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  • v.12(3); 2021 Jun

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Writing, reading, and critiquing reviews

Écrire, lire et revue critique, douglas archibald.

1 University of Ottawa, Ontario, Canada;

Maria Athina Martimianakis

2 University of Toronto, Ontario, Canada

Why reviews matter

What do all authors of the CMEJ have in common? For that matter what do all health professions education scholars have in common? We all engage with literature. When you have an idea or question the first thing you do is find out what has been published on the topic of interest. Literature reviews are foundational to any study. They describe what is known about given topic and lead us to identify a knowledge gap to study. All reviews require authors to be able accurately summarize, synthesize, interpret and even critique the research literature. 1 , 2 In fact, for this editorial we have had to review the literature on reviews . Knowledge and evidence are expanding in our field of health professions education at an ever increasing rate and so to help keep pace, well written reviews are essential. Though reviews may be difficult to write, they will always be read. In this editorial we survey the various forms review articles can take. As well we want to provide authors and reviewers at CMEJ with some guidance and resources to be able write and/or review a review article.

What are the types of reviews conducted in Health Professions Education?

Health professions education attracts scholars from across disciplines and professions. For this reason, there are numerous ways to conduct reviews and it is important to familiarize oneself with these different forms to be able to effectively situate your work and write a compelling rationale for choosing your review methodology. 1 , 2 To do this, authors must contend with an ever-increasing lexicon of review type articles. In 2009 Grant and colleagues conducted a typology of reviews to aid readers makes sense of the different review types, listing fourteen different ways of conducting reviews, not all of which are mutually exclusive. 3 Interestingly, in their typology they did not include narrative reviews which are often used by authors in health professions education. In Table 1 , we offer a short description of three common types of review articles submitted to CMEJ.

Three common types of review articles submitted to CMEJ

More recently, authors such as Greenhalgh 4 have drawn attention to the perceived hierarchy of systematic reviews over scoping and narrative reviews. Like Greenhalgh, 4 we argue that systematic reviews are not to be seen as the gold standard of all reviews. Instead, it is important to align the method of review to what the authors hope to achieve, and pursue the review rigorously, according to the tenets of the chosen review type. Sometimes it is helpful to read part of the literature on your topic before deciding on a methodology for organizing and assessing its usefulness. Importantly, whether you are conducting a review or reading reviews, appreciating the differences between different types of reviews can also help you weigh the author’s interpretation of their findings.

In the next section we summarize some general tips for conducting successful reviews.

How to write and review a review article

In 2016 David Cook wrote an editorial for Medical Education on tips for a great review article. 13 These tips are excellent suggestions for all types of articles you are considering to submit to the CMEJ. First, start with a clear question: focused or more general depending on the type of review you are conducting. Systematic reviews tend to address very focused questions often summarizing the evidence of your topic. Other types of reviews tend to have broader questions and are more exploratory in nature.

Following your question, choose an approach and plan your methods to match your question…just like you would for a research study. Fortunately, there are guidelines for many types of reviews. As Cook points out the most important consideration is to be sure that the methods you follow lead to a defensible answer to your review question. To help you prepare for a defensible answer there are many guides available. For systematic reviews consult PRISMA guidelines ; 13 for scoping reviews PRISMA-ScR ; 14 and SANRA 15 for narrative reviews. It is also important to explain to readers why you have chosen to conduct a review. You may be introducing a new way for addressing an old problem, drawing links across literatures, filling in gaps in our knowledge about a phenomenon or educational practice. Cook refers to this as setting the stage. Linking back to the literature is important. In systematic reviews for example, you must be clear in explaining how your review builds on existing literature and previous reviews. This is your opportunity to be critical. What are the gaps and limitations of previous reviews? So, how will your systematic review resolve the shortcomings of previous work? In other types of reviews, such as narrative reviews, its less about filling a specific knowledge gap, and more about generating new research topic areas, exposing blind spots in our thinking, or making creative new links across issues. Whatever, type of review paper you are working on, the next steps are ones that can be applied to any scholarly writing. Be clear and offer insight. What is your main message? A review is more than just listing studies or referencing literature on your topic. Lead your readers to a convincing message. Provide commentary and interpretation for the studies in your review that will help you to inform your conclusions. For systematic reviews, Cook’s final tip is most likely the most important– report completely. You need to explain all your methods and report enough detail that readers can verify the main findings of each study you review. The most common reasons CMEJ reviewers recommend to decline a review article is because authors do not follow these last tips. In these instances authors do not provide the readers with enough detail to substantiate their interpretations or the message is not clear. Our recommendation for writing a great review is to ensure you have followed the previous tips and to have colleagues read over your paper to ensure you have provided a clear, detailed description and interpretation.

Finally, we leave you with some resources to guide your review writing. 3 , 7 , 8 , 10 , 11 , 16 , 17 We look forward to seeing your future work. One thing is certain, a better appreciation of what different reviews provide to the field will contribute to more purposeful exploration of the literature and better manuscript writing in general.

In this issue we present many interesting and worthwhile papers, two of which are, in fact, reviews.

Major Contributions

A chance for reform: the environmental impact of travel for general surgery residency interviews by Fung et al. 18 estimated the CO 2 emissions associated with traveling for residency position interviews. Due to the high emissions levels (mean 1.82 tonnes per applicant), they called for the consideration of alternative options such as videoconference interviews.

Understanding community family medicine preceptors’ involvement in educational scholarship: perceptions, influencing factors and promising areas for action by Ward and team 19 identified barriers, enablers, and opportunities to grow educational scholarship at community-based teaching sites. They discovered a growing interest in educational scholarship among community-based family medicine preceptors and hope the identification of successful processes will be beneficial for other community-based Family Medicine preceptors.

Exploring the global impact of the COVID-19 pandemic on medical education: an international cross-sectional study of medical learners by Allison Brown and team 20 studied the impact of COVID-19 on medical learners around the world. There were different concerns depending on the levels of training, such as residents’ concerns with career timeline compared to trainees’ concerns with the quality of learning. Overall, the learners negatively perceived the disruption at all levels and geographic regions.

The impact of local health professions education grants: is it worth the investment? by Susan Humphrey-Murto and co-authors 21 considered factors that lead to the publication of studies supported by local medical education grants. They identified several factors associated with publication success, including previous oral or poster presentations. They hope their results will be valuable for Canadian centres with local grant programs.

Exploring the impact of the COVID-19 pandemic on medical learner wellness: a needs assessment for the development of learner wellness interventions by Stephana Cherak and team 22 studied learner-wellness in various training environments disrupted by the pandemic. They reported a negative impact on learner wellness at all stages of training. Their results can benefit the development of future wellness interventions.

Program directors’ reflections on national policy change in medical education: insights on decision-making, accreditation, and the CanMEDS framework by Dore, Bogie, et al. 23 invited program directors to reflect on the introduction of the CanMEDS framework into Canadian postgraduate medical education programs. Their survey revealed that while program directors (PDs) recognized the necessity of the accreditation process, they did not feel they had a voice when the change occurred. The authors concluded that collaborations with PDs would lead to more successful outcomes.

Experiential learning, collaboration and reflection: key ingredients in longitudinal faculty development by Laura Farrell and team 24 stressed several elements for effective longitudinal faculty development (LFD) initiatives. They found that participants benefited from a supportive and collaborative environment while trying to learn a new skill or concept.

Brief Reports

The effect of COVID-19 on medical students’ education and wellbeing: a cross-sectional survey by Stephanie Thibaudeau and team 25 assessed the impact of COVID-19 on medical students. They reported an overall perceived negative impact, including increased depressive symptoms, increased anxiety, and reduced quality of education.

In Do PGY-1 residents in Emergency Medicine have enough experiences in resuscitations and other clinical procedures to meet the requirements of a Competence by Design curriculum? Meshkat and co-authors 26 recorded the number of adult medical resuscitations and clinical procedures completed by PGY1 Fellow of the Royal College of Physicians in Emergency Medicine residents to compare them to the Competence by Design requirements. Their study underscored the importance of monitoring collection against pre-set targets. They concluded that residency program curricula should be regularly reviewed to allow for adequate clinical experiences.

Rehearsal simulation for antenatal consults by Anita Cheng and team 27 studied whether rehearsal simulation for antenatal consults helped residents prepare for difficult conversations with parents expecting complications with their baby before birth. They found that while rehearsal simulation improved residents’ confidence and communication techniques, it did not prepare them for unexpected parent responses.

Review Papers and Meta-Analyses

Peer support programs in the fields of medicine and nursing: a systematic search and narrative review by Haykal and co-authors 28 described and evaluated peer support programs in the medical field published in the literature. They found numerous diverse programs and concluded that including a variety of delivery methods to meet the needs of all participants is a key aspect for future peer-support initiatives.

Towards competency-based medical education in addictions psychiatry: a systematic review by Bahji et al. 6 identified addiction interventions to build competency for psychiatry residents and fellows. They found that current psychiatry entrustable professional activities need to be better identified and evaluated to ensure sustained competence in addictions.

Six ways to get a grip on leveraging the expertise of Instructional Design and Technology professionals by Chen and Kleinheksel 29 provided ways to improve technology implementation by clarifying the role that Instructional Design and Technology professionals can play in technology initiatives and technology-enhanced learning. They concluded that a strong collaboration is to the benefit of both the learners and their future patients.

In his article, Seven ways to get a grip on running a successful promotions process, 30 Simon Field provided guidelines for maximizing opportunities for successful promotion experiences. His seven tips included creating a rubric for both self-assessment of likeliness of success and adjudication by the committee.

Six ways to get a grip on your first health education leadership role by Stasiuk and Scott 31 provided tips for considering a health education leadership position. They advised readers to be intentional and methodical in accepting or rejecting positions.

Re-examining the value proposition for Competency-Based Medical Education by Dagnone and team 32 described the excitement and controversy surrounding the implementation of competency-based medical education (CBME) by Canadian postgraduate training programs. They proposed observing which elements of CBME had a positive impact on various outcomes.

You Should Try This

In their work, Interprofessional culinary education workshops at the University of Saskatchewan, Lieffers et al. 33 described the implementation of interprofessional culinary education workshops that were designed to provide health professions students with an experiential and cooperative learning experience while learning about important topics in nutrition. They reported an enthusiastic response and cooperation among students from different health professional programs.

In their article, Physiotherapist-led musculoskeletal education: an innovative approach to teach medical students musculoskeletal assessment techniques, Boulila and team 34 described the implementation of physiotherapist-led workshops, whether the workshops increased medical students’ musculoskeletal knowledge, and if they increased confidence in assessment techniques.

Instagram as a virtual art display for medical students by Karly Pippitt and team 35 used social media as a platform for showcasing artwork done by first-year medical students. They described this shift to online learning due to COVID-19. Using Instagram was cost-saving and widely accessible. They intend to continue with both online and in-person displays in the future.

