment. When considering the comprehensive perspective of 360-degree evaluation, peer review feedback emerges as a crucial element. In this article, we’ll explore the importance of peer review feedback and equip you with powerful peer review examples to facilitate the process.

Peer review feedback is the practice of colleagues and co-workers assessing and providing meaningful feedback on each other’s performance. It is a valuable instrument that helps organizations foster professional development, teamwork, and continuous improvement.

Peoplebox lets you conduct effective peer reviews within minutes. You can customize feedback, use tailored surveys, and seamlessly integrate it with your collaboration tools. It’s a game-changer for boosting development and collaboration in your team.

See Peoplebox in Action

  • Why are Peer Reviews Important?

Here are some compelling reasons why peer review feedback is so vital:

Broader Perspective: Peer feedback offers a well-rounded view of an employee’s performance. Colleagues witness their day-to-day efforts and interactions, providing a more comprehensive evaluation compared to just a supervisor’s perspective.

Skill Enhancement: It serves as a catalyst for skill enhancement. Constructive feedback from peers highlights areas of improvement and offers opportunities for skill development.

Encourages Accountability: Peer review fosters a culture of accountability . Knowing that one’s work is subject to review by peers can motivate individuals to perform at their best consistently.

Team Cohesion: It strengthens team cohesion by promoting open communication. and constructive communication. Teams that actively engage in peer feedback often develop a stronger sense of unity and shared purpose.

Fair and Unbiased Assessment: By involving colleagues, peer review helps ensure a fair and unbiased assessment. It mitigates the potential for supervisor bias and personal favoritism in performance evaluations.

Identifying Blind Spots: Peers can identify blind spots that supervisors may overlook. This means addressing issues at an early stage, preventing them from escalating.

Motivation and Recognition: Positive peer feedback can motivate employees and offer well-deserved recognition for their efforts. Acknowledgment from colleagues can be equally, if not more, rewarding than praise from higher-ups.

Now, let us look at the best practices for giving peer feedback in order to leverage its benefits effectively.

Best practices to follow while giving peer feedback

  • 30 Positive Peer Feedback Examples

Now that we’ve established the importance of peer review feedback, the next step is understanding how to use powerful phrases to make the most of this evaluation process.  In this section, we’ll equip you with various examples of phrases to use during peer reviews, making the journey more confident and effective for you and your team .

Must Read: 60+ Self-Evaluation Examples That Can Make You Shine

Peer Review Example on Work Quality

When it comes to recognizing excellence, quality work is often the first on the list. Here are some peer review examples highlighting the work quality:

  • “Kudos to Sarah for consistently delivering high-quality reports that never fail to impress both clients and colleagues. Her meticulous attention to detail and creative problem-solving truly set the bar high.”
  • “John’s attention to detail and unwavering commitment to excellence make his work a gold standard for the entire team. His consistently high-quality contributions ensure our projects shine.”
  • “Alexandra’s dedication to maintaining the project’s quality standards sets a commendable benchmark for the entire department. Her willingness to go the extra mile is a testament to her work ethic and quality focus.”
  • “Patrick’s dedication to producing error-free code is a testament to his commitment to work quality. His precise coding and knack for bug spotting make his work truly outstanding.”

Peer Review Examples on Competency and Job-Related Skills

Competency and job-related skills set the stage for excellence. Here’s how you can write a peer review highlighting this particular skill set:

  • “Michael’s extensive knowledge and problem-solving skills have been instrumental in overcoming some of our most challenging technical hurdles. His ability to analyze complex issues and find creative solutions is remarkable. Great job, Michael!”
  • “Emily’s ability to quickly grasp complex concepts and apply them to her work is truly commendable. Her knack for simplifying the intricate is a gift that benefits our entire team.”
  • “Daniel’s expertise in data analysis has significantly improved the efficiency of our decision-making processes. His ability to turn data into actionable insights is an invaluable asset to the team.”
  • “Sophie’s proficiency in graphic design has consistently elevated the visual appeal of our projects. Her creative skills and artistic touch add a unique, compelling dimension to our work.”

Peer Review Sample on Leadership Skills

Leadership ability extends beyond a mere title; it’s a living embodiment of vision and guidance, as seen through these exceptional examples:

  • “Under Lisa’s leadership, our team’s morale and productivity have soared, a testament to her exceptional leadership skills and hard work. Her ability to inspire, guide, and unite the team in the right direction is truly outstanding.”
  • “James’s ability to inspire and lead by example makes him a role model for anyone aspiring to be a great leader. His approachability and strong sense of ethics create an ideal leadership model.”
  • “Rebecca’s effective delegation and strategic vision have been the driving force behind our project’s success. Her ability to set clear objectives, give valuable feedback, and empower team members is truly commendable.”
  • “Victoria’s leadership style fosters an environment of trust and innovation, enabling our team to flourish in a great way. Her encouragement of creativity and openness to diverse ideas is truly inspiring.”

Feedback on Teamwork and Collaboration Skills

Teamwork is where individual brilliance becomes collective success. Here are some peer review examples highlighting teamwork:

  • “Mark’s ability to foster a collaborative environment is infectious; his team-building skills unite us all. His open-mindedness and willingness to listen to new ideas create a harmonious workspace.”
  • “Charles’s commitment to teamwork has a ripple effect on the entire department, promoting cooperation and synergy. His ability to bring out the best in the rest of the team is truly remarkable.”
  • “David’s talent for bringing diverse perspectives together enhances the creativity and effectiveness of our group projects. His ability to unite us under a common goal fosters a sense of belonging.”

Peer Review Examples on Professionalism and Work Ethics

Professionalism and ethical conduct define a thriving work culture. Here’s how you can write a peer review highlighting work ethics:

  • “Rachel’s unwavering commitment to deadlines and ethical work practices is a model for us all. Her dedication to punctuality and ethics contributes to a culture of accountability.”
  • “Timothy consistently exhibits the highest level of professionalism, ensuring our clients receive impeccable service. His courtesy and reliability set a standard of excellence.”
  • “Daniel’s punctuality and commitment to deadlines set a standard of professionalism we should all aspire to. His sense of responsibility is an example to us all.”
  • “Olivia’s unwavering dedication to ethical business practices makes her a trustworthy and reliable colleague. Her ethical principles create an atmosphere of trust and respect within our team, leading to a more positive work environment.”

Feedback on Mentoring and Support

Mentoring and support pave the way for future success. Check out these peer review examples focusing on mentoring:

  • “Ben’s dedication to mentoring new team members is commendable; his guidance is invaluable to our junior colleagues. His approachability and patience create an environment where learning flourishes.”
  • “David’s mentorship has been pivotal in nurturing the talents of several team members beyond his direct report, fostering a culture of continuous improvement. His ability to transfer knowledge is truly outstanding.”
  • “Laura’s patient mentorship and continuous support for her colleagues have helped elevate our team’s performance. Her constructive feedback and guidance have made a remarkable difference.”
  • “William’s dedication to knowledge sharing and mentoring is a driving force behind our team’s constant learning and growth. His commitment to others’ development is inspiring.”

Peer Review Examples on Communication Skills

Effective communication is the linchpin of harmonious collaboration. Here are some peer review examples to highlight your peer’s communication skills:

  • “Grace’s exceptional communication skills ensure clarity and cohesion in our team’s objectives. Her ability to articulate complex ideas in a straightforward manner is invaluable.”
  • “Oliver’s ability to convey complex ideas with simplicity greatly enhances our project’s success. His effective communication style fosters a productive exchange of ideas.”
  • “Aiden’s proficiency in cross-team communication ensures that our projects move forward efficiently. His ability to bridge gaps in understanding is truly commendable.”

Peer Review Examples on Time Management and Productivity

Time management and productivity are the engines that drive accomplishments. Here are some peer review examples highlighting time management:

  • “Ella’s time management is nothing short of exemplary; it sets a benchmark for us all. Her efficient task organization keeps our projects on track.”
  • “Robert’s ability to meet deadlines and manage time efficiently significantly contributes to our team’s overall productivity. His time management skills are truly remarkable.”
  • “Sophie’s time management skills are a cornerstone of her impressive productivity, inspiring us all to be more efficient. Her ability to juggle multiple tasks is impressive.”
  • “Liam’s time management skills are key to his consistently high productivity levels. His ability to organize work efficiently is an example for all of us to follow.”

Though these positive feedback examples are valuable, it’s important to recognize that there will be instances when your team needs to convey constructive or negative feedback. In the upcoming section, we’ll present 40 examples of constructive peer review feedback. Keep reading!

