A step-by-step guide to peer review: a template for patients and novice reviewers
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While relatively novel, patient peer review has the potential to change the healthcare publishing paradigm. It can do this by helping researchers enlarge the pool of people who are welcome to read, understand and participate in healthcare research. Academic journals who are early adopters of patient peer review have already committed to placing a priority on using person-centred language in publicly available abstracts and focusing on translational and practical research.
A wide body of literature has shown that including people with lived experiences in a truly meaningful way can improve the quality and efficiency of health research. Traditionally considered only as ‘subjects’ of research, over the last 10–15 years, patients and care partners have increasingly been invited to contribute to the design and conduct of studies. Established institutions are increasingly recognising the distinctive expertise patients possess—many patients have acquired deep insights about their conditions, symptoms, medical treatments and quality of healthcare delivery. Among some funders, including the views of patients is now a requirement to ensure research proposals are meaningful to persons with the lived experience of illness. Further illustrating these developments, patients are now involved in reviewing and making recommendations as part of funding institutions, setting research agendas and priorities, being funded for and leading their own research and leading or coauthoring scholarly publications, and are now participating in the peer review process for academic journals.1–5 Patients offer an outsider’s perspective within mainstream healthcare: they have fewer institutional, professional or social allegiances and conflicts of interest—factors recognised as compromising the quality of research. Patient involvement is essential to move away from rhetorical commitments to embrace a truly patient-centred healthcare ecosystem where everyone has a place at the table.
As people with lived health experiences climb a ladder of engagement in patient–researcher partnerships, they may be asked to act as peer reviewers of academic manuscripts. However, many of these individuals do not hold professional training in medicine, healthcare or science and have never encountered the peer review process. Little guidance exists for patients and care partners tasked with reviewing and providing input on manuscripts in search of publication.
In conversation, however, even experienced researchers confess that learning how to peer review is part of a hidden curriculum in academia—a skill outlined by no formal means but rather learnt by mimicry.6 As such, as they learn the process, novices may pick up bad habits. In the case of peer review, learning is the result of reading large numbers of academic papers, occasional conversations with mentors or commonly “trial by fire” experienced via reviewer comments to their own submissions. Patient reviewers are rarely exposed to these experiences and can be at a loss for where to begin. As a result, some may forgo opportunities to provide valuable and highly insightful feedback on research publications. Although some journals are highly specific about how reviewers should structure their feedback, many publications—including top-tier medical journals—assume that all reviewers will know how to construct responses. Only a few forward-thinking journals actively seeking peer review from people with lived health experiences currently point to review tips designed for experienced professionals.7
As people with lived health experiences are increasingly invited to participate in peer review, it is essential that they be supported in this process. The peer review template for patients and novice reviewers (table 1) is a series of steps designed to create a workflow for the main components of peer review. A structured workflow can help a reviewer organise their thoughts and create space to engage in critical thinking. The template is a starting point for anyone new to peer review, and it should be modified, adapted and built on for individual preferences and unique journal requirements. Peer reviews are commonly submitted via website portals, which vary widely in design and functionality; as such, reviewers are encouraged to decide how to best use the template on a case-by-case basis. Journals may require reviewers to copy and paste responses from the template into a journal website or upload a clean copy of the template as an attachment. Note: If uploading the review as an attachment, remember to remove the template examples and writing prompts.
Table 1
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Peer review template for patients and other novice reviewers
It is important to point out that patient reviewers are not alone in facing challenges and a steep learning curve in performing peer review. Many health research agendas and, as a result, publications straddle disciplines, requiring peer reviewers with complementary expertise and training. Some experts may be highly equipped to critique particular aspects of research papers while unsuited to comment on other parts. Curiously, however, it is seldom a requirement that invited peer reviewers admit their own limitations to comment on different dimensions of papers. Relatedly, while we do not suggest that all patient peer reviewers will be equipped to critique every aspect of submitted manuscripts—though some may be fully competent to do so—we suggest that candour about limitations of expertise would also benefit the broader research community.
As novice reviewers gain experience, they may find themselves solicited for a growing number of reviews, much like their more experienced counterparts or mentors.8 Serving as a patient or care partner reviewer can be a rewarding form of advocacy and will be crucial to harnessing the feedback and expertise of persons with lived health experiences. As we move into a future where online searches for information are a ubiquitous first step in searching for answers to health-related questions, patient and novice reviewers may become the much-needed link between academia and the lay public.
Twitter: @TheLizArmy, @@crblease
Contributors: Both authors contributed substantially to the manuscript. LS conceived the idea and design and drafted the text. CB refined the idea and critically revised the text.
Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests: The authors have read and understood the BMJ policy on declaration of interests and declare the following interests: LS is a member of the BMJ Patient Advisory Panel, serves as a BMJ patient reviewer and is an ad hoc patient reviewer for the Patient-Centered Outcomes Research Institute; CB is a Keane OpenNotes scholar; both LS and CB work on OpenNotes, a philanthropically funded research initiative focused on improving transparency in healthcare.
Provenance and peer review: Commissioned; externally peer reviewed.
Ethics statements
Patient consent for publication:
Not required.
Acknowledgements
LS thanks the experienced and novice reviewers who encouraged her to publish this template.
Engage with Us. Patient-Centered outcomes research Institute (PCORI). 2019;
Coordinating Center for Clinical Trials - Patient Advocate Steering Committee [Internet]. National Cancer Institute. U.S. Department of Health and Human Services. National Institute of Health.
Transforming Healthcare through Innovative and Impactful Research [Internet]. Peer Reviewed Cancer Research Program, Congressionally Directed Medical Research Programs. U.S. Department of Defense. 2021;
Rubenstein J, Salmi L. How to Cultivate a "Friendtorship" [Internet]. CLOSLER. Miller Coulson Academy of Clinical Excellence, Johns Hopkins Medicine. 2021;
