Why Do Manuscripts Get Rejected?

For over 300 years, the academic manuscript has been the de facto currency of academia. It is through generation and publication of articles that authors have the opportunity to communicate their scientific findings, promote scientific discussion, and ultimately advance their careers. To produce a manuscript, authors first need to present research questions, design and conduct a study, and then assimilate the data. If your manuscript is accepted, it is time for celebration and accolades. However, rejection is also part of the manuscript submission process, and rejections can be difficult for authors to process. In high-impact journals such as The New England Journal of Medicine, the rejection rate can be as high as 90 percent.1Plastic and Reconstructive Surgery rejects as many as 85 percent of manuscript submissions.2 Why are these numbers so high? The journal acceptance rate often declines over time because the ultimate goal of most top journals is to enhance their quality through greater selectivity. Furthermore, there has been an influx in the number of manuscript submissions over time as many authors seek quantity rather than quality of articles to leverage their next promotion. In other words, we know we must “publish or perish.” Without question, each journal encourages the submission of original, valid articles. However, submission of poorly designed, poorly organized papers wastes valuable time from editors, peer reviewers, and even the authors themselves. Most of the time, uninspiring papers that do not pass the “so what” test will be rejected summarily. Other reasons for instant rejection are incoherent writing; rampant spelling mistakes and poor syntax; fishing expeditions in using large data sets; and, more commonly today, systematic reviews that do not provide impactful findings. The purpose of this editorial is to understand the process of manuscript submission and review, and to understand why manuscripts get accepted or rejected. THE IDEAL MANUSCRIPT What are we looking for? The ideal, successful manuscript has multiple key characteristics (Fig. 1).3 It is the culmination of an important research question answered with a well-designed study. Bordage reports the top nine reasons reviewers accept articles.4 Positive attributes include answering research questions that are timely, relevant, and prevalent. The manuscript also needs to be appropriate for the specific journal and convey the message of the study clearly and concisely according to journal guidelines.3Fig. 1.: The ideal scientific manuscript.MANUSCRIPT SUBMISSION AND PEER REVIEW PROCESS Once submitted to a journal, the manuscript undergoes a rigorous review process by the editor-in-chief and co-editor followed by peer review (Fig. 2). Peer reviewers are experts in the field who critically assess manuscripts for their content and suitability for the journal.Fig. 2.: Manuscript submission and review. *Plastic and Reconstructive Surgery uses single-blinded review with the manuscript’s authors visible to the reviewers and authors blinded to the reviewers’ identities.Although there are basic similarities, each journal has a specific way of conducting the review process with variability in the number of reviewers invited per paper and whether reviews are blinded. In an open review, authors and reviewers are identified. Plastic and Reconstructive Surgery has typically followed a single-blinded review whereby authors are identified but reviewers are blinded. In a double-blinded review, both authors and reviewers are blinded. Although a double-blinded review may seem ideal, it creates more work for the editorial staff, and it often fails to hide the identities of the respective parties. In subspecialty journals, failures occur because reviewers are familiar with the work in the field and can recognize authors purely based on the content of the manuscript or by author self-citation. One study showed that 46 percent of reviewers were able to correctly identify the authors despite blinding.5 When Plastic and Reconstructive Surgery piloted a double-blind review strategy, there was no effect on reviewer recommendation or manuscript ranking.6 First-Pass Rejections The internal review is the first possible stage for manuscript rejection. At this stage, the editor screens the manuscript for fatal flaws.7,8 Fatal flaws are flaws that cannot be corrected with additional data or clarity by the authors. Initially, the manuscript is screened for technical errors. Plagiarism and violations of publication ethics are simply not acceptable. Other technical violations include simultaneous submission to another journal, missing key elements, and the manuscript not being prepared according to journal guidelines (e.g., title, list of authors). After the basic tenets of the manuscript have been satisfied, attention is turned to the study design and methodology. In their article “Making the First Cut,” Meyer et al. examined the most common reasons for manuscript rejection during the internal review process. Insufficient study design or methodology was at the top of the list. Specifically, the most common methodologic issues are ineffective study question (92 percent of rejections) and suboptimal data collection process (49 percent of rejections).9 The ability to communicate findings effectively is an important aspect of a successful manuscript. Poor language, spelling, and grammar detract from the manuscript’s message. Writing the manuscript forces the author to examine and interpret their findings in the context of preexisting knowledge. As Ayn Rand described, “Words are a lens to focus one’s mind.” It is commonly assumed that language barriers may exist for authors from other countries. Ehara and Takahashi found that the acceptance rate of articles from countries where English is not the primary language was significantly lower than the acceptance rate in countries where English is the primary language.10 A well-written paper from a non–English speaking country may have an advantage because it shares the dedication of the authors in the refinement of scientific writing, which often impresses the reviewers. An organized, well-written manuscript gives the reader a better understanding and perception of its findings. The editors also examine the novelty and relevance of the manuscript’s content. Manuscripts may have sound findings and lack fatal flaws; however, if the material offers nothing new to the journal and the field, it is unappealing. The topic itself may be irrelevant or of marginal interest to the readership. In addition, although not always in the control of the authors, the timing of the content is essential. Recent publication of similar content in the same journal or other similar journals