A guide to performing a peer review of randomised controlled trials
Del Mar and Hoffmann BMC Medicine
A guide to performing a peer review of randomised controlled trials
Chris Del Mar 0
Tammy C. Hoffmann 0
0 Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University , Gold Coast, Queensland 4229 , Australia
Peer review of journal articles is an important step in the research process. Editors rely on the expertise of peer reviewers to properly assess submissions. Yet, peer review quality varies widely and few receive training or guidance in how to approach the task. This paper describes some of the main steps that peer reviewers in general and, in particular, those performing reviewes of randomised controlled trials (RCT), can use when carrying out a review. It can be helpful to begin with a brief read to acquaint yourself with the study, followed by a detailed read and a careful check for flaws. These can be divided into 'major' (problems that must be resolved before publication can be considered) and 'minor' (suggested improvements that are discretionary) flaws. Being aware of the appropriate reporting checklist for the study being reviewed (such as CONSORT and its extensions for RCTs) can also be valuable. Competing interests or prejudices might corrode the review, so ensuring transparency about them is important. Finally, ensuring that the paper's strengths are acknowledged along with a dissection of the weaknesses provides balance and perspective to both authors and editors. Helpful reviews are constructive and improve the quality of the paper. The proper conduct of a peer review is the responsibility of all who accept the role.
CONSORT statement; Editorial responsibilities; Medical journal publishing; Peer review; Randomised controlled trial
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Background
Peer review of journal articles is an important process in
research. It is part of the underlying engine that aims to
sort out which papers will be published and what
modifications are needed before this occurs.
It is easy to assume that reviewers’ duties and editors’
objectives are identical: we all want to see that good
papers are accepted and flawed ones rejected, and that all
are papers improved by the review process. In a study of
over 200 reviewers of randomised controlled trials
(RCTs) in high impact medical journals, reviewers ranked
activities such as ‘evaluating the risk of bias’, and ‘checking
that the conclusions were consistent with the results’, top
[1]. However, the 171 participating editors ranked these
much lower, instead wanting to simply know whether the
reviewers ‘did or did not recommend publication’ and
‘whether this was an important topic’ [1].
Editors rely on the expertise of their peer reviewers to
provide the necessary background (typically content
and/or methodological) to properly assess submissions.
While there are imperfections in the peer review system
and some doubts about the impact of peer review [2, 3],
it is a system that is used universally. However, the
quality of peer review varies enormously and few reviewers
receive training in how to do it and may not be aware of
some of the elements to consider or when new to
reviewing, how to approach the task. In this paper, we
describe some of the main steps that peer reviewers of
research papers in general, and RCTs in particular, can
use to guide their review.
General steps – for all research articles
Acquaint yourself with the paper
It is a good idea to read the paper soon after your
commission to referee it. Leaving it to the last minute risks
introducing a delay if you discover a problem which
means that you cannot complete it (for example, a
conflict of interest that only emerges after a detailed read or
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addressing an area in which you have no expertise). In
any case, a rapid read allows you to get a fast grasp of
the content to prepare you for the full task. Breaking the
research study into its component parts can help you to
understand the main elements of the study. For those
familiar with doing this step in critical appraisal, the
example component parts for most RCTs would be:
Participants/Patient, Intervention, Comparator, and
Outcomes (or PICO). For studies that are not RCTs, many
of these components are still relevant – for example,
Participants/Problem/Population, Issue/Index (if an
observational study), and Outcomes. Identifying what the study’s
question is can help (...truncated)