Adapting clinical skills volunteer patient recruitment and retention during COVID-19 by Nazerali-Maitland et al. 36 proposed a SLIM-COVID framework as a solution to the problem of dwindling volunteer patients due to COVID-19. Their framework is intended to provide actionable solutions to recruit and engage volunteers in a challenging environment.

In Quick Response codes for virtual learner evaluation of teaching and attendance monitoring, Roxana Mo and co-authors 37 used Quick Response (QR) codes to monitor attendance and obtain evaluations for virtual teaching sessions. They found QR codes valuable for quick and simple feedback that could be used for many educational applications.

In Creation and implementation of the Ottawa Handbook of Emergency Medicine Kaitlin Endres and team 38 described the creation of a handbook they made as an academic resource for medical students as they shift to clerkship. It includes relevant content encountered in Emergency Medicine. While they intended it for medical students, they also see its value for nurses, paramedics, and other medical professionals.

Commentary and Opinions

The alarming situation of medical student mental health by D’Eon and team 39 appealed to medical education leaders to respond to the high numbers of mental health concerns among medical students. They urged leaders to address the underlying problems, such as the excessive demands of the curriculum.

In the shadows: medical student clinical observerships and career exploration in the face of COVID-19 by Law and co-authors 40 offered potential solutions to replace in-person shadowing that has been disrupted due to the COVID-19 pandemic. They hope the alternatives such as virtual shadowing will close the gap in learning caused by the pandemic.

Letters to the Editor

Canadian Federation of Medical Students' response to “ The alarming situation of medical student mental health” King et al. 41 on behalf of the Canadian Federation of Medical Students (CFMS) responded to the commentary by D’Eon and team 39 on medical students' mental health. King called upon the medical education community to join the CFMS in its commitment to improving medical student wellbeing.

Re: “Development of a medical education podcast in obstetrics and gynecology” 42 was written by Kirubarajan in response to the article by Development of a medical education podcast in obstetrics and gynecology by Black and team. 43 Kirubarajan applauded the development of the podcast to meet a need in medical education, and suggested potential future topics such as interventions to prevent learner burnout.

Response to “First year medical student experiences with a clinical skills seminar emphasizing sexual and gender minority population complexity” by Kumar and Hassan 44 acknowledged the previously published article by Biro et al. 45 that explored limitations in medical training for the LGBTQ2S community. However, Kumar and Hassen advocated for further progress and reform for medical training to address the health requirements for sexual and gender minorities.

In her letter, Journey to the unknown: road closed!, 46 Rosemary Pawliuk responded to the article, Journey into the unknown: considering the international medical graduate perspective on the road to Canadian residency during the COVID-19 pandemic, by Gutman et al. 47 Pawliuk agreed that international medical students (IMGs) do not have adequate formal representation when it comes to residency training decisions. Therefore, Pawliuk challenged health organizations to make changes to give a voice in decision-making to the organizations representing IMGs.

In Connections, 48 Sara Guzman created a digital painting to portray her approach to learning. Her image of a hand touching a neuron showed her desire to physically see and touch an active neuron in order to further understand the brain and its connections.

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How to Review a Journal Article

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For many kinds of assignments, like a  literature review , you may be asked to offer a critique or review of a journal article. This is an opportunity for you as a scholar to offer your  qualified opinion  and  evaluation  of how another scholar has composed their article, argument, and research. That means you will be expected to go beyond a simple  summary  of the article and evaluate it on a deeper level. As a college student, this might sound intimidating. However, as you engage with the research process, you are becoming immersed in a particular topic, and your insights about the way that topic is presented are valuable and can contribute to the overall conversation surrounding your topic.

IMPORTANT NOTE!!

Some disciplines, like Criminal Justice, may only want you to summarize the article without including your opinion or evaluation. If your assignment is to summarize the article only, please see our literature review handout.

Before getting started on the critique, it is important to review the article thoroughly and critically. To do this, we recommend take notes,  annotating , and reading the article several times before critiquing. As you read, be sure to note important items like the thesis, purpose, research questions, hypotheses, methods, evidence, key findings, major conclusions, tone, and publication information. Depending on your writing context, some of these items may not be applicable.

Questions to Consider

To evaluate a source, consider some of the following questions. They are broken down into different categories, but answering these questions will help you consider what areas to examine. With each category, we recommend identifying the strengths and weaknesses in each since that is a critical part of evaluation.

Evaluating Purpose and Argument

  • How well is the purpose made clear in the introduction through background/context and thesis?
  • How well does the abstract represent and summarize the article’s major points and argument?
  • How well does the objective of the experiment or of the observation fill a need for the field?
  • How well is the argument/purpose articulated and discussed throughout the body of the text?
  • How well does the discussion maintain cohesion?

Evaluating the Presentation/Organization of Information

  • How appropriate and clear is the title of the article?
  • Where could the author have benefited from expanding, condensing, or omitting ideas?
  • How clear are the author’s statements? Challenge ambiguous statements.
  • What underlying assumptions does the author have, and how does this affect the credibility or clarity of their article?
  • How objective is the author in his or her discussion of the topic?
  • How well does the organization fit the article’s purpose and articulate key goals?

Evaluating Methods

  • How appropriate are the study design and methods for the purposes of the study?
  • How detailed are the methods being described? Is the author leaving out important steps or considerations?
  • Have the procedures been presented in enough detail to enable the reader to duplicate them?

Evaluating Data

  • Scan and spot-check calculations. Are the statistical methods appropriate?
  • Do you find any content repeated or duplicated?
  • How many errors of fact and interpretation does the author include? (You can check on this by looking up the references the author cites).
  • What pertinent literature has the author cited, and have they used this literature appropriately?

Following, we have an example of a summary and an evaluation of a research article. Note that in most literature review contexts, the summary and evaluation would be much shorter. This extended example shows the different ways a student can critique and write about an article.

Chik, A. (2012). Digital gameplay for autonomous foreign language learning: Gamers’ and language teachers’ perspectives. In H. Reinders (ed.),  Digital games in language learning and teaching  (pp. 95-114). Eastbourne, UK: Palgrave Macmillan.

Be sure to include the full citation either in a reference page or near your evaluation if writing an  annotated bibliography .

In Chik’s article “Digital Gameplay for Autonomous Foreign Language Learning: Gamers’ and Teachers’ Perspectives”, she explores the ways in which “digital gamers manage gaming and gaming-related activities to assume autonomy in their foreign language learning,” (96) which is presented in contrast to how teachers view the “pedagogical potential” of gaming. The research was described as an “umbrella project” consisting of two parts. The first part examined 34 language teachers’ perspectives who had limited experience with gaming (only five stated they played games regularly) (99). Their data was recorded through a survey, class discussion, and a seven-day gaming trial done by six teachers who recorded their reflections through personal blog posts. The second part explored undergraduate gaming habits of ten Hong Kong students who were regular gamers. Their habits were recorded through language learning histories, videotaped gaming sessions, blog entries of gaming practices, group discussion sessions, stimulated recall sessions on gaming videos, interviews with other gamers, and posts from online discussion forums. The research shows that while students recognize the educational potential of games and have seen benefits of it in their lives, the instructors overall do not see the positive impacts of gaming on foreign language learning.

The summary includes the article’s purpose, methods, results, discussion, and citations when necessary.

This article did a good job representing the undergraduate gamers’ voices through extended quotes and stories. Particularly for the data collection of the undergraduate gamers, there were many opportunities for an in-depth examination of their gaming practices and histories. However, the representation of the teachers in this study was very uneven when compared to the students. Not only were teachers labeled as numbers while the students picked out their own pseudonyms, but also when viewing the data collection, the undergraduate students were more closely examined in comparison to the teachers in the study. While the students have fifteen extended quotes describing their experiences in their research section, the teachers only have two of these instances in their section, which shows just how imbalanced the study is when presenting instructor voices.

Some research methods, like the recorded gaming sessions, were only used with students whereas teachers were only asked to blog about their gaming experiences. This creates a richer narrative for the students while also failing to give instructors the chance to have more nuanced perspectives. This lack of nuance also stems from the emphasis of the non-gamer teachers over the gamer teachers. The non-gamer teachers’ perspectives provide a stark contrast to the undergraduate gamer experiences and fits neatly with the narrative of teachers not valuing gaming as an educational tool. However, the study mentioned five teachers that were regular gamers whose perspectives are left to a short section at the end of the presentation of the teachers’ results. This was an opportunity to give the teacher group a more complex story, and the opportunity was entirely missed.

Additionally, the context of this study was not entirely clear. The instructors were recruited through a master’s level course, but the content of the course and the institution’s background is not discussed. Understanding this context helps us understand the course’s purpose(s) and how those purposes may have influenced the ways in which these teachers interpreted and saw games. It was also unclear how Chik was connected to this masters’ class and to the students. Why these particular teachers and students were recruited was not explicitly defined and also has the potential to skew results in a particular direction.

Overall, I was inclined to agree with the idea that students can benefit from language acquisition through gaming while instructors may not see the instructional value, but I believe the way the research was conducted and portrayed in this article made it very difficult to support Chik’s specific findings.

Some professors like you to begin an evaluation with something positive but isn’t always necessary.

The evaluation is clearly organized and uses transitional phrases when moving to a new topic.

This evaluation includes a summative statement that gives the overall impression of the article at the end, but this can also be placed at the beginning of the evaluation.

This evaluation mainly discusses the representation of data and methods. However, other areas, like organization, are open to critique.

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Article Contents

Introduction, selection of a topic, scientific literature search and analysis, structure of a scientific review article, tips for success, acknowledgments, conflict of interest statement.

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A Step-by-Step Guide to Writing a Scientific Review Article

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Manisha Bahl, A Step-by-Step Guide to Writing a Scientific Review Article, Journal of Breast Imaging , Volume 5, Issue 4, July/August 2023, Pages 480–485, https://doi.org/10.1093/jbi/wbad028

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Scientific review articles are comprehensive, focused reviews of the scientific literature written by subject matter experts. The task of writing a scientific review article can seem overwhelming; however, it can be managed by using an organized approach and devoting sufficient time to the process. The process involves selecting a topic about which the authors are knowledgeable and enthusiastic, conducting a literature search and critical analysis of the literature, and writing the article, which is composed of an abstract, introduction, body, and conclusion, with accompanying tables and figures. This article, which focuses on the narrative or traditional literature review, is intended to serve as a guide with practical steps for new writers. Tips for success are also discussed, including selecting a focused topic, maintaining objectivity and balance while writing, avoiding tedious data presentation in a laundry list format, moving from descriptions of the literature to critical analysis, avoiding simplistic conclusions, and budgeting time for the overall process.

Scientific review articles provide a focused and comprehensive review of the available evidence about a subject, explain the current state of knowledge, and identify gaps that could be topics for potential future research.

Detailed tables reviewing the relevant scientific literature are important components of high-quality scientific review articles.

