Guidance for BMJ patient reviewers

Patient peer review at The BMJ

If you’re a patient living with disease, a carer of a patient, a patient advocate acting on behalf of a patient group, or you play a leading part in advocating for patient participation and partnership in healthcare we’d like to invite you to take part in a unique initiative. The BMJ has committed to improving the relevance and patient centredness of its research, education, analysis, and editorial articles by asking patients to comment on them. We need your help to make these changes.

If you already review for The BMJ as a researcher or clinician, but you are also interested in reviewing as a patient or patient advocate, you can do this too. We will, however, need you to register a new additional account with a different personal email address, using the guidance below so that we can distinguish your role as a patient reviewer versus a traditional peer reviewer.

Patient peer review is a new initiative for The BMJ. We are taking the lead here and hope other publishers will follow. We apologise in advance if our systems seem impersonal or are not yet ideally tailored for patient reviewers. If you have suggestions for how we could do this better, please contact Tessa Richards, The BMJ’s patient partnership editor (trichards@bmj.com), or Rosamund Snow, our patient editor (rsnow@bmj.com). We hope to improve things with your feedback and support.

About peer review
When medical researchers or clinicians complete their study they write a paper presenting their methods, findings, and conclusions and send it to a scientific journal (like The BMJ) to be considered for publication. If the journal’s editors think a paper might be suitable for publication they send the paper out to other scientists and specialist experts who research, practise, and publish in the same area, asking them to comment on whether the research is done well and if it provides an important contribution to scientific knowledge. For more information about what we ask them to do, see our guidance for traditional peer reviewers. The scientists assessing the papers are called referees or reviewers, and the whole process is called peer review. The aim of peer review is to reject poor quality and unoriginal studies, promote good ones, and offer feedback and constructive criticism to researchers so they can improve the clarity and impact of their paper.

About patient peer review
We will ask you to register your details on our editorial database, which editors use to identify appropriate reviewers for each paper. We will need you to list any medical conditions you have, or have had, or that you have experience of through your role as a carer or for which you are a patient advocate (for example, cancer, heart disease, or stroke). Our database is a rather inflexible system, and in order for us to identify you easily in our searches, we need you to state in the special interests section that you are for example “a patient with diabetes” or “a carer for a patient with multiple sclerosis” or “a patient advocate for patients with cancer,” etc.
If a suitable paper is submitted to The BMJ, an editor will search the database, looking for patient reviewers with some experience on the topic of the article that is being reviewed. If we select you to do a patient review, we will send you an invitation by email. You will see the title of the paper, the names of the authors, and a short summary of its contents. You will have the opportunity to accept or decline the invitation to review. If you are unable to review please do let us know, and if you are able to suggest an alternative reviewer that would be most helpful.

Patient reviewers do not need medical or scientific training, because what we need from you are answers to a slightly different set of questions than those posed to traditional peer reviewers. As a patient reviewer we’d like your views on:
• Is this an issue that matters to you, and/or other patients and carers?
• Are there any areas relevant to patients and carers that are missing or should be highlighted?
• If the article is a research paper looking at a new intervention or treatment, say if you think it will really work in practice. What challenges might patients face?
• Are the outcomes measured and issues discussed in the article the ones that are important to patients? Are there others that should have been considered?
• Do you have any suggestions that might help the author(s) strengthen their paper to make it more useful for doctors to share and discuss with patients?

All unpublished manuscripts are confidential documents. If we invite you to review an article, please do not discuss it with anyone. All reviewers are asked to provide their opinion within two weeks of being sent a paper using our online manuscript tracking system. Most medical reviewers provide opinions of 500-1000 words, but it’s quality not quantity that counts, and we are seeking an informed independent viewpoint presented in a clear and constructive way.

We ask all our reviewers to declare all conflicts of interest. A conflict of interest exists when judgment concerning a primary interest (such as whether a paper is accepted) might be influenced by a secondary interest (for example, the researcher is your doctor or you’ve been paid to be a patient advocate by the sponsor of the study). Read more on competing interests here.

Why do it?
By answering these questions you will be giving the editors your perspective on the patient focused aspects of selected manuscripts, drawing on your experience of a particular topic, condition, or intervention. It’s your opportunity to have a real voice in shaping the way researchers design and report research and clinicians act, and to further their understanding on what is most important to, and of benefit to patients. To say thank you, all reviewers get a year's free online subscription to The BMJ. We also name and thank all peer reviewers annually on our website.

What happens to your comments?
We do not ask any of our reviewers to comment on whether they think the paper should be published. Your comments, alongside those from the traditional peer reviewers, will be used to guide editors’ views about the paper under consideration, but the decision to accept or reject a paper is made by the editors. It is not unusual for reviewers to disagree, and it is the editors’ job to weigh up the importance of the various comments. As such it is extremely important that all reviewers provide justifications for their opinions. Once a decision has been made, reviewers are copied into the detailed decision letter sent to the authors, and they can then see the other reviewers’ comments. You should be aware that research papers, in particular, have a very high rejection rate at The BMJ.

The BMJ currently asks reviewers to sign their reports, so that authors know who has reviewed their work. This includes patient reviewers, and we have now adopted a policy of publishing all reviewers signed comments on our website alongside the paper, so that all readers can see them. We appreciate that there may be circumstances when that will prove difficult for some patient reviewers and are willing to discuss this with individual patients.

Ready to volunteer?
We’re glad you’re willing to get started. The first step is to register yourself on our reviewer database. Remember, the software that powers our database was designed to register researchers rather than patients, so not all questions will seem relevant. We have created a short video showing you how to register. Once your account is ready, you’ll receive a confirmatory email. If you run into any problems or have any questions that haven’t been answered here, please email Tessa Richards (trichards@bmj.com), and if you have any problems logging onto our system please email papersadmin@bmj.com. Thanks again for volunteering your time and helping to get the patient voice heard.

Additional resources

Some frequently asked questions

What happens if you want to stop reviewing once you’ve signed up?
If we send you a paper, but you are unable to review it for any reason, you can simply decline the invitation in the email we send you. If you don’t decline or accept the invitation to review, you may receive an automated reminder.

If you have registered to be a patient reviewer but have changed your mind, you can contact papersadmin@bmj.com at any time and ask for your account to be closed.

I have registered on your database, so why haven’t I been invited to do a review yet?
Because some conditions are more common than others, it might be the case that after volunteering you don’t get asked to do any reviews for quite a while. This is quite normal, even a reviewer in a highly active area, such as diabetes or cancer, might be asked to review only a few papers a year.

How many reviews will I be expected to review?
This depends on your area of expertise and the content of the papers we receive. If we don’t receive any papers that match your experience then we will not contact you. We do keep track of reviewer activity and would try to only send you a couple of reviews a year.

Can I see some sample patient reviews?
We plan to add some links to real patient reviews here soon.