  • 40 Constructive Peer Review Feedback

Receiving peer review feedback, whether positive or negative, presents a valuable chance for personal and professional development. Let’s explore some examples your team can employ to provide constructive feedback , even in situations where criticism is necessary, with a focus on maintaining a supportive and growth-oriented atmosphere.

Constructive Peer Review Feedback on Work Quality

  • “I appreciate John’s meticulous attention to detail, which enhances our projects. However, I noticed a few minor typos in his recent report. To maintain an impeccable standard, I’d suggest dedicating more effort to proofreading.”
  • “Sarah’s research is comprehensive, and her insights are invaluable. Nevertheless, for the sake of clarity and brevity, I recommend distilling her conclusions to their most essential points.”
  • “Michael’s coding skills are robust, but for the sake of team collaboration, I’d suggest that he provides more detailed comments within the code to enhance readability and consistency.”
  • “Emma’s creative design concepts are inspiring, yet consistency in her chosen color schemes across projects could further bolster brand recognition.”
  • “David’s analytical skills are thorough and robust, but it might be beneficial to present data in a more reader-friendly format to enhance overall comprehension.”
  • “I’ve observed Megan’s solid technical skills, which are highly proficient. To further her growth, I recommend taking on more challenging projects to expand her expertise.”
  • “Robert’s industry knowledge is extensive and impressive. To become a more well-rounded professional, I’d suggest he focuses on honing his client relationship and communication skills.”
  • “Alice’s project management abilities are impressive, and she’s demonstrated an aptitude for handling complexity. I’d recommend she refines her risk assessment skills to excel further in mitigating potential issues.”
  • “Daniel’s presentation skills are excellent, and his reports are consistently informative. Nevertheless, there is room for improvement in terms of interpreting data and distilling it into actionable insights.”
  • “Laura’s sales techniques are effective, and she consistently meets her targets. I encourage her to invest time in honing her negotiation skills for even greater success in securing deals and partnerships.”

Peer Review Examples on Leadership Skills

  • “I’ve noticed James’s commendable decision-making skills. However, to foster a more inclusive and collaborative environment, I’d suggest he be more open to input from team members during the decision-making process.”
  • “Sophia’s delegation is efficient, and her team trusts her leadership. To further inspire the team, I’d suggest she share credit more generously and acknowledge the collective effort.”
  • “Nathan’s vision and strategic thinking are clear and commendable. Enhancing his conflict resolution skills is suggested to promote a harmonious work environment and maintain team focus.”
  • “Olivia’s accountability is much appreciated. I’d encourage her to strengthen her mentoring approach to develop the team’s potential even further and secure a strong professional legacy.”
  • “Ethan’s adaptability is an asset that brings agility to the team. Cultivating a more motivational leadership style is recommended to uplift team morale and foster a dynamic work environment.”

Peer Review Examples on Teamwork and Collaboration

  • “Ava’s collaboration is essential to the team’s success. She should consider engaging more actively in group discussions to contribute her valuable insights.”
  • “Liam’s teamwork is exemplary, but he could motivate peers further by sharing credit more openly and recognizing their contributions.”
  • “Chloe’s flexibility in teamwork is invaluable. To become an even more effective team player, she might invest in honing her active listening skills.”
  • “William’s contributions to group projects are consistently valuable. To maximize his impact, I suggest participating in inter-departmental collaborations and fostering cross-functional teamwork.”
  • “Zoe’s conflict resolution abilities create a harmonious work environment. Expanding her ability to mediate conflicts and find mutually beneficial solutions is advised to enhance team cohesion.”
  • “Noah’s punctuality is an asset to the team. To maintain professionalism consistently, he should adhere to deadlines with unwavering dedication, setting a model example for peers.”
  • “Grace’s integrity and ethical standards are admirable. To enhance professionalism further, I’d recommend that she maintain a higher level of discretion in discussing sensitive matters.”
  • “Logan’s work ethics are strong, and his commitment is evident. Striving for better communication with colleagues regarding project updates is suggested, ensuring everyone remains well-informed.”
  • “Sophie’s reliability is appreciated. Maintaining a high level of attention to confidentiality when handling sensitive information would enhance her professionalism.”
  • “Jackson’s organizational skills are top-notch. Upholding professionalism by maintaining a tidy and organized workspace is recommended.”

Peer Review Feedback Examples on Mentoring and Support

  • “Aiden provides invaluable mentoring to junior team members. He should consider investing even more time in offering guidance and support to help them navigate their professional journeys effectively.”
  • “Harper’s commendable support to peers is noteworthy. She should develop coaching skills to maximize their growth, ensuring their development matches their potential.”
  • “Samuel’s patience in teaching is a valuable asset. He should tailor support to individual learning styles to enhance their understanding and retention of key concepts.”
  • “Ella’s mentorship plays a pivotal role in the growth of colleagues. She should expand her role in offering guidance for long-term career development, helping them set and achieve their professional goals.”
  • “Benjamin’s exceptional helpfulness fosters a more supportive atmosphere where everyone can thrive. He should encourage team members to seek assistance when needed.”
  • “Mia’s communication skills are clear and effective. To cater to different audience types, she should use more varied communication channels to convey her message more comprehensively.”
  • “Lucas’s ability to articulate ideas is commendable, and his verbal communication is strong. He should polish non-verbal communication to ensure that his body language aligns with his spoken message.”
  • “Evelyn’s appreciated active listening skills create strong relationships with colleagues. She should foster stronger negotiation skills for client interactions, ensuring both parties are satisfied with the outcomes.”
  • “Jack’s presentation skills are excellent. He should elevate written communication to match the quality of verbal presentations, offering more comprehensive and well-structured documentation.”
  • “Avery’s clarity in explaining complex concepts is valued by colleagues. She should develop persuasive communication skills to enhance her ability to secure project proposals and buy-in from stakeholders.”

Feedback on Time Management and Productivity

  • “Isabella’s efficient time management skills contribute to the team’s success. She should explore time-tracking tools to further optimize her workflow and maximize her efficiency.”
  • “Henry’s remarkable productivity sets a high standard. He should maintain a balanced approach to tasks to prevent burnout and ensure sustainable long-term performance.”
  • “Luna’s impressive task prioritization and strategic time allocation should be fine-tuned with goal-setting techniques to ensure consistent productivity aligned with objectives.”
  • “Leo’s great deadline adherence is commendable. He should incorporate short breaks into the schedule to enhance productivity and focus, allowing for the consistent meeting of high standards.”
  • “Mila’s multitasking abilities are a valuable skill. She should strive to implement regular time-blocking sessions into the daily routine to further enhance time management capabilities.”
  • Do’s and Don’t of Peer Review Feedback

Peer review feedback can be extremely helpful for intellectual growth and professional development. Engaging in this process with thoughtfulness and precision can have a profound impact on both the reviewer and the individual seeking feedback.

However, there are certain do’s and don’ts that must be observed to ensure that the feedback is not only constructive but also conducive to a positive and productive learning environment.

Do’s and don’t for peer review feedback

The Do’s of Peer Review Feedback:

Empathize and Relate : Put yourself in the shoes of the person receiving the feedback. Recognize the effort and intention behind their work, and frame your comments with sensitivity.

Ground Feedback in Data : Base your feedback on concrete evidence and specific examples from the work being reviewed. This not only adds credibility to your comments but also helps the recipient understand precisely where improvements are needed.

Clear and Concise Writing : Express your thoughts in a clear and straightforward manner. Avoid jargon or ambiguous language that may lead to misinterpretation.

Offer Constructive Criticism : Focus on providing feedback that can guide improvement. Instead of simply pointing out flaws, suggest potential solutions or alternatives.

Highlight Strength s: Acknowledge and commend the strengths in the work. Recognizing what’s done well can motivate the individual to build on their existing skills.

The Don’ts of Peer Review Feedback:

Avoid Ambiguity : Vague or overly general comments such as “It’s not good” do not provide actionable guidance. Be specific in your observations.

Refrain from Personal Attacks : Avoid making the feedback personal or overly critical. Concentrate on the work and its improvement, not on the individual.

Steer Clear of Subjective Opinions : Base your feedback on objective criteria and avoid opinions that may not be universally applicable.

Resist Overloading with Suggestions : While offering suggestions for improvement is important, overwhelming the recipient with a laundry list of changes can be counterproductive.

Don’t Skip Follow-Up : Once you’ve provided feedback, don’t leave the process incomplete. Follow up and engage in a constructive dialogue to ensure that the feedback is understood and applied effectively.

