Written by Sachin Wani, MD, from University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.

Contributing to the peer review process is one of the joys of academic medicine. Not only do you have the opportunity to contribute to the publication of high quality studies but on a personal level, it exposes you to the latest advances in the field. Being a peer reviewer has had a tremendous impact on my research and I have certainly learned a great deal from the entire process of reviewing manuscripts to the final decision of accepting/rejecting a manuscript.

Here are some salient points to consider during a manuscript review:

• Invitation to review a manuscript – It is critical that before you accept to review a manuscript, you ensure that the manuscript in question is within the realm of your practice and research. This can be easily determined by reading the title and abstract. Also, it is important to be respectful of the time frame that the journal is requesting you to send your review in. Delaying sending a review in ultimately reflects poorly on the reviewer and the journal as a whole.
• Reviewing the manuscript – On average, the entire review of the manuscript takes me approximately 3 hours. My first review of the manuscript provides a broad overview of the study goals, methods, results, and discussion. I use this information to perform a background search of the appropriate literature. I routinely review the study protocol if the trial has been registered at clinicaltrials.gov. This is followed by an in-depth review of the manuscript.
• Comments to the authors – I start by summarizing the study aim, methods, and results followed by the main conclusion of the study. This is followed by highlighting the strengths of the study (e.g. randomized controlled trial – study design, large population based study, etc) followed by major and minor comments related to the study. This is the most relevant section which will help the authors improve the quality of their manuscript for publication. The major comments should focus on the main limitations of the study that typically revolve around study methods (inclusion/exclusion criteria, standardization of protocol, randomization protocol, appropriate selection of controls, definition of study outcomes, among others), statistical analysis and sample size calculation, and study results and conclusions (generalizability, biases, conclusions congruent with results). It is critical to be selective and realistic regarding how many changes you would like to see the authors make to their manuscript. Minor comments typically revolve around changes to the figures/tables, rearrangement of sections (methods/results), and ensuring relevant literature is cited.
• Comments to the associate editor/editor – I use this section to provide my recommendation for publication along with my justification. It is important not to summarize all the points highlighted in the comments to the authors section.