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Durga Prasanna Misra1, Vinod Ravindran2

Author Affiliations: 

1Assistant Professor, Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India; 2Consultant Rheumatologist, Centre for Rheumatology, Calicut, Kerala, India

Correspondence to: 

Vinod Ravindran, Consultant Rheumatologist, Centre for Rheumatology Calicut, Kerala, India


Journal Issue: 
Volume 50: Issue 4: 2020
Cite paper as: 
J R Coll Physicians Edinb 2020; 50: 362–4



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For the authors, submission of their manuscript to a journal represents the culmination of the hard work in conducting and reporting their study. But before it gets published, a manuscript must clear several hurdles of the editorial process. Outcome in the form of a rejection can often be disheartening whereas a careless revision can ruin the chances of an otherwise good manuscript. In this editorial we discuss strategies which would help authors in responding appropriately to the reviewer’s comments while revising their manuscript. We also discuss how to reconcile with an editorial decision of ‘reject’ by providing the context of such decisions from the editorial perspective. Lastly, we offer some thoughts on what to keep in mind while structuring a rebuttal against a reject decision.

A poorly written manuscript is liable to be rejected.1 A well written manuscript results from paying due attention not only to a report’s major components (e.g. in a research paper they would be Introduction, methods, results and discussion) but also to preparing adequate abstract and providing proper and relevant references along with an informative and well thought out title.2 For different types of studies, reviews and case reports, adherence to minimum reporting standards is essential.3 Prospective registration in the relevant clinical trial registry is now mandatory and to avoid wasting time and efforts in performing a redundant systematic review, prior registration in Prospective Register of Systematic Reviews (PROSPERO) is equally important.3 Furthermore, the importance of selecting the right journal cannot be overemphasised. The scope and intended readership of the journal and it having published similar papers (case report or a study) in the recent past are some of the commonly overlooked factors in this regard. Plagiarism detection software used by the journals flag manuscripts with high similarity to the editors and may lead to rejection.4 A journal with higher rejection rate implies that the margin of any sort of error is very low for the authors. A manuscript not prepared in accordance with instructions to the authors may be potentially rejected straightaway. Some journals have policy to commission papers such as editorials, reviews and perspectives and would not process any unsolicited ones. Therefore if the option is available, even before starting to prepare papers in such categories, it is advisable to approach the editorial office to get a go ahead first.

One of the most common examples of handling of a manuscript is depicted in Figure 1. A critical first step for a manuscript is ’editorial review’. Here the Editor-in-Chief (EiC) alone or in conjunction with the associate editor (when the manuscript is assigned by the EiC) and sometimes with more members of the editorial board first appraise the overall merit of a paper and may make a reject decision based on a number of factors including those mentioned previously. The other factors considered are the need, import and relevance of a particular manuscript for the journal. Though in the decision letter the phrases commonly used are ’we receive more papers than we can ever publish…’; ’we are applying ever more stringent criteria….’ and ’on this occasion…’, it implies that overall the paper was not considered worth even a peer review (so called ’desk rejections‘). In practical terms it also means that the authors have chosen the wrong journal. On the other hand, some submissions in certain categories might be accepted at this stage itself.

Figure 1 A common example of manuscript handling


The next step is the familiar ‘peer review’. Journals state their peer review policies in their instructions to the authors (such as open vs. single blind vs. double blind).5 For some papers in some journals this may also involve an additional review by a patient. Usually two to three peer reviewers are asked to comment on the overall quality of the manuscript based on the clear implications for research, practice and/society at large, scientific merit (including if the methodology being appropriate to the subject matter of the paper and whether the paper contains new and significant information to justify publication) and other equally important aspects (length of manuscript, adequacy of the abstract, pertinent and concise introduction and clear presentation of results of appropriately analysed data including statistical methods used).1 In addition, based on their critical appraisal of a manuscript, reviewers also provide comments as free text to the authors. This would normally include general comments first followed by specific comments for major and minor revisions. Confidential comments to the editor are written with the objectives of informing the editors and enabling them in taking appropriate final decision (Table 1). It is important to mention here that the editors may not always agree with recommendations of the reviewers; for example recommendations of major revisions could be deemed a reject or, a reject as a major revision depending on the second appraisal of the manuscript by the editors in view of reviewer’s comments.

