An e-mail pops up from the journal to which you submitted your recent masterpiece, a manuscript describing an exciting medical education innovation. It feels like a long time since you submitted this epic work. With trepidation you open the e-mail. It is extensive: a revision is requested. You are elated that the paper has not been rejected, but the length of the e-mail indicates that considerable efforts are still required. As you read the many comments and requests for more data, analyses, discussion, limitations, and references, your spirits sink. You worry: Did the reviewers understand your paper? Can you respond to all of the comments? Where will you find the time to respond?

Do not despair. The Journal of Graduate Medical Education (JGME) editors are here to help you craft a stellar author response letter, one that will help editors say “yes” to your paper.

First Things First

Sit down, take your pulse, and then find some time to read the comments carefully. Keep in mind that the reviewers and editors—many, if not all, are volunteers—have the same goal as you: to make your paper the best it can be. A fundamental principle of peer review is that revision always produces a better paper. Most authors agree that their papers are improved through the review process.1 

The good news is that a revise and resubmit decision indicates that your first submission is potentially a good “fit” for this venue. Articles that are outside the scope or on topics that have already received heavy coverage by a journal will be rejected on first review. Thus, your paper has promise. Your goal is to craft a strong author response letter to accompany your revised manuscript.

Common Reasons for Getting A “Major Revision” Decision

The most common reason for a manuscript to receive a major revision decision is that, while the topic is of interest and relevant to readers of the journal, the editors are unable to determine, from the existing version of the paper, whether the quality is sufficient for dissemination. This conclusion can be due to missing information or analyses, poor paper organization, or unclear writing. The reviewers' and editors' comments provide guideposts as to why a paper receives a “major” versus “minor” revision decision. For some journals, including JGME, major versus minor is not determined by the number of comments, but by the journal's commitment to publish. In this situation, if all requested changes are made, a minor decision indicates a journal's commitment to publish the revised manuscript.

Planning Your Response

Start by dividing the comments into (1) revisions that are easy, quick fixes (eg, incorrect citation, wrong order of methods); (2) items that need more time and coauthors' input (eg, new data analyses, rewriting sections); and (3) requests that you are not sure you understand or can address. If you cannot respond to most of the comments or to key “must do” comments (perhaps the additional data requested can no longer be obtained), you will not be able to revise the paper. You may consider a different venue for dissemination or further work in the area.

However, if most of the revision requests seem possible, you should gather your coauthors, virtually or in person, to decide how to approach the revision. Speed is important, as journals usually have firm deadlines for revisions. However, if you need more time to resubmit, always ask the journal if this is possible, before the due date. Many journals routinely give 1 to 2 weeks or even longer extensions.

Often the lead author writes the entire revision and author response letter, but comments and sections may also be divided among the group, to distribute the workload. To facilitate planning, the lead author can create a comment and response table (see table 1), which includes every editor and reviewer comment. Coauthors may be assigned a specific response/revision task, along with a deadline for completion. When revising, changes can be tracked with track changes. If a team approach is used, it is essential that the lead author read the final product carefully, to ensure consistency and accuracy.

table 1

Sample Approach for Planning a Revision

Sample Approach for Planning a Revision
Sample Approach for Planning a Revision

Assume Beneficence

Although some editor and reviewer requests may appear inappropriate or even harsh, often a deeper read will reveal that these comments stem from unclear writing or poor organization on the authors' part. Editors and reviewers read your paper more carefully than the typical reader; thus, if they do not understand your work, it is likely that readers will also be confused. Do not assume that these comments are an attack on your work or yourself. This reaction is unlikely to produce a compelling and persuasive response letter. No matter the tone of reviewer comments, it is best to assume they are provided for your benefit. For comments or queries that are not clear, ask the journal for clarification. This is particularly apt if reviewers ask for opposite responses. Editors try to catch unclear or misleading requests in order to provide guidance to authors. Given the volume of papers, mixed messages do happen. When this occurs, you can ask for clarification before submitting your revision, or choose the response you believe is most suitable and explain your rationale in the author response letter.

If, after careful consideration, a reviewer's comments appear inappropriate in tone, contact the editor, separately from your author response letter. Most editors and reviewers try hard to help authors, but we are fallible. However, adopting a non-defensive stance and mindset that the editors' and reviewers' intentions are positive will serve you well.2 

Organizing the Author Response Letter

Each year editors read thousands of papers and even more revisions. Make your author response letter crystal clear—as clear yet as brief as possible. Make the comments, response to comments, and location of changes in the manuscript easy to visualize by using a table approach (table 1) or different fonts or colors, to differentiate comments from responses and manuscript changes (table 2). If the journal provides a template in the author instructions for the author response letter, follow the template closely.

table 2

Sample Author Response Letter

Sample Author Response Letter
Sample Author Response Letter

Most editors request that reviewers number each comment or query, to assist authors. Nonetheless, you will receive decision letters with reviewer—and even editor—comments that are not numbered, or that have several comments buried in a single paragraph. The best approach is to divide these comments into single topics, number them, and answer in the order in which they occur in your decision letter. Explicitly answer each query, even when several are located together in a numbered comment or long paragraph.

