From Journal Selection to Manuscript Review

Ochner and Mineo. HCA Healthcare Journal of Medicine (2020) 1:1 https://doi.org/10.36518/2689-0216.1023

Education

A Brief Tutorial on Manuscript Preparation: From Journal Selection to Manuscript Review

1,2 1,2 Christopher N. Ochner, PhD, Jocelyn Mineo Author affiliations are listed at the end of this article. Abstract Correspondence to: Description Dr. Christopher Ochner This article is designed to introduce the novice researcher to the process of journal selection, 450 East Las Olas Blvd, manuscript submission and manuscript review. PubMed indexing, journal readership, scope, Suite 1100 focus, impact factor, fees and acceptable manuscript types are discussed in the first section. The remainder of this article focuses on manuscript preparation, submission and review, Fort Lauderdale, FL 33301 including formatting, pre-submission inquiry, submission portals, and the manuscript review (Christopher.Ochner@ process. Specific recommendations are provided to assist the reader in navigating these hcahealthcare.com) stages.

Keywords publication; GME; manuscript; journal selection; scholarly communication; journal impact factor Introduction as well as a collection of techniques of which Several factors need to be taken into consider- more experienced authors may also be able to ation when attempting to bring a manuscript take advantage. from preparation to publication in a reputable academic journal. For authors unfamiliar with Journal Selection this process, it may seem daunting. This article Journal selection is discussed prior to man- is designed to familiarize the reader with the uscript preparation in this article, as these journal selection, manuscript submission and authors recommend identifying several appro- manuscript review processes. Although writ- priate journals to which the manuscript may be ten primarily for inexperienced authors, some submitted prior to completing the manuscript. suggestions offered in this article may help This is for two main reasons, both stemming even seasoned authors maximize the proba- from the strong recommendation to conduct bility of manuscript acceptance. With regard what is called a “presubmission inquiry” (dis- to journal selection, PubMed indexing, journal cussed in the second half of this manuscript) readership, scope, focus, impact factor, fees prior to submitting an article for publication. and acceptable manuscript types are discussed. First, it will be easier and faster to format the The remainder of this article focuses on man- manuscript for the journal to which it is to be uscript preparation, submission and review. In submitted prior to completion. Second, the Ed- this latter section, formatting, presubmission itor-in-Chief of a target journal may be inter- inquiry, submission portals and the manuscript ested in an article but ask the author to pivot review process are discussed in detail. Specific and make changes to the article, which is easier recommendations are provided to assist the to do prior to completion. A number of rele- reader in navigating these stages and consider- vant factors should be taken into consideration ing factors relevant to each. This article should when gathering a short list of journals to which serve as a guide for new authors and those to potentially submit a manuscript, discussed with relatively little authorship experience, below.

