#ACGME2021 Session Summaries: JGME Unravels the Mysteries of the Manuscript Review and Editorial Process

You’ve written your manuscript. You’ve edited, proofed, and reread it. Now here you are, on the submission page of a medical education journal, ready to click “submit.” Your paper is about to disappear into a mysterious process you hope will lead to peer review and ultimately acceptance and publication. Exactly what does that process entail, and what can you do before clicking the submit button to increase your odds of success? And how can understanding this process help you deal with the inevitable rejections or difficult revisions that you are likely to encounter as you aim to publish a paper? These are the questions that the editors of the Journal of Graduate Medical Education (JGME) sought to answer in their 2021 ACGME Annual Educational Conference session, Explaining the Mysteries of the Manuscript Review and Editorial Process.

The panel included JGME Editor-in-Chief Gail Sullivan, MD, MPH, Executive Editor Nicole Deiorio, MD, and Deputy Editors Anthony R. Artino Jr., PhD, Deborah Simpson, PhD, and Lalena Yarris, MD, MCR.

The session followed a fictional submission entitled, “A preparatory course improves total scores on the WCAT (Wizard College Entrance Test)” by A. Dumbledore, S. Snape, and A. Moody, on its way from submission to acceptance, along with the potential pitfalls.

Triage
The first phase of a manuscript’s journey through the process is what the JGME editors called “triage.” At this stage, a number of well-written papers may be rejected simply because they do not fit JGME’s mission and focus. Papers about medical school or medicine in general, for example, are rejected early in the process, because of JGME’s focus on residents and fellows and the environments in which they learn. For this reason, the JGME editors stressed the importance of finding the right journal for your submission. Do some research and read the author instructions on multiple journal websites. Doing so will save time and raise the odds of your paper finding the right home.

The editors also stressed that, at the triage stage, a number factors over which an author has no control could play into a rejection. Did the journal just publish, or will it soon publish, something very similar? Is the topic currently a hot one? How much space is left in the issue? In the past year, the number of submissions to JGME and other journals have also gone up considerably, so many excellent papers unfortunately cannot be considered.

A paper may also be rejected during triage because of quality concerns. Here, again, you can hedge your bets by carefully reading the JGME instructions for authors. These instructions, for example, include a link to a podcast interview with Dr. Sullivan that can help authors avoid many common mistakes.

Peer Review
If your paper makes it past triage, then it’s on to peer review. JGME has a large database of volunteer peer reviewers who are matched with submissions, usually based on areas of expertise. The handling editor is responsible for finding the best reviewers and adjudicating the reviewer comments and recommended decisions before passing them on to the author. Professor Dumbledore and his wizard co-authors were fortunate enough to move onto this stage with their paper.

After the reviews come in and the editors confer, a paper will come back to the author with one of the following decisions: Major Revision; Minor Revision; Accept; or Reject. A Major Revision is not a commitment to publish, but it could be good news if significant issues are addressed. A Minor Revision is closer to acceptance, pending a small number of edits. Acceptance with no revisions is rare at this point, but possible.

Dealing with Disappointment
During the session, JGME editors addressed how authors can deal with the dreaded Reject decision. Dr. Simpson likes to compare the typical author reaction to stages of grief: Anger (“Who were these reviewers anyway?”); Denial (“There must be some mistake.”); Bargaining (“I’ll just write a letter to the Editor-in-Chief.”); Depression (“Why bother?”); and Acceptance (“Okay…My goal now is to make my submissions better.”).

Even a Major Revision can elicit a grief response as an author grapples with making cuts and rewriting entire sections of their work. The editors presented several challenging real-life examples of troubling reviewer comments, along with some brilliant role-play. While JGME strives to make sure reviewers’ comments are helpful and respectful before authors see them, some legitimately frustrating ones can slip through at any journal. Some examples included: vague feedback (“The authors need to revise their introduction considerably.”); scope creep (“Could the authors broaden their discussion to include…?”); and contradiction (Reviewer 1: “The discussion is too short for this important topic.” versus Reviewer 2: “The discussion is too long ...”).

Dr. Simpson wonderfully played the role of the author stuck in the Anger and Denial phases, lashing out and showing us all what NOT to say. Dr. Deiorio played the opposite, demonstrating the more mature response of an author who has moved into Acceptance. She explained how, if needed, an author could respectfully ask for more clarification, even politely explaining a rationale for not being able to incorporate a reviewer’s comments. Respectful and clear communication is always helpful if you have questions. Asking for an extension, for example, is always better than going quiet and avoiding the deadline.

2020 Best Papers
JGME presented a second session with the return of its popular JGME Editors’ Hot Picks: Best Medical Education Papers from 2020, in which the editors presented their choices of non-JGME papers with the potential to change GME practices, and then discussed how each paper moved the field forward. These papers generated quite a bit of Twitter discussion under the hashtag #ACGME2021.

The JGME editors’ top papers were:

• Performance Assessment: Consensus Statement and Recommendations From the 2020 Ottawa Conference Boursicot K, Kemp S, Wikinson T, et al. Medical Teacher
• Reconsidering Systems-Based Practice: Advancing Structural Competency, Health Equity, & Social Responsibility in GME Castillo EG, Isom J, DeBonis KL, Jordan A, Braslow JT, Rohrbaugh R. Academic Medicine.
• National Mixed Methods Evaluation of Preparedness for General Surgery Residency & Association with Resident Burnout Englehardt KE, Bilimoria KY, Johnson JK, et al. JAMA Surgery
• Beyond Summative Decision-making: Illuminating the Broader Roles of Competence Committees  Pack R, Lingard L, Watling C, Cristancho S. Medical Education

The sessions from JGME at the ACGME Annual Educational Conference are always popular with potential authors, but they’re also a hit with anyone who has an interest in academic publishing or the currently happenings in GME. While we missed seeing attendees in person, the virtual format worked well, and the chat was lively throughout both sessions. Both of these sessions can still be viewed on demand, with conference registration available through June 1, 2021. Will Professor Dumbledore’s paper make it to acceptance? You may have to come to the 2022 Annual Educational Conference to find out!