Most medical journals run 1–3 peer-review rounds; simple papers clear in one, while complex work can require more before a decision.
What A Peer Review Round Means
When people ask how many rounds of peer review in medical journals to expect, a round means one trip through external critiques and an editorial call. The editor sends the manuscript to reviewers, collects reports, and issues a verdict such as accept, minor changes, major changes, or reject. If revisions are invited, the author replies and submits a tracked update, and the cycle repeats. Some journals send the same reviewers the revision; others add a fresh voice if someone is unavailable. A round ends when the editor records a decision and gives the author a letter.
How Many Rounds Of Peer Review Do Medical Journals Use?
Across clinical and biomedical titles, the common range is one to three rounds for many titles. A clean, well prepared paper can pass in a single cycle after minor edits. Complex trials, meta-analyses, and methods-heavy studies often need a second pass to tighten statistics, clarify protocols, or expand data sharing. A third round appears when a change touches core claims or new analyses raise fresh questions. Beyond that, editors tend to rule one way or the other to avoid drag. Some journals state that repeated major changes past two or three cycles should lead to a firm decision so authors are not stuck in limbo.
| Journal Type/Model | Typical Rounds | Notes |
|---|---|---|
| General Medical Weekly | 1–2 | Fast triage; heavy editor screening |
| Specialty Clinical Title | 1–3 | Deep methods checks; data clarifications common |
| Open Peer Review | 1–3 | Signed or published reviews; transparent dialogues |
| Mega-Journal | 1–2 | Soundness-only criteria; scope often broad |
| Registered Reports | 2 | One stage on protocol; one on final results |
Why Paper Types Drive The Number Of Rounds
Study design and risk shape the path. Trials with patient outcomes draw close reading on randomization, blinding, and harms. Systematic reviews meet checks on search strings, inclusion rules, bias tools, and data synthesis. Lab studies face replication detail and reagent notes. Public health work needs clear denominators and confounder handling. When a result affects clinical practice, editors ask for tighter proof, which can add another cycle. Short reports and technical notes often see a lighter path and can finish in one round when scope is narrow and methods are plain.
What Editors And Reviewers Look For Each Round
Round one asks, is the question clear, the methods sound, and the data credible? Reviewers flag design gaps, missing registry links, or odd variance. They point to reporting checklists, data access, and whether statistics match the plan. Round two checks how the authors met the list. Did the reply letter map point by point? Do new analyses sit on correct tests and sample sizes? Round three, when it happens, closes the loop on remaining items or confirms that a change did not weaken earlier fixes.
Policies That Shape Rounds
Open models publish the reviews with the paper, which can nudge tighter replies in fewer passes. Soundness-only models judge technical rigor rather than splash, which can cut deep rewrites. A handful of journals timestamp every step on the article page, making delay visible and prompting crisp cycles.
Real-World Policies You Can Check
If you want a concrete view, read a medical journal’s stated steps. The PLOS Medicine editorial process lays out screening, reviewer selection, and decisions. Many editors also align reviewer conduct with the COPE Ethical Guidelines for Peer Reviewers. Those pages show how decisions progress and why a paper might need a second or third pass before it is ready.
Time Per Round And Decision Paths
Speed varies by field, reviewer availability, and the season. Holidays can slow reviewer responses. One cycle can take a few weeks in best cases or stretch much longer when the right experts are busy. Many journals now let editors desk reject at intake to save authors from long waits when a mismatch is clear. Once past triage, the file moves to reviewers, then to a draft letter, then to the author for a reply. If the reply meets the list and the editor signs off, the paper moves to production.
| Round | Common Duration | Usual Outcomes |
|---|---|---|
| Round 1 | 4–12 weeks | Minor changes, major changes, or reject |
| Round 2 | 2–8 weeks | Accept, minor changes, or another revision |
| Round 3 | 2–6 weeks | Accept or final decision after remaining fixes |
Why Some Papers Need Three Or More Rounds
Big data sets and multi-site trials bring moving parts. If a reviewer finds a mislabeling issue or a gap in the analysis plan, the repair can touch many figures. New data pulled in to answer a point can expose a separate edge case. A fresh reviewer might spot a clarity snag missed earlier. Rounds stack not because the work is weak, but because the claim is large or the data are dense. Editors watch the arc to keep the process fair and timely.
