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Peer Review and editing process at
Pakistan Journal of Medical Sciences

Shaukat Ali Jawaid*

There has been a gradual increase in the number of manuscripts that we receive for publication in Pakistan Journal of Medical Sciences and this number is likely to cross three hundred manuscripts in 2007.The contributors are from over thirty six countries. The number of manuscripts has increased manifold ever since we have gone on the net (www.pjms.com.pk) in 2003.1 This has not only increased the visibility of the journal and readership but is a great source of good quality manuscripts thereby helping us achieve our prime objective of publishing a good quality peer reviewed journal from this region. Almost 90% of these manuscripts are received through e mail online while we still receive about 10% manuscripts by post.
Editors of peer reviewed medical journals particularly in the not so developed countries where the art and science of medical writing has not yet fully developed, face lot of problems.2,3 Editing and publishing a quality journal is at times very frustrating and stressful job. Some of these problems can be eliminated altogether or reduced to a great extent if the authors read and follow instructions to the authors carefully. Our experience shows that while previously over 90% of the authors never read these instructions now this figures has dropped to about 80% during the last couple of years. In case the authors are a bit more careful and follow these instructions in letter and spirit, it will not only minimize the trauma to their manuscripts, accelerate the review and editing process but also relieve the agony of editorial staff and reviewers which they have to undergo while evaluating these manuscripts.
Editing and peer review process at Pak J Med Sci goes through different stages which are as under:
Initial Assessment
All the manuscripts whether received through e mail or by post first undergo initial assessment. The idea is to detect if there are any major deficiencies so that it could be pointed out to the authors at this stage so that they can rectify and resubmit the manuscripts without losing any time. At this initial stage an effort is made to see whether the manuscript has all the essential components i.e. structured abstract with key words in case of original studies, Summary with key words in case of Reviews. The length of the manuscript is another important issue. We do not accept or rarely entertain manuscripts which are over 2500 words in case of original article, over 3500 words in case of reviews, hence the authors are asked to shorten it if need be. It is also ascertained if the figures, illustrations mentioned in the manuscript have been attached, tables are in place if any. The authors have tried to add latest references after doing proper literature search. The references have been written properly as per International Committee of Medical Journal Editors (ICMJE) Uniform Requirement for Manuscript Submission to Biomedical Journals. 4 If everything is OK and the manuscript is also accompanied by Letter of Undertaking signed by all the authors confirming exclusive submission and willingness to pay the publication charges if approved after peer review, this is an indication that the authors are not only familiar with the art of medical writing but have also read, followed instructions to authors. Such manuscripts are accepted for further processing. Almost 30-35% of the manuscripts that we receive are rejected at this initial stage. The manuscripts marked for further processing are then graded into A and B category. Epidemiological, original interesting studies are categorized as A and are processed on fast track during peer review while those falling in category-B are processed as a routine. Efforts are also made to get these A-category manuscripts reviewed quickly and they are also preferred as per our publication policy.
The correspondence author of these manuscripts which have been marked for further processing are then sent an acknowledgement and they are also issued a Reference No. of their manuscript which they are supposed to refer to in all future correspondence. This acknowledgement gives detailed information about the peer review process, likely time which it will take as well as the publication charges which the authors will have to pay in case of its acceptance. In some cases if the manuscript is good but is not accompanied with Letter of Undertaking or there are some minor deficiencies like a few incomplete references etc., this is also communicated to the authors with a request to provide this missing information immediately. No manuscript is processed further and sent for peer review unless we have received the Letter of Undertaking signed by all the authors. In our experience almost 50% of the manuscripts are not accompanied by Letter of Undertaking which is provided later on when it is pointed out.

