Editor's Opinion: Preventing and Managing Manuscript Rejection: An Overview to Help You Publish

Almost every health care professional who has submitted manuscripts for publication in an indexed and peer-reviewed journal has a story to tell about manuscript rejection(s). This puts them in good company and their manuscript(s) squarely in the majority. From what can be gleaned from the literature, the manuscript acceptance rate for medical and nursing journals is <50% (ranging from about 10% to 75%).^1-3 The acceptance rate for manuscripts submitted to Ostomy Wound Management can be categorized as average; currently, approximately 35% of manuscripts submitted to our journal are accepted for publication. 

These numbers represent frequent disappointment and a loss of time for authors, editors, and reviewers. Such data also have the potential to increase the appeal of submitting the rejected manuscript for publication in a predatory journal where it will be more likely to be published; however, doing so can negatively impact the authors’ pocketbooks and reputations while ensuring the work will be lost because it is not indexed in reputable databases (eg, Medline and the Cumulative Index to Nursing and Allied Health Literature; it also may not be archived by the “publisher”.⁴ 

Because communications from clinicians and researchers through scholarly publications in peer-reviewed and indexed journals remain the gold standard for advancing science, knowing how to prevent your work from gathering dust is crucial. Let’s look at some of the most common reasons manuscripts are rejected for publication. 

The topic is not relevant for the readers of the journal or the information does not provide new knowledge or a new or updated perspective on a particular issue, concern, or methodology.^1,2,5 Manuscripts that simply rehash information are not a publishing priority. It is crucial to carefully consider the target audience of the journal before submitting your manuscript. For example, most of our readers are clinicians. As a result, the number of preclinical studies we publish is limited. Check the mission of the journal before submitting your manuscript (eg, author instructions and the focus of publications in OWM can be found at www.o-wm.com/authorinfo ). 

The manuscript contains flaws in study design, methodology, analysis, the results reporting and interpretation. Missing information is a common shortcoming among manuscripts submitted to this and other journals.^1,2,5 This includes inconsistencies among the purpose of the work, the methods used, and the results reported. It also includes omitting a clear description regarding Institutional Review Board approval, informed consent, participant identity protection procedures used, numbers that do not add up, and other missing information. Whether a randomized controlled clinical study, case study, case series, survey, literature review, or meta-analysis, all publications containing original data must adhere to established scientific criteria for the work and follow the same manuscript format. The bottom line for all reporting of original data is that the reader should be able to duplicate the work reported.

The manuscript is poorly written. In one survey, editors of nursing journals reported that poor writing was the second most common reason for rejecting manuscripts.² In another report, 24% of rejected manuscripts were categorized as being “difficult to follow”.¹ At OWM, we also see a considerable number of manuscripts that are poorly organized, difficult to follow, and/or poorly written. No matter how much work went into a project, a poorly written manuscript means reviewers will have a difficult time understanding what was done and how. This significantly decreases the likelihood acceptance. There are few excuses for submitting work that is poorly organized and poorly written. Authors should get a second, third, or even fourth opinion before submitting. Ask colleagues (preferably persons who are not familiar with your work) to tell you honestly if they understand what you did/did not do. 

The author(s) did not follow the guidelines for authors. This, too, is a common but very preventable reason for manuscript rejection. All journals provide detailed instructions about the required manuscript format and general adherence to the American Medical Association or American Psychological Association manuals of style guidelines. Simply follow the instructions. If you have written a paper for another purpose that was not published (eg, a class assignment; FYI, we welcome student authors), you typically cannot simply submit it for publication without considering this requirement (as well as the above-mentioned considerations). In one study, one third of rejected manuscripts did not adhere to the journal’s author guidelines.² Clearly, reviewers will not reject a manuscript if someone missed a few periods in a reference list. But, as with reason 3 above, there are few excuses for not reading and following the guidelines. 

The conclusions are overstated, the results overinterpreted, or the Discussion or Conclusion is weak. These common reasons cited for manuscript rejection^1,5,6 could technically be considered under the elements mentioned under reason 2 but warrant a separate review here because they are common concerns cited by OWM reviewers. After reviewing and reading the reviews of approximately 1000 manuscripts (that is what happens after being in this position for >20 years), I see 2 themes related to problems with the discussion and conclusion. The first centers on a disconnect between the method of the work and its implications for practice and research. This often involves an incorrect interpretation of terms such as effectiveness, efficacy, and cost effectiveness — in other words, the basics of science. The second theme involves the overinterpretation of some or all of the results and is frequently supported by carefully selected references. For example, important references pertaining to the topic typically are ignored in favor of those that support the authors’ belief and represents failure to consider alternative explanations, uncritical acceptance of results, unexplained inconsistencies, inflation of the importance of the findings, or a conclusion disproportionate to the results.⁵ 

Hopefully, the explanations of common reasons for manuscript nonacceptance will help aspiring authors and prevent receipt of the dreaded “your manuscript was rejected” letter (we try to word our decision letters a bit more delicately). These considerations also may help authors develop a strategy on how to address the cited reasons for rejection — that is, if at first you don’t succeed…. Clearly, if the study design or methodology exhibits major flaws, there may be little you can do aside from taking it as a lesson learned for future studies and projects. However, if the main concerns about your manuscript appear to center on analysis, interpretation, clarity, or organization, these issues can be fixed. However, not unlike medicine itself and the entire process of scientific publishing, there are no magic bullets. For authors, even the adage that writing is 5% inspiration and 95% perspiration does not apply to developing manuscripts for publication— it’s more like 1% inspiration and 99% perspiration! For the editors and reviewers at OWM, the same equation applies.We, too, must adhere to established guidelines. The process is not perfect, but we (editors, staff, and reviewers) do what we can to make it expedient, sound, and fair, including the use of a double-blind review process to reduce the risk of bias.⁷ 

Please don’t be discouraged if we cannot accept your manuscript; it is not a comment on your intelligence or your skills as a clinician. Our files are thick with manuscripts we could not accept. We want (no, make that we need) to have lots of submissions to review. Before you submit a manuscript, consider what your most demanding English, Research, or Statistics professor would write across the top of the paper. If you think your manuscript would earn you a high passing grade, please send it our way.

The opinions and statements expressed herein are specific to the respective authors and not necessarily those of OWM or HMP. This article was not subject to the Ostomy Wound Management peer-review process.