Remember that the art of giving peer review feedback is a valuable skill, and when done right, it can foster professional growth, foster collaboration, and inspire continuous improvement. This is where performance management software like Peoplebox come into play.
  • Start Collecting Peer Review Feedback On Peoplebox 

In a world where the continuous improvement of your workforce is paramount, harnessing the potential of peer review feedback is a game-changer. Peoplebox offers a suite of powerful features that revolutionize performance management, simplifying the alignment of people with business goals and driving success. 

Through Peoplebox, you can effortlessly establish peer reviews, customizing key aspects such as:

  • Allowing the reviewee to select their peers
  • Seeking managerial approval for chosen peers to mitigate bias
  • Determining the number of peers eligible for review, and more.

Peoplebox lets you choose your peers to review

And the best part? Peoplebox lets you do all this from right within Slack.

Use Peoplebox to collect performance reviews on Slack

  • Peer Review Feedback Template That You Can Use Right Away

Still on the fence about using software for performance reviews? Here’s a quick ready-to-use peer review template you can use to kickstart the peer review process.

Free peer review template on Google form

Download the Free Peer Review Feedback Form here.

If you ever reconsider and are looking for a more streamlined approach to handle 360 feedback, give Peoplebox a shot!

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Goals and performance management have never been easier, quicker and impactful, thanks to Peoplebox seamless integration with your existing tools and workflows.

You may also like to read:

  • Mastering Performance Coaching: A Comprehensive Guide
  • Best People Analytics Software of 2024
  • The Only HR Metrics You Need in 2024: 45 Key Metrics [+ Formulas]
  • Performance Management Training for Success
  • Buying vs. Building Your People Analytics Platform: A Guide for HR Professionals

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  • Published: 12 February 2024

Teaching breaking bad news in a gyneco-oncological setting: a feasibility study implementing the SPIKES framework for undergraduate medical students

  • Cosima Zemlin 1 ,
  • Nasenien Nourkami-Tutdibi 2 ,
  • Pascal Schwarz 1 ,
  • Gudrun Wagenpfeil 3 &
  • Sybelle Goedicke-Fritz 2  

BMC Medical Education volume  24 , Article number:  134 ( 2024 ) Cite this article

187 Accesses

Metrics details

It is a crucial task for physicians to deliver life threatening information to patients (breaking bad news; BBN). Many aspects influence these conversations on both sides, patients, and doctors. BBN affects the patient-physician relationship, patients’ outcome, and physicians’ health. Many physicians are still untrained for this multi-facetted task and feel unprepared and overburdened when facing situations of BBN. Therefore, any faculties should aim to integrate communication skills into their medical curricula as early as possible. The SPIKES protocol is an effective framework to deliver BBN. Aim of this study is to evaluate the feasibility and obstacles of a BBN seminar and its acceptance and learning curve among undergraduate medical students.

158 2nd year undergraduate medical students attended a compulsory BBN seminar. The task was to deliver a cancer diagnosis to the patient within a patient - physician role-play in a gyneco-oncological setting before and after a presentation of the SPIKES protocol by the lecturer. The students evaluated important communication skills during these role-plays respectively. Self-assessment questionnaires were obtained at the beginning and end of the seminar.

Most students indicated that their confidence in BBN improved after the seminar ( p  < 0.001). They like the topic BBN to be part of lectures (76%) and electives (90%). Communication skills improved. Lecturer and seminar were positively evaluated (4.57/5).

The seminar significantly increased confidence and self-awareness in delivering life-threatening news to patients among undergraduate medical students. Important learning aspects of BBN and communication skills could be delivered successfully to the participants within a short time at low costs. The integration of communication skills should be implemented longitudinally into medical curricula starting before clinical education to increase the awareness of the importance of communication skills, to decrease anxiety, stress, and workload for future doctors and– most importantly– to the benefit of our patients.

Peer Review reports


Patient - physician conversation is an essential task for daily clinical practice [ 1 , 2 , 3 , 4 , 5 ]. Physicians not only act as communicators to transmit medical information to patients and their relatives, but also as specialists in the disease and as companions and therapists of the patients. Delivering life threatening diagnosis and/or findings negatively influencing a patient’s outcome is described as “breaking bad news” (BBN) in literature and are demanding situations for patients, their relatives, and all members of the medical team [ 1 , 2 , 6 ]. How information is conveyed to a patient affects the patient– physician relationship, the understanding, compliance and can impact the treatment course and response [ 7 ]. BBN remains the most challenging aspect within patient-physician relationship [ 6 ].

Age, sex, living conditions, medical history and current state of health, socio-cultural background, religious beliefs, philosophy of life, and level of education are important aspects to be considered in patient– physician relationship and communication on both sides [ 8 ]. In addition, doctors are also influenced by their beliefs about “what is best for the patient” and may feel powerless and helpless when therapies no longer work, and when they are confronted in revealing this information to their patients [ 9 , 10 ]. BBN is challenging as bad news should be delivered standardized yet individualized according to each patient´s needs at the same time [ 1 , 2 , 6 ]. To be able to respond to the various needs of the different patients, and to avoid being influenced by own personal perspectives it is of utmost importance to first listen to the patient’s needs and knowledge before the doctor delivers the message that threatens the patient’s existence [ 11 , 12 ]. Unprepared and untrained physicians and members of the treatment team often feel overburdened and overstressed when facing situations of BBN [ 9 ]. They acknowledge that insufficient training in communication and management skills is a major factor that leads to stress, lack of job satisfaction and emotional burnout [ 7 ]. In addition they are often unaware of the great impact that manner, mode and setting of these sensitive conversations may have on their patient’s perception, acceptance and compliance [ 9 ]. Thus, the way how the patient is informed affects both patients and physicians [ 7 , 13 ].

The latter is of extreme importance especially in oncologic settings as BBN is always a vulnerable and important moment for the patient and the treating physician. BBN in oncology can mean, to inform the patient about a cancer diagnosis, recurrence or progression of disease, treatment failure, the occurrence of severe side effects, medical malpractice, and other undesirable conditions [ 3 , 11 , 14 ].

In addition, BBN and how sensitive information is conveyed in a healthcare system impacts on working atmosphere and can either create extreme stress on the health care team members or ease working and daily patient care [ 1 , 4 , 15 , 16 ]. Delivering bad news is not restricted to oncology though [ 17 ]. Delivering bad news is an important competence in most medical subspecialties, such as obstetrics, cardiology, emergency room and many others specialties [ 5 ].

The inclusion of BBN competence as a mandatory component of treating critically ill patients in study protocols and guidelines was an important achievement [ 18 ]. The SPIKES protocol is a well-evaluated guideline and effective approach to deliver sensitive information to the patient [ 1 ]. The protocol describes six steps to be applied while breaking the bad news. The six steps comprise “Setting, Perception, Invitation, Knowledge, Emotions and Strategy and Summary” (SPIKES) [ 5 ]. The SPIKES protocol is of great international importance and is also used in Germany as a teaching protocol [ 5 ]. According to the SPIKES protocol, the goals of the informed consent dialogue are to gather information from the patient, provide medical information, offer support to the patient, while developing a plan with the patient at the same time. Other approaches/protocols to deliver bad news are e.g., PENS, BREAKS; ABCDE or EPICES [ 19 ].

Professional education programs to train communication skills, with a focus on conveying breaking bad news are vital for a trustable patient-physician relationship [ 3 , 4 , 11 , 12 , 15 , 16 , 20 , 21 ]. Therefore, according to the current master plan for medical studies in Germany, it must be part of the curriculum at medical faculties [ 22 , 23 ].

Given the importance of communication skill training (CST), more and more medical faculties start to implement longitudinal communication curricula that address this basic skill at multiple stages of the medical training. This allows students a harmonized progress in medical knowledge and CST [ 24 , 25 , 26 , 27 ]. Throughout Germany, many medical faculties successfully implemented CST into their core curricula [ 28 ]. In France e.g., Bonnaud-Antignac used a videotaped simulated interview with actors as an approach to teach students BBN [ 29 ]. Before and after participating in an interactive lecture, based on the SPIKES protocol, the students conducted role-plays in between themselves. In our study the group was divided into “actors” (respectively “doctors” and “patients”) and observers. For the evaluation, we used questionnaires based on Likert scales, which dealt with the students’ self-assessment during the course of the seminar (QA), the communication skills of the “doctor” during the respective role-plays (QB), and the evaluation of the seminar (QE) (Supplement 2 ).

Aim of this study is to evaluate the feasibility and obstacles of a BBN seminar and its acceptance and learning curve among undergraduate medical students.