Tips for success include selecting a focused topic, maintaining objectivity and balance, avoiding tedious data presentation, providing a critical analysis rather than only a description of the literature, avoiding simplistic conclusions, and budgeting time for the overall process.

The process of researching and writing a scientific review article can be a seemingly daunting task but can be made manageable, and even enjoyable, if an organized approach is used and a reasonable timeline is given. Scientific review articles provide authors with an opportunity to synthesize the available evidence about a specific subject, contribute their insights to the field, and identify opportunities for future research. The authors, in turn, gain recognition as subject matter experts and thought leaders in the field. An additional benefit to the authors is that high-quality review articles can often be cited many years after publication ( 1 , 2 ). The reader of a scientific review article should gain an understanding of the current state of knowledge on the subject, points of controversy, and research questions that have yet to be answered ( 3 ).

There are two types of review articles, narrative or traditional literature reviews and systematic reviews, which may or may not be accompanied by a meta-analysis ( 4 ). This article, which focuses on the narrative or traditional literature review, is intended to serve as a guide with practical steps for new writers. It is geared toward breast imaging radiologists who are preparing to write a scientific review article for the Journal of Breast Imaging but can also be used by any writer, reviewer, or reader. In the narrative or traditional literature review, the available scientific literature is synthesized and no new data are presented. This article first discusses the process of selecting an appropriate topic. Then, practical tips for conducting a literature search and analyzing the literature are provided. The structure of a scientific review article is outlined and tips for success are described.

Scientific review articles are often solicited by journal editors and written by experts in the field. For solicited or invited articles, a senior expert in the field may be contacted and, in turn, may ask junior faculty or trainees to help with the literature search and writing process. Most journals also consider proposals for review article topics. The journal’s editorial office can be contacted via e-mail with a topic proposal, ideally with an accompanying outline or an extended abstract to help explain the proposal.

When selecting a topic for a scientific review article, the following considerations should be taken into account: The authors should be knowledgeable about and interested in the topic; the journal’s audience should be interested in the topic; and the topic should be focused, with a sufficient number of current research studies ( Figure 1 ). For the Journal of Breast Imaging , a scientific review article on breast MRI would be too broad in scope. Examples of more focused topics include abbreviated breast MRI ( 5 ), concerns about gadolinium deposition in the setting of screening MRI ( 6 ), Breast Imaging Reporting and Data System (BI-RADS) 3 assessments on MRI ( 7 , 8 ), the science of background parenchymal enhancement ( 9 ), and screening MRI in women at intermediate risk ( 10 ).

Summary of the factors to consider when selecting a topic for a scientific review article. Adapted with permission from Dhillon et al (2).

Summary of the factors to consider when selecting a topic for a scientific review article. Adapted with permission from Dhillon et al ( 2 ).

Once a well-defined topic is selected, the next step is to conduct a literature search. There are multiple indexing databases that can be used for a literature search, including PubMed, SCOPUS, and Web of Science ( 11–13 ). A list of databases with links can be found on the National Institutes of Health website ( 14 ). It is advised to keep track of the search terms that are used so that the search could be replicated if needed.

While reading articles, taking notes and keeping track of findings in a spreadsheet or database can be helpful. The following points should be considered for each article: What is the purpose of the article, and is it relevant to the review article topic? What was the study design (eg, retrospective analysis, randomized controlled trial)? Are the conclusions that are drawn based on the presented data valid and reasonable? What are the strengths and limitations of the study? In the discussion section, do the authors discuss other literature that both supports and contradicts their findings? It can also be helpful to read accompanying editorials, if available, that are written by experts to explain the importance of the original scientific article in the context of other work in the field.

If previous review articles on the same topic are discovered during the literature search, then the following strategies could be considered: discussing approaches used and limitations of past reviews, identifying a new angle that has not been previously covered, and/or focusing on new research that has been published since the most recent reviews on the topic ( 3 ). It is highly encouraged to create an outline and solicit feedback from co-authors before writing begins.

Writing a high-quality scientific review article is “a balancing act between the scientific rigor needed to select and critically appraise original studies, and the art of telling a story by providing context, exploring the known and the unknown, and pointing the way forward” ( 15 ). The ideal scientific review article is balanced and authoritative and serves as a definitive reference on the topic. Review articles tend to be 4000 to 5000 words in length, with 80% to 90% devoted to the body.

When preparing a scientific review article, writers can consider using the Scale for the Assessment of Narrative Review Articles, which has been proposed as a critical appraisal tool to help editors, reviewers, and readers assess non–systematic review articles ( 16 ). It is composed of the following six items, which are rated from 0 to 2 (with 0 being low quality and 2 being high quality): explanation of why the article is important, statement of aims or questions to be addressed, description of the literature search strategy, inclusion of appropriate references, scientific reasoning, and appropriate data presentation. In a study with three raters each reviewing 30 articles, the scale was felt to be feasible in daily editorial work and had high inter-rater reliability.

The components of a scientific review article include the abstract, introduction, body, conclusion, references, tables, and figures, which are described below.

Abstracts are typically structured as a single paragraph, ranging from 200 to 250 words in length. The abstract briefly explains why the topic is important, provides a summary of the main conclusions that are being drawn based on the research studies that were included and analyzed in the review article, and describes how the article is organized ( 17 ). Because the abstract should provide a summary of the main conclusions being drawn, it is often written last, after the other sections of the article have been completed. It does not include references.

The introduction provides detailed background about the topic and outlines the objectives of the review article. It is important to explain why the literature on that topic should be reviewed (eg, no prior reviews, different angle from prior reviews, new published research). The problem-gap-hook approach can be used, in which the topic is introduced, the gap is explained (eg, lack of published synthesis), and the hook (or why it matters) is provided ( 18 ). If there are prior review articles on the topic, particularly recent ones, then the authors are encouraged to justify how their review contributes to the existing literature. The content in the introduction section should be supported with references, but specific findings from recent research studies are typically not described, instead being discussed in depth in the body.

In a traditional or narrative review article, a methods section is optional. The methods section should include a list of the databases and years that were searched, search terms that were used, and a summary of the inclusion and exclusion criteria for articles ( 17 , 19 ).

The body can take different forms depending on the topic but should be organized into sections with subheadings, with each subsection having an independent introduction and conclusion. In the body, published studies should be reviewed in detail and in an organized fashion. In general, each paragraph should begin with a thesis statement or main point, and the sentences that follow it should consist of supporting evidence drawn from the literature. Research studies need not be discussed in chronological order, and the results from one research study may be discussed in different sections of the body. For example, if writing a scientific review article on screening digital breast tomosynthesis, cancer detection rates reported in one study may be discussed in a separate paragraph from the false-positive rates that were reported in the same study.

Emphasis should be placed on the significance of the study results in the broader context of the subject. The strengths and weaknesses of individual studies should be discussed. An example of this type of discussion is as follows: “Smith et al found no differences in re-excision rates among breast cancer patients who did and did not undergo preoperative MRI. However, there were several important limitations of this study. The radiologists were not required to have breast MRI interpretation experience, nor was it required that MRI-detected findings undergo biopsy prior to surgery.” Other examples of phrases that can be used for constructive criticism are available online ( 20 ).

The conclusion section ties everything together and clearly states the conclusions that are being drawn based on the research studies included and analyzed in the article. The authors are also encouraged to provide their views on future research, important challenges, and unanswered questions.

Scientific review articles tend to have a large number of supporting references (up to 100). When possible, referencing the original article (rather than a review article referring to the original article) is preferred. The use of a reference manager, such as EndNote (Clarivate, London, UK) ( 21 ), Mendeley Desktop (Elsevier, Amsterdam, the Netherlands) ( 22 ), Paperpile (Paperpile LLC, Cambridge, MA) ( 23 ), RefWorks (ProQuest, Ann Arbor, MI) ( 24 ), or Zotero (Corporation for Digital Scholarship, Fairfax, VA) ( 25 ), is highly encouraged, as it ensures appropriate reference ordering even when text is moved or added and can facilitate the switching of formats based on journal requirements ( 26 ).

Tables and Figures

The inclusion of tables and figures can improve the readability of the review. Detailed tables that review the scientific literature are expected ( Table 1 ). A table listing gaps in knowledge as potential areas for future research may also be included ( 17 ). Although scientific review articles are not expected to be as figure-rich as educational review articles, figures can be beneficial to illustrate complex concepts and summarize or synthesize relevant data ( Figure 2 ). Of note, if nonoriginal figures are used, permission from the copyright owner must be obtained.

Example of an Effective Table From a Scientific Review Article About Screening MRI in Women at Intermediate Risk of Breast Cancer.

Abbreviations: ADH, atypical ductal hyperplasia; ALH, atypical lobular hyperplasia; CDR, cancer detection rate; LCIS, lobular carcinoma in situ; NR, not reported; PPV, positive predictive value. NOTE: The Detailed Table Provides a Summary of the Relevant Scientific Literature on Screening MRI in women with lobular neoplasia or ADH. Adapted with permission from Bahl ( 10 ).

a The reported CDR is an incremental CDR in the studies by Friedlander et al and Chikarmane et al. In all studies, some, but not all, included patients had a prior MRI examination, so the reported CDR represents a combination of both the prevalent and incident CDRs.

b This study included 455 patients with LCIS (some of whom had concurrent ALH or ADH). Twenty-nine cancers were MRI-detected, and 115 benign biopsies were prompted by MRI findings.

Example of an effective figure from a scientific review article about breast cancer risk assessment. The figure provides a risk assessment algorithm for breast cancer. Reprinted with permission from Kim et al (28).

Example of an effective figure from a scientific review article about breast cancer risk assessment. The figure provides a risk assessment algorithm for breast cancer. Reprinted with permission from Kim et al ( 28 ).

Select a Focused but Broad Enough Topic

A common pitfall is to be too ambitious in scope, resulting in a very time-consuming literature search and superficial coverage of some aspects of the topic. The ideal topic should be focused enough to be manageable but with a large enough body of available research to justify the need for a review article. One article on the topic of scientific reviews suggests that at least 15 to 20 relevant research papers published within the previous five years should be easily identifiable to warrant writing a review article ( 2 ).

Provide a Summary of Main Conclusions in the Abstract

Another common pitfall is to only introduce the topic and provide a roadmap for the article in the abstract. The abstract should also provide a summary of the main conclusions that are being drawn based on the research studies that were included and analyzed in the review article.

Be Objective

The content and key points of the article should be based on the published scientific literature and not biased toward one’s personal opinion.

Avoid Tedious Data Presentation

Extensive lists of statements about the findings of other authors (eg, author A found Z, author B found Y, while author C found X, etc) make it difficult for the reader to understand and follow the article. It is best for the writing to be thematic based on research findings rather than author-centered ( 27 ). Each paragraph in the body should begin with a thesis statement or main point, and the sentences that follow should consist of supporting evidence drawn from the literature. For example, in a scientific review article about artificial intelligence (AI) for screening mammography, one approach would be to write that article A found a higher cancer detection rate, higher efficiency, and a lower false-positive rate with use of the AI algorithm and article B found a similar cancer detection rate and higher efficiency, while article C found a higher cancer detection rate and higher false-positive rate. Rather, a better approach would be to write one or more paragraphs summarizing the literature on cancer detection rates, one or more paragraphs on false-positive rates, and one or more paragraphs on efficiency. The results from one study (eg, article A) need not all be discussed in the same paragraph.

