Medical Peer Review Example | Real-World Walkthrough

New to journal submissions and want to see what a complete medical peer review looks like from start to finish? This guide walks through a realistic scenario, using plain language and conventions that leading journals follow. You will see the stages, the players, and the documents you will write or receive, plus a clean sample you can adapt. It mirrors real editorial workflows across journals today, widely used.

Where it matters, links point to trusted sources such as the ICMJE Recommendations, the COPE ethical guidance, and the EQUATOR checklists that journals ask authors to use.

Peer Review In Medicine: A Worked Example

Think of a randomized trial that tests a blood pressure app against standard care. Authors prepare a manuscript, upload it to a journal, and confirm disclosures. The editor in chief performs a quick triage, then assigns an associate editor who seeks two or three domain reviewers. Those reviewers assess design, analysis, and reporting, write reports, and send a recommendation. The associate editor synthesizes the advice and issues a decision letter.

Submission To First Decision: Typical Timeline

Day 0–3: Technical checks confirm formatting, word count, figures, and disclosures. Many journals also screen for scope and desk reject if the fit is poor.

Day 3–10: An associate editor invites reviewers. Invitations state the title, abstract, and due date. Reviewers accept only when they have the right skill set, time, and no competing interests.

Day 10–30: Reviewers read the paper, request any clarifications through confidential notes to the editor, and submit their reports. Some journals ask for structured reports with a summary, major points, minor points, and a rating on novelty and methodological strength.

Day 30–45: The associate editor compares the reports and writes a consolidated decision. Most decisions fall into revise, reject but encourage resubmission, outright reject, or accept with edits.

What Reviewers See And Do

Journals use single blind, double blind, or open review. Single blind shows author names; double blind hides them; open review may publish reports and names. Whatever the model, the duty is to be fair, specific, and respectful.

A good report starts with a short summary, then numbered points. Reviewers back claims with reasons, disclose any roles that could be conflicts, and keep all material confidential, in line with COPE.

Screening And Desk Decision

At triage the editor scans fit to scope, clarity, and reporting basics. Trials without registration, unclear primary outcomes, or missing ethics statements often stop here. Strong science that does not match the journal’s audience can also stop with advice to try a better-fitting venue.

Selecting Reviewers

Editors balance method skill and topic knowledge. One reviewer may be a trialist who weighs randomization, blinding, and allocation concealment; another may be a clinician who gauges clinical value. A third might be a statistician who checks the model choices and sensitivity work.

The Review Reports

Reports usually start with a short summary, then major points that affect validity or clarity, then minor edits. Major points might ask for a clearer outcome definition, a corrected sample size calculation, or a preplanned sensitivity analysis. Minor points catch typos, labeling, and figure clarity.

Tone And Structure Of Good Comments

Plain writing helps authors act. Numbered points with short headers speed up the author response. Where a change is optional, reviewers say so. Where a fix is needed for validity, they explain why and suggest a simple path forward.

Sample Medical Peer Review Report: Annotated

The sample below mirrors what many journals request. It fits both trials and observational studies with edits. You can copy the headers and adapt the lines to your paper.

Reviewer Report

Summary: This manuscript reports a parallel-group trial testing a blood pressure app against usual care across three clinics. Primary outcome is change in systolic blood pressure at 6 months. The question matters to primary care and the trial looks feasible.

Major Points

1. Outcome Definition: The primary outcome is measured in clinic and at home. State which source drives the primary analysis and how the other source is used.
2. Sample Size: The calculation assumes an SD of 18 mmHg and 90% power. Show the source of the SD and include a small margin for attrition.
3. Missing Data: Predefine handling of dropouts and partial data. Multiple imputation or a mixed model may fit better than complete cases only.
4. Harms: Add a line in Methods and Results on adverse events, even if no events occurred.
5. Transparency: Link the protocol and analysis code if journal policy allows, and note who had access to the raw data.

Minor Points

1. Figure 1 labels use small fonts; increase size for legibility on mobile.
2. Spell out acronyms at first use in the abstract and main text.
3. Round effect estimates to a sensible number of decimals.

Recommendation: Major revision

Model Author Response

Authors respond beneath each point with a short header, a one-line action, and a quote of the new text. They note any changes to tables or figures and state line numbers. Here is a pattern that reads well.