The BBN-seminar was conducted at the Saarland University Medical Center in Homburg/Saar (UKS) as part of the EKM curriculum “Introduction to clinical medicine” ( E inführung in die k linische M edizin ) in the 2nd undergraduate year. It is a mandatory seminar in the afternoon. Clinicians are supposed to familiarize pre-clinical students in 90 min with a topic from the clinical routine. A lecturer experienced in BBN, who was trained to conduct the training, led all sessions.

158 2nd year medical students took part in the course in 8 groups with 10–28 participants, respectively. Prior to this seminar, students had not participated in communication skill training. As part of their studies, they had completed an 8-week nursing internship.

BBN-seminar and evaluation

The training model proposed in this publication consisted of two sections: theoretical training and practical training including role-plays. To assess the development of the students’ self-assessment in terms of self-confidence, importance, and their own interest in BBN before and after the seminar, one questionnaire each (QA1/QA2) was distributed and collected immediately at the beginning of the seminar and immediately after the interactive teaching (Fig.  1 ). To evaluate the impact of the teaching in the development of the students’ communication skills one questionnaire each (QB1/QB2) was distributed before the role-plays and collected after (Fig.  1 ).

figure 1

Sequence of the BBN seminar. (BBN = Breaking Bad News; QA1 = questionnaire A to evaluate the students’ self-assessment before lesson; QB1 = questionnaire B to evaluate the students’ communication skills during the role-play before lesson; SPIKES = Setting, Perception, Invitation, Knowledge, Emotions, and Strategy and Summary; QA2 = questionnaire A to evaluate the students’ self-assessment after lesson; QB2 = questionnaire B to evaluate the students’ communication skills during the role-play after lesson QE = questionnaire for seminar evaluation)

The performers received a brief written introduction to the fictitious role-play characters based on real cases which were created by the authors (Supplement 1 ). In the role of a junior doctor, the students’ task was to explain to a patient that she has a histologically confirmed diagnosis of breast cancer (BBN), but the recommendation for further therapy has not yet been determined because of other pending results. The role of the patient was individualized: the student who took on the role of the patient was instructed to react based on her individual personal background. In the second role-play the patient had different characteristics. The observers were seated nearby the roleplay to observe. They obtained the QB sheet at the beginning of the role-play to be able to rate the items. For the role-play, students were organized into groups with a minimum of 3 students (one physician, one patient, one observer). A timeframe was given and the role-play itself should not exceed 15 min. The participants were asked to voluntarily play the role of the patient or the physician. If necessary, a lot was drawn. A debriefing was conducted after the role-plays respectively. During the debriefing, the participants were encouraged to describe their feelings about breaking bad news, in case of being the physician, and how they felt about receiving bad news, in case of being the patient, during the role play. The debriefing was held as a 360°feedback involving all students and the lecturer. This allowed a formative self and peer- assessment cycle to continuously improve the student’s attainment and the lecturer’s didactic strategy.

Thus, the first part of the seminar consisted of an interactive introduction related to lecturer and student experiences with BBN (a brief definition of bad news, examples of bad news communications not only in oncological settings), filling out the questionaries’ and performing the first role-play. The mean duration was 30 min.

The second part consisted of the theoretical training with an average duration of 30 min (Fig.  2 ). It included a PowerPoint™ presentation (Supplement 3 ) based on the SPIKES protocol. Every single step of the SPIKES protocol for “breaking bad news” was taught and discussed. This was followed by a brief introduction to gyneco-oncology and the needs of the patients based on the lecturer’s experiences.

figure 2

A slide from the interactive lecture on the SPIKES-protocol for breaking bad news

The last part of the seminar consisted of the second role-play, filling out the questionnaires, a final debriefing in the sense of a formative self-and peer assessment. Students had time to ask questions and get answers. The 360°feedback included the evaluation questionnaire about the whole seminar (QE) and an encouragement of the students to give feedback about the training to the lecturer directly. The mean duration was 30 min.

All questionnaires were anonymous. Questionnaire QA and QB, written introduction to the fictitious role-play and lecture slides are provided in Supplementary Data (Supplement 1 – 3 ).

Data analysis

Categorical variables are represented as absolute frequencies or both absolute and relative frequencies. Ordinal variables are illustrated by displaying the median with the interquartile range (IQR) represented by [1st quartil– 3rd quartil]. Since the questionnaires were submitted anonymously and there is no way to link the pre- and post-questionnaires, we used statistical tests for independent samples. So, ordinal variables were compared using the Mann-Whitney U test and categorical variables were compared by the Fisher-Freeman-Halton exact test. Any p values are two-sided.

Statistical analyses were performed using SPSS 29.0 (IBM, Armonk, USA) software. A p -value of less than 0.05 was considered significant for all tests.

158 students attended the BBN Seminar in the summer semester 2023. Classes were bigger in the beginning of the semester. Except for the last class, it was always possible to provide 4 doctors and 4 patients respectively for all role-plays. In the last seminar there were 3 doctor- patient- observer groups (Table  1 ).

The results of the QA1/2 and QB1/2 questionnaires are shown in Tables  2 and 3 .

The items for students’ self-assessment in questionnaire QA1/2 show an improvement in all areas, all of which are significant except for item 2 (“interest in gyneco- or oncology”) and 6 (“personal importance of communication in oncology”). For question 6, the median value of the rating increased from 90 to 100%, for question 2 the rating is similar from 50 to 50% (Table  2 ).

In the initial survey, 68% of the students wished for role-plays in their studies, 77% wanted the topic to be part of lectures and 88% wanted them to be part of further seminars. In the second survey after the interactive teaching, 72% of the students wanted role-plays in their studies, 76% wanted the topic as part of lectures and 90% of other seminars (Table  3 ).

The items used to evaluate the students’ skills using the QB1/2 questionnaire (peer-assessment) showed no significant differences on the 11-point Likert scale (Table  2 ) except for the item 7 (“Did the doctor summarize the essentials at the end of the conversation?”). This item showed a highly significant improvement. The ratings in the second part of the QB1/2 questionnaire using a 2-point Likert scale (yes/no), showed significant improvements in questions 8–12, 14, and 17. Questions 13 and 15 showed no significant differences. Item 16 decreased significantly from 96 to 89% (Table  3 ).

The students rated the seminar on a 5-point Likert scale (1="strongly disagree” to 5="absolutely agree”) with 10 items (QE) in the sense of a 360°feedback. Almost all points were rated with a median score of 5. The questions “I learn a lot in the event” and “The event promotes my interest in the subject” scored a median of 4, respectively (Table  4 ).

Despite of numerous approaches for communication skill training (CST) existing for medical students, especially for BBN some questions remain unanswered: When to start training, which framework and setting is effective and at what costs?

We postulate that it is a good time to start CST for medical students even before entering the clinical phase of their studies. According to the German curriculum, students had gained some clinical experience in their nursing internships before the end of their 2nd year of studies. Additionally, students also experience in the private sector of how bad news are broken by physicians in everyday medical practice. In our seminar, most of the students talked about these experiences and the desire to do better. All students had an opinion on the subject, although they classified themselves as rather inexperienced. Using a formative self- and peer assessment with 360°feedback during the seminar, we could show that both the students’ self-confidence and skills improved significantly [ 30 ]. In Germany, longitudinal curricula are now recommended, which should offer the topic of BBN several times during medical studies using different training settings (Masterplan; NKLM 2.0 [ 23 ]). Thus, teaching communication skills especially BBN, is a mandatory part of medical education. Therefore, it must be integrated in most subspecialties, should not be taught separately [ 31 ] and validated teaching concepts for BBN seminars are urgently needed. In addition, despite the implementation of CST into medical curricula, it is not guaranteed that the skills are learned and acquired in a sustained way, since different interest of the students influence the acceptance and application to offered seminars [ 32 ]. The acceptance of such seminars could be demonstrated in those studies on CST recruiting volunteer participants [ 32 ]. In contrast to the latter study, our seminar was compulsory, ruling out a selection bias as all students were required to attend the seminar regardless of their interest in CST and BBN. Interestingly, students’ self-confidence and skills improved significantly in our study.

Depending on the teaching strategy, student’s assessments of their peer’s communication skills may significantly differ from the judgement of real patients [ 12 ]. Thus, it is a limitation of our study that the feedback of students to their peers may not reflect the true needs of the patients. The assessments of communication skills were already very good in the first questionnaire, so it was hardly possible to improve them in some cases. Moreover, although this study reports a relatively large number of participants in comparison to other reports, our group of students might not be representative for others. However, the student’s performance in BBN was also assessed by an experienced lecturer.

The use of anonymous questionnaires makes it impossible to link individual pre and post answers of the participants. Thus, we cannot identify individual or group specific predictors that would allow more individualized teaching strategies. Future studies should consider using personal identifiers to overcome this limitation.