Move from Description (Summary) to Analysis

A common pitfall is to describe and summarize the published literature without providing a critical analysis. The purpose of the narrative or traditional review article is not only to summarize relevant discoveries but also to synthesize the literature, discuss its limitations and implications, and speculate on the future.

Avoid Simplistic Conclusions

The scientific review article’s conclusions should consider the complexity of the topic and the quality of the evidence. When describing a study’s findings, it is best to use language that reflects the quality of the evidence rather than making definitive statements. For example, rather than stating that “The use of preoperative breast MRI leads to a reduction in re-excision rates,” the following comments could be made: “Two single-institution retrospective studies found that preoperative MRI was associated with lower rates of positive surgical margins, which suggests that preoperative MRI may lead to reduced re-excision rates. Larger studies with randomization of patients are needed to validate these findings.”

Budget Time for Researching, Synthesizing, and Writing

The amount of time necessary to write a high-quality scientific review article can easily be underestimated. The process of searching for and synthesizing the scientific literature on a topic can take weeks to months to complete depending on the number of authors involved in this process.

Scientific review articles are common in the medical literature and can serve as definitive references on the topic for other scientists, clinicians, and trainees. The first step in the process of preparing a scientific review article is to select a focused topic. This step is followed by a literature search and critical analysis of the published data. The components of the article include an abstract, introduction, body, and conclusion, with the majority devoted to the body, in which the relevant literature is reviewed in detail. The article should be objective and balanced, with summaries and critical analysis of the available evidence. Budgeting time for researching, synthesizing, and writing; taking advantage of the resources listed in this article and available online; and soliciting feedback from co-authors at various stages of the process (eg, after an outline is created) can help new writers produce high-quality scientific review articles.

The author thanks Susanne L. Loomis (Medical and Scientific Communications, Strategic Communications, Department of Radiology, Massachusetts General Hospital, Boston, MA) for creating Figure 1 in this article.

None declared.

M.B. is a consultant for Lunit (medical AI software company) and an expert panelist for 2nd.MD (a digital health company). She also receives funding from the National Institutes of Health (K08CA241365). M.B. is an associate editor of the Journal of Breast Imaging . As such, she was excluded from the editorial process.

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Gregory AT , Denniss AR. An introduction to writing narrative and systematic reviews—tasks, tips and traps for aspiring authors . Heart Lung Circ 2018 ; 27 ( 7 ): 893 – 898 .

Heacock L , Reig B , Lewin AA , Toth HK , Moy L , Lee CS. Abbreviated breast MRI: road to clinical implementation . J Breast Imag 2020 ; 2 ( 3 ): 201 – 214 .

Neal CH. Screening breast MRI and gadolinium deposition: cause for concern ? J Breast Imag 2022 ; 4 ( 1 ): 10 – 18 .

Morris EA , Comstock CE , Lee CH , et al.  ACR BI-RADS ® Magnetic Resonance Imaging . In: ACR BI-RADS ® Atlas, Breast Imaging Reporting and Data System . Reston, VA : American College of Radiology ; 2013 .

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Nguyen DL , Myers KS , Oluyemi E , et al.  BI-RADS 3 assessment on MRI: a lesion-based review for breast radiologists . J Breast Imag 2022 ; 4 ( 5 ): 460 – 473 .

Vong S , Ronco AJ , Najafpour E , Aminololama-Shakeri S. Screening breast MRI and the science of premenopausal background parenchymal enhancement . J Breast Imag 2021 ; 3 ( 4 ): 407 – 415 .

Bahl M. Screening MRI in women at intermediate breast cancer risk: an update of the recent literature . J Breast Imag 2022 ; 4 ( 3 ): 231 – 240 .

National Library of Medicine . PubMed . Available at: https://pubmed.ncbi.nlm.nih.gov/ . Accessed October 5, 2022 .

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Clarivate . Web of Science . Available at: https://clarivate.com/webofsciencegroup/solutions/web-of-science/ . Accessed October 5, 2022 .

National Institutes of Health (NIH) Office of Management . NIH Library . Available at: https://www.nihlibrary.nih.gov/services/systematic-review-service/literature-search-databases-and-gray-literature/ . Accessed October 5, 2022 .

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Baethge C , Goldbeck-Wood S , Mertens S. SANRA—a scale for the quality assessment of narrative review articles . Res Integr Peer Rev 2019 ; 4 : 5 . doi: 10.1186/s41073-019-0064-8 .

Sanders DA. How to write (and how not to write) a scientific review article . Clin Biochem 2020 ; 81 : 65 – 68 .

Lingard L , Colquhoun H. The story behind the synthesis: writing an effective introduction to your scoping review . Perspect Med Educ 2022 ; 11 ( 5 ): 289 – 294 .

Murphy CM. Writing an effective review article . J Med Toxicol 2012 ; 8 ( 2 ): 89 – 90 .

The University of Manchester Academic Phrasebank . Being critical. Available at: https://www.phrasebank.manchester.ac.uk/being-critical/ . Accessed October 5, 2022 .

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RefWorks . Available at: https://www.refworks.com/refworks2/ . Accessed October 5, 2022 .

Zotero . Available at: https://www.zotero.org/ . Accessed October 5, 2022 .

Grimm LJ , Harvey JA. Practical steps to writing a scientific manuscript . J Breast Imag 2022 ; 4 ( 6 ): 640 – 648 .

Gasparyan AY , Ayvazyan L , Blackmore H , Kitas GD. Writing a narrative biomedical review: considerations for authors, peer reviewers, and editors . Rheumatol Int 2011 ; 31 ( 11 ): 1409 – 1417 .

Kim G , Bahl M. Assessing risk of breast cancer: a review of risk prediction models . J Breast Imag 2021 ; 3 ( 2 ): 144 – 155 .

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How to Write Critical Reviews

When you are asked to write a critical review of a book or article, you will need to identify, summarize, and evaluate the ideas and information the author has presented. In other words, you will be examining another person’s thoughts on a topic from your point of view.

Your stand must go beyond your “gut reaction” to the work and be based on your knowledge (readings, lecture, experience) of the topic as well as on factors such as criteria stated in your assignment or discussed by you and your instructor.

Make your stand clear at the beginning of your review, in your evaluations of specific parts, and in your concluding commentary.

Remember that your goal should be to make a few key points about the book or article, not to discuss everything the author writes.

Understanding the Assignment

To write a good critical review, you will have to engage in the mental processes of analyzing (taking apart) the work–deciding what its major components are and determining how these parts (i.e., paragraphs, sections, or chapters) contribute to the work as a whole.

Analyzing the work will help you focus on how and why the author makes certain points and prevent you from merely summarizing what the author says. Assuming the role of an analytical reader will also help you to determine whether or not the author fulfills the stated purpose of the book or article and enhances your understanding or knowledge of a particular topic.

Be sure to read your assignment thoroughly before you read the article or book. Your instructor may have included specific guidelines for you to follow. Keeping these guidelines in mind as you read the article or book can really help you write your paper!

Also, note where the work connects with what you’ve studied in the course. You can make the most efficient use of your reading and notetaking time if you are an active reader; that is, keep relevant questions in mind and jot down page numbers as well as your responses to ideas that appear to be significant as you read.

Please note: The length of your introduction and overview, the number of points you choose to review, and the length of your conclusion should be proportionate to the page limit stated in your assignment and should reflect the complexity of the material being reviewed as well as the expectations of your reader.

Write the introduction

Below are a few guidelines to help you write the introduction to your critical review.

Introduce your review appropriately

Begin your review with an introduction appropriate to your assignment.

If your assignment asks you to review only one book and not to use outside sources, your introduction will focus on identifying the author, the title, the main topic or issue presented in the book, and the author’s purpose in writing the book.

If your assignment asks you to review the book as it relates to issues or themes discussed in the course, or to review two or more books on the same topic, your introduction must also encompass those expectations.

Explain relationships

For example, before you can review two books on a topic, you must explain to your reader in your introduction how they are related to one another.

Within this shared context (or under this “umbrella”) you can then review comparable aspects of both books, pointing out where the authors agree and differ.

In other words, the more complicated your assignment is, the more your introduction must accomplish.

Finally, the introduction to a book review is always the place for you to establish your position as the reviewer (your thesis about the author’s thesis).

As you write, consider the following questions:

  • Is the book a memoir, a treatise, a collection of facts, an extended argument, etc.? Is the article a documentary, a write-up of primary research, a position paper, etc.?
  • Who is the author? What does the preface or foreword tell you about the author’s purpose, background, and credentials? What is the author’s approach to the topic (as a journalist? a historian? a researcher?)?
  • What is the main topic or problem addressed? How does the work relate to a discipline, to a profession, to a particular audience, or to other works on the topic?
  • What is your critical evaluation of the work (your thesis)? Why have you taken that position? What criteria are you basing your position on?

Provide an overview

In your introduction, you will also want to provide an overview. An overview supplies your reader with certain general information not appropriate for including in the introduction but necessary to understanding the body of the review.

Generally, an overview describes your book’s division into chapters, sections, or points of discussion. An overview may also include background information about the topic, about your stand, or about the criteria you will use for evaluation.

The overview and the introduction work together to provide a comprehensive beginning for (a “springboard” into) your review.

  • What are the author’s basic premises? What issues are raised, or what themes emerge? What situation (i.e., racism on college campuses) provides a basis for the author’s assertions?
  • How informed is my reader? What background information is relevant to the entire book and should be placed here rather than in a body paragraph?

Write the body

The body is the center of your paper, where you draw out your main arguments. Below are some guidelines to help you write it.

Organize using a logical plan

Organize the body of your review according to a logical plan. Here are two options:

  • First, summarize, in a series of paragraphs, those major points from the book that you plan to discuss; incorporating each major point into a topic sentence for a paragraph is an effective organizational strategy. Second, discuss and evaluate these points in a following group of paragraphs. (There are two dangers lurking in this pattern–you may allot too many paragraphs to summary and too few to evaluation, or you may re-summarize too many points from the book in your evaluation section.)
  • Alternatively, you can summarize and evaluate the major points you have chosen from the book in a point-by-point schema. That means you will discuss and evaluate point one within the same paragraph (or in several if the point is significant and warrants extended discussion) before you summarize and evaluate point two, point three, etc., moving in a logical sequence from point to point to point. Here again, it is effective to use the topic sentence of each paragraph to identify the point from the book that you plan to summarize or evaluate.