1. Outcome Definition: We now clarify that clinic measurements drive the primary analysis, with home readings in a sensitivity check. New text: “The primary outcome was clinic systolic blood pressure at 6 months; home readings informed a prespecified sensitivity analysis.”
2. Sample Size: We cite a prior trial that reported an SD of 17.8 mmHg and add a 10% attrition cushion. New text: “A total of 220 participants provide 90% power to detect a 5 mmHg difference, assuming an SD of 18 mmHg and 10% attrition.”
3. Missing Data: We switched to a mixed model with repeated measures and plan multiple imputation as a check. Details appear in the Statistical Analysis section.
4. Harms: We add a sentence on adverse events; none were related to the intervention.
5. Transparency: We deposit de-identified code and analysis scripts in a public repository and note that the sponsor had no access to raw data.

Decision Letters And Author Actions

Author Checklist For A Smooth Round

Before you press submit, run through a short list that saves time for you and the reviewers.

• Match your study type to the right reporting checklist from EQUATOR and upload it with the manuscript.
• Fill the ICMJE disclosure form for each author and include funding and role statements.
• Name a data access coordinator and describe where code and de-identified data will live if shared.
• Cut unneeded jargon, tighten tables, and keep figure text large enough for a phone screen.
• Write a short letter to the editor that states the study’s aim, the main result, and any prior posting as a preprint.

Peer Review Models And Variations

Many clinical journals use single blind. Some surgical and internal medicine titles use double blind. Large open-access titles may post public reviews with names, or publish the history of revisions along with the paper. Preprint servers can host early versions before or during journal review, with links back once the paper is published.

Editors and reviewers follow shared norms across all of these paths. They avoid undisclosed conflicts, keep manuscripts confidential, and base feedback on reporting standards, sound methods, and fair reading of the results.

Ethics And Transparency Touchpoints

Shared norms guide the process. COPE outlines fairness, confidentiality, and when editor edits to reviews are acceptable. ICMJE lists roles, trial registration, authorship, and data sharing. These norms shape both reviews and decisions.

• Conflicts and roles: Declare funding, sponsor input, and who had data access.
• Registration and protocol: For trials, list a registry ID; for systematic reviews, cite a protocol when available.
• Data sharing: State where de-identified data and code will reside, along with any embargo.
• Corrections: Be ready to fix small slips after acceptance; journals issue corrections when needed.

Editor’s Consolidated Letter: Anatomy

Most decision letters open with the decision type, then two sections: the editor’s summary of the main changes and the reviewer comments in full. The summary is your map and lists the points that matter most.

When reports conflict, the editor often sets the path. If a claim hinges on evidence, add a brief analysis with a citation, not a reply by opinion. Keep the tone calm and factual.

How To Write A Crisp Rebuttal

A neat response packet speeds a second look. Start with a brief note that lists big changes. Then paste each reviewer point in italics and follow with your answer in normal text. Quote any added or revised lines, and call out updated tables or figures.

When you disagree, supply a short rationale and, when helpful, a citation or a small analysis that settles the point. If a request sits outside your data, say so and offer a simple check that speaks to the concern.

Common Pitfalls And Clean Fixes

• Vague primary outcome: Name the metric, unit, time point, and source; align across abstract, text, tables, and registry.
• Underpowered analysis: Revisit the calculation and report uncertainty with intervals, not only P values.
• Selective results: Present all prespecified outcomes, even when neutral; place any unplanned analyses in a clear box or subsection.
• Messy figures: Use readable fonts and consistent scales; avoid chart types that hide variation.
• Missing data: Use principled methods and show a flow diagram of participants.

Reusable Peer Review Template

Use this compact structure when you serve as a reviewer or when you pre-write a response plan as an author.

Summary (2–3 lines)
Major Points
1) [Title] – Why it matters – Requested action
2) [Title] – Why it matters – Requested action
Minor Points
a) Style or wording
b) Figure or table tweak
Recommendation: accept / minor revision / major revision / reject
Confidential note to editor (optional): conflicts, scope fit, or sensitive remarks

What Success Looks Like

A strong round ends with clearer methods, a tighter story, and numbers that readers can trust. Authors learn which claims stand on solid ground and which need softer language. Editors gain confidence that the paper fits the journal and serves its readers.

Use the example, the two tables, and the linked advice as a starter kit. With clean reporting, fair reading of evidence, and crisp replies, your next round will move faster and feel less stressful. Good science reads clean when peers are done and happy.