We conclude that it is important to evaluate different settings for communication skill training at various time points within medical studies. Despite our rather simple setting using peer role play actors, the students’ interest in the topic increased during the seminars. Most students asked for further opportunities to learn BBN and communication skills in other settings, e.g., lectures and other seminars. Although the seminar was held as a compulsory course in the afternoon after a full day of studying, the students rated the course very well. They even stated that their interest in the topic had increased together with their communication skills.

We chose the SPIKES protocol as it is well documented that it serves the most important needs of the patients and gives the doctor an easily applicable guide for a successful conversation [ 1 ]. But further studies are needed to evaluate the effects of other programs.

The students stated that the setting with repeated role play was very helpful. In particular, the students reported to benefit very much from putting themselves into the patient’s role. The rating was even better than in other programs with actors [ 28 ].

Our teaching model is very effective, very well rated, and significantly increased communication skills even in undergraduate medical students. Since professional actors are unnecessary, our teaching strategy using peer role plays and assessment is inexpensive and easy to establish longitudinally during medical studies.

Communication and delivering bad news are important skills that can be learned, like any other skill in medicine [ 11 ]. During the second round of role plays, the “physicians” were rated to appear less “calm” in comparision to the first role play. This could be due to an increased awareness of the students for the importance of BBN and therefore increased arousal.

The fear of BBN can turn into satisfaction if it succeeds [ 11 ]. There is compelling evidence that good communication skills are important for patients as well as for doctors. Training for breaking bad news can sharpen the perception of students and doctors for the aspects that are important in physician-patient communication [ 17 ]. The awareness and skills of the participants can be increased by BBN seminars with formative self-and peer assessment and due to the direct exchange of experience, it can also be instructive even for the experienced teachers to hold BBN seminars using 360°feedback [ 30 ].

We postulate that, first, it is possible and recommended to start communication skill training in the pre-clinical phase of medical studies. Role-plays can be conducted by students themselves, thus these seminars require little staffing and are cost-effective. Second, even more important, students experience increased self-awareness when participating in the role-play and by serving as observers. Communication skills should be taught repeatedly during seminars of multiple subspecialties and should be an integral and compulsory part of medical curricula using formative assessments. Despite the limitations described above, our study adds to the knowledge of BBN among medical students and generates insights that can be used in future research and interventions to improve medical students’ skills for BBN. Successor studies should aim to examine the effectiveness of various teaching programs and the impact on the real-life doctor-patient conversation during clinical routine.

Data availability

The datasets supporting the conclusions of this article are included within the article or are available from the corresponding author ([email protected]) upon reasonable request.


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CZ: conception and design, data analysis and interpretation, manuscript writing, final approval of manuscript. PS: conception and design, final approval of manuscript. NNT: manuscript writing, final approval of manuscript. GW: data analysis, final approval of manuscript. SGF: data analysis and interpretation, manuscript writing, final approval of manuscript. All authors have read and agreed to the published version of the manuscript.

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Zemlin, C., Nourkami-Tutdibi, N., Schwarz, P. et al. Teaching breaking bad news in a gyneco-oncological setting: a feasibility study implementing the SPIKES framework for undergraduate medical students. BMC Med Educ 24 , 134 (2024). https://doi.org/10.1186/s12909-024-05096-9

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  • SPIKES protocol
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Calcific bursitis of the Gruberi bursa: a case report

  • Nikhil N. Patel   ORCID: orcid.org/0000-0002-3231-3541 1 ,
  • Jean Jose 1 &
  • Cristina Pravia 1  

Journal of Medical Case Reports volume  18 , Article number:  58 ( 2024 ) Cite this article

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Bursitis is the inflammation of a synovial bursa, a small synovial fluid-filled sac that acts as a cushion between muscles, tendons, and bones. Further, calcific bursitis results from calcium deposits on the synovial joint that exacerbates pain and swelling. The Gruberi bursa is located dorsolaterally in the ankle, between the extensor digitorium longus and the talus. Despite limited literature on its pathophysiology, the aim of this case is to discuss the bursa’s association with calcific bursitis and its management via a case presented to our clinic.

Case presentation

A 47-year-old Caucasian female with no past medical or family history presents with acute right ankle pain following a minor injury 3 months prior with no improvement on analgesic or steroid therapy. Imaging demonstrated incidental calcium deposits. The day prior to presentation, the patient stated she used 1-pound ankle weights that resulted in mild swelling and gradual pain to the right dorsoanterior ankle. Physical exam findings displayed a significant reduction in the range of motion limited by pain. Imaging confirmed calcification within the capsule of the talonavicular joint, consistent with Gruberi bursitis. Initial management with prednisone yielded minimal improvement, requiring an interventional approach with ultrasound-guided barbotage that elicited immediate improvement.

The presented case report highlights a rare and unique instance of acute ankle pain and swelling caused by calcific Gruberi bursitis in a young female. Although the Gruberi bursa is a relatively new discovery, it contains inflammatory components that may predispose it to calcification and should be considered in the differential of ankle swelling. Therefore, utilizing a systematic approach to a clinical presentation and considering all differential diagnoses is essential.

Peer Review reports

Ankle pain and swelling is a common clinical presentation resulting from various conditions, including sprains, gout, and calcific periarthritis. A synovial bursa is a small sac filled with synovial fluid that acts as a cushion between muscles, tendons, and bones [ 1 ]. Bursitis is a common musculoskeletal presentation of an irritated, swollen, or infected bursa capsule that elicits pain and reduces range of motion [ 2 , 3 ]. The four most common locations for bursitis are prepatellar, olecranon, trochanteric, and retrocalcaneal; typically, these respond to non-surgical management [ 4 ]. Calcific bursitis is the build-up of calcium deposits in soft tissue, which can result in painful swelling of the bursa in synovial joints such as the shoulder, elbow, fingers, wrist, hip, knee, and, less commonly, the ankle [ 5 ]. In this report, we present a case of acute onset ankle pain and swelling secondary to calcific Gruberi bursitis requiring interventional non-operative management.

First described by Alexander Monro (1825), the Gruberi bursa is located between the extensor digitorum longus (EDL) tendon and talus [ 6 ]. The Gruberi bursa is found on the dorsolateral ankle. There is limited literature describing its pathophysiology and its relationship with calcific bursitis.

A 47-year-old Caucasian female with no past medical or family history presented to the clinic for evaluation and treatment of 1-day acute right ankle pain. The patient stated that she sustained a minor injury 3 months prior when she tripped and fell, hyper-plantarflexing the right ankle; she endorsed pain toward the base of her toes rather than her ankle. A plain X-ray of the right ankle in anteroposterior (AP) and lateral noted “incidental calcium deposits over the talonavicular region” (Fig. 1 ).

figure 1

A 1.4 × 0.9 × 1.1 cm focus of soft tissue calcification, with juxta-articular deposits of calcium hydroxyapatite along the dorsal aspect of the talus (arrows)

Subsequently, she went to a pilates class and used 1-pound ankle weights for the first time. The next day, she woke up with mild swelling and gradual, progressive pain to the right dorsoanterior ankle. She was unable to ambulate or bear weight on that foot within 24 hours of the pilates session. The patient denied fevers, chills, rashes, or previous history of rheumatological disorders. Upon physical exam, the right ankle showed noticeable swelling to the anterior aspect without erythema or warmth. Dorsalis pedis was palpable, and strength was 4/5 in all muscle groups of the right leg. The pain was localized predominantly to the anterior aspect of the ankle centrally and over the talonavicular region and tender at the extensor digitorum commonness. The Achilles, posterior ankle, tibialis anterior, and extensor hallux longus tendons were non-tender. Sensation was intact to light touch. Range of motion was severely limited by pain.