Questions to keep in mind as you write

With either organizational pattern, consider the following questions:

  • What are the author’s most important points? How do these relate to one another? (Make relationships clear by using transitions: “In contrast,” an equally strong argument,” “moreover,” “a final conclusion,” etc.).
  • What types of evidence or information does the author present to support his or her points? Is this evidence convincing, controversial, factual, one-sided, etc.? (Consider the use of primary historical material, case studies, narratives, recent scientific findings, statistics.)
  • Where does the author do a good job of conveying factual material as well as personal perspective? Where does the author fail to do so? If solutions to a problem are offered, are they believable, misguided, or promising?
  • Which parts of the work (particular arguments, descriptions, chapters, etc.) are most effective and which parts are least effective? Why?
  • Where (if at all) does the author convey personal prejudice, support illogical relationships, or present evidence out of its appropriate context?

Keep your opinions distinct and cite your sources

Remember, as you discuss the author’s major points, be sure to distinguish consistently between the author’s opinions and your own.

Keep the summary portions of your discussion concise, remembering that your task as a reviewer is to re-see the author’s work, not to re-tell it.

And, importantly, if you refer to ideas from other books and articles or from lecture and course materials, always document your sources, or else you might wander into the realm of plagiarism.

Include only that material which has relevance for your review and use direct quotations sparingly. The Writing Center has other handouts to help you paraphrase text and introduce quotations.

Write the conclusion

You will want to use the conclusion to state your overall critical evaluation.

You have already discussed the major points the author makes, examined how the author supports arguments, and evaluated the quality or effectiveness of specific aspects of the book or article.

Now you must make an evaluation of the work as a whole, determining such things as whether or not the author achieves the stated or implied purpose and if the work makes a significant contribution to an existing body of knowledge.

Consider the following questions:

  • Is the work appropriately subjective or objective according to the author’s purpose?
  • How well does the work maintain its stated or implied focus? Does the author present extraneous material? Does the author exclude or ignore relevant information?
  • How well has the author achieved the overall purpose of the book or article? What contribution does the work make to an existing body of knowledge or to a specific group of readers? Can you justify the use of this work in a particular course?
  • What is the most important final comment you wish to make about the book or article? Do you have any suggestions for the direction of future research in the area? What has reading this work done for you or demonstrated to you?

how to write a critical review of a medical journal article

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What is critical appraisal?

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Critical appraisal is a crucial part of evidence-based medicine, yet reading and critiquing a journal article can seem like a daunting and complex task. Breaking the process down into steps should enable you to build up the necessary skills, such as:

- Skimming the article in the first instance to look for the author's main points and conclusions

- Being familiar with the way that many journal articles are structured (abstract, method, results, discussion etc)

- Reflecting on and being critical of what you are reading

A checklist or toolkit such as those on this page will guide you through this process in a structured way. This page will also direct you to articles, web pages, online guides and books to guide you toward effectively appraising scientific articles.

If you have any suggestions for helpful books, links, or resources about critical appraisal please email [email protected]

how to write a critical review of a medical journal article

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  • IoPPN Biostatistics and Health Informatics Advisory Service This service is intended to provide advice to staff and students from IoPPN departments on statistical aspects of a research project including PhD thesis and MSc dissertations, technical support with informatics related projects and qualitative research advice. Note This is only available to staff and students based at the Institute of Psychiatry, Psychology and Neuroscience KCL.

Critical Appraisal Glossaries

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Trustworthiness assessment

how to write a critical review of a medical journal article

Abstract Background There is increasing concern that a significant proportion of randomized controlled trials (RCTs) included in Cochrane reviews may not be trustworthy. Applying the Cochrane Pregnancy and Childbirth Trustworthiness Screening Tool (CPC-TST) has already had a clinically important effect on several reviews published by the Cochrane Pregnancy and Childbirth Group.

Objectives We wanted to assess the impact of removing untrustworthy RCTs from already-published Cochrane reviews on a defined clinical area (antenatal and postnatal nutritional interventions).

Methods We applied the tool to 18 Cochrane reviews (374 RCTs). The tool had four domains: (i) is the research governance trustworthy; (ii) are the baseline characteristics trustworthy; (iii) is the study feasible; (iv) are the results plausible? When additional information was needed, authors were contacted using a standard template. At least two attempts were made to contact the authors. At the end of the evaluation process each study was classified as: (i) included (YES to all questions); (ii) excluded (retracted study); or (iii) awaiting classification (any NO to the questions).

Results Ninety-three out of 374 included studies (25%) were reclassified as “excluded” or “awaiting classification.” The number of included RCTs was reduced in 14 out of 18 reviews. Six reviews (33%) were judged to require updating because of important differences in the Summary of Findings tables (direction and size of effects and/or GRADE ratings), conclusions, implication for practice, and/or implication for research.

Conclusions Formal assessment of trustworthiness, and inclusion only of studies that satisfy prespecified criteria for trustworthiness, affect conclusions in a relatively large number of Cochrane reviews, with potentially important clinical implications for practice and research.

Weeks J, Cuthbert A, Alfirevic Z. Trustworthiness assessment as an inclusion criterion for systematic reviews—What is the impact on results? Cochrane Ev Synth. 2023; e12037. doi:10.1002/cesm.12037

Toolkits and checklists for critical appraisal

  • Critical Appraisal Skills Programme (CASP) - eight critical appraisal tools to be used when reading research. - tools for Systematic Reviews, Randomised Controlled Trials, Cohort Studies, Case Control Studies, Economic Evaluations, Diagnostic Studies, Qualitative studies and Clinical Prediction Rule.
  • JBI’s critical appraisal tools JBI’s critical appraisal tools assist in assessing the trustworthiness, relevance and results of published papers. They provide checklists for Analytical Cross Sectional Studies; Case Control Studies; Case Reports; Case Series; Cohort Studies; Diagnostic Test Accuracy Studies; Economic Evaluations; Prevalence Studies; Qualitative Research; Quasi-Experimental Studies; Randomized Controlled Trials; Systematic Reviews and Text and Opinion.
  • Mixed Methods Appraisal Tool (MMAT) Appraisal tool used for qualitative, quantitative, and/or mixed methods studies. Helpful for those working on a Mixed Methods Review.
  • CONSORT Statement - set of recommendations for reporting Randomised Controlled Trials. - Use the checklist to help you assess the different aspects of an RCT paper you are reading.
  • PRISMA Statement - aims to help authors improve the reporting of systematic reviews and meta-analyses by providing a minimum set of items to be included. - use the checklist to help you check for any gaps.in a review you are reading - please note this is not designed explicitly to be a critical appraisal tool as it focuses on the minimum to be expected

Helpful links

  • BMJ - How to read a paper article series by Trisha Greenhalgh. Articles include: 'Getting your bearings (deciding what the paper is about)'; 'Statistics for the non-statistician'; 'Papers that report drug trials' and 'Papers that go beyond numbers (qualitative research).
  • Critical appraisal links Helpful links from the library pages for NHS staff.
  • How to critically appraise an article Young, J. M. and Solomon, M. J. (2009) 'How to critically appraise an article', Nature Clinical Practice Gastroenterology & Hepatology, 6(2), 82-91. (log in via your institution with King's username and password off campus)

Books and ebooks

New books are published regularly on the topic of reading a paper, study skills, critical appraisal etc - click the books below or use Library Search to explore books in our collection:

how to write a critical review of a medical journal article

New to using Library Search?

You can find online tutorials on using Library Search to find books and journals around your subject. Find them in the  Getting Started With Your Studies  section of KLaSS:

how to write a critical review of a medical journal article

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How to read a paper, critical review

Reading a scientific article is a complex task. The worst way to approach this task is to treat it like the reading of a textbook—reading from title to literature cited, digesting every word along the way without any reflection or criticism.

A critical review (sometimes called a critique, critical commentary, critical appraisal, critical analysis) is a detailed commentary on and critical evaluation of a text. You might carry out a critical review as a stand-alone exercise, or as part of your research and preparation for writing a literature review. The following guidelines are designed to help you critically evaluate a research article.

How to Read a Scientific Article

You should begin by skimming the article to identify its structure and features. As you read, look for the author’s main points.

  • Generate questions before, during, and after reading.
  • Draw inferences based on your own experiences and knowledge.
  • To really improve understanding and recall, take notes as you read.

What is meant by critical and evaluation?

  • To be critical does not mean to criticise in an exclusively negative manner.   To be critical of a text means you question the information and opinions in the text, in an attempt to evaluate or judge its worth overall.
  • An evaluation is an assessment of the strengths and weaknesses of a text.   This should relate to specific criteria, in the case of a research article.   You have to understand the purpose of each section, and be aware of the type of information and evidence that are needed to make it convincing, before you can judge its overall value to the research article as a whole.

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JAY SIWEK, M.D., MARGARET L. GOURLAY, M.D., DAVID C. SLAWSON, M.D., AND ALLEN F. SHAUGHNESSY, PHARM.D.

Am Fam Physician. 2002;65(2):251-258

Traditional clinical review articles, also known as updates, differ from systematic reviews and meta-analyses. Updates selectively review the medical literature while discussing a topic broadly. Nonquantitative systematic reviews comprehensively examine the medical literature, seeking to identify and synthesize all relevant information to formulate the best approach to diagnosis or treatment. Meta-analyses (quantitative systematic reviews) seek to answer a focused clinical question, using rigorous statistical analysis of pooled research studies. This article presents guidelines for writing an evidence-based clinical review article for American Family Physician . First, the topic should be of common interest and relevance to family practice. Include a table of the continuing medical education objectives of the review. State how the literature search was done and include several sources of evidence-based reviews, such as the Cochrane Collaboration, BMJ's Clinical Evidence , or the InfoRetriever Web site. Where possible, use evidence based on clinical outcomes relating to morbidity, mortality, or quality of life, and studies of primary care populations. In articles submitted to American Family Physician , rate the level of evidence for key recommendations according to the following scale: level A (randomized controlled trial [RCT], meta-analysis); level B (other evidence); level C (consensus/expert opinion). Finally, provide a table of key summary points.

American Family Physician is particularly interested in receiving clinical review articles that follow an evidence-based format. Clinical review articles, also known as updates, differ from systematic reviews and meta-analyses in important ways. 1 Updates selectively review the medical literature while discussing a topic broadly. An example of such a topic is, “The diagnosis and treatment of myocardial ischemia.” Systematic reviews comprehensively examine the medical literature, seeking to identify and synthesize all relevant information to formulate the best approach to diagnosis or treatment. Examples are many of the systematic reviews of the Cochrane Collaboration or BMJ's Clinical Evidence compendium. Meta-analyses are a special type of systematic review. They use quantitative methods to analyze the literature and seek to answer a focused clinical question, using rigorous statistical analysis of pooled research studies. An example is, “Do beta blockers reduce mortality following myocardial infarction?”