Table 1 Outcome of the peer-review process

Confidential comments to the editor

Comments to the authors

Frank overall opinion

Concerns about authenticity of the work

Concerns about appropriateness of reporting Need for statistical review

Diplomatic overall opinion

Comments on quality/interest

Highlighting relevant work by others

Need for the paper to improve



Major revision

Minor revision


Reject & transfer to a sister journal

Action points for authors




Suggestions for revising

Flagging up inappropriate references


If the final decision is of a major or minor revision, it is important to read the decision letter carefully with a view to complying with them while revising. When responding to the reviewers’ comments it is both polite and proper to start by thanking the reviewers and editors for their inputs. Address each comment individually in point wise manner. In this regard good practice is to break further down (as relevant) all general and specific comments. State clearly where and what changes in the original manuscript are being made accordingly. If there is any critique or clarification sought by the reviewers where authors feel no changes in the manuscript are required it is never the less essential to provide a clear explanation to the queries raised. Journals often ask for a marked (highlighted/changes tracked) and clean version of the revised manuscript to help the reviewers and editors assess the appropriateness of the revisions carried out.

An offer to submit a revised version is an important opportunity for the authors to carefully revise the entire manuscript to weed out yet overlooked minor issues from their end. Editorial review of such a revised manuscript may result in one of the several different outcomes:

  • further round(s) of peer review and revision(s) followed ultimately by acceptance
  • a further round of peer review followed by rejection (implying that it was deemed that the manuscript would not improve even with a re-revision)
  • rejection

One may rightly feel disappointed when faced with a ‘reject’ decision. However if the authors consider such editorial decision in the context of peer review process as outlined, and the fact that the reasons for a manuscript getting rejected are often varied; they could more effectively analyse and try to rectify the reasons for rejections as applicable to their manuscript.1,6 In fact authors could consider several different options at their disposal now, namely:

  • Try other journal (without any changes to the manuscript)
  • Try other journal (after revising in view of reviewers/editorial comments)
  • Ask a (non-author) colleague to give (honest) opinion and then take a final call
  • Extend the study (if possible and if this would improve its chances in other journals)
  • Give up! (if now the authors also consider their manuscript unsalvageable)
  • Write a rebuttal (if the journal provides that option)

When structuring a rebuttal, it is important to be objective and precise and shun emotionalism. Rather than rambling about why the authors think that their manuscript deserves reconsideration, being specific about the scientific merits of paper would help the editors in a quicker appraisal. It is not advisable to assert your previous publication record or to mention your ‘standing’ in the scientific world. It would be useful to gently suggest that you wish to bring to attention some important aspects of your work that might have been overlooked rather than criticising the reviewers and editors for any reason, or demanding another set of reviewers. The outcome of such rebuttals may still be rejection, but following the above steps would help ensure that communications with editors and peer reviewers who contribute voluntarily in propagating evidence based medicine remains polite and professional all the time.

In conclusion, revisions, rejections and rebuttals all are an integral part of medical academic publishing. Authors may find themselves better equipped to revise, structure rebuttal and reconcile with a rejection in view of what we have discussed in this editorial. 


1 Ravindran V, Narsimulu G. How to appraise a scientific paper? Ind J Rheumatol 2013; 8: 27–29.

2 Goyal M, Dua A, Kedia AK et al. Usefulness of a workshop on scientific writing and publication in improving the baseline knowledge deficit among postgraduates. J R Coll Physicians Edinb 2020; 50: 316–21.

3 Misra DP, Ravindran V. Reporting standards in scientific publishing: need, relevance and future perspectives. J R Coll Physicians Edinb 2019; 49: 269–271.

4 Misra DP, Ravindran V, Negi VS. Plagiarism: Software based detection and the importance of (human) hardware. Ind J Rheumatol 2017; 12: 188–9.

5 Misra DP, Ravindran V. Peer review in academic publishing: threats and challenges. J R Coll Physicians Edinb 2019; 49: 99–100.

6 Khadilkar SS. Rejection Blues: Why Do Research Papers Get Rejected? J Obstet Gynaecol India. 2018; 68: 239–41.


Financial and Competing Interests: 
DPM is an Associate Editor of the Journal of the Royal College of Physicians of Edinburgh (JRCPE) and serves as Editor/Editorial board member/Reviewer for several other international journals. VR is the Editor-in-chief of the JRCPE and serves as Editor/Editorial board member/Reviewer for several other international journals. This paper has undergone peer review in accordance with JRCPE’s policies.