Peer Review

Most of the manuscripts are reviewed by two, one internal and one external reviewer. In case of unsatisfactory review by any of the reviewers or in case of conflict of opinion between both the reviewers, a third reviewer may be asked to evaluate the manuscript before taking final decision to accept or reject the manuscript. Our experience shows that about 25% of the manuscripts have to be reviewed by more than two reviewers. The peer review process itself takes about four months at an average.
In our reviewers data base we have one hundred thirty reviewers, ninety from Pakistan and forty from overseas although the number of overseas reviewers has now increased further ever since this presentation was made at the conference. We are constantly looking for good reviewers to increase our reviewer’s database. Based on the quality of manuscripts of some of the contributors, we have selected some of them as reviewers and this has been a very rewarding experience. Those authors whose manuscripts get good comments from the reviewers and whose manuscripts have been graded as A category, are then invited to join the team of reviewers. However, still we find a great difficulty to find good quality reviewers in some of the specialties and sub-specialties in particular with the result that manuscripts on these topics naturally require more time for peer review which at times is quite frustrating for the authors.

Online Review: We welcome and prefer those reviewers who are willing to receive online manuscripts for review which is not only quick but also quite economical. However, so far only 20% of our reviewers have shown interest in online review while the rest 80% still require hard copies. It is not uncommon to find out that at times the reviewers misplace the manuscripts and have to be supplied additional copies. We usually give four weeks time to the reviewers. While the overseas reviewers who mostly do online review take two to three weeks to review the manuscript and send their comments, others have to be sent reminders time and again. Among the local reviewers within the country, hardly 10% stick to the timing and the rest of them have to be pursued. We expect our reviewers to be sympathetic to the authors and their reviews should help and guide them to further improve their manuscripts. About 20% of our reviewers do not mind rewriting the manuscript if need be. About 50% of the reviewers give detailed comments which are helpful for the authors. Excellent reviewers who take care of minute details and the manuscripts reviewed by them do not need any major work up by the editorial team account for just 10%. Almost 90% of the manuscripts have to be looked at in detail by the editorial team even after peer review as regards correction, improvement of English language, references, tables etc. In case the manuscripts need revision and rewriting, the reviewer’s comments are communicated to the authors, almost 40% of the manuscripts fall in this category.
Acceptance Rate: About 25% of the manuscripts are accepted after minor editing, 35% of manuscripts get rejected due to serious flaws in the study design, sample size, statistical analysis and no correlation between the study objective, actual study and the conclusions drawn. Hence, our overall acceptance rate is between 50-55%. Of these, about 25% fall into the category of primary acceptance and the remaining 30-35% manuscripts are those which are accepted after revision and rewriting.

English Language

About 30% of the manuscripts from within the country and from overseas particularly a few countries from Gulf and Islamic Republic of Iran in particular, have extremely poor English. Some of the busy reviewers do not appreciate receiving such manuscripts for review. They feel that the editorial team should first correct the English language and then forward them these manuscripts for peer review. However, if the study is good and the topic selected is interesting, efforts are made to rewrite, help rewrite and revise these manuscripts without any change in their actual contents. These manuscripts are then sent to the authors for approval. No rewritten manuscript is published unless the rewritten version has been approved by the original authors. Processing of such manuscripts take more time and the authors are asked to be patient. In some cases processing of such manuscripts took more than one year before they were accepted and published but the authors were extremely grateful. It takes about four to six months at an average for peer review and the time from receipt of the manuscript to final publication in most of the cases is about one year though some manuscripts do get published much early, these are the manuscripts which are processed on fast track and fall in category A during initial assessment.. Efforts are being made to accelerate the peer review process and reduce the publication time.5 Another measure which we took to reduce the publication time during the Year 2007 has been publication of additional issues. We published one additional issue in April-June 2007(Part-II) while another additional issue is planned in October 2007. Pakistan Journal of Medical Sciences is a quarterly publication and we cannot change the frequency of publication because it may not be sustainable in the long run due to economic reasons though we very much wish to make it a bi-monthly publication. The number of manuscripts included in each issue has also been increased from 12-15 in 2001-2002 to 40-45 in the Year 2007. All this is meant to clear the backlog of accepted manuscripts. It is but natural that once some one has written something, he or she is too keen to see it in print as soon as possible but unfortunately there are no short cuts. It is not uncommon to receive phone calls from authors asking as to when and how much time it will take to get the manuscript published though they may not have yet submitted the manuscript. My answer to such callers is “you are trying to determine the sex of the baby before proper engagement”. A vast majority of the authors are not fully familiar with the editing and peer review process which is time consuming otherwise they won’t be asking such questions.