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PubMed indexing peal, authors are likely better off submitting to The first, and potentially most important, a targeted journal focused on the area related factor discussed is that of PubMed indexing. In to the content of the article. 1996, the National Library of Medicine estab- lished the PubMed Index system.1 With the Journal focus exception of new journals that have not yet Journals often prefer to publish manuscripts had the opportunity to earn PubMed indexing, that are either more clinically oriented or more authors should look to publish in journals that research oriented. Most journals will not state are indexed on PubMed, as this is a quick litmus this overtly, but authors can determine the test of journal legitimacy. Journals indexed on journal focus (clinical practice vs. research) by PubMed can generally be considered to be rep- looking at the types of articles accepted and utable, peer-reviewed academic journals and the titles of articles recently published. If only journals not indexed on PubMed can generally review and original research articles are ac- be considered to be less reputable and/or non- cepted and recently published articles are more peer reviewed, again, with the exception of new academic in nature, with heavy emphasis on 2 journals that are yet to be indexed. Although precise methodology and statistics, the journal far from a perfect indicator due to a number likely has a research focus. The Editor-in-Chief of exceptions, the vast majority of reputable, of these journals will likely have a PhD as op- peer-reviewed journals are indexed on PubMed posed to an MD or DO degree. If the journal and very few (if any) illegitimate or non-peer accepts case reports and most of the articles reviewed journals are indexed on PubMed. appear to be relevant to clinical practice, the PubMed indexing is, in fact, so important that journal likely has more of a clinical orienta- the Accreditation Council on Graduate Med- tion. The Editor-in-Chief of these journals will ical Education considers PubMed-indexed likely have an MD or DO, as opposed to a PhD publications to be one of the highest forms of degree. Overall, journals with a clinical orienta- scholarly activity achievable, it considers non- tion are more accepting of, and more likely to PubMed-index publications to be on par with publish, articles relevant to clinical practice. poster presentations. PubMed indexing can be checked by going to PubMed and searching Journal scope the name of the journal. If articles from that Every journal website lists the scope of that journal appear on PubMed, the journal is likely journal, which informs potential authors about PubMed indexed. the range of topics that journal thinks would be of interest to its readership and is willing General readership vs. targeted to publish. In order to increase the chances of audience publication, a manuscript should only be sub- General readership journals cover an extensive mitted to a journal if it fits within the scope array of topics and appeal to a broad audience. of the journal. If a manuscript falls outside the For example, journals such as Nature and Sci- stated scope of a particular journal, it is better ence could potentially contain articles covering submitted to a more appropriate journal, as any aspect of nature or science. Similarly, their journals very rarely make exceptions in accept- readership could be anyone interested in nature ing manuscripts with topics that fall outside or science, a very general readership. Converse- their stated scope. ly, targeted journals typically publish articles relevant only to a particular specialty or sub- Types of manuscripts accepted specialty. The Journal of Cardiovascular Mag- Journals only accept particular types of arti- netic Resonance, for example, is clearly a more cles, which will be listed on the journal’s web- esoteric journal, which publishes articles relat- site, typically in the author guidelines. Some ing only to this specialty and is likely read only journals will accept brief reports, or short by individuals with some interest in this partic- reports, which are similar to original research ular specialty. There are exceptions, but general manuscripts, but brief reports have strict readership journals tend to be more selective length limits. This type of manuscript is suit- in accepting manuscripts for publication. Thus, able for preliminary studies and small-scale unless an article has very clear broad-based ap- research. Less than 50% of journals accept

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case reports, and even fewer journals accept uscript is rare. If encountered, authors should mini-reviews. If an author is writing a case re- consider removing that journal from their list port or mini-review manuscript, they may have of candidate journals. An increasing number of to spend some time finding the relatively few legitimate journals are charging a publication journals that are relevant to the topic they are fee, but there are also less reputable “open writing about and accept the type of manu- access” journals that charge $1500 to $3000 or script they are composing. more to publish articles. These journals, known as “predatory journals,”5 are rarely indexed Impact factor on PubMed and should generally be avoided. The impact factor of a journal describes its It should be noted that not all open access overall influence. Technically, it is calculated by journals are predatory journals, as there are an algorithm that assesses how many times a number of reputable and PubMed-indexed, articles published in that journal are cited by open access journals (e.g., PLOS Medicine); articles published in other PubMed indexed however, nearly all predatory journals are open journals.3 As the name implies, the impact access journals. factor serves as a marker of how large of an impact the articles published in a particular Manuscript Preparation, Submis- journal have on its content area but can also be thought of as an indicator of the breadth sion and Review of a journal’s reach. Impact factor ranges The manuscript preparation, submission and from 0.1 for journals that are less reputable review process can be intimidating for inexperienced authors. This section reviews and pro- up to around 80 for the New England Journal vides essential tips to navigate this process in a of Medicine. There are a considerable number of journals with impact factors below 3.0 and way that maximizes the chance of manuscript relatively few journals with an impact factor publication. Primarily because it is a challenging 10.0 or higher.4 The higher the impact factor, and time-consuming process, publication in the more selective the journal, and the low- PubMed-indexed journals is considered one of er the likelihood of a submitted manuscript the highest forms of scholarly activity a resi- being published. The perceived impact of the dent, fellow or graduate medical education fac- manuscript should be commensurate with the ulty member can achieve, and it is particularly impact factor of the journal to which an author important for residents seeking fellowship. submits their manuscript. In the experience of these authors, the majority of case reports and Manuscript preparation articles describing smaller research or quality The first step in preparing a manuscript for improvement projects are published in journals submission is to read the author instructions with impact factors below 3.0 (usually 0.5 to for the journal to which the author plans to 2.0). In the opinion of these authors, it is better submit and follow the instructions exactly. to have several publications in lower impact Most journal websites will have a page that journals than it is to have one publication in a includes the journal’s preferred style for cita- higher-impact journal, so manuscripts should tions and references, and limits on the number be submitted to the highest quality journal of pages, words, references, tables and figures. that the authors believe is very likely to publish The manuscript should be set up in the appro- the manuscript. If a journal does not have an priate order, which is as follows: (1) title page, impact factor, authors should check to confirm (2) abstract, (3) body, (4) references, (5) tables, the journal is indexed on PubMed or if the jour- (6) figures and (7) appendices. Tables and fig- nal is new before deciding to submit to that ures should be located after the references, not particular journal. New journals will not have embedded in the text. an impact factor because it takes up to three years to calculate. To begin manuscript preparation, experienced authors often create an outline, which sum- Submission and/or publication fees marizes the information to be included in each Journals charging a submission fee for a man- section of the manuscript. The outline serves as a tool in assisting authors to adhere to the

