Reflections from the Liminal Space: Reflections on Peer Review

By Katie Huth (@KathleenHuth)

The concept of liminality  is new to me. However, I am experiencing it daily in my transitioning into the role of clinician and medical educator. Standing on the academic threshold carries a sense of ambiguity and often unease. This was also the case as I moved from being simply a consumer of medical knowledge, to an emerging contributor, to being asked to appraise others’ contributions through peer review.

The peer review process exposes liminality. It obliges you to straddle viewpoints of reader, author and editor, for the purpose of upholding quality in the literature that informs clinical and educational practice. How does one learn to do this well?

There are a number of useful online resources available, including toolkits offered by medical journals (The BMJ and JAMA Pediatrics, for example) and this paper on becoming a peer reviewer to medical education journals. They offer a helpful framework to start from—what questions should I ask myself as I read a manuscript? What they don’t offer is an opportunity for dialogue, on how someone thinks through a critique of a manuscript and shapes a constructive response.

Mentored Peer Review

I wanted to find my voice as a peer reviewer, while getting specific feedback from someone modelling the process.  Moreover, given the methodological differences and unique challenges of educational research compared to biomedical research, I wanted more guidance on critically appraising this type of literature.

I asked a trusted mentor with experience in medical education and scholarship if she could offer this guidance. Enter Teresa Chan. Here are the steps we took to engage in a mentored peer review:

  • Identify an appropriate journal for a co-review: Teresa approached the editorial board of a journal in our field to see if there was a formal process for co-review of manuscripts. For example, JGME has an initiative for recognizing and inviting mentored peer review. This also ensured respect for confidentiality as we shared the article and our critiques.
  • Set your own deadline: Once we were invited to review a manuscript in our areas of interest/expertise, Teresa and I arranged to connect over videoconference a week prior to the journal’s review deadline, to discuss our response.
  • Commit to your comments: I read through the manuscript and jotted down my general impressions (i.e. the importance of the topic, its alignment with existing literature), specific comments about methodology and analysis, and outstanding questions I had. The important point is that I wrote it all down. This helped me to commit to my own opinions rather than adopting those of my mentor.
  • Use a web-based application with concurrent editing or screen sharing: We used GoogleDocs to formulate the review, which allowed us to write and edit the response concurrently while videoconferencing. I watched in real-time as Teresa adjusted my wording, re-organized my comments, fleshed out my ideas, and added new points and references. Being a part of this process helped me to understand her reasoning rather than simply seeing the final product.
  • Seek feedback: After we compiled the final response, Teresa distilled a few key messages for me to work on for future reviews.

Peer Review Pearls

The value of this mentored experience was in learning the general approach, rather than specific information about the manuscript itself. Here are some of the pearls I gathered:

  • Situate yourself” and share your background up front, so the authors and editor understand your perspective and the context of your response.
  • Situate the paper”, understanding how it fits into the broader conversation in the literature, and ensuring it aligns with the style and standards of the journal.
  • “Be specific” with your recommendations, and offer references for suggested reading or examples.
  • “If its not clear to you, it won’t be clear to the reader!” –Don’t doubt your ability to understand the story that the authors are trying to tell. Share your concern about lack of clarity and offer constructive feedback for how they can make the logic of the paper easier to follow.

I’ve recognized another benefit of peer review—it is attuning me to the elements of thoughtful study design expected by the medical community, giving me a more critical eye in my own work. And just as I’ve found value in mentorship when developing scholarship, I’ve also found value in mentorship when learning to review it.

If you have served as a mentor or mentee for peer review, can you share your thoughts below?


  1. The BMJ. Guidance for peer reviewers.
  2. Cummings, P., & Rivara, F.P. (2002). Reviewing manuscripts for Archives of Pediatrics & Adolescent Medicine. Arch Pediatr Adolesc Med, 156(1):11-13
  3. Azer, S., Ramani, S., & Peterson, R. (2012). Becoming a peer reviewer to medical education journals. Medical Teacher, 34(9):698-704.

Image a deppe. Flickr. under Creative Commons License CC2.0


Thank you to our editor, Teresa Chan (@TChanMD), for recruiting Katie for this article!

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