Editing of manuscripts

Once the manuscripts are approved through the peer review process, they go though internal editing process by the editorial team. After it is accomplished, the authors are issued letter of acceptance. They are also communicated the likely date of issue in which their manuscript will be included. In the meantime they are requested to arrange for publication charges. Authors from some of the countries like Bangladesh, Iraq, and Palestine are exempt from publication charges. Some other deserving authors can also request for assistance and if possible, genuine requests are entertained with a positive outlook. If members of the editorial board or international advisory board recommend, some the authors do get some concession in publication charges.

Proof Reading

About 90% of the authors which includes all the authors from overseas and a few within the country are sent PDF files for proof reading. If the result of some of the figures and illustrations is not good, the authors are advised to arrange them in JPEG format. Although it is clearly mentioned in instructions to authors that figures, illustrations should always be sent in JPEG format while submitting the manuscript but some authors do not bother to follow the instrucitons. Any minor deficiencies i.e. missing year or name of the journal in References etc., are also pointed out so that these are corrected in proof reading. Here again, some of the authors do not know how to convey the corrections to the PDF file. Some resend the entire manuscript with corrections without highlighting them making it almost impossible to find out corrections. Some do not know what is meant by JPEG and GIF format and all this is quite frustrating. It is impossible for the editors to teach the authors how to use computers sitting at a distance but they have no other option to live with it and face these professional hazards.
Correspondence author: All developments concerning each manuscript from formal acknowledgment to acceptance letter, proof reading etc., are communicated to the correspondence author who is supposed to keep the co-authors informed of these developments. But sometimes it does not happen. If there are four or five authors in a manuscript, all of them start making phone calls or sending e mails enquiring about the progress of their manuscript. Some time they even do not know or mention the reference number and all this is extremely frustrating, agonizing, wasting lot of precious time. One of my Editor friends once told me that as a policy they do not speak to the authors. Instead the authors are requested to communicate through e mail. It does save lot of un-necessary calls and time particularly when one is hard pressed on timing but I personally do not agree with this approach.

Simultaneous submission and duplicate publication

This is another menace which needs to be tackled firmly. Despite the fact that some authors have given written undertaking confirming exclusive submission of the manuscript to the journal, but in fact they do submit it to some other journals at the same time hoping that when they get a positive response from one journal, they will withdraw the manuscript from other journals. In some cases the authors do get their manuscript processed through peer review and when they are helped to rewrite, revise and finalize it and is accepted for publication, they send it somewhere else to get it published immediately as they are very impatient due to various reasons i.e. departments and institutional pressure, further academic promotion etc. Some time one is lucky enough to detect such manuscripts before publication when they are taken out of the publication schedule but nothing can be done when such manuscripts do get published. In the present circumstances, it is humanly impossible to timely detect such cases of simultaneous submissions. The Editors cannot work as Policemen and they have to trust the authors but sometime this trust is betrayed.
In Pakistan Journal of Medical Sciences, we have had our share of such unfortunate incidents. Strict action was taken against all those involved in such unethical publication practices. These authors were not only black listed refusing to entertain any manuscript from them in future but the decision of this publication misconduct was also conveyed to their respective head of the institution, provincial government in case of government employees, Pakistan Medical and Dental Council as well as the Higher Education Commission.6 Copies of such an action taken against these authors were also sent to Editors of other important journals. In some cases the authors promised to arrange for the publication charges but once their manuscripts were published, they did not respond. Little do they realize that they can cheat but only once? As a policy we have black listed a number of such authors as well.