The best clinical review articles base the discussion on existing systematic reviews and meta-analyses, and incorporate all relevant research findings about the management of a given disorder. Such evidence-based updates provide readers with powerful summaries and sound clinical guidance.

In this article, we present guidelines for writing an evidence-based clinical review article, especially one designed for continuing medical education (CME) and incorporating CME objectives into its format. This article may be read as a companion piece to a previous article and accompanying editorial about reading and evaluating clinical review articles. 1 , 2 Some articles may not be appropriate for an evidence-based format because of the nature of the topic, the slant of the article, a lack of sufficient supporting evidence, or other factors. We encourage authors to review the literature and, wherever possible, rate key points of evidence. This process will help emphasize the summary points of the article and strengthen its teaching value.

Topic Selection

Choose a common clinical problem and avoid topics that are rarities or unusual manifestations of disease or that have curiosity value only. Whenever possible, choose common problems for which there is new information about diagnosis or treatment. Emphasize new information that, if valid, should prompt a change in clinical practice, such as the recent evidence that spironolactone therapy improves survival in patients who have severe congestive heart failure. 3 Similarly, new evidence showing that a standard treatment is no longer helpful, but may be harmful, would also be important to report. For example, patching most traumatic corneal abrasions may actually cause more symptoms and delay healing compared with no patching. 4

Searching the Literature

When searching the literature on your topic, please consult several sources of evidence-based reviews ( Table 1 ) . Look for pertinent guidelines on the diagnosis, treatment, or prevention of the disorder being discussed. Incorporate all high-quality recommendations that are relevant to the topic. When reviewing the first draft, look for all key recommendations about diagnosis and, especially, treatment. Try to ensure that all recommendations are based on the highest level of evidence available. If you are not sure about the source or strength of the recommendation, return to the literature, seeking out the basis for the recommendation.

In particular, try to find the answer in an authoritative compendium of evidence-based reviews, or at least try to find a meta-analysis or well-designed randomized controlled trial (RCT) to support it. If none appears to be available, try to cite an authoritative consensus statement or clinical guideline, such as a National Institutes of Health Consensus Development Conference statement or a clinical guideline published by a major medical organization. If no strong evidence exists to support the conventional approach to managing a given clinical situation, point this out in the text, especially for key recommendations. Keep in mind that much of traditional medical practice has not yet undergone rigorous scientific study, and high-quality evidence may not exist to support conventional knowledge or practice.

Patient-Oriented vs. Disease-Oriented Evidence

With regard to types of evidence, Shaughnessy and Slawson 5 – 7 developed the concept of Patient-Oriented Evidence that Matters (POEM), in distinction to Disease-Oriented Evidence (DOE). POEM deals with outcomes of importance to patients, such as changes in morbidity, mortality, or quality of life. DOE deals with surrogate end points, such as changes in laboratory values or other measures of response. Although the results of DOE sometimes parallel the results of POEM, they do not always correspond ( Table 2 ) . 2 When possible, use POEM-type evidence rather than DOE. When DOE is the only guidance available, indicate that key clinical recommendations lack the support of outcomes evidence. Here is an example of how the latter situation might appear in the text: “Although prostate-specific antigen (PSA) testing identifies prostate cancer at an early stage, it has not yet been proved that PSA screening improves patient survival.” (Note: PSA testing is an example of DOE, a surrogate marker for the true outcomes of importance—improved survival, decreased morbidity, and improved quality of life.)

Evaluating the Literature

Evaluate the strength and validity of the literature that supports the discussion (see the following section, Levels of Evidence). Look for meta-analyses, high-quality, randomized clinical trials with important outcomes (POEM), or well-designed, nonrandomized clinical trials, clinical cohort studies, or case-controlled studies with consistent findings. In some cases, high-quality, historical, uncontrolled studies are appropriate (e.g., the evidence supporting the efficacy of Papanicolaou smear screening). Avoid anecdotal reports or repeating the hearsay of conventional wisdom, which may not stand up to the scrutiny of scientific study (e.g., prescribing prolonged bed rest for low back pain).

Look for studies that describe patient populations that are likely to be seen in primary care rather than subspecialty referral populations. Shaughnessy and Slawson's guide for writers of clinical review articles includes a section on information and validity traps to avoid. 2

Levels of Evidence

Readers need to know the strength of the evidence supporting the key clinical recommendations on diagnosis and treatment. Many different rating systems of varying complexity and clinical relevance are described in the medical literature. Recently, the third U.S. Preventive Services Task Force (USPSTF) emphasized the importance of rating not only the study type (RCT, cohort study, case-control study, etc.), but also the study quality as measured by internal validity and the quality of the entire body of evidence on a topic. 8

While it is important to appreciate these evolving concepts, we find that a simplified grading system is more useful in AFP . We have adopted the following convention, using an ABC rating scale. Criteria for high-quality studies are discussed in several sources. 8 , 9 See the AFP Web site ( www.aafp.org/afp/authors ) for additional information about levels of evidence and see the accompanying editorial in this issue discussing the potential pitfalls and limitations of any rating system.

Level A (randomized controlled trial/meta-analysis): High-quality randomized controlled trial (RCT) that considers all important outcomes. High-quality meta-analysis (quantitative systematic review) using comprehensive search strategies.

Level B (other evidence): A well-designed, nonrandomized clinical trial. A nonquantitative systematic review with appropriate search strategies and well-substantiated conclusions. Includes lower quality RCTs, clinical cohort studies, and case-controlled studies with non-biased selection of study participants and consistent findings. Other evidence, such as high-quality, historical, uncontrolled studies, or well-designed epidemiologic studies with compelling findings, is also included.

Level C (consensus/expert opinion): Consensus viewpoint or expert opinion.

Each rating is applied to a single reference in the article, not to the entire body of evidence that exists on a topic. Each label should include the letter rating (A, B, C), followed by the specific type of study for that reference. For example, following a level B rating, include one of these descriptors: (1) nonrandomized clinical trial; (2) nonquantitative systematic review; (3) lower quality RCT; (4) clinical cohort study; (5) case-controlled study; (6) historical uncontrolled study; (7) epidemiologic study.

Here are some examples of the way evidence ratings should appear in the text:

“To improve morbidity and mortality, most patients in congestive heart failure should be treated with an angiotensin-converting enzyme inhibitor. [Evidence level A, RCT]”

“The USPSTF recommends that clinicians routinely screen asymptomatic pregnant women 25 years and younger for chlamydial infection. [Evidence level B, non-randomized clinical trial]”

“The American Diabetes Association recommends screening for diabetes every three years in all patients at high risk of the disease, including all adults 45 years and older. [Evidence level C, expert opinion]”

When scientifically strong evidence does not exist to support a given clinical recommendation, you can point this out in the following way:

“Physical therapy is traditionally prescribed for the treatment of adhesive capsulitis (frozen shoulder), although there are no randomized outcomes studies of this approach.”

Format of the Review

Introduction.

The introduction should define the topic and purpose of the review and describe its relevance to family practice. The traditional way of doing this is to discuss the epidemiology of the condition, stating how many people have it at one point in time (prevalence) or what percentage of the population is expected to develop it over a given period of time (incidence). A more engaging way of doing this is to indicate how often a typical family physician is likely to encounter this problem during a week, month, year, or career. Emphasize the key CME objectives of the review and summarize them in a separate table entitled “CME Objectives.”

The methods section should briefly indicate how the literature search was conducted and what major sources of evidence were used. Ideally, indicate what predetermined criteria were used to include or exclude studies (e.g., studies had to be independently rated as being high quality by an established evaluation process, such as the Cochrane Collaboration). Be comprehensive in trying to identify all major relevant research. Critically evaluate the quality of research reviewed. Avoid selective referencing of only information that supports your conclusions. If there is controversy on a topic, address the full scope of the controversy.

The discussion can then follow the typical format of a clinical review article. It should touch on one or more of the following subtopics: etiology, pathophysiology, clinical presentation (signs and symptoms), diagnostic evaluation (history, physical examination, laboratory evaluation, and diagnostic imaging), differential diagnosis, treatment (goals, medical/surgical therapy, laboratory testing, patient education, and follow-up), prognosis, prevention, and future directions.

The review will be comprehensive and balanced if it acknowledges controversies, unresolved questions, recent developments, other viewpoints, and any apparent conflicts of interest or instances of bias that might affect the strength of the evidence presented. Emphasize an evidence-supported approach or, where little evidence exists, a consensus viewpoint. In the absence of a consensus viewpoint, you may describe generally accepted practices or discuss one or more reasoned approaches, but acknowledge that solid support for these recommendations is lacking.

In some cases, cost-effectiveness analyses may be important in deciding how to implement health care services, especially preventive services. 10 When relevant, mention high-quality cost-effectiveness analyses to help clarify the costs and health benefits associated with alternative interventions to achieve a given health outcome. Highlight key points about diagnosis and treatment in the discussion and include a summary table of the key take-home points. These points are not necessarily the same as the key recommendations, whose level of evidence is rated, although some of them will be.

Use tables, figures, and illustrations to highlight key points, and present a step-wise, algorithmic approach to diagnosis or treatment when possible.

Rate the evidence for key statements, especially treatment recommendations. We expect that most articles will have at most two to four key statements; some will have none. Rate only those statements that have corresponding references and base the rating on the quality and level of evidence presented in the supporting citations. Use primary sources (original research, RCTs, meta-analyses, and systematic reviews) as the basis for determining the level of evidence. In other words, the supporting citation should be a primary research source of the information, not a secondary source (such as a nonsystematic review article or a textbook) that simply cites the original source. Systematic reviews that analyze multiple RCTs are good sources for determining ratings of evidence.

The references should include the most current and important sources of support for key statements (i.e., studies referred to, new information, controversial material, specific quantitative data, and information that would not usually be found in most general reference textbooks). Generally, these references will be key evidence-based recommendations, meta-analyses, or landmark articles. Although some journals publish exhaustive lists of reference citations, AFP prefers to include a succinct list of key references. (We will make more extensive reference lists available on our Web site or provide links to your personal reference list.)

You may use the following checklist to ensure the completeness of your evidence-based review article; use the source list of reviews to identify important sources of evidence-based medicine materials.

Checklist for an Evidence-Based Clinical Review Article

The topic is common in family practice, especially topics in which there is new, important information about diagnosis or treatment.

The introduction defines the topic and the purpose of the review, and describes its relevance to family practice.

A table of CME objectives for the review is included.

The review states how you did your literature search and indicates what sources you checked to ensure a comprehensive assessment of relevant studies (e.g., MEDLINE, the Cochrane Collaboration Database, the Center for Research Support, TRIP Database).

Several sources of evidence-based reviews on the topic are evaluated ( Table 1 ) .

Where possible, POEM (dealing with changes in morbidity, mortality, or quality of life) rather than DOE (dealing with mechanistic explanations or surrogate end points, such as changes in laboratory tests) is used to support key clinical recommendations ( Table 2 ) .

