In medical journals, “under review” means external peer reviewers are assessing your manuscript for quality, novelty, and fit.
Seeing that status can trigger mixed feelings. You want a clear sense of what’s happening, who is involved, how long it may take, and what you can do to help the process along. This guide breaks down the moving parts in plain language, so you know what “under review” covers, what updates to expect, and how to respond at each stage.
What “Under Review” Means End-To-End
In most editorial systems, that label starts the moment an editor moves the paper beyond intake checks and begins seeking expert feedback. In some platforms the tag may also appear while the editor screens the work or invites referees. Either way, your study is being assessed for methodological soundness, clarity, and suitability for the journal’s audience.
The people involved include the handling editor, one or more external reviewers with subject expertise, and often a statistical or methods advisor for clinical or epidemiologic research. Each provides comments and a recommendation, which the editor weighs before issuing a decision.
Common Status Terms You Might See
Different systems display slightly different wording. The table below translates the most common ones you’ll encounter during the review window.
| Status Term | What It Means | Typical Next Step |
|---|---|---|
| With Editor | Editor is screening scope, ethics, and basic reporting. | Either send to reviewers or issue an early decision. |
| Reviewers Invited | Editor has sent invitations to potential referees. | Move to “Reviewers Assigned” after acceptances. |
| Reviewers Assigned | Enough experts agreed to evaluate the paper. | Reviewers submit reports within the set window. |
| Under Review | External assessment is in progress (or editor screening in some systems). | Await “Reviews Completed” or direct decision. |
| Required Reviews Completed | Editor has the minimum reports to proceed. | Editorial decision and letter preparation. |
| Decision In Process | Editor is weighing recommendations and drafting the outcome. | Receive accept, reject, or revise decision. |
Who Does What During Peer Review
Editors decide whether to send a manuscript for external feedback, select suitable reviewers, and synthesize the reports into a clear decision letter. They also check adherence to journal policies on authorship, ethics approvals, and data transparency.
Reviewers evaluate the evidence, the methods, the clarity of reporting, and the value to readers. Good reports are specific and give actionable edits on design, analysis, and presentation. Many journals encourage reviewers to declare any conflicts and keep timelines tight.
Authors can speed things up by ensuring clean reporting, supplying data and code on request, and responding to messages from the office promptly.
Under Review In Medical Journals: Timeline And Outcomes
Time varies by field and by journal workflow. Fast-track clinical reports may move in a few weeks, while complex trials or meta-analyses can take longer due to specialist checks. The path often looks like this:
- Editor screening: days to a couple of weeks.
- Reviewer recruitment: days to a few weeks, depending on availability.
- Report writing: often two to four weeks per reviewer, set by the office.
- Editorial synthesis: days to a week once the final review lands.
Outcomes at the end of this window typically include reject, accept, or a request for minor or major revision. A revision path is common and can still lead to publication if the core science is sound and the feedback is addressed well.
Why The Same Label Can Mean Different Things
Editorial dashboards aren’t standardized across publishers. Some show a single tag from invitation through report submission. Others expose each micro-step. That’s why the same phrase can appear while the editor is still securing referees or while reviews are already underway. When in doubt, check the journal’s “status” help page or contact the office for a neutral update.
What Reviewers Are Asked To Judge
Medical journals ask referees to comment on study design, data integrity, statistical approach, reporting clarity, and interpretability. Many forms include questions about trial registration, protocol availability, data sharing, and whether the claims match the evidence. Reviewers may also flag ethical issues, missing approvals, or patient privacy risks.
Transparent policies and reviewer duties are published by recognized bodies. You can read the ICMJE Recommendations on roles in the review process, and the COPE peer review guidelines used by many medical titles.
How Editors Weigh Conflicting Reports
Mixed reviews are common. In that case the editor looks at the strength of methods and the clarity of revisions suggested. They may add a tie-breaker reviewer or seek a statistical read. The decision letter should outline the path forward, grouping requests into must-fix items and presentation edits.
Reading The Tea Leaves In Status Changes
Small shifts in the dashboard can hint at where your paper sits in the queue. Here’s how to interpret common transitions without over-reading them.
“With Editor” For A While
This often means the editor is still screening or trying to secure referees. Some fields have a short list of qualified experts, so invitations can take time. A brief, polite query to the office is fine after a few weeks if the label hasn’t moved.