How To Keep The Number Of Rounds Low
Start with a tight methods section and a full set of links. Register trials and share data in line with journal policy. Use reporting checklists that match the design, such as CONSORT for trials or PRISMA for systematic reviews. Provide code, seeds, and versions for analysis. In the reply letter, answer each reviewer point with short quotes and page marks. Where you agree, make the change and cite the new line number. Where you disagree, give a brief reason and, when helpful, add a small analysis in the supplement to show why the claim still holds.
Choosing A Journal To Match Your Study
Pick a target that fits scope, methods, and audience. Read recent articles of your type to see how deep the methods go and how long papers read. Some journals showcase decision histories on article pages, which hints at pace and number of rounds. Publisher sites also share median times from submission to first decision. A match on scope, checklists, and data policy trims surprises later.
What Editors Weigh Before Adding Another Round
Editors map reviewer points against the claims in the abstract. If the remaining items are narrow and easy to verify, a small change can be handled at the desk. If a request asks for new data that sit outside the plan, the editor may ask the reviewers whether the change is fair. They also check tone and time spent so far. When the balance tips, the editor moves to accept or reject rather than start a long new cycle.
Transparency Signals Around Rounds
Some journals print the dates for received, revised, and accepted, along with the full decision letter and author replies. Open models show the names of the reviewers with consent. Registered reports publish the first decision on the protocol, then link the final paper to that record. These signals let readers see how the work changed and how many cycles it took.
Common Myths About Peer Review Rounds
Myth one: more rounds always mean a better paper. Past a point, extra cycles add delay with little gain. Myth two: desk rejections mean a low-quality study. Many are scope mismatches or timing issues. Myth three: switching journals resets the clock by months. Transfers within a publisher can move prior reviews, which helps the editor make a quick call.
Inside A Typical Round, Step By Step
1) Editor screens the file for scope, ethics statements, and basic reporting elements.
2) Reviewers are invited; the file goes out with a clear list of points to weigh.
3) Reports arrive; the editor reads them together and looks for alignment or gaps.
4) A decision letter goes out with a ranked list of items and any journal-specific asks.
5) Authors revise the text, figures, and data packages; the reply letter links claims to edits.
6) If needed, the editor sends the revision back to one or more reviewers for a quick check.
7) The editor makes a call and, when accepted, moves the file to production.
Transfers And Cascading Peer Review
Many publishers give authors a chance to move a declined paper to a sister title. With permission, the reviews and reply letter travel with the file so a fresh editor can act fast. This route spares a new first round and can trim months. The new journal may still add a short check, but the heavy lift is already done.
Preprints, Open Comments, And Rounds
Posting a preprint lets readers spot clarity issues while formal review is pending. Some medical journals allow public comments to inform the editor’s view when the paper enters review. Linking a preprint in the submission fields also helps reviewers see version history and cited datasets. This context can tighten the next round by answering small questions up front.
Dealing With Conflicts And Tone
Editors watch for conflicts of interest and unhelpful tone. If a review drifts into unhelpful territory or shows a conflict, editors can invite an extra opinion and set expectations for courteous feedback. Clear rules on data access, trial registration, and author roles help keep the exchange factual and brisk.
Ready-To-Submit Checklist
• Title and abstract match the actual question and outcomes.
• Trial registration or protocol link is present and correct.
• Reporting checklist fits the design and is uploaded.
• Data and code are organized and shareable as policy allows.
• Figures match the numbers in the text, and units are consistent.
• Submission note states fit, value, and any related preprints.
• Reply letter template prepared for point-by-point answers.
• A short statement on data access, ethics, and funding is in place.