Why Peer Review: An Interview with Associate Editor Lee M. Akst, MD

Lee M. Akst, MD, director of the Johns Hopkins Division of Laryngology, has served as Associate Editor of Laryngology and Neurolaryngology for the AAO-HNSF's flagship journal, Otolaryngology Head and Neck Surgery, since 2015, and for its sister journal, OTO Open, since its inception in 2017. Dr. Akst caught up with the Bulletin to share his journey to becoming an Associate Editor, why peer review is crucial to the specialty, and some valuable tips for how to approach peer review.

Share a little about yourself, your career, and your journey to working with the OTO journals as an Associate Editor.
I’m a laryngologist, and director of the Division of Laryngology at Johns Hopkins. My clinical practice focuses mostly on managing patients with laryngeal disease. One of the things I like best about my job is the ability to share exam findings with patients on a monitor in real-time. Looking at a patient’s exam results with them at time of the visit and reviewing the nature of their laryngeal disorder visually really helps their understanding and buy-in to treatment plans.

I started with Otolaryngology-Head and Neck Surgery (OTO-HNS) as an author and co-author in residency and began reviewing for the journal right out of residency. I found that the time and effort spent learning how to go a good review made me a better “consumer” of medical literature and helped me to become a better researcher and author myself. I found myself doing more and more reviews and began to earn Star Reviewer status for the quantity, quality, and timeliness of the number of reviews I would do in a year. Then, in 2015, I was asked to become an Associate Editor for laryngology.

Can you tell us why you choose to be actively involved with the journals and participate in peer review as part of volunteering your time to the specialty and patient care?
A large part of it is a desire to be connected to the greater otolaryngology community broadly, and the laryngology community in particular. As a field, otolaryngologists are a great group of people. I also really like the process of clinical research and, in particular, I enjoy the team-building aspects of putting together groups of colleagues and trainees with whom to do research. I realized early on that my “ticket” to meetings so that I could be part of this community—and a key part of both personal satisfaction and professional advancement—was contributing to our body of knowledge.

I thought it was only fair that if I was going to submit to these journals that I review for them as well—and I noticed that time and attention spent on becoming a better reviewer paid dividends in helping me to become a better researcher and writer as well. One thing led to another, and I ended up as an Associate Editor. It takes a lot of time and effort, but it is a labor of love.

I continue to benefit from being connected to the broader community generally and remaining updated on advances in the field by doing this work. Certainly, time spent reviewing papers within my discipline has helped me to be a better clinician as well.

What is the value of protecting the quality of research published in the OTO journals to patient care and the specialty?
Otolaryngology-Head and Neck Surgery has a broad audience and is largely clinical in scope. If we are going to take research findings and use them to advance patient care, we need to be able to trust in the quality of the papers that we are reading. Excellent peer review is crucial in helping this to happen. I don’t know how we can grow and evolve as a field without protecting the quality of the research that we share with one another. 

What are your guiding principles for peer review or acting as an Associate Editor? Have they always been the same or have they changed or altered over time?
I think that the principles have remained largely the same over time: be fair, bring an open mind, and try to make criticism as constructive as possible. Careful peer review can make for a better paper and commenting on a submission’s strengths and weaknesses can help the authors revise in a way that helps a paper to better tell its story. Sometimes there are issues that cannot be mitigated by new analysis or revision and sometimes a paper is inherently limited by the available data, absence of appropriate controls, or something that cannot be easily fixed in revision. The goal then is to decide what is an acceptable limitation and what is not—and then communicate this to the authors as clearly as possible so that they can improve next time.

What encouragement would you give to your peers to consider becoming a reviewer? And what advice would you give them as they get started?While reviewing may seem like a lot of work at first, the rewards personally and professionally are well worth the effort. Time spent in learning how to do a good review will make you a better researcher and writer, and you will become a savvier consumer of medical literature—which in turn may make you a better clinician.

There are certainly tools out there that can help you to become a better reviewer. Consider reading, for instance, “How to Review Journal Manuscripts” ¹ by Richard M. Rosenfeld, MD, MPH, who was the Editor in Chief of OTO-HNS from 2006 to 2014. Finally, when doing a review, try to remember the big picture. You are not there to correct grammar line-by-line but to ask the overarching question, such as:

• Is there a hypothesis?
• Are the methods appropriate to adequately test this hypothesis?
• Are the results clearly explained?
• Are the results put into appropriate context by a discussion that acknowledges the limitations of the work while assessing the existing information in the field and tells a reader how the current findings move the field forward?
• Are the conclusions supported by the findings of the paper?

Commenting on how a submission does or does not do each of those things can form the backbone of an excellent review.

The more reviews you do, the more quickly and efficiently you’ll be able to do them!

Reference

1. Rosenfeld, R.M. (2010), How to review journal manuscripts. Otolaryngology–Head and Neck Surgery, 142: 472-486. https://doi.org/10.1016/j.otohns.2010.02.010