Repeat X-ray at this acute presentation demonstrated no evidence of fracture or osteochondral pathology but again showed a calcification dorsal to the talonavicular region. This appeared different than an ossicle or osteophyte, providing concern for acute calcific periarthritis. A magnetic resonance imaging (MRI) of her ankle did not show any soft tissue masses but confirmed calcification within the capsule of the talonavicular joint without involvement of the extensor tendons. Using the MRI findings, the precise anatomical location was determined to be consistent with Gruberi bursitis (Fig. 2 ). She was prescribed prednisone 40 mg daily for 4 days without significant improvement.

figure 2

( A ) Sagittal Short Tau Inversion Recovery, ( B ) Sagittal T1, and ( C ) Axial Proton Density Magnetic Resonance Images demonstrate a calcified soft tissue mass with surrounding inflammatory changes along the dorsal aspect of the talus, involving the inferior extensor retinaculum (frondiform ligament) as it passes along the extensor digitorum tendons, reflecting calcific Gruberi bursitis (arrows)

Upon consultation with interventional radiology, an ultrasound (US)-guided barbotage was performed (Fig. 3 ). The inflamed right ankle Gruberi bursa was identified, and amorphous calcifications were noted dorsally to the talus, measuring 1.4 × 0.6 × 1.8 cm, consistent with calcific bursitis (Fig. 4 ). A 20-gauge needle was advanced into the right foot, and a mixture of lidocaine and saline was injected with multiple passes through the amorphous calcifications, breaking them down enough to be lavaged out. Subsequently, a mixture containing 1 cc (40 mg) of Kenalog and lidocaine was injected into the area of calcific bursitis. Within minutes, the ankle pain significantly improved [Numeric Pain Rating Scale (NRS) pain pre-procedure 10/10 and post-procedure 2/10], and the patient immediately returned to baseline ambulation. Rest, ice, and anti-inflammatories were recommended on discharge. Upon 6-month follow-up, this patient is endorsing no pain in her ambulation nor at rest.

figure 3

( A ), ( B ) Longitudinal grayscale ultrasound images of the ankle demonstrate ultrasound-guided calcific bursitis lavage using a 20-gauge spinal needle (arrows)

figure 4

( A ) Longitudinal grayscale and ( B ) color Doppler ultrasound images of the ankle demonstrate hyperechoic foci with acoustic posterior shadowing, internal calcific content, and no appreciable internal vascularity (arrows)

Despite mentions of this anatomical bursa in early twentieth-century anatomy textbooks and multiple reports using MRI or US, extensive debate exists on whether the Gruberi bursa communicates with the talonavicular joint, the tibiotalar joint, and the EDL tendon [ 1 , 7 , 8 , 9 , 10 ].

In this report, we present a unique case of Gruberi bursitis as a rare cause of acute dorsolateral ankle pain and swelling in a young female. While calcific bursitis can affect various bursae in the body, no such literature exists, with only Ragab et al. discussing MRI findings of Gruberi bursitis [ 1 ].

Calcific bursitis presents with localized pain, swelling, tenderness, and reduced range of motion that can worsen with activity, repetitive trauma, or chronic irritation and deposit formation [ 11 , 12 ]. Common management includes rest, immobilization, nonsteroidal anti-inflammatory drugs (NSAIDs), and physical therapy to reduce pain and inflammation [ 13 ]. Ice and compression can further alleviate associated symptoms. In consultation with orthopedic surgery, operative management, including arthroscopic removal of the calcific deposit, excision of the bursa, or performing a bursectomy, can be considered if conservative treatment fails to improve the bursitis. Interventional radiology measures, as in our case, can also be performed to aspirate the calcification and inject corticosteroids for pain and inflammation management. Barbotage is a low-risk procedure requiring local anesthesia and relatively quick recovery. The improvement seen in this patient thus supports the belief that inflammatory bursitis to the Gruberi bursa due to calcific involvement exists.

A common differential diagnosis for calcific bursitis is acute calcific periarthritis [ 14 , 15 , 16 ]. Although periarthritis is also caused by calcium deposits within soft tissue, resulting in rapid onset monoarticular pain, swelling, erythema, or fever, the cardinal difference is the involvement of tendons [ 14 , 17 , 18 , 19 ]. Similarly, calcific periarthritis is found in big joints such as the shoulder and is self-resolving or requires conservative treatment [ 15 ]. Our case represents a unique presentation in the ankle that required alternative therapy. Despite high doses of oral steroids, the patient was non-ambulatory for at least 1 week before the barbotage. Thus, this case is significant in providing support for ultrasound-guided barbotage for patients who do not respond to conservative medical management. Patients of any age who endorse severe pain at rest or ambulation would benefit from this therapy.

Furthermore, it is important to utilize a systematic approach to the clinical presentation due to high misdiagnosis rates for infective or inflammatory pathophysiology, arthropathies, or neoplasia [ 20 , 21 , 22 ]. Diagnosis, including gout, pseudogout, or infectious etiologies such as osteomyelitis, must be considered in acute ankle pain presentations. Laboratory tests such as C-reactive protein, complete blood count, erythrocyte sedimentation rate, and diagnostic imaging such as MRI or US should be considered [ 23 ]. Although our case lacked laboratory testing due to an emergent presentation, it is imperative to consider all differentials.

While it is a relatively new discovery, the Gruberi bursa does contain inflammatory components that predispose it to calcification, as presented in this case. Further research is needed to determine the pathophysiology of calcification in the talonavicular region. Additionally, studies should be performed to identify inclusion criteria and compare the efficacy of ultrasound-guided barbotage to other treatments of calcific Gruberi bursitis. This report demonstrates the value of enhanced MRI and significant improvement using ultrasound-guided barbotage after failed conservative medical management.

Availability of data and materials

The data and materials supporting the findings of this study are available upon reasonable request from the corresponding author.


Extensor digitorum longus


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Patel, N.N., Jose, J. & Pravia, C. Calcific bursitis of the Gruberi bursa: a case report. J Med Case Reports 18 , 58 (2024). https://doi.org/10.1186/s13256-024-04377-7

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Advancing the science of communication to improve lives

Serving as a peer reviewer for NIDCD grant applications, and an update on NIDCD’s January advisory council meeting

Dr. Debara Tucci Banner

Debara L. Tucci, M.D., M.S., M.B.A.

February 15, 2024

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NIDCD's extramural research program funds extensive research and training opportunities at universities, medical centers, and other institutions through research grants, career development awards, and other funding mechanisms. To ensure that NIDCD supports research that meets the highest level of scientific and ethical standards to improve the lives of millions of people with communication disorders, we depend on an informed and inclusive peer review process.

In this director’s message, I outline the process and value of serving as a peer reviewer for NIDCD grant applications, and I explain how scientific and clinical experts in our mission areas can participate. I also summarize topics discussed at the January National Deafness and Other Communication Disorders Advisory Council Meeting.

The NIH Peer Review Process

The National Institutes of Health’s two-tiered peer review system ensures that grant applications are objectively evaluated based on their scientific and technical merit and in a manner that is free from inappropriate influence. To promote rigorous and fair evaluation of applications for research and training funding in our mission areas—hearing, balance, taste, smell, voice, speech, and language—NIDCD is always seeking to expand the pool of qualified peer reviewers.

NIDCD grant applications are primarily reviewed by panels managed by the NIH Center for Scientific Review and the NIDCD Scientific Review Branch (SRB). Review of applications by the NIDCD SRB is conducted by either the Communication Disorders Review Committee (CDRC) or a Special Emphasis Panel (SEP) . 

The CDRC consists of 21 members who are designated by the NIH Director to serve for overlapping four-year terms. Committee members are selected based on their expertise in NIDCD’s mission areas within disciplines such as academic medicine, basic research, and clinical science. Committee membership is supplemented on an as‑needed, meeting-by-meeting basis.

The other type of NIDCD-managed review panel responsible for reviewing grant applications is the NIDCD SEP. SEPs are formed on an ad hoc basis to provide peer review of specific grant applications. More than 250 members from the extramural scientific community served on NIDCD SEPs in 2021 and 2022. Membership selection is based on expertise in a specific biomedical area, and panel participants serve for an individual meeting rather than fixed terms. Individuals interested in serving on an NIDCD review panel may submit a reviewer interest registration form to the NIDCD SRB.

Serving as a Peer Reviewer

To ensure that review of NIDCD grant applications is fair, equitable, timely, and free of bias, it is important to maintain a diverse pool of reviewers who can be called upon to serve in the above-described groups.

Reasons to serve as an NIDCD peer reviewer include:

  • Eligibility for extended application submission deadlines—depending on the type of review service and specific Notice of Funding Opportunity
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If you are a scientist, grantee, clinician, or statistician in our mission areas , I encourage you to register your interest in serving as a peer reviewer . You can learn more about peer review processes by exploring NIH resources, including advice from experienced peer reviewers (video) , a mock peer review study section (video), and guidance on the new simplified peer review framework for research project grant applications, effective January 25, 2025.

National Deafness and Other Communication Disorders Advisory Council Meeting, January 25-26

On January 25-26, the institute’s advisory council convened virtually at the National Institutes of Health in Bethesda, Maryland. Portions of our council meetings are open to the public, and I invite you to watch the archived videocasts of the January 25 and January 26 open sessions. I also encourage you to join us online for our next meeting, to be held May 16, 2024. A few highlights from January’s meeting are summarized below.