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conventions of academic manuscripts, which Manuscript Submission are to include all relevant detail but no excess Most journal websites will have a link to the information or colloquialisms.6 This uniformity manuscript submission portal. Authors typical- allows readers to derive sought-after informa- ly have to register for an account if they have tion from the manuscript in minimal time. never submitted a manuscript to that journal before. Once registered, the system should Presubmission inquiry provide step-by-step instructions for the Authors can only submit a manuscript to one submission process, which should be followed journal at a time, however, it is possible to exactly. gauge interest in a manuscript from multiple journals at once by submitting several pre- Authors are often asked to upload the cover submission inquiries. A presubmission inquiry letter, manuscript body, tables and figures as allows authors to contact editors to inquire separate files. The cover letter is sometimes whether they may be interested in their article, optional, but it is recommend to submit a brief since it is the editors that ultimately decide cover letter with the following regardless of which articles to publish. Editors do not always whether it is required: respond but, when they do, it is a useful tool to get feedback from multiple journals simulta- Dear Dr. [NAME OF EDITOR], neously regardless of whether the response is We are pleased to submit this [TYPE OF MAN- positive or negative. USCRIPT] for publication in [JOURNAL NAME]. This manuscript represents original work, and Using their short list of appropriate journals, all authors have approved the final version for authors should search the website of each jour- submission. None of the authors have anything nal to find information about the editorial team to disclose [IF THIS IS TRUE, OTHERWISE and locate the name of the Editor-in-Chief. DESCRIBE ANY POTENTIAL CONFLICTS OF Their email address might be listed, but au- INTEREST]. The presented manuscript has not thors may have to search the web to find a been previously published and is not under con- recent publication of theirs on PubMed. If the sideration anywhere else. Please let me know if Editor-in-Chief is listed as the corresponding there are any questions concerning this manu- author, their email address will be listed. Au- script. thors can then send a brief message with the Sincerely, abstract of their manuscript, which reads as follows: Some experienced authors also suggest volun- tarily including the names and emails for sug- Dear Dr. [NAME OF EDITOR-IN-CHIEF], gested reviewers and/or any reviewers that the I apologize for the unsolicited email, but my authors feel should be avoided (e.g., someone colleagues and I are working on a manuscript known to have a rivaling opinion). In some rare about [TOPIC] that we thought might be of instances, journals mandate reviewer sugges- interest to your readership. The abstract is be- tions. In this circumstance, that information low. Would you please let me know if you would will typically be entered into the submission be interested in having this article reviewed for system itself but may be included in the cover possible publication in [JOURNAL NAME]? letter. If authors are unsure of how to identify Your feedback is greatly appreciated. appropriate experts in the area for their article, Sincerely, they should look at the names of the authors cited in the Introduction of the article. A positive response would be if the editor indicates that the manuscript may be appro- The manuscript body usually contains the title priate for their readership and encourages page, abstract, body and references together in submission. Negative responses are also useful that order. Some journals want tables included because authors do not lose time submitting to at the end of the manuscript file, while others one journal and waiting for a response before prefer them to be uploaded separately. Simi- submitting to another journal. larly, some journals want figure captions included with the manuscript file, while others want them included in a separate file. Discrepancies