Studies of patients likely to be representative of those in primary care practices, rather than subspecialty referral centers, are emphasized.

Studies that are not only statistically significant but also clinically significant are emphasized; e.g., interventions with meaningful changes in absolute risk reduction and low numbers needed to treat. (See http://www.cebm.net/index.aspx?o=1116 .) 11

The level of evidence for key clinical recommendations is labeled using the following rating scale: level A (RCT/meta-analysis), level B (other evidence), and level C (consensus/expert opinion).

Acknowledge controversies, recent developments, other viewpoints, and any apparent conflicts of interest or instances of bias that might affect the strength of the evidence presented.

Highlight key points about diagnosis and treatment in the discussion and include a summary table of key take-home points.

Use tables, figures, and illustrations to highlight key points and present a step-wise, algorithmic approach to diagnosis or treatment when possible.

Emphasize evidence-based guidelines and primary research studies, rather than other review articles, unless they are systematic reviews.

The essential elements of this checklist are summarized in Table 3 .

Siwek J. Reading and evaluating clinical review articles. Am Fam Physician. 1997;55:2064-2069.

Shaughnessy AF, Slawson DC. Getting the most from review articles: a guide for readers and writers. Am Fam Physician. 1997;55:2155-60.

Pitt B, Zannad F, Remme WJ, Cody R, Castaigne A, Perez A, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med. 1999;341:709-17.

Flynn CA, D'Amico F, Smith G. Should we patch corneal abrasions? A meta-analysis. J Fam Pract. 1998;47:264-70.

Slawson DC, Shaughnessy AF, Bennett JH. Becoming a medical information master: feeling good about not knowing everything. J Fam Pract. 1994;38:505-13.

Shaughnessy AF, Slawson DC, Bennett JH. Becoming an information master: a guidebook to the medical information jungle. J Fam Pract. 1994;39:489-99.

Slawson DC, Shaughnessy AF. Becoming an information master: using POEMs to change practice with confidence. Patient-oriented evidence that matters. J Fam Pract. 2000;49:63-7.

Harris RP, Helfand M, Woolf SH, Lohr KN, Mulrow CD, Teutsch SM, et al. Methods Work Group, Third U.S. Preventive Services Task Force. Current methods of the U.S. Preventive Services Task Force. A review of the process. Am J Prev Med. 2001;20(3 suppl):21-35.

CATbank topics: levels of evidence and grades of recommendations. Retrieved November 2001, from: http://www.cebm.net/ .

Saha S, Hoerger TJ, Pignone MP, Teutsch SM, Helfand M, Mandelblatt JS. for the Cost Work Group of the Third U.S. Preventive Services Task Force. The art and science of incorporating cost effectiveness into evidence-based recommendations for clinical preventive services. Am J Prev Med. 2001;20(3 suppl):36-43.

Evidence-based medicine glossary. Retrieved November 2001, from: http://www.cebm.net/index.aspx?o=1116 .

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A critical review is a description and evaluation of a source, usually a journal article or book. It moves beyond a summary to assess the strengths and weaknesses of the source and to comment on the quality of the source as a whole.

  • Do not be confused by the term “critical”: it does not mean that you only look at the negative aspects of what the researcher has done. You should address both the positive and negative aspects.

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  • Article or book review
  • Read the article or book carefully
  • Briefly summarize the main point and key details of the source
  • Originality (e.g. Does the study address a clear gap in the previously existing literature or in the field of study?) 
  • Reliability (e.g. Is the article or book peer reviewed? Is it free of author bias?)
  • Validity (e.g. Is the study repeatable? Are the research results generalizable?)
  • Relevance (e.g. Is the research well connected or related to other research in the field? Does it make a useful or timely contribution?)
  • Presentation (e.g. Is the article or book well organized? Does the writing logically flow between sections, paragraphs, and sentences? 
  • Analyze the strengths and weaknesses to determine the source’s overall value and contribution to the area of study. 
  • The specific purpose, length, and amount of research will vary from assignment to assignment.
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How to review a case report

  • Rakesh Garg 1 ,
  • Shaheen E. Lakhan 2 &
  • Ananda K. Dhanasekaran 3  

Journal of Medical Case Reports volume  10 , Article number:  88 ( 2016 ) Cite this article

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Peer Review reports

Introduction

Sharing individual patient experiences with clinical colleagues is an essential component of learning from each other. This sharing of information may be made global by reporting in a scientific journal. In medicine, patient management decisions are generally based on the evidence available for use of a particular investigation or technology [ 1 ]. The hierarchical rank of the evidence signifies the probability of bias. The higher up the hierarchy, the better its reliability and thus its clinical acceptance (Table  1 ). Though case reports remain lowest in the hierarchy of evidence, with meta-analysis representing the highest level, they nevertheless constitute important information with regard to rare events and may be considered as anecdotal evidence [ 2 ] (Table  1 ). Case reports may stimulate the generation of new hypotheses, and thus may support the emergence of new research.

The definition of a case report or a case series is not well defined in the literature and has been defined variously by different journals and authors. However, the basic definition of a case report is the detailed report of an individual including aspects like exposure, symptoms, signs, intervention, and outcome. It has been suggested that a report with more than four cases be called a case series and those with fewer than four a case report [ 3 ]. A case series is descriptive in design. Other authors describe “a collection of patients” as a case series and “a few patients” as a case report [ 4 ]. We suggest that should more than one case be reported, it may be defined as a case series—a concept proposed by other authors [ 5 ].

The importance of case reports

A case report may describe an unusual etiology, an unusual or unknown disorder, a challenging differential diagnosis, an unusual setting for care, information that can not be reproduced due to ethical reasons, unusual or puzzling clinical features, improved or unique technical procedures, unusual interactions, rare or novel adverse reactions to care, or new insight into the pathogenesis of disease [ 6 , 7 ]. In recent years, the publication of case reports has been given low priority by many high impact factor journals. However, the need for reporting such events remains. There are some journals dedicated purely to case reports, such as the Journal of Medical Case Reports , emphasizing their importance in modern literature. In the past, isolated case reports have led to significant advancements in patient care. For example, case reports concerning pulmonary hypertension and anorexic agents led to further trials and the identification of the mechanism and risk factors associated with these agents [ 2 , 8 ].

Reporting and publishing requirements

The reporting of cases varies for different journals. The authors need to follow the instructions for the intended publication. Owing to significant variability, it would be difficult to have uniform publication guidelines for case reports. A checklist called the CARE guidelines is useful for authors writing case reports [ 9 , 10 ]. However, it would be universally prudent to include a title, keywords, abstract, introduction, patient information, clinical findings, timeline, diagnostic assessment, therapeutic interventions, follow-up and outcomes, discussion, patient perspective, and informed consent.

Peer review process

The peer review process is an essential part of ethical and scientific writing. Peer review ultimately helps improve articles by providing valuable feedback to the author and helps editors make a decision regarding publication. The peer reviewer should provide unbiased, constructive feedback regarding the manuscript. They may also highlight the strengths and weaknesses of the report. When reviewing an article, it is prudent to read the entire manuscript first to understand the overall content and message. The reviewer than may read section-wise and provide comments to the authors and editorial team accordingly. The reviewer needs to consider the following important points when reviewing a case for possible publication [ 8 , 9 ] (summarized in Table  2 ).

Novelty remains the foremost important aspect of a case. The case report should introduce novel aspects of patient evaluation, investigation, treatment, or any other aspect related to patient care. The relevant information becomes a hypothesis generator for further study. The novelty may at times be balanced with some important information like severe adverse effects, even if they have been reported earlier. Reporting adverse events remains important so that information on cumulative adverse effects can be gathered globally, which helps in preparing a policy or guideline or a warning note for its use in patients. The data related to adverse effects include not only the impact but also the number of patients affected. This becomes more important for serious adverse effects. In the absence of an international registry for adverse effects, published case reports are important pieces of information. Owing to ethical concerns, formal evaluation may not be feasible in the format of prospective study.

Essential description

The case needs to have all essential details to allow a useful conclusion to emerge. For example, if a case is being reported for hemodynamic variability due to a drug, then the drug dose and timing along with timed vital signs need to be described.

Authenticity and genuineness

Honesty remains the most important basic principle of all publications. This remains a primary responsibility of the authors. However, if there is any doubt, reviewers may seek clarification. This doubt may result from some discordance in the case description. At times, a lack of correlation between the figures and description may act as “red flags.” For instance, authors may discuss a technique for dealing with a difficult airway, but the figure is of a normal-appearing airway. Another example would be where the data and figure do not correlate in a hemodynamic response related to a drug or a technique, with the graphical picture or screenshot of hemodynamics acting as an alert sign. Such cause for concern may be communicated in confidence to the editor.

Ethical or competing interests

Ethical issues need to be cautiously interpreted and communicated. The unethical use of a drug or device is not desirable and often unworthy of publication. This may relate to the route or dose of the drug administered. The off-label use of drugs where known side effects are greater than potential benefit needs to be discouraged and remains an example of unethical use. This use may be related to the drug dose, particularly when the drug dose exceeds the routine recommended dose, or to the route of administration. As an example, the maximal dose of acetaminophen (paracetamol) is 4g/day, and if an author reports exceeding this dose, it should be noted why a greater than recommended dose was used. Ultimately, the use of a drug or its route of administration needs to be justified in the manuscript. The reviewers need to serve as content experts regarding the drugs and other technologies used in the case. A literature search by the reviewer provides the data to comment on this aspect.

Competing interests (or conflicts of interest) are concerns that interfere or potentially interfere with presentation, review, or publication. They must be declared by the authors. Conflicts can relate to patient-related professional attributes (like the use of a particular procedure, drug, or instrument) being affected by some secondary gains (financial, non-financial, professional, personal). Financial conflict may be related to ownership, paid consultancy, patents, grants, honoraria, and gifts. Non-financial conflicts may be related to memberships, relationships, appearance as an expert witness, or personal convictions. At times, the conflict may be related to the author’s relationship with an organization or another person. A conflict may influence the interpretation of the outcome in an inappropriate and unscientific manner. Although conflicts may not be totally abolished, they must be disclosed when they reasonably exist. This disclosure should include information such as funding sources, present membership, and patents pending. Reviewers should cautiously interpret any potential bias regarding the outcome of the case based on the reported conflicts. This is essential for transparent reporting of research. At times, competing interests may be discovered by a reviewer and should be included in comments to the editorial team. Such conflicts may again be ascertained when the reviewer reviews the literature during the peer review process. The reviewer should also disclose their own conflicts related to the manuscript review when sending their report to the editorial team.

Impact on clinical practice

This is an important aspect for the final decision of whether to publish a case report. The main thrust or carry-home message needs to be emphasized clearly. It needs to be elaborated upon in concluding remarks.

