I have read the article about peer reviewing of manuscripts submitted to medical journals with interest.1 I would like to comment on some aspects that may have been surprising or confusing for some readers.

In the article, references to editors and management (the “director” or editor-in-chief) can be confusing. The authors state that the editor-in-chief is responsible for choosing the editors. However, they attribute the responsibility for “coordinating and overseeing the entire editorial process” and making “the final decisions regarding publication” to editors. These are the responsibilities of the editor-in-chief, who is ultimately responsible for everything that is published. The authors noted that editors usually were clinicians or even researchers in the field covered by the journal. This may be optimal for clinical publications and common in journals published by medical professional associations. But there are highly prestigious journals (e.g., Nature Medicine, Lancet Respiratory Medicine) where editors work exclusively for the journal and do not combine their editorial work with clinical practice or academia.

I feel that the errors that Candal-Pedriara et al attribute to the use of inexperienced reviewers (deficient evaluation of research methods and the rejection of “good” articles due to excessively detailded review) are not necessarily related to the expertise of reviewers. There may be experienced reviewers who are not able to detect certain methodological flaws, as many expert clinicians are not as knowledgeable about research methods or, if they are, they may have certain gaps (e.g., advanced statistics). On the other hand, being meticulous is not negative in and of itself. As an author, I prefer to be given extensive feedback (even for the smallest concerns) to be able to reflect on them and respond as I deem appropriate. In my experience, “fastidious” reviewers are those who devote the most time to examining the work, something that should always be appreciated.

I am not sure that I fully understand the proposal to create a “reviewer academy”. It is not practical to leave training in the hands of each individual journal. On the other hand, training courses are already available in publisher websites (e.g., Wiley, Springer Nature, Taylor and Francis), and there are even “certified” courses (e.g., Elsevier Research Academy). In addition, the Equator Network provides information on peer review trainings and resources.2 There are also publishers (such as Springer Nature) that make reviewers follow certain pre-established steps and fill out specific fields (ranging from a critique of the abstract to the appropriateness of the statistical analysis) in the review feedback forms. Such templates are very useful, as they ensure that reviewers do not fail to address any of those aspects.

In the conclusion, the authors proposed “creating incentives, recognising and possibly remunerating in some form the work of reviewers”. While they mentioned several ways to incentivise and recognise review work throughout the article, this is the first time they suggest that it could be “remunerated”, which the reader ought to interpret as “paid”. It would have been worth it for the authors to broach this controversial aspect in the depth that it deserves.