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among formatting preferences is the reason it teria and has passed the editorial review stage, is imperative to review the author instructions it will be sent out for external review. carefully. External review involves the solicitation of rec- ognized experts on the subject matter of the Manuscript Review Process submitted article, which are usually researchers Following submission, manuscripts are as- who have many publications on the topic of the signed an editor. All journals have a certain submitted manuscript. These may be experts number of editors and usually only one edi- who published articles cited in the introduction tor-in-chief. Each article will be assigned to an of the submitted manuscript. These experts editor, who manages the review and decision will be invited to review the article, offer feed- process. This editor will typically ask an asso- back and make a recommendation to the editor ciate, or junior editor, to do an internal review about whether the journal should publish the of the manuscript to confirm the following: (1) article (Figure 1). Most manuscripts sent for ex- the manuscript is a type of article the journal ternal review will be reviewed by two or three accepts; (2) the topic falls within the scope reviewers, but that number can range from of the journal and would be of interest to the one to five. The editorial team will take about journal readership; (3) the overall quality of the two to three weeks to identify the appropriate manuscript and potential impact of the results experts, invite them to review the manuscript are high. and receive a response, though this timeline can vary dramatically. These external reviewers If the article does not meet one of these crite- will take an additional three to four weeks to ria, it is likely to be rejected right away, which is offer a recommendation on the manuscript. referred to as an “editorial reject.” If the article Again, however, the time required for this can receives an editorial reject, authors will typically vary substantially. The external reviewers will be notified within about two weeks of sub- provide specific criticisms of the manuscript 7 mission. If authors do not receive a response and provide one of the following recommenda- from the journal for more than three weeks, tions to the editor about the disposition of the their manuscript has likely passed the editorial article: review stage. If the article meets the above cri-

Figure 1. The Manuscript Review Process External reviewers will write out specific criticisms of the manuscript and provide recommendations to the editor about the disposition of the article.

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• Reject without opportunity to revise: If au- residents applying for fellowship. The best way thors receive this, they should submit their to ensure the manuscript gets published is to manuscript to the next journal on their thoroughly address all reviewer comments and short list. submit a revised manuscript with a separate • Reject with minor revisions: This is also list of each reviewer criticism and the authors’ known as “revise and resubmit,” which indi- response to each of them. It is not uncommon cates that there were minor criticisms that to disagree with particular comments and/or need to be addressed. The reviewers do not reviewer perspectives. In these instances, it is believe the manuscript should be accepted vital to address the reviewer in a professional in its current form, but the authors should manner and either adhere to the request or be given the opportunity to address the detail why you disagree and substantiate your minor criticisms. position with evidence (i.e., references). Note, • Reject with major revisions: This is similar however, that most experts suggest adher- to “reject with minor revisions,” but the ing to most reviewer suggestions unless the criticisms are major and must be complete- authors feel the change would substantively re- ly addressed for the reviewers to recom- duce the accuracy or impact of the manuscript. mend acceptance. • Accept with minor revisions: This is less The revised manuscript and list of responses to common, but it is still used occasionally. criticisms will be sent back out to the review- This recommendation indicates that the ers, almost always the same reviewers that authors need to make only a few very minor provided the initial feedback. They will evaluate changes for the reviewers to deem it ready whether the authors adequately addressed all for publication. criticisms and make a recommendation to the • Accept with no revisions: This means that editor about whether the article should be ac- the journal is accepting the manuscript cepted for publication. If the authors have done exactly as submitted, which is rare. well in addressing reviewer criticisms, most of the time the article will be accepted. Howev- Ultimately, the editor makes the final decision er, it is possible that further revisions may be about the disposition of the manuscript, but requested or that the manuscript is rejected they will follow the recommendations of the without the opportunity to revise again. If external reviewers the vast majority of the more revisions are required, the same process time. They may use their own discretion when and disposition options repeat until the manu- reviewers make different recommendations script reaches one of the two terminal disposi- about the article. This is not uncommon, and tions (i.e., reject without opportunity to revise a third reviewer will often be asked to offer an or accept without revisions). opinion if there were only two external reviewers initially. Note that most reviews are single-blind, mean- ing that the identity of the reviewers will not If authors receive a reject with the opportunity be revealed to the authors, but the authors’ to revise and resubmit their manuscript, they identities will be revealed to the reviewers. will generally want to take that opportunity. However, some journals practice double-blind Only in very rare instances where a reviewer review, where neither the authors nor review- wants a major revision, such as redoing all of ers will know the identity of the other party. the analyses or rewriting the entire manuscript, For double-blind reviews, authors will likely be would it be worth starting the submission asked to submit a version of the manuscript process over with a different journal. Although that does not contain their names. There are they are similar, receiving an ‘accept with minor even a few journals that do not blind the names revisions’ is different from receiving a ‘reject of the authors or reviewers. with minor revisions.’ If an author receives an ‘accept with minor revisions,’ the publication For articles sent for external review, this entire can be added to their curriculum vitae (or resi- process can take from one to nine months, with dency/fellowship application) with the disposi- an average of three to four months, including tion of “accepted,” which can make a difference time for review and revision.7 For this reason, for medical students applying for residency and some authors become frustrated with this

