In this next module, I'm going to give you an overview of the submission process. In the three modules that follow, I will interview longtime journal editors who will give you more information about the publication process. So, I'll just set it up for you here and then you can listen to them for more advice and tips. So, how does the submission process work? The first thing you should do, even before you start writing your manuscript, you should identify the journal where you're going to be submitting to. And that is a whole art in itself. You need to spend some time thinking about what's the appropriate journal. You have to figure out who is the audience that's going to care about my data, and it may not be the most prestigious journal. It may be more of a niche journal. If you're junior, talk to some more senior people about what journal is really appropriate for your submission. You want to aim high, but be realistic about where your paper belongs. The second step is to go online and look at the online instructions for authors of the journal you are targeting. Journals give you detailed tips for how to write and format the manuscript. How many references are allowed. How should those references be formatted. How should tables and figures be formatted. It's critical to follow these instructions as you write up your manuscript. Then, once you've written your paper and all of your co-authors have signed off on it, if you are the corresponding author, then you're going to be the one submitting the manuscript online. Online submission is a wonderful. Way back when, when I was a graduate student, we still had to photocopy the papers and put them in an envelope and mail them to the journal in snail mail. Months later, you'd get a letter back in snail mail. It was a much less efficient process. Nowadays, the online submission process has streamlined everything. It does usually take a couple of hours to enter all the information online, so just be aware that it still takes some time and thought to submit the manuscript. You also need to collect conflict of interest and copyright forms with signatures from all your authors and this can take some time, so just factor that in as well. Once you have submitted your manuscript, you may hear from the editor rather quickly if the editor decides to reject the paper outright. Maybe you shot too high or it's just not a topic of interest to the journal, so the paper is not even sent for review. Barring that, assuming your manuscript goes out for review that it usually takes at least a few weeks before you hear back. And your paper is going to be put in one of four categories. You might get the paper accepted outright with no changes, that hardly ever happens, almost never. You could also get the paper accepted, pending some minor revisions. This is an extremely positive outcome that does occasionally occur but it's also rare. Most papers that are eventually published in journals go through the third category. Rejected but resubmission possible, also called revise and resubmit. The first time you get a revise and resubmit letter it sounds terrible. The letter basically says that your paper has been rejected, so it sounds like a rejection. But you have to read the fine print because if they are inviting you to revise and resubmit, that's actually a positive outcome. That means that the editor believes your paper will likely be publishable if you can address the concerns of the reviewers. Journal editors actually want you to have to go through a round of revision to make sure that the paper has been thoroughly vetted and that the paper is as good as it can be. So, that's really what you're aiming for when you submit an original research manuscript. You're aiming for that reject but resubmit category. And then, finally you may get an outright rejection. This means that you will have to try submitting elsewhere. Now, you're going to be tempted to just send it elsewhere as is without addressing the reviewers comments, but don't do that. Make sure that you read through those reviewers comments, even though you don't have to respond to them. Read through them and figure out the problems in your paper and revise it before you send it somewhere else. Because if you send it somewhere else, the same problems are just going to pop up again. Use the feedback to make the paper better and increase your chances of getting it published elsewhere. If you get in that revise and resubmit category, you're going to have to submit a cover letter that addresses the reviewers critiques point by point - I'll go over this in just a minute - and then hopefully, your paper will get accepted. Congratulations. Once it's accepted, the last step is that you will have to review the final proofs from the journal. They will format the paper in journal style and then send you the proofs. Make sure you look at those carefully because it is almost always the case that small errors get introduced in that formatting and layout process, and you want to catch those. I've also caught just silly mistakes in the proofs and managed to catch them before they went to publication. So make sure you review those proofs carefully. Again, the revise and resubmit category sounds pretty bad when you first read the letter from the editor. It sounds very negative. The first paper I ever submitted as a graduate student, I got this letter back in snail mail. It said, 'The paper was rejected.' And I was like, 'oh I guess my paper was rejected.' But I showed the letter to somebody more senior and they said, "no no no no no, this is actually a good outcome because if you read further in the letter, it says that they are allowing you to revise and