  • Merav Sabri, Ph.D., NIDCD Program Director and coordinator for the BRAIN Initiative, provided an overview of this NIH-led effort and described several funding opportunities within NIDCD’s mission areas . To view this segment, start at the 00:18:00 mark of the January 25 videocast .
  • Maria Geffen, Ph.D., Associate Professor in the Department of Otorhinolaryngology, Neuroscience and Neurology, and Co-Director of the Computational Neuroscience Initiative at the University of Pennsylvania, discussed combining computational and behavioral approaches to unravel the neurocircuitry of hearing in uncertain environments, such as holding a conversation in a crowded room. To view this segment, start at the 00:21:00 mark of the January 25 videocast .
  • Argye Hillis, M.D., Professor in the Department of Neurology at Johns Hopkins University, described the use of longitudinal functional brain imaging to reveal mechanisms of language recovery after stroke and the translation of these findings into individualized treatments. To view this segment, start at the 00:55:00 mark of the January 25 videocast .
  • “Dissemination & Implementation (D&I) Science in Communication Disorders” aims to encourage the NIDCD scientific community and the D&I scientific community to increase the quality and quantity of D&I research in communication disorders, with the ultimate goal of narrowing or closing the gap between research and clinical practice.
  • “Augmentative and Alternative Communication (AAC) Users - Research to Promote Robust and Effective Communication” encourages the NIDCD scientific community, AAC users, and other invested parties to collaborate in research efforts to promote the accessibility and effective use of robust communication systems for those who cannot rely on spoken language as their primary means of communication.
  • “NIDCD Transition to Independence Award for Extramural and Intramural Clinician–Scientists” is designed to help clinician–scientists in NIDCD mission areas transition from mentored positions to independent positions. The concept specifically aims to facilitate a transition to mainstream NIH research funding such as an R21 or R01 during the independent phase.
  • Susan Thibeault, Ph.D., Professor in the Division of Otolaryngology-Head & Neck Surgery at the University of Wisconsin-Madison, described using tissue engineering to regenerate the vocal fold lamina propria and epithelium in mouse models and human tissues, as well as research to better understand innate immune-microbial interactions in vocal fold inflammation. To view this segment, start at the 02:20:45 mark of the January 25 videocast .
  • Katherine Bouton, an author, public speaker, and advocate for people who are deaf or hard of hearing, described the experience of losing her hearing in midlife. She also discussed the promise and challenges of assistive hearing technologies and outlined her vision of hearing aids and cochlear implants that mimic normal speech. To view this segment, start at the 02:31:15 mark of the January 25 videocast .
  • Diana W. Bianchi, Ph.D., Director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), described collaborative efforts between NIDCD, NICHD, and other institutes, including the Tackling Acquisition of Language in Kids (TALK) initiative to advance understanding of late language emergence in children with various risk factors; the INCLUDE (INvestigation of Co-occurring conditions across the Lifespan to Understand Down syndromE) Project , which addresses the health needs of people with Down syndrome; and the NIH Autism Centers of Excellence Program . To view this segment, start at the 00:04:42 mark of the January 26 videocast .
  • Cendrine Robinson, Ph.D., NIDCD’s Chief Diversity Officer, described a 2021 report from the Enhancing Diversity, Equity, Inclusion, and Accessibility at NIDCD Working Group. She also outlined NIDCD’s initiatives to increase diversity-focused mentoring programs in the extramural and intramural workforce and diversity-related grant opportunities that support mentoring networks and research experiences. To view this segment, start at the 01:41:00 mark of the January 26 videocast .
  • Holly Storkel, Ph.D., Program Officer in NIDCD’s Language Program, described the goals and main themes of NIDCD’s October 2023 virtual workshop, Dissemination and Implementation (D&I) Science in Communication Disorders . She noted that D&I efforts advance NIDCD’s strategic plan ( Theme 4 ). To view this segment, start at the 02:06:00 mark of the January 26 videocast .
  • Becky Wagenaar-Miller, Ph.D., Director of NIDCD’s Division of Extramural Activities, provided an overview of recent NIH policy updates and described NIH’s January 2024 virtual event , which explained policy updates and potential impacts on grantee institutions. To view this segment, start at the 00:2:15:50 mark of the January 26 videocast .

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Pediatric scurvy case report: a novel presentation with deep vein thrombosis secondary to large bilateral spontaneous iliac subperiosteal hematomas

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Scurvy is an uncommon disease in developed countries caused by deficiency of vitamin C. We present a case of scurvy in a 14-year-old male with autism with both novel presentation and imaging findings. This case had the novel presentation of lower limb deep vein thrombosis (DVT) secondary to compression of the external iliac vein from large bilateral iliac wing subperiosteal hematomas. Subperiosteal hematoma is a well-recognised feature of scurvy but large and bilateral pelvic subperiosteal hematoma causing DVT has not previously been described.

Case presentation

A 14 year old Caucasian male with background of autism and severe dietary restriction presented with lower limb swelling and immobility. He was diagnosed with lower limb DVT. Further investigation revealed an iron deficiency anaemia, and he was found on MRI to have large bilateral subperiosteal iliac hematomata causing compression of the iliac vessels. He improved following treatment with vitamin C replacement and follow-up imaging demonstrated resolution of the DVT and hematoma.

DVT is rare in children and when diagnosed should prompt investigation as to the underlying cause. This case demonstrates an unusual cause of DVT and as an unusual presentation of paediatric scurvy.

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Scurvy is a disease caused by deficiency of vitamin C. Scurvy is uncommon in developed countries and the clinical manifestations are non-specific and wide ranging, including bleeding, musculoskeletal pain, iron deficiency anaemia and rash. Therefore, vitamin C deficiency is frequently initially misdiagnosed or the diagnosis delayed. We present a case of scurvy in a teenage boy with a background of autism, who presented with a two month history of immobility and acute lower limb swelling due to a deep vein thrombosis. MRI of the pelvis and hips revealed large bilateral subperiosteal iliac hematomas. Further interrogation of the clinical history and examination findings, together with subsequent improvement following vitamin C replacement are consistent with the diagnosis of scurvy.

To the authors knowledge, this is the first reported case of large spontaneous bilateral iliac bone subperiosteal hematomas in scurvy and the first case of deep vein thrombosis caused by pelvic subperiosteal hematoma. Our objective is to highlight this case to musculoskeletal radiologists to improve the awareness of scurvy as a cause of spontaneous bleeding and particularly to emphasize the importance of early clinical suspicion in the context of children or adults with developmental issues, cognitive impairment, or severe dietary restriction for any other reasons.

A 14-year-old boy with a diagnosis of autism and pathological demand avoidance with severe dietary restriction, presented with their parents to the local Children’s Assessment Unit with acute swelling of the left foot following a two month history of progressive immobility. The patient denied specific pain in the left lower limb but did complain of generalised muscle aching.

The progressive immobility was first thought to be psychosomatic, having had a similar episode two years prior trigged by illness of a pet and resolved following physical therapy. The patient had been seen by physiotherapy and orthopaedic teams prior to this admission.

Doppler ultrasound examination of the lower limbs demonstrated extensive deep vein thrombosis in the left superficial femoral vein extending into the left common femoral vein, the proximal extent was not seen [Fig.  1 , Fig.  2 ]. More proximal assessment of the distal external iliac veins was not possible because the patient declined examination of this intimate region. Treatment with low molecular weight heparin, subcutaneous injection of enoxaparin 1 mg/kg twice daily was commenced and then titrated based on anti-Factor Xa activity. Ultrasound examination of the abdominal organs was normal. There was no apparent cause for the deep vein thrombosis, although it was considered that the immobility could be a contributing factor.

figure 1

Colour doppler ultrasound of the left common femoral vein bifurcation (solid white arrow proximal). Echogenic material is seen occluding the lumen of the vessel with absence of colour flow in keeping with occlusive deep vein thrombosis which extends into the superficial femoral vein (curved arrow). There is colour doppler flow seen at the origin of the profunda femoris vein (open arrow) indicating partial patency although non-occlusive echogenic thrombus is seen here

figure 2

Colour doppler ultrasound of the left common femoral vein (star marks proximal) demonstrates extension of the thrombus proximally from the level of the femoral head (arrow heads). The full proximal extent is not seen on these images

Physical examination was difficult so further investigations were requested. Radiographs of the upper and lower limbs were initially interpreted as normal, the metaphyseal findings typical of scurvey were recognised during a second review for the pediatric multidisciplinary meeting [Fig.  3 , Fig.  4 ]. Laboratory testing demonstrated a severe anaemia with microcytosis and low ferritin in keeping with a severe iron deficiency anaemia. The patient also had folate deficiency, a mildly increased erythrocyte sedimentation rate and c-reactive protein but normal white cell counts. A serum autoantibody and rheumatology screen was negative [Table  1 ].