“Required Reviews Completed”
The editor has enough reports to decide. Many journals move to “decision in process” soon after. At this point, be ready to receive a letter that may ask for a revision with a deadline.
Back To “Under Review” After A Revision
That usually means the editor sent your revision back to one or more original referees or to a methods reviewer. It can also mean the editor is doing a thorough re-read. Both patterns are normal.
How Long You Might Wait
Published targets vary. Many medical journals aim for a first decision within weeks, though the actual span depends on reviewer response time and the complexity of the work. Specialized or multi-arm clinical studies often need more time because the office seeks specific expertise and detailed checks on analysis and reporting.
Why Timelines Stretch
- Reviewer availability: invitations may be declined during busy seasons.
- Specialist input: statistical or methodological checks add an extra step.
- Ethics or data queries: missing approvals, consent, or dataset access slow things.
- Multiple rounds: a major revision can return to the same or new referees.
What You Can Do While Waiting
Use the quiet period to prepare for likely requests and to keep momentum on your research program. The table below lists practical actions that tend to pay off after the decision letter arrives.
| Situation | Smart Action | What Not To Do |
|---|---|---|
| Expecting a revision | Draft point-by-point templates; line-number your manuscript. | Wait until the deadline window is tight. |
| Anticipating methods queries | Organize code, analysis logs, and raw data access notes. | Scramble for files after the letter arrives. |
| Scope or audience concerns | List alternative journals that match the study’s niche. | Send mass emails to editors. |
| Authorship or ethics checks | Confirm contributions, approvals, and registrations are documented. | Assume the office won’t ask for proof. |
| Communication lag | Send a brief status query after a reasonable span; include ID and title fragment. | Ping weekly or pressure the office. |
How To Respond To A Decision Letter
Read the letter twice before editing. Group the items into must-fix points, clarifications, and presentation edits. Create a reply document with each reviewer comment quoted in full, followed by your response and the exact change location (page and line). Keep the tone calm and factual; match each request with a precise edit or a concise justification.
For analysis changes, show updated numbers, add a short methods note, and upload clean and marked-up files. If you disagree with a point, explain why, cite standards or data, and offer a small experiment or extra check when feasible.
When A Transfer Offer Appears
Some publishers offer a transfer to a sister title after a negative scope call. A transfer can save time if the match is strong and the reports can travel with the manuscript. Read the aims of the destination journal and decide based on fit, not speed alone.
Ethics, Transparency, And What Reviewers Expect
Medical titles lean on clear reporting and research integrity. Many ask for trial registration, data availability statements, and author contribution details. Referees value clean methods, accessible data where appropriate, and tight claims that line up with the results. Guidance from the ICMJE Recommendations and the COPE guidelines for peer reviewers shapes these expectations across the field.
Tips To Keep Your Paper Moving
- Before submission: follow the journal’s checklist, upload clean figures, and include reporting checklists where relevant (CONSORT, STROBE, PRISMA).
- During review: keep email filters from hiding editor messages; respond quickly to data or ethics queries.
- During revision: mirror the order of comments in your reply; cite page and line for every change; keep edits as clear diffs.
- After acceptance: check proofs carefully for clinical terms, units, and dose formatting.
Plain-Language Answers To Common Concerns
Does “Under Review” Mean External Peer Review Every Time?
Not always. Some dashboards apply the same wording to editor screening and to external reports. Check the journal’s status guide or send a brief query if you need clarity.
Is A Long “Under Review” Span A Bad Sign?
Not by itself. Delays often reflect reviewer recruitment or a full queue, not a negative outcome. A measured follow-up to the office is fine after a sensible wait.
What If The Decision Is Reject?
Read the feedback for reusable edits. Tighten the methods and reporting, adjust scope, and submit to a better-matched title. Many strong papers land after an initial miss.
A Quick Checklist Before You Submit
- Match the aims and audience of the target journal.
- Align with reporting standards for your study type.
- Confirm ethics approvals and registrations are in place.
- Prepare a data or code access note when appropriate.
- Keep figures legible, captioned, and numbered cleanly.
- Suggest calm, qualified reviewers without conflicts.
Bottom Line For Authors
That single label covers a busy set of steps. An editor screens and recruits experts, reviewers assess design and clarity, and the editor translates those reports into a decision. Use the waiting time to prep materials, plan for a possible revision, and keep communication short and courteous. With clean methods and clear writing, the process works best—and a revision path often leads to a solid, citable paper.