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process and many high-quality manuscripts of reviewers. As long as revisions address all become “orphaned,” even when they may have reviewer criticisms, the vast majority of “revise been quite close to acceptance for publication. and resubmit” articles wind up being accepted For all, but especially new authors, we stress and published. Overall, the process is generally patience and perseverance through this pro- lengthy and can be trying at times, but publica- cess. The rewards of publication can be great tion in a PubMed-indexed journal is considered and many. one of the highest forms of scholarly activity, and can be highly rewarding for those willing to Conclusion put in the time and effort. Although it typically requires years of experience, and much trial and error, to truly be- Conflicts of Interest come an expert in the process of manuscript The authors declare they have no conflicts of publication, the techniques described in this interest. article should demystify the process for novice authors and provide some additional in- Dr. Christopher Ochner and Jocelyn Mineo are sight for more seasoned authors. In preparing employees of HCA Physician Services Group, a a manuscript for publication, remember to company affiliated with the journal’s publisher. include all important and relevant detail, but no unnecessary wording. Avoid colloquialisms This research was supported (in whole or in and imprecise language. The writing should be part) by HCA Healthcare and/or an specific and purposeful, adhering to all relevant HCA Healthcare affiliated entity. The views conventions for scientific publication. Make expressed in this publication represent those of sure that anything not considered axiom, or the author(s) and do not necessarily represent general knowledge, is properly cited and refer- the official views of HCA Healthcare or any of enced. Software, such as EndNote, Microsoft its affiliated entities. Word, Zotero and Paperpile may be helpful in formatting references. After completing Author Affiliations a compelling abstract, create a short list of 1. HCA Healthcare: East Florida Division GME, appropriate journals and solicit editor feedback Ft. Lauderdale, FL on the abstract from each one. Upon choosing 2. HCA Physician Services Group, East Florida the first (and hopefully only) journal to which Division, Ft. Lauderdale, FL to submit a manuscript, follow the instructions for authors on the journal’s website precisely. Many reviewers consider imprecision in format- References 1. Canese K, Weis S. PubMed: The Bibliographic ting, grammar and spelling in a manuscript as a Database. The NCBI Handbook [Internet]. 2nd reflection of imprecision in the way the project edition. https://www.ncbi.nlm.nih.gov/books/ was conducted and the manuscript written. NBK153385/. Published March 20, 2013. Accessed Remember, the peers (experts) who review December 12, 2019. articles only make suggestions about whether 2. Manca A, Moher D, Cugusi L, Dvir Z, Deriu F. the article should be published to the editor How predatory journals leak into PubMed. assigned to that article, who makes the ulti- CMAJ. 2018;190(35):E1042–E1045. https://doi. mate decision. Except in very rare circumstanc- org/10.1503/cmaj.180154 3. Alberts B. Impact factor distortions. Science. es where the authors feel they would be unable 2013;340(6134):787. https://doi.org/10.1126/sci- to adequately address reviewer criticisms, an ence.1240319 article that is rejected with the opportunity 4. Leydesdorff L. Alternatives to the journal im- to revise (i.e., reject with minor or major revi- pact factor: I3 and the top-10% (or top-25%?) sions) should be carefully revised according to of the most-highly cited papers. Scientometrics. reviewer instruction and resubmitted within a 2012; 92(2):355–365. https://doi.org/10.1007/ month (or sooner if specified by the journal). s11192-012-0660-6 Revised manuscripts that are not resubmitted 5. Beall J. Predatory publishers are corrupting open in a timely manner may be treated as a new access. Nature. 2012;489(7415):179. https://doi. org/10.1038/489179a submission and sent to different reviewers who 6. Bhargava P. The KISS Principle in Academic may look at it less favorably than the first set Writing. Curr Probl Diagn Radiol. 2015;44(6):473.

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https://doi.org/10.1067/j.cpradiol.2015.08.005 7. Huisman J, Smits J. Duration and quality of the peer review process: the author’s perspective. Scientometrics. 2017;113(1):633–650. https://doi. org/10.1007/s11192-017-2310-5