Online Edition (www.pjms.com.pk)

After carrying out the corrections as conveyed by the authors, the manuscripts are finalized, page numbering is done and the issue is uploaded on the net. The authors whose manuscripts are included in this issue are sent email informing them that the issue is now accessible on the net. We offer open access, so they are encouraged to have another look at their manuscript and if they find that some correction has been left out or there is some other mistake, convey it immediately so that the corrections are carried out before the issue is sent for printing. It is quite useful and sometime one can avoid some serious mistakes. It is not difficult to carry out corrections in the online edition and that particular manuscript can be uploaded again within no time but it is impossible to do anything once the issue has been published except to publish errata in the next issue.
Before final order for printing, an ammonia proof is arranged to have a final check to see if the page numbering is in order, figures, illustrations are visible and of good quality. A signed copy of ammonia proof is then passed on to the press for final printing. Usually the printed issue is ready three to four weeks after the issue has been uploaded on the net.
Table-I gives the details of the number of manuscripts received and published by Pakistan Journal of Medical Sciences from the Year 2003-2006:

Self Publication Audit

Annual self audit is a regular feature with us and its details are published regularly.7-9 It not only gives information about the number of manuscripts being received but also countries, details about accepted and rejected manuscripts. It helps to make further improvement through appropriate interventions as the weak areas are also identified through this process. We have already published a study regarding Characteristics of our Reviewers and the quality of their reviews10 which had some interesting findings. Two more studies are now planned using the information gathered through such self publication audit.

Rejection of manuscripts

It is not uncommon to receive some uncharitable and unpalatable comments and remarks from those authors whose manuscripts are rejected. However, in order to maintain standard, peer review is a must and short cuts are not advisable. During this process, one can lose many good friends as well. But remember, “ in general the only people who love Editors are their wives, husbands, children and parents.11


1. Jafary MH, Jawaid SA. Online edition of a journal: a great source of manuscript and potential regional cooperation. Pak J Med Sci 2006;22(2):107-9.
2. Jawaid SA. Problems faced by Editors of Peer Reviewed medical journals. Saudi Med J 2004; 25, Suppl 1: 447-511.
3. Jawaid SA. What Medicine and Medical Editing Means To Me: In: What Medicine Means To Me (Ajai R. Singh, Shakuntala A. Singh Eds.) MSM Men Sana Monographs 2006; III, IV, p62-77.
4. International Committee of Medical Journal Editors (ICMJE). Uniform requirements for Manuscripts Submitted to Biomedical Journals. (Updated 2006). Available at: http://www.icmje.org (Accessed July 15, 2007).
5. Jawaid SA, Jafary MH. Speedy peer review and reducing publication time. Pak J Med Sci 2007;23(2):155-6.
6. Jawaid SA. Simultaneous submission and duplicate publication: Curse and a menace which needs to be checked. Pak J Med Sci 2005; 21(3); 245-48.
7. Jawaid SA. Self audit (PJMS) for the Year 2000-2001. Pak J Med Sci 2002;18(1):5-10.
8. Jawaid SA. Publication audit 2003. Pak J Med Sci 2004; 20(1):1-3.
9. Jawaid SA and Jawaid M. Publication audit and the importance of Online Medical Journals. Pak J Med Sci 2005; 21(1):6-9.
10. Jawaid SA, Jawaid M, Jafary MH. Characteristics of reviewers and quality of reviews: A retrospective study of reviewers at Pakistan Journal of Medical Sciences. Pak J Med Sci 2006; 22(2):101-6.
11. Harvey M. What Medical Journal Editing Means To Me. In: Mens Sana Monographs (Ajai R. Singh, Shakuntala A.Singh Eds.) 2007;(In Press).

* Managing Editor
Pakistan Journal of Medical Sciences,
Karachi. Pakistan.
E mail: pjms@pjms.com.pk, pulse@pulsepakistan.com