Getting published in a peer-reviewed journal remains the hallmark of scientific verification of a study’s content and an important way to disseminate information to our colleagues and the public. Although the peer-review process is a generally accepted framework, the submission and review process varies from one journal to another. In addition, the advent of the electronic submission and review process, as well as other factors, has led to a change in the publishing process. The following encompasses changes that have occurred at Foot & Ankle International.

Electronic submission

Those of us who have been in academic publishing for many years may remember when submitting an article meant sending four copies of the paper along with black and white glossy photos to the editor. For each round of review, one set of the paper and photos was sent to each reviewer, along with a self-addressed return envelope so the hard copies could be returned to the editor. The process was time-consuming and expensive.

In 2005, Foot & Ankle International switched to an electronic publishing platform, which greatly improved the ease of submission and speed of the review process. This, along with growth in the number of academic papers submitted by international surgeons, led to a substantial increase in article submissions. In 2007, when I became an editor of the journal, we received 407 paper submissions. This has trended gradually upward, and 2017 set a record with 844 submissions, representing a 12.7 percent increase over 2016 submissions. In the days of mailed reviews, it took about three months for an article to be reviewed. Now, our average time to first decision after submission has decreased from 47 days in 2008 to 20 days in 2017.

Despite the vast increase in number of submissions, the number of published articles has increased much more slowly. This disparity is due to a much lower manuscript-acceptance rate. At the start of the electronic publishing period, our average acceptance rate was approximately 50 percent; in 2017, it dropped to 26 percent. We also have seen a much higher number of manuscript submissions from our international colleagues: In 2007, approximately 50 percent of our manuscript submissions came from international sources, leading to about a third of our publications. For the past three to four years, we have received about two-thirds of our submissions from our international colleagues, and they have accounted for about half of our published articles (Fig. 1).

Courtesy of David B. Thordarson, MD

Digital submissions and review also have decreased the time to online publication after an article is accepted. Although the time to publication after acceptance in the monthly paper issue has remained at about five months, articles are now available online and searchable about 30 days after acceptance.

Review process

Many aspects of the peer-review process have been updated in recent years. Approximately 25 percent of papers are reviewed by the editor-in-chief and not sent for review if they are more appropriate for another journal due to subject matter or poor quality. All papers accepted for publication in Foot & Ankle International are reviewed by at least two peers in a double-blind process, meaning that neither the authors nor the reviewers know each other’s identity. All reviewers have self-designated areas of interest and expertise, including PhD bioengineers and gait experts.

After an initial review by two reviewers, a decision is made whether to ask for revisions (essentially no paper is accepted without this) and resubmission, or whether to reject due to insufficient new information, inappropriate subject matter for the specific journal, or scientifically unsound content. Most papers are accepted after one or two revisions, but it can take up to four versions, as each new version may raise further questions. Because neither the editor-in-chief nor most of the reviewers are statistics experts, we sometimes have a paid statistics expert review papers. In cases of divergent reviewer opinion, an assistant editor will review the comments and help break the tie, but all papers must be approved by the editor-in-chief. We are fortunate to have a large group of expert reviewers who volunteer their time and expertise to review papers, especially in light of the increased volume of submissions in recent years.

During the review process and after publication, all articles have a full disclosure of conflicts of interest (COI), and authors must complete an International Committee of Medical Journal Editors (ICMJE) form on apparent and unrelated COI for each article. The editor-in-chief reviews those and includes the relevant COI in the published paper. All ICMJE forms are available through the online journal. We also assign a level of evidence for each clinical paper to emphasize the scientific merit.

One benefit of our rigorous review process is our gradually improving journal impact factor, which is calculated by dividing the number of article citations for the preceding two years by the number of articles published in the preceding two years. Although imperfect, this is still the most accepted method to measure a journal’s scientific impact.

Our 2017 journal impact factor was released in late June, and we made a significant positive jump from 1.87 to 2.65, continuing our track record of being the most highly rated foot and ankle journal in the world.

Each paper also is assessed with antiplagiarism software, iThenticate, which compares a submitted article to anything previously published or available on the internet. Any article that reaches a set threshold is reviewed by the editor-in-chief, and if there is concern, it is reviewed by two assistant editors. In 2017, 21 submissions had significant duplication and required revision of the duplicate portions before publication consideration.

New trends in the online/electronic era of publication

In addition to electronic submission and publication processes, our publisher, Sage, has encouraged social media use to promote articles, and our readers receive email updates about journal content. Sage also uses Publons, an online platform that allows reviewers to state the number of reviews they conduct for the journal. To increase article visibility for authors, they use Kudos, a service that provides tools to authors to increase both visibility and impact. Because social media have become a larger aspect of publishing, they are now using Altmetric, which measures online mentions of an article through social media, news outlets, blogs, and reference sites.

Electronic articles also allow for multimedia content. We include a podcast associated with a featured article in which the lead or senior author expands on the content. Our podcasts have averaged about 800 downloads, and online journal access continues to increase. We had more than 381,000 full-text downloads in 2017.

Currently, many readers still want to receive a paper issue, so we continue our print publication. We now have launched our online-only sister journal, Foot & Ankle Orthopaedics, which serves as another venue for our authors to publish content more rapidly.

I believe the future is bright and our content will continue to improve.

David B. Thordarson, MD, is a professor in the Division of Orthopaedics at Cedars-Sinai Medical Center’s Department of Surgery in Los Angeles. He is also editor-in-chief of Foot & Ankle International.