makes the manuscript less interesting to the editors and readership. This can often be a sole reason for rejection. It is the author’s duty to avoid “salami-slicing.” Salami-slicing is defined as dividing the same project into multiple manuscripts.11,12 Sometimes similar experiments were performed by varying one of the ingredients. Although this increases the number of manuscripts the authors could publish, this often lowers the overall impact of the manuscript. It is the authors’ responsibility to conduct their research with integrity and to disseminate their findings in a manner that presents a complete and accurate picture of the methods and results of their research. External Review After a manuscript completes the editors’ internal review, the external process of peer review begins. During the external review process, the most common reasons for rejection are based on the global content of the manuscript. Problems with the research can be divided into poorly conducted studies, flaws in methodology, and flaws in interpretation of the data. Good quality research often begins with an interesting research question. A weak theory or hypothesis is hard to overcome with even the best research methodology. Bordage underscores the importance of the research question and the study by finding that the most common reasons reviewers reject papers are results and problem statements. If the research question is sound, the study must then strive to answer the question.4,13 Gibert and Chubin found “poor argumentation” to be a major source for content rejection.14 Simply put, the authors fail to make a convincing case. Methodology is the backbone of the research study. It contains all the elements of the study design and execution. Errors in methodology are often fatal, because the research has already been performed and new studies would need to be designed to answer the inquiries. Commonly, this is attributable to an underpowered study with inadequate sample size. However, flaws may also result from lack of a control group and inappropriate or incomplete statistics. Overall, when rejection was attributable to methodology, it was found that most common negative comments given by reviewers were attributable to the inappropriate statistics (11 percent of rejections) and overinterpretation of the results (9 percent of rejections).4,13 Surprisingly, some research designs embark with a novel question, use a sound study design, yet fail in interpretation of the data. Overinterpretation of the results is a common cause for negative reviews. Furthermore, if the conclusions cannot be justified by the paper, it is sure to be rejected. Altogether, the lack of a well-supported conclusion accounts for close to 37 percent of manuscript rejections.4,13 In these rejections, the data do not support the conclusions, the conclusions ignore current literature, and/or the arguments are illogical and invalid. Aside from problems with the research conduct, the paper may fail because of issues with language, presentation, organization, timing, and salami-slicing as we have discussed in the internal review of the paper. The authors’ ability to convey the message through the writing and presentation of the manuscript is critical for manuscript acceptance. When a manuscript is poorly written, filled with jargon, and does not follow the journal guidelines, the manuscript can appear to be carelessly prepared and be rejected.14 Similarly, flippant titles, excessively long titles, and exaggeration of priority will often detract the reviewers’ enthusiasm. Unethical practices such as excessively long listings of authors when most of them do not have the expertise on the subject presented, or if authors were added simply because of their seniority in an organization, will heighten the reviewers’ concerns regarding the integrity of the research group. REVISION PROCESS Based on the protocol of a specific journal, the revision process can vary. As a critical part of manuscript review, the revision process often determines whether a manuscript is ultimately accepted.15 Revisions should be thought of as opportunities for improvement. Even brilliant authors revise their work. “Half my life is an act of revision,” stated John Irving. From an author’s perspective, anticipation of reviewers’ comments in the original submission is the key to success. Although authors do not have to agree with all the reviewers’ critiques, they should strive to make the changes that they are able to make with the spirit to make their paper better and provide reasons why they are choosing not to make certain changes.2 These responses should also be specific to the questions and clear to the reviewers by listing each question asked and providing a suitable response. It is not polite to make general statements and ask the reviewers to search for the responses in the manuscript. In addition, it is important to note that reviewers have the tendency to focus on different issues. Specifically, Chubin and Hackett reported poor agreement among reviewers, with interrater reliability in the 0.25 range.16 Therefore, the focus of the responses should be as comprehensive as possible to answer the concerns and comments brought up by each reviewer. In the response to reviewers, the authors should state clearly where revisions have occurred. The reviewers should not have to play detective to figure out the difference between the original and revised manuscript.17 Lastly, revisions should be submitted back to the journal in a timely manner. In some cases, because of reviewer availability, a new reviewer could be solicited because of a late revision submission or to serve as a tie-breaker in the cases of mixed reviews. REJECTION Not every manuscript can be accepted, and rejection does not imply a paper is unworthy of publication. It is not a personal decision, but rather based on merit, novelty, and appropriateness for a specific journal. Once rejected, submission to another journal can be considered by the authors. Before resubmission, the manuscript should be edited properly according to the critiques provided, which typically serve to improve the paper. Even in rejection, the reviewers’ comments are invaluable. Additional studies may be considered before resubmission. Most importantly, the authors should think about the secondary journal choice carefully. It should be one that targets the correct audience while considering all the points discussed above. CONCLUSIONS Ultimately, manuscript submission is humbling and challenging. With a timely submission supported by an interesting hypothesis, sound results, and appropriate interpretation, a manuscript has a better chance of succeeding in the review process and avoiding lost time, energy, and spirit that comes from rejection.