Demystifying the Peer Review Process

In this three-part series, we will demystify the peer review process, provide tips on how to increase your chances of success following a “revise and resubmit,” and explain how to prepare a constructive peer report.

The peer review process is a universal source of anxiety and frustration for all scholars, from students to tenured professors. Conflicting reviews, reviewers who seem to be reviewing a completely different manuscript, and editors who take eternity to reach a decision can all be a huge source of frustration.

But what really happens behind the scenes? And how can you navigate this process? In this three-part series, we will demystify the peer review process, provide tips on how to increase your chances of success following a “revise and resubmit,” and explain how to prepare a constructive peer report.

What Is Peer Review?

Peer review is the process of subjecting a manuscript to the scrutiny of experts in the field (ie, peers) prior to making a determination about the suitability of the work for publication. Depending on the topic of the work, the editor of the journal, and the policies of the journal, a manuscript will be reviewed by two or more content or methodological experts in two or more rounds of review and revision.

The Peer Review Process Explained in Two Simple Flowcharts

To demystify the peer review process, we broke it down into two flowcharts.

Preliminary Editorial Determination

Authors submit the manuscript to the editorial office; most journals now use an editorial management system. An editorial production assistant (either a human being or artificial intelligence) may do a quality control check to ensure the article is properly formatted and contains all required elements. The manuscript may be sent back to authors at this stage for revision and resubmission.

After the manuscript passes that initial check, an editor is assigned (hereafter, “managing editor”). Large journals may have a hierarchical structure with an Editor-in-Chief and multiple associate or section editors who work as part of a team. For JPHMP, articles are reviewed by either the Editor or Associate Editor. Special issues such as JPHMP’s recent supplements on HRSA’s Investment in Public Health Training Centers and Transformation and Innovations in Public Health may have guest editors. The managing editor does a preliminary review to determine whether to send the manuscript out for peer review. Manuscripts might be rejected at this stage for a variety of reasons: poor fit with the journal, not a topic that is a current editorial priority (eg, findings are not novel), or based on the managing editor’s determination that the quality is insufficient to be successful in the peer review process.

If the manuscript passes the initial editorial review, it will go out to peer reviewers. The exact number of reviewers depends on the journal, but typically it is 2 to 4. In seeking peer reviewers, the editor will rely on the journal’s database of peer reviewers to locate reviewers who have expertise in the area and can comment on the substance and scientific approach.

Initial Peer Review

Peer reviewers are invited to review the article. Upon accepting the invitation, they receive access to the draft in the editorial management system. After reading the draft, they write a peer review report and provide a recommendation to the editor about the publication priority.

Peer reviewers submit their peer review reports and recommendations through the editorial management system. Typically, reviewers will be asked to submit their peer review reports and provide a recommendation (eg, “accept without revisions,” “minor revisions,” “major revisions,” and “reject”). Journals may also ask reviewers to provide a numeric score on different aspects of article quality. JPHMP asks reviewers to answer questions about the publication priority, JPHMP audience appeal, whether data support the thesis, whether the article is important to the field, and whether the article is too long and should be shortened. In addition to the peer review report, which will be sent to authors, reviewers can submit confidential comments to the editor that will not be shared with authors.

The managing editor will review the peer review reports and confidential comments. If the peer review reports diverge or a peer review report is not usable (eg, there is insufficient amount of detail), the editor may seek out another external reviewer. Some journals have an interim step where managing editors have an internal meeting to discuss articles before assigning final decisions.

The managing editor’s decision is then sent to authors along with a copy of the peer review reports. In very rare cases, a manuscript will be accepted as is. More typically, an article will receive a determination of “minor revise and resubmit,” “major revise and resubmit,” or “reject.” For all decisions, authors will receive the peer review reports. For articles that receive a “revise and resubmit” determination, the editor may occasionally provide comments such as additional points to address, emphasizing the most critical issues, or offering guidance in situations where peer reviewers have conflicting feedback.

For most journals, the peer reviewers will also receive a copy of the final determination including the complete set of peer reviewer reports. (Tip: Being a peer reviewer is a great way to learn about common critiques from reviewers and how to improve your manuscripts!)

Revisions and Subsequent Editorial or Peer Reviews

Authors receiving a “revise and resubmit” will have a certain time window to update their manuscript following the reviewers’ feedback. The revision entails preparing an updated manuscript and a detailed response memo that explains how each requested revision was addressed.

Upon receiving the authors’ revision, the managing editor reviews the materials to assess whether the authors were sufficiently responsive to the reviewers’ concerns. If additional revisions are needed, the manuscript will receive another “revise and resubmit” determination with a list of additional feedback to address. If the manuscript revisions were satisfactory, the final decision will be “accept” and the article will be moved into production.

The article might go back to the peer reviewers at this stage, particularly if the initial determination was a “major revise and resubmit.” If the article goes back to peer reviewers, they receive another invitation to review and will be able to access the revised manuscript and response memo in the editorial management system. They will conduct another review, focusing on whether the article has addressed past issues raised. However, peer reviewers might also raise new concerns. Their peer review reports are transmitted back to the managing editor and… rinse and repeat!

In many cases, authors who are attentive to the reviewers’ comments can expect their article to be accepted after 1 or 2 rounds of revisions. However, an article can be rejected in the “revise and resubmit” stage if authors did not make sufficient revisions or reviewers identify additional major concerns in subsequent reviews.

Wrapping Up

In today’s post, we tried to break down the peer review process. In our next post, we will explain expectations for the manuscript revisions and response memo, and some tips to improve your chances of article acceptance following a “revise and resubmit.” We will finish this series with a post on how to prepare a constructive peer review – and how becoming a peer reviewer can improve your own writing.


Erika Martin, PhD, MPH, is Professor and PhD Director at Rockefeller College of Public Affairs and Policy, University at Albany-SUNY. As an applied health policy researcher, she uses mixed methods to evaluate issues related to the allocation of scarce public health resources, the adoption and impact of public health policies, with a focus on domestic HIV and related syndemics. She also studies ways to improve the sustainability and impact of open data platforms. Articles she’s written have appeared in an array of leading health and public policy journals such as the New England Journal of MedicineJournal of the American Medical AssociationHealth AffairsAmerican Journal of Public HealthPublic Administration Review, and Journal of Policy Analysis and Management.

Justin B. Moore, PhD, MS, FACSM is an Associate Professor in the Department of Implementation Science in the Division of Public Health Sciences at the Wake Forest School of Medicine in Winston-Salem, NC, USA. He holds joint appointments in the departments of Family & Community Medicine and Epidemiology & Prevention. Dr. Moore also serves as the Director of the Implementation Science Affinity Group within the Clinical and Translational Science Institute at Wake Forest University. He conducts community-engaged research focused on the dissemination and implementation of evidence-based strategies for the promotion of healthy behaviors in underserved populations. He also conducts epidemiological research examining the determinants of health behaviors and related comorbidities across the lifespan. He serves as the Associate Editor of the Journal of Public Health Management and Practice as an Associate Editor-in-Chief for the Translational Journal of the American College of Sports Medicine. He previously served at the chair of the editorial board of the American Journal of Public Health. Full bio