What peer reviewers look for in a manuscript

Stetleaf Academy

Reviewed by Alex Juusela, MD, MPH, FACOG, Maternal-Fetal Medicine Physician · Last reviewed 2026-11-05

Before a journal sends your manuscript to peer reviewers, you can ask yourself the same questions those reviewers are likely to ask. Most reviews walk through the paper section by section: is the question clear, is the design fit for it, are the methods reported so the work can be judged, do the results match the methods, and do the conclusions stay within the data? This article is written for authors. It sets out those questions in order, so you can tighten the manuscript before it goes out.

Why it matters

Peer review is the usual gate between a submitted manuscript and a published paper. Reviewers read for substance and for clarity: whether the question matters, whether the methods can answer it, and whether the claims follow from what is reported. Provenzale and Stanley set out a systematic way to review a manuscript, with a template of questions that works as a section-by-section checklist [1]. Authors who know those questions can often fix gaps before submission.

Peer review also has limits. In a study of reports of randomized trials published under open peer review, many methods details were still missing after review, which means reviewers had not caught them; most of the changes reviewers did request improved the reporting, but some requests, such as extra analyses that had not been planned, could make the final report worse [2]. The lesson for authors is double: make the reporting complete enough that a careful reviewer can find what they need, and be ready to push back politely when a request would harm the report.

Key ideas

Title and abstract

Reviewers ask whether the title names the design and the main variables, and whether the abstract matches the full text. Numbers, conclusions and registrations in the abstract should agree with the body. A mismatch here is an early warning that something is wrong deeper in the paper.

Introduction

Is the gap clear? Does the last paragraph state a specific objective or hypothesis? Reviewers look for a short path from what is known, to what is not, to the question this study answers. A long literature review that never lands on a question is a common complaint.

Methods

This is where many reviews spend the most time. Can a reader tell who was included, how they were chosen, what was done, what was measured and how the analysis was planned? Provenzale and Stanley's guide walks through design, population, procedures and statistics as separate checks [1]. Matching the manuscript to the reporting guideline for its design (for example STROBE for an observational study, CONSORT for a randomized trial) is one of the fastest ways to see what a reviewer will look for. Ethics approval, consent and registration, where they apply, belong here too.

Results

Do the results follow the methods, in the same order? Are participant numbers accounted for from start to finish? Are the main results given as effect sizes with intervals, not only as P values? Reviewers compare tables and figures with the text and flag contradictions. New analyses that were not described in the methods will draw questions.

Discussion and conclusions

Does the discussion open with the main finding, put it in context, and state the important limitations? Do the conclusions stay inside what the design and the data can support? Over-claiming — causal language for an observational study, or practice recommendations from a single-centre sample — is one of the comments authors see most often.

References, figures, tables and end matter

Reviewers skim whether key prior work is cited, whether figures and tables are readable on their own, and whether funding, competing interests and data-sharing statements are present when the journal asks for them. Inconsistencies between a figure and the text are easy for a reviewer to spot and hard for an author to defend.

What reviewers are not for

Reviewers advise the editor; the decision on the manuscript is the editor's. They also should not be expected to rebuild a poorly reported study from clues. Clear reporting is the author's job. Reporting guidelines help before submission; they do not take the place of peer review afterwards.

Worked example

Illustrative example (invented). Not a real study.

An author is about to submit an invented cohort study of a postpartum text-message reminder program. Overnight, the author walks through the paper with a reviewer's questions in mind.

Title and abstract. The title says "improves postpartum care" but the study is observational. The author changes it to name the design and the association. The abstract's 14% and 22% figures are checked against Table 2; one number was out of date and is fixed.
Introduction. The last paragraph stated a broad aim ("to explore reminders"). It is rewritten as a specific objective: to compare missed 7-day blood-pressure checks between patients who enrolled and patients who did not.
Methods. A reviewer would ask how "enrolled" was defined in the records. The author adds the date window and the fields used to flag enrollment. The reporting guideline for cohort studies is checked; the items on setting, participants and variables now have a clear paragraph each.
Results. The flow of 1,000 eligible → 500 enrolled → outcomes is already in Figure 1. A secondary analysis that appeared only in the results is either moved into the methods as pre-specified or labelled as exploratory.
Discussion. The draft said the program "reduces" missed checks. That becomes "was associated with fewer missed checks", and a limitations paragraph notes unmeasured differences between groups.
End matter. Funding and competing interests were present; a data-sharing sentence is added to match the journal's instructions.

None of these edits assures that the journal will take the paper. Each one removes a comment the author would otherwise have had to answer later.

Common pitfalls

Abstract that does not match the body. Reviewers notice; so do editors.
Objective missing or vague. The introduction never states what question the study answers.
Methods that cannot be repeated. Missing dates, codes, or how participants were chosen.
Results that introduce new analyses. If it was not in the methods, say so or move it.
Conclusions that outrun the design. Causal claims from observational data, or broad practice advice from one centre.
Ignoring the reporting guideline. Reviewers who know the guideline will ask for the missing items by number.
Treating peer review as copy-editing. Clarity matters, but substance and reporting come first.

Quick self-check, in our own words

My title and abstract name the design and agree with the full text.
The introduction ends with a specific objective or hypothesis.
The methods would let a careful reader judge who was studied and what was done.
I have checked the manuscript against the reporting guideline for my design.
Results follow the methods, with numbers that match the tables and figures.
Conclusions stay within what the data and design can support.
Limitations are stated in plain language.
Funding, competing interests and other required statements are present.

References

Provenzale JM, Stanley RJ. A systematic guide to reviewing a manuscript. AJR Am J Roentgenol. 2005;185(4):848-54. doi:10.2214/AJR.05.0782. PMID: 16177399.
Hopewell S, Collins GS, Boutron I, Yu LM, Cook J, Shanyinde M, et al. Impact of peer review on reports of randomised trials published in open peer review journals: retrospective before and after study. BMJ. 2014;349:g4145. doi:10.1136/bmj.g4145. PMID: 24986891.