Patient anonymity, consent, and ethical approval

When reviewing the manuscript of a case report, reviewers should ensure that the patient’s anonymity and confidentiality is protected. The reviewers should check that patient identifiers have been removed or masked from all aspects of the manuscript, whether in writing or within photograph. Identifiers can include things like the name of the patient, geographical location, date of birth, phone numbers, email of the patient, medical record numbers, or biometric identifiers. Utmost care needs to be taken to provide full anonymity for the patient.

Consent is required to participate in research, receive a certain treatment, and publish identifiable details. These consents are for different purposes and need to be explained separately to the patient. A patient’s consent to participate in the research or for use of the drug may not extend to consent for publication. All these aspects of consent must be explained to the patient, written explicitly in the patient’s own language, understood by the patient, and signed by the patient. For the purpose of the case, the patient must understand and consent for any new technique or drug (its dose, route, and timing) being used. In the case of a drug being used for a non-standard indication or route, consent for use must also be described. Patient consent is essential for the publication of a case if patient body parts are displayed in the article. This also includes any identifiers that can reveal the identity of the patient, such as the patient’s hospital identification number, address, and any other unique identifier. In situations where revealing the patient’s identity cannot be fully avoided, for example if the report requires an image of an identifiable body part like the face, then this should be explained to the patient, the image shown to them, and consent taken. Should the patient die, then consent must be obtained from next of kin or legal representative.

With case series, securing individual patient consent is advised and preferable. The authors may also need institutional review board (IRB) approval to publish a case series. IRBs can waive the need for consent if a study is conducted retrospectively and data are collected from patient notes for the purpose of research, usually in an anonymized way. However, wherever possible, individual patient consent is preferable, even for a retrospective study. Consent is mandatory for any prospective data collection for the purpose of publication as a case series. Consent and/or IRB approval must be disclosed in the case report and reasons for not obtaining individual consent may be described, if applicable.

There may be situations in which publishing patient details without their consent is justified, but this is a decision that should be made by the journal editor, who may decide to discuss the case with the Committee on Publication Ethics. Reviewers need to emphasize the issue to the editor when submitting their comments.

Manuscript writing

The CARE guidelines provide a framework that supports transparency and accuracy in the publication of case reports and the reporting of information from patient encounters. The acronym CARE was created from CA (the first two letters in “case”) and RE (the first two letters in “reports”). The initial CARE tools are the CARE checklist and the Case Report Writing Templates. These tools support the writing of case reports and provide data that inform clinical practice guidelines and provide early signals of effectiveness, harms, and cost [ 10 ].

The presentation of the case and its interpretation should be comprehensive and related. The various components of the manuscript should have sufficient information for understanding the key message of the case. The reviewer needs to comment on the relevant components of the manuscript. The reviewer should ascertain that the title of the case manuscript is relevant and includes keywords related to the case. The title should be short, descriptive, and interesting. The abstract should be brief, without any abbreviations, and include keywords. It is preferable to use Medical Subject Headings (MeSH) keywords. Reviewers must ensure that the introduction emphasizes the context of the case and describes the relevance and its importance in a concise and comprehensive manner. The case description should be complete and should follow basic rules of medical communication. The details regarding patient history, physical examination, investigations, differential diagnosis, management, and outcome should be described in chronological order. If repeated observations are present, then they may be tabulated. The use of graphs and figures helps the readers to better understand the case. Interpretation or inferences based on the outcomes should be avoided in this section and should be considered a part of the discussion. The discussion should highlight important aspects of the case, with its interpretation within the context of the available literature. References should be formatted as per the journal style. They should be complete and preferably of recent publications.

Reviewer responsibility

The reviewer’s remarks are essential not only for the editorial team but also for authors. A good peer review requires honesty, sincerity, and punctuality. Even if a manuscript is rejected, the authors should receive learning points from peer review commentary. The best way to review a manuscript is to read the manuscript in full for a gross overview and develop general comments. Thereafter, the reviewer should address each section of the manuscript separately and precisely. This may be done after a literature search if the reviewer needs to substantiate his/her commentary.

Constructive criticism

The reviewer’s remarks should be constructive to help the authors improve the manuscript for further consideration. If the manuscript is rejected, the authors should have a clear indication for the rejection. The remarks may be grouped as major and minor comments. Major comments likely suggest changes to the whole presentation, changing the primary aim of the case report, or adding images. Minor comments may include grammatical errors or getting references for a statement. The editorial team must be able to justify their decision on whether or not to accept an article for publication, often by citing peer review feedback. It is also good style to tabulate a list of the strengths and weaknesses of the manuscript.

Fixed time for review

Reviewer remarks should be submitted within a specified timeframe. If any delay is expected, it should be communicated to the editorial team. Reviewers should not rush to submit feedback without sufficient time to adequately review the paper and perform any necessary literature searches. Should a reviewer be unable to submit the review within the specified timeframe, they should reply to the review invitation to decline at their earliest convenience. If, after accepting a review invitation, the reviewer realizes they do not have time to perform the review, this must be communicated to the editorial team.

Conflict of interest

The reviewer’s conflicts of interest should be included along with the review. The conflicts may be related to the contents of the case, drugs, or devices pertaining to the case; the author(s); or the affiliated institution(s) of the author(s).

Lack of expertise

The reviewer may decline to review the manuscript if they think the topic is out of their area of expertise. If, after accepting an invitation to review, the reviewer realizes they are unable to review the manuscript owing to a lack of expertise in that particular field, they should disclose the fact to the editorial team.

Confidentiality

The reviewer should keep the manuscript confidential and should not use the contents of the unpublished manuscript in any form. Discussing the manuscript among colleagues or any scientific forum or meetings is inappropriate.

Review of revised manuscript

At times, a manuscript is sent for re-review to the reviewer. The reviewer should read the revised manuscript, the author’s response to the previous round of peer review, and the editorial comments. Sometimes, the authors may disagree with the reviewer’s remarks. This issue needs to be elaborated on and communicated with the editor. The reviewer should support their views with appropriate literature references. If the authors justify their reason for disagreeing with the viewer, then their argument should be considered evidence-based. However, if the reviewer still requests the revision, this may be politely communicated to the author and editor with justification for the same. In response to reviewers remarks, authors may not agree fully and provide certain suggestion in the form of clarification related to reviewers remarks. The reviewers should take these clarifications judiciously and comment accordingly with the intent of improving the manuscript further.

Peer reviewers have a significant role in the dissemination of scientific literature. They act as gatekeepers for science before it is released to society. Their sincerity and dedication is paramount to the success of any journal. The reviewers should follow a scientific and justifiable methodology for reviewing a case report for possible publication. Their comments should be constructive for the overall improvement of the manuscript and aid the editorial team in making a decision on publication. We hope this article will help reviewers to perform their important role in the best way possible. We send our best wishes to the reviewer community and, for those who are inspired to become reviewers after reading this article, our warm welcome to the reviewers’ club.

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how to write a critical review of a medical journal article

Writing an Effective Review Article

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Avoid common mistakes on your manuscript.

Review articles present an excellent overview of material pertaining to a specific topic or clinical question. There are different formats used to write review articles, and within academic medicine, a debate over the best format for review articles exists. The focus of a review may dictate the format; however, regardless of the format chosen, a structured approach is critical for crafting a comprehensive review with limited bias.

There are two general categories or types of review articles: narrative and systematic. Narrative review articles provide an overview of a broad spectrum of material in an easily readable format. Systematic review articles traditionally have employed very detailed and extensive searches for literature pertaining to a given topic with a critical review of the literature selected [ 1 , 2 ]. Many people consider the systematic review the gold standard of reviews because of the rigorous methods employed in evaluating existing literature. The thought behind this being that the more stringent the methods and critique are, the less author bias is introduced.

Systematic reviews can be further broken down into qualitative and quantitative reviews (see Table  1 for examples). In both qualitative and quantitative systematic reviews, authors attempt to obtain all relevant primary research, search multiple databases, perform manual searches of relevant referenced material, contact authors of abstracts containing unpublished material, systematically review and rate the literature, and critically evaluate the studies included in the review [ 2 ]. The key difference is that quantitative reviews attempt to pool data between studies and statistically compare them (ex: meta-analysis).

Realistically, some topics are just better covered as a narrative review—historical reviews or reviews that are based heavily on historical information and studies do not fit well into systematic review formats. Additionally, within toxicology, research on a given topic may include multiple animal studies with varying animal models or clinical/in vivo evidence which may be limited to case series or case reports that do not fit well with the systematic review format. If the data are best presented in the narrative format, there are multiple ways to strengthen the review by incorporating elements of the systematic review to assist in limiting author bias (Table  1 ). First and foremost, provide full disclosure of the search methods used to allow for greater transparency and reproducibility. Use at minimum two databases for searching, as not all journals are indexed in MEDLINE and this will help to prevent accidental omission of key articles [ 2 ]. Finally, articles should convey a clear message.

Review articles provide a great deal of information to readers. While editors prefer systematic over narrative reviews, both have strengths. Striking a balance between the two is necessary for topics that may lend themselves to more of a narrative style.

Guidelines for preparation of review articles for JMT:

Focused and comprehensive reviews are expected to be critical assessments of literature and data sources pertaining to clinical topics, emphasizing factors such as etiology, diagnosis, prognosis, therapy, or prevention.

Systematic and narrative reviews are accepted, although a systematic approach should be used whenever possible.

All articles or data sources should be searched for and selected systematically for inclusion and critically evaluated. The specific type of study or analysis, population, intervention, exposure, tests, or outcomes should be described for each article or data source.

The title should indicate to the reader this is a review (ex: “Clearing the air: a review of the effects of particulate matter air pollution on human health” [ 9 ])

Review articles that address a specific clinical question should include a short case vignette or paragraph (no more than 100 words) describing the clinical question in the Introduction .

The search and selection process of reviewed material must be described in the manuscript for all review types in the Methods section. At a minimum, this should include databases and years searched, and key words used, as well as inclusion and exclusion criteria. Presentation of this information in written or tabular form within this section is acceptable.

Other sections should be included when appropriate and depending on the review topic (ex: Pathophysiology , Pharmacokinetics , Clinical Presentation , Diagnosis , Management , Prevention ).

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Murphy, C.M. Writing an Effective Review Article. J. Med. Toxicol. 8 , 89–90 (2012). https://doi.org/10.1007/s13181-012-0234-2

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    Include a few opening sentences that announce the author(s) and the title, and briefly explain the topic of the text. Present the aim of the text and summarise the main finding or key argument. Conclude the introduction with a brief statement of your evaluation of the text.

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    To assert the article's practical and theoretical significance. In general, the conclusion of your critical review should include. A restatement of your overall opinion. A summary of the key strengths and weaknesses of the research that support your overall opinion of the source. An evaluation of the significance or success of the research.

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    1. Focused and comprehensive reviews are expected to be critical assessments of literature and data sources pertaining to clinical topics, emphasizing factors such as etiology, diagnosis, prognosis, therapy, or prevention. 2. Systematic and narrative reviews are accepted, although a systematic approach should be used whenever possible.