Joseph Cusimano, PharmD, BCPP
Psychiatric Pharmacist
Dr. Cusimano received a Bachelor of Science in Biochemistry (Medicinal Chemistry) from Arizona State University. He completed his PharmD with a Graduate Interdisciplinary Specialization in Biomedical, Clinical, and Translational Science at The Ohio State University. He completed pharmacy practice and psychiatric pharmacy residencies at the University of Michigan Health System, including one year as chief resident. He served 3 years in a faculty position at the Shenandoah University Bernard J. Dunn School of Pharmacy while practicing at Valley Health Winchester Medical Center’s inpatient Behavioral Health Service. He currently serves as a Safety Evaluator for the Division of Pharmacovigilance-I Divisions of Psychiatry and Dermatology team at the U.S. Food and Drug Administration. Dr. Cusimano was recognized as an Outstanding Peer Reviewer for the Mental Health Clinician.
Disclaimer: The opinions represented in this article are the authors’ own and should not be construed as an official position of the U.S. Food and Drug Administration or the U.S. Government.
Peer review is at the heart of the scientific enterprise. Sometimes dreaded as the final, high-stakes hurdle on the path to publication, peer review provides an invaluable service to researchers, the scientific community, and the public at large. My goal with this commentary is to inspire pharmacists to participate in the peer review process and provide helpful tips.
Why should I engage in peer review?
When you peer review, you are participating in an important gatekeeping role. Bad science can prompt clinicians to make bad decisions that hurt people, reduce trust in science and healthcare professionals, and waste precious time and money. While there are issues with the peer review process (e.g., lack of reviewer compensation, inconsistencies in critiques, mismatches in expertise, incomplete blinding, bias), the endeavor is still a worthy one. Peer reviewing has even improved the quality of my own writing. Additionally, discovering that everyone makes mistakes is a potent weapon against imposter syndrome.
What are some tips for performing peer review?
Practically, I begin peer review with a quick read of the entire manuscript to formulate an initial overall impression. Then, the real work begins. If I need education or a refresher on a topic for my review, I’ll read a recent review article or crack open a textbook. I obtain full-text copies of references, especially if I encounter claims I’m unsure about. A spot-check often suffices; however, evidence of unsubstantiated claims or misquoting warrants additional scrutiny throughout. It helps to set aside more time than you think you’ll need to peer review, especially early in your career.
Next, I formulate my response. Think of your first paragraph as the abstract of your peer review. Begin by thanking the editor for the opportunity to review the manuscript. This is followed by a summary of the article, your decision, and rationale. The body of your review should be organized by article section with comments in the format of “line(s) [##]. [text]”. However, I also like to use “general comment [#]” under each section to address big picture concepts.
Journals ask peer reviewers to recommend a manuscript disposition using one of the following categories: accept, major revisions, minor revisions, or reject. Accept should rarely—if ever—be invoked on the first round of peer review. Major revisions allow authors to respond to reviewer comments and resubmit. Minor revisions reflect changes that do not need further peer review. As a new peer reviewer, don’t fear rejecting an article. Rejection can be useful when a manuscript’s problems are too great to be solved by major revisions, like when additional data should be collected or most of the manuscript needs rewriting. In addition to the four categories above, some journals (like the Mental Health Clinician) ask for a numerical rating. Akin to the Axis V Global Assessment of Functioning, this rating is subjective and relies upon your judgement, so just try to be consistent.
It is important to consider the role of a peer reviewer as you provide comments. A good critique will ensure that the introduction provides sufficient context, the methods are understandable, valid, and replicable, the results are completely and clearly presented, and the discussion provides a reasonable commentary on the findings. It is sensible to double-check percentages and sums in tables. However, you are not a copyeditor; it is not necessary to correct spelling or grammar, as this is part of the journal staff’s final review. Limit comments about word choice to those that critically impact your understanding (e.g., clarifying whether the authors meant to say “akathisia” instead of “akinesia”) or are strongly warranted (e.g., encouraging use of person-first language). Consider journal fit and audience. Do the authors use jargon that your colleagues may not be familiar with? Is the article interesting? When providing constructive criticism, don’t just tear the work down—help the authors build it back up again through actionable comments. For example, rather than merely point out that you think a claim should be cited, find an appropriate article to support it.
Given the widespread availability of large language models, it is worth commenting that you should not run manuscripts through LLMs without permission. Unpublished scientific manuscripts are confidential and should not be shared with uninvolved parties. Companies generally retain user data when submitting prompts to LLMs, raising ethical concerns—especially for data involving patients and vulnerable populations. When in doubt, ask the editor if your intended LLM use case is acceptable and how it should be disclosed.
Who should engage in peer review?
Peer reviewing is not just for senior clinicians and academics (although experience does help). Board Certified Psychiatric Pharmacists are generally qualified to review articles related to psychiatric pharmacotherapy. However, it is important to recognize your limits: do not agree to review manuscripts outside your expertise. That doesn’t mean that you need to be an expert on every single aspect of the work, but you should be able to offer substantive comments, especially regarding most of the methods. When in doubt, be clear in your peer review about what you don’t know or cannot verify. For example, if you don’t understand the authors’ choice of statistical test, acknowledge that in your review. This can be done in the confidential comments to the editor at the end of your peer review and lets editors know when additional peer review may be necessary.
For preceptors, consider bringing students into the process. A peer review can be an excellent learning opportunity for pharmacy students and residents. You can discuss your style and approach to peer reviewing and explore the nuances of manuscript dispositions.
Concluding remarks
In closing, I will leave you with a couple parting thoughts:
- Be open to changing your mind. Be receptive when reading an authors’ rebuttal, comments from an editor, or another peer reviewer. Being willing to change one’s mind is critical to one’s integrity as a scientist.
- Assume good faith—be kind to your colleagues. To err is human. Most mistakes can be chalked up to human error or inexperience. Treat your colleagues how you would want to be treated. Remember that your vocal tone and facial expressions are not communicated in writing, so criticism may come off harsher than intended. Don’t forget to let the authors know what they did well in their paper too.
Happy reviewing!