resubmit." This is the outcome you're actually shooting for with that initial submission, but it feels negative. It will say something like 'your manuscript is not acceptable for publication.' But if you keep reading, it'll say something like if you feel that you can suitably address the reviewers comments then I invite you to revise and resubmit your manuscript. That's positive. That means they're interested in the paper. So don't be discouraged by the negative tone these letters usually have. This is actually a positive outcome. If you are asked to revise and resubmit, you're going to prepare detailed point by point responses to the reviewers. You'll want to be polite and appreciative as I'm showing you in the example here. So, you would say, 'Dear Editor, We appreciate your helpful comments and those of the reviewers. We feel that the manuscript is now greatly improved.' You want to be polite because the review process is meant to make your paper better. And ultimately, I believe it does make your paper better. When you get that first set of criticisms from the reviewers, it won't be your first instincts to be polite and courteous and to thank the reviewers. Most of us respond to criticisms defensively. It's everybody's natural instinct when you get a bunch of criticisms about your paper to get defensive. But you need to get over that defensiveness as fast as you can and use the reviewers feedback to improve your paper. The funny thing is reviewers don't always hit the problem on the head. Sometimes, they are off the mark, that is they don't quite identify the flaw in your paper correctly. They get it wrong. But what's really interesting is even when they get it wrong, they usually identify some other flaw. For example, a reviewer might think you did your analysis wrong. But it's not that you did your analysis wrong, it's just that you explained it poorly. You weren't clear in your writing. Even when the reviewers don't pinpoint the problem quite right, they usually get somewhere in the vicinity. By them raising an issue, it leads you to find something that was wrong in the paper that needs to be fixed. I had a situation with one paper where we screwed up on the numbering of some references. And the way that was found is one of the reviewers was talking about the background literature and they had the literature mixed up. And my first instinct was to say, 'well, this reviewer just doesn't know the literature. They're ignorant. They don't know what they're talking about.' But then, when I looked more carefully, what I realized is that they were quoting the literature wrong because we had numbered our references wrong. The reason they were misquoting a particular paper is because we had attributed a fact to the wrong paper, through our misnumbering. So even though they didn't identify the actual mistake we had, it led me to finding that mistake and thankfully fixing it before it went to publication. It's human nature to react to criticism defensively. But the faster you can see the reviewers critiques as an opportunity to learn and to improve your paper, the easier your life is going to be. In fact, I think this is one of the life skills that if you can master, it is absolutely essential to success. For any type of criticism you receive, the faster you can separate yourself from the criticisms - not take them personally, not take them as a critique of you as a person, but change your perspective and view it as an opportunity to improve and learn - the better off you're going to be. By the time you respond to the reviewers in a formal cover letter, hopefully, you will see how they have helped your paper. So be polite and acknowledge that help. You need to then address each comment point by point with numbers. For example, reviewer one said there little discussion of x. Respond very specifically, 'We agree with reviewers one and maybe reviewer two that the section on X was too abbreviated. Therefore, we have added a paragraph that highlights this.' And then, you point out the exact location of that specific paragraph. You don't need to make every change the reviewers ask for. But if it's something small and inconsequential, just make the change. If it's a change that you disagree with and you think the reviewers got it wrong, which certainly happens, then just explain to the reviewer why you're not making that change. But give a thoughtful and respectful response to each specific comment. Most journals also want you to include a copy of the paper with the changes tracked. This is helpful for editors and reviewers so they can go back and see exactly where you made those changes. When I'm reviewing a paper, I like to verify that the authors actually did make the changes I requested. So, track changes is helpful and it's required by many journals. Finally, as I was preparing these lectures, I was looking at this book Guidebook to better medical writing. And he said something interesting in it. He didn't have a citation for this, so I'm not sure where this statistic came from but it resonates with me. He says, "About 60% of reviewers criticisms pertain to the quality of the writing or the tables and graphs; and only about 40% pertain to the quality of the scientific work." This just reinforces the point of this course. To get published, good writing and good data presentation are key. Again, I don't know where he got those numbers from, but I would say that it's true for me, that more than half of the time when I'm reviewing papers, more than half of my comments have to do with writing and presentation rather than with methodologic problems in the science. So good writing and good data presentation are central to getting published.