Sometimes reviewers request additional information or tables that will make the paper go over word count or graphics limits. If there are no other areas in which to trim words, it is best to provide the requested information in the author response letter rather than in the manuscript. Depending on the journal, additional information can be placed in online-only appendices. Alternatively, authors can provide the requested answers in the response letter and state that this information can be added to the paper, if the editors prefer. Do not use “we cannot respond as it will put the paper over the word count limit” as a reason for nonresponse. See table 3 for tricky reviewer and editor comments and potential solutions for authors.

table 3

Problems and Potential Solutions for Author Response Letters

Problems and Potential Solutions for Author Response Letters
Problems and Potential Solutions for Author Response Letters

Brevity is a virtue, yet your responses must be complete. However, some comments may not require a response (eg, “the authors have tackled an interesting subject”). Some authors respond to every comment with “Thank you for this extremely valuable and insightful comment.” In our opinion, compliments are unnecessary, require more reading on our part, and seem overly obsequious, especially after the 30th comment. A simple response (“Thank you” or “Agree”) is sufficient.

Avoiding a Rejection or Another Revision Request

One of the most difficult editor tasks is cross-checking reviewer suggestions with author responses. Are all comments and queries addressed and have the revisions sufficiently improved the quality of the paper? If the author responses appear incomplete, you are likely to receive a “reject” or another “major revision” decision. (Even when responses are complete, you may receive these decisions because the new information now challenges the quality, usefulness, or fit of your paper for the journal.)

Your best approach to avoiding a rejection is to answer all comments completely and follow the specific journal format for writing papers in this category. JGME continues to receive second versions of manuscripts that have not followed the required format, despite pointing the authors to resources that explicitly describe the correct format in the decision letter. Alert authors read these resources before submitting the original manuscript, and again when submitting their revision. Not following the required format is likely to garner at least a minor revision decision. We understand how long and overly complex author instructions are for many journals. To assist authors, JGME provides resources that further describe the content and order of each manuscript section.3 

Before submitting your revision and author response letter, we strongly recommend that someone outside your immediate working group read the paper and letter for clarity, as well as grammar and typos. An editor should not be the first outside person to read your revision. See box 1 for successful strategies and box 2 for helpful resources.

box 1 Strategies for Success for Author Response Letters
  • Work within a group.

  • Make your response letter visually very clear.

  • Answer every request or question, but use no more words than necessary.

  • Be polite, diplomatic, and not defensive: use the “we're all on the same side” philosophy.

  • Find peers or a mentor to review your author response letter—as well as your paper—before resubmission.

  • The editors and reviewers are (nearly) always right.

box 2 Resources

In Summary

A request to revise your manuscript can be seen as a glass half full (“not rejected”) or a glass half empty (“more work”), yet this additional effort is ultimately to your benefit. A revise and resubmit decision is a second chance and evidence of a journal's investment in your work. Paying attention to editor and reviewer comments will sharpen your understanding of the topic, research methods, and writing skills. Keep in mind that “med ed” is a small world: if you resubmit your work to another journal, your paper may be examined by the same reviewers. Thus, paying attention to the original reviews, even when submitting your manuscript to a new journal, is suggested.

Dividing the work among your colleagues, viewing comments in a positive rather than negative light, being complete yet concise, and crafting a visually clear response letter will improve your chance of success. Your goal is to make it easy for your editor to get to “yes.”

References

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Ware
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Sullivan
GM.
Writing education papers for publication
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J Grad Med Educ
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New Rip Out Series: Career Transitions

Jeffrey S. Berger, MD, MBA, Deborah Simpson, PhD, Gail M. Sullivan, MD, MPH

Becoming a practicing physician involves multiple transitions—from college to medical student to resident/fellow to practicing physician. At each transition one gains more autonomy over decisions and overall competence. At transitions we consider the impacts on other parts of life, whether related to physical moves, changing responsibilities, or the effects on loved ones. One thing seems universal: transitions are harder than expected.

To support and facilitate this transition, the Journal of Graduate Medical Education is launching a new Rip Out series on Career Transitions, which will focus on the transition from resident/fellow to practicing physician. In this issue, we highlight “How to Approach the First Physician Job Search” on page 231. Subsequent Rip Outs concern CVs, letters of recommendation, the job interview, and contracts. The series will conclude with key concepts and principles about career transitions. As always, these Rip Outs are intended to provide evidence-based guidance on what to do short-term and long-term to ease the transition from trainee to independent practicing physician. Please let us know your comments and suggestions on Twitter (@JournalofGME #RipOut).