figure 3

Anteroposterior radiograph of the left wrist. Although initially interpreted as normal demonstrates classical radiographic features seen in scurvy: dense metaphyseal bands known as Frankel lines (solid white arrow) and metaphyseal spurs known as Pelkin spurs (open white arrow). Symmetrical appearances were seen in the contralateral wrist

figure 4

Horizontal beam lateral radiograph of the right knee. Although initially interpreted as normal demonstrates classical radiographic features seen in scurvy: dense metaphyseal bands known as Frankel lines (solid white arrow), also with underlying band of lucency known as Trümmerfeld zones, and metaphyseal spurs known as Pelkin spurs (open white arrow)

MRI of the head, spine, pelvis and hip was performed. The brain and spinal cord were normal. In the pelvis there were large collections, lentiform in shape, along the medial margin of the iliac wings bilaterally. The collections showed mixed high and intermediate T1 and high STIR signal. They measured approximately 9 × 6 × 4 cm (anteroposterior x craniocaudal x width) and displaced the iliacus and psoas muscles medially to compress the external iliac vessels. The signal characteristics and location were in keeping with subperiosteal hematomata. A similar smaller subperiosteal hematoma was seen on the lateral aspect of the left iliac wing, deep to the gluteal muscles. Small bilateral hip joint effusions and high signal in the adductor muscles was also seen. There was no significant bone marrow oedema. [Fig.  5 , Fig.  6 ] Following discussion in the pediatric multidisplinary meeting, scurvy was suggested as the unifying diagnosis after review of the clinical history, blood results, radiograph and MRI findings. It was at this second review that the radiographic features of scurvy were recognised. A reducing regime of oral vitamin C replacement was commenced, starting at 1000 mg once daily, reducing to 500 mg, 200 mg, 100 mg and stopping at 2 weekly intervals.

figure 5

MRI of the pelvis, axial T1. Bilateral high signal ovoid collections along the medial margin of the iliac wing (long arrow) bilaterally represent subperiosteal hematoma (marked with *). Displacement of the iliac vessels (curved arrow) and iliopsoas muscles. Smaller high signal collection seen along the lateral margin of the left iliac wing deep to the gluteal muscles (short arrow)

figure 6

MRI of the pelvis, coronal T2 fat saturated. Mixed but predominantly high signal collections are seen along the medial margin of the iliac wings bilaterally (marked with *). Small bilateral hip effusions (long arrows) and high signal in the adductor muscles (short arrows), more so on the left

In the two months prior to this presentation, the patient’s parents reported a significant reduction in the variety of his already narrow diet, mostly eating cheese sandwiches and crackers. Prior to this he was eating jam and toast which would have been a source of vitamin C. His admission weight was 36.45 kg, significantly lower than the 45 kg weight recorded at an outpatient clinic visit two months earlier. During this period, the patient had been complaining of ‘pain all over’ and his mobility had steadily declined from walking to being wheelchair bound. Following subsequent scrutiny of the clinical history, the patient and his family did remember a rash on the lower legs around the hair follicles and some bleeding when brushing his teeth. These features had all resolved by the time of the MRI, probably because the patient had been prescribed a multivitamin on admission, Forceval 1 capsule once daily one hour after food, whichcontains vitamin C.

Serum vitamin C levels prior to vitamin C replacement had not been measured but considering the clinical history, imaging findings and improvement of symptoms following commencement of vitamin C replacement, scurvy is the presumed underlying cause of the spontaneous hematomata. This would also explain the iron deficiency anaemia, both follow blood loss and as a direct effect of vitamin C deficiency on iron metabolism. Compression of the left external iliac vein due to the hematomas was the reason for development of DVT in this child.

Severe anaemia was treated with blood transfusion, 3 units of packed red cells, seeing improvement in hemoglobin from 4.8 to 9.2 g/dL. High dose vitamin C replacement, Forceval one capsule once daily one hour after food, was commenced along with intensive physiotherapy and dietician input. The patient’s mobility improved during his two-week inpatient stay but he did remain dependent on his wheelchair, struggling to extend his legs fully. His physical health and mood also improved during this time. Enoxaparin was changed to oral rivaroxaban, 15 mg once daily, on discharge.

Follow-up doppler ultrasound of the lower limbs demonstrated resolution of the DVT at 12 weeks, a repeat haemoglobin was normal at 12.7 g/dL and the patient’s ESR and CRP had normalised. Serum vitamin C was normal at this time.

Follow-up MRI scan 4 months following the initial presentation demonstrated a significant reduction in subperiosteal iliac hematomata with only thin residual collections along the medial and lateral iliac margins. [Fig.  7 ] The patient continues to take the multivitamin daily and will do so indefinitely to prevent future vitamin deficiencies. Rivaroxaban was discontinued at 4 months post initiation. The patient’s mobility has continued to improve, and he is now mobilising short distances.

figure 7

Follow-up MRI at 5 months post presentation, axial T2 fat saturated. The previously seen iliac subperiosteal hematoma have significantly reduced in size, there are thin residual high signal collections (white arrows)

Discussion and conclusions

Vitamin C is an essential nutrient, an important cofactor for the biosynthesis of collagen in blood vessels, skin amongst other tissues. Vitamin C also promotes iron absorption and transport. Humans cannot synthesis or store vitamin C which means we are reliant of minimum daily dietary intake to prevent deficiency [ 1 ].

Vitamin C deficiency (< 11µmol/L) is more common in developed countries than most clinicians would think, with a prevalence of 1–16% [ 2 ] Severe deficiency is however much less common, its prevalence < 0.01% and typically seen in patients with severe dietary restriction such as children with autism and older adults with cognitive impairment.

Severe vitamin C deficiency can lead to potentially life-threatening haemodynamic instability but has a diverse clinical presentation, usually with multisystem involvement. The most common clinical findings are bleeding tendencies including a petechial rash, perifollicular hyperkeratosis, iron deficiency anaemia, lower limb pain and reluctance to walk.

In this case, the patient had recognised risk factors for vitamin C deficiency, namely autism and a severely restricted diet. Recognition of these risk factors led to the suspicion of nutritional deficiencies as a cause for his symptoms and appropriate early initiation of multivitamin replacement. Non-specific lower limb pain, reduced mobility, petechial rash as present in this case are all well recognised in vitamin C deficiency. Vitamin C deficiency often co-existes with other nutritional deficiencies such as folic acid, vitamin D and vitamin B12. Whilst spontaneous haemorrhage is well recognised manifestation, this is mostly commonly: intra-orbital, subdural or when subperiosteal, in the lower limbs [ 3 , 4 , 5 ]. This is, to the authors knowledge, the first reported case of intra-pelvic subperiosteal hematoma due to scurvy.

The MRI findings in scurvy are often non-specific with patchy bone marrow oedema. Finding of subperiosteal hematoma is less common but more specific [ 6 ]. The most important consideration of imaging is not in the diagnosis of scurvy but the exclusion of other acute pathologies which could mimic the presentation including haematological malignancy, septic arthritis, insufficiency fracture and slipped upper femoral epiphysis.

Classically described radiograph findings in scurvy include cortical thinning, dense zone of provisional calcification, epiphyseal increased density in a ring around the periphery and transverse lucency in the metaphysis on the diaphyseal side of the dense provisional calcification. In practice these can be difficult to pick up due to the rarity of the condition and are often only appreciated in retrospect after the diagnosis has already been made [ 7 ].

DVT in children is rare in children, usually caused by the use of intravenous catheters or prothrombotic conditions [ 8 ]. Unlike in adults, immobility is not a strongly correlated risk factor. Therefore, DVT in a child with proximal into the iliac vessels should prompt a thorough search to exclude a compressive lesion such as May-Thurner syndrome [ 9 ] or as reported by Culler at al, faecal impaction causing gross rectal distention compressing the left external iliac vein in a child [ 10 , 11 ]. Cases of large periosteal hematoma have been reported, commonly in the long bones [ 12 ] ,but this is the first reported case of large iliac subperiosteal hematoma and is a previously unreported cause of external iliac vessel compression and DVT. This casedoes demonstrate the need for cross-sectional imaging of the pelvis in cases were DVT remains unexplained after ultrasound in the absence of haematological conditions.

Data availability

The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.

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de Boer, H.C., Sawhney, J.S. Pediatric scurvy case report: a novel presentation with deep vein thrombosis secondary to large bilateral spontaneous iliac subperiosteal hematomas. BMC Pediatr 24 , 126 (2024). https://doi.org/10.1186/s12887-024-04579-4

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