Every day doctors make decisions on how to treat their patients based on evidence published in medical journals. The fact that these treatment decisions affect the wellbeing and quality of life of real people reflects the extent to which published literature is trusted, at least by the medical profession.
The only requirement for publication is that the research undergoes peer review; a system that we know is not perfect. It is because of the recognized flaws in the current system that new models of peer review have been developed to address some of them. The world of publishing has embraced these concerns and there’s not a conference or meeting that goes by without at least one discussion on what’s wrong with peer review and what we should be doing to fix it.
Awareness among practicing physicians
A conversation with my clinical co-authors highlighted that, while there is significant ‘angst’ about peer review in some fields, these concerns are going unnoticed by practicing physicians. We wondered how far this was true and whether it really mattered. This prompted our survey, recently published in Research Integrity and Peer Review, which asked trainee doctors whether they were aware of different peer review models and how far they trusted the contents of various medical journals.
There is a belief that if an article is peer reviewed and published it can be unquestioningly viewed as valid.
Unsurprisingly, the doctors we surveyed trusted familiar journal names such as the Lancet, BMJ, and NEJM. They paid little attention to the type of peer review model adopted by a journal and had little interest in open peer review, where the names of the peer reviewers are known to the authors (and vice versa). They also expressed little desire to scrutinize peer review reports themselves in journals that operate open peer review; ironic given that open peer review was pioneered in the field of medicine to increase transparency and accountability, but also unsurprising.
Why does this matter?
Our study suggests that peer review is important to our respondents because publication is not seen as part of an evolving self-correcting process. There is a belief that if an article is peer reviewed and published it can be unquestioningly viewed as valid.
For journal editors and publishers this highlights their responsibility to deliver on these expectations by focusing on the quality of peer review, not just on the speed and efficiency of the process.
The study also raises many other broader questions: should there be an alternative approach to peer review in medicine? Should systematic reviews of medical research consider the peer review model? Should those who write evidence based clinical guidelines for junior doctors do the same? Should doctors be given training on how to assess peer review reports? How realistic or fair is it to add peer review to an already stretched medical curriculum? What is the value of opening peer review if the end user does not look at it?
We acknowledge that our survey was of a small and selective sample of doctors in training. Nonetheless, it offers a first insight into how a specific community views peer review innovations. We hope it will stimulate more interest among the medical community on how medical research is peer reviewed and validated and the publishing industry to think about medical specific innovations that meet the expectations of practicing doctors.