Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills
to build their own research program, whether or not they have a mentor.
As clinicians, we spend a decade or more as trainees learning to take care of patients.
When we finally start our careers, we want to build research programs, but then we find
that our years of clinical training did not adequately prepare us to lead our research
program.
Through no fault of our own, we struggle to find mentors, and when we can't, we quit.
However, clinicians hold the keys to the greatest research breakthroughs.
For this reason, the Clinician Researcher podcast exists to give academic clinicians
the tools to build their own research program, whether or not they have a mentor.
Now introducing your host, Toyosi Onwuemene.
Welcome to the Clinician Researcher podcast.
I'm your host, Toyosi Onwuemene, and it is an absolute pleasure to be talking with you
today.
I am recording this episode in the middle of a break from writing, and this is the writing
that prompts this episode is that I am responding to reviewer criticisms for an article that
I wrote, and I have to say that there's a range of reviewer criticisms that kind of
gets to you in a different way.
This is one of those set of reviewer criticisms that just is very, very touching.
It just touches me in different ways.
Or I want to throw away the paper and say, you know what, how about I just don't resubmit.
But here I am, I am working through the revisions, and as I'm working through revisions, I can
see the benefit of the reviewer criticisms.
I can now see them.
My eyes were glazed over with anger, but now the anger has resolved and I now see the light.
And so here I am to share it with you.
So this particular article that I'm working on is one that I was invited to write.
Okay, it felt really good to be invited to write the article.
And even though I didn't actually want to write the article because I was like, oh,
this is not work I'm doing right now.
It's distracting me from the work I really want to move forward, but it makes sense because
this is work I've done before and it is a sign of honor and it's something good that
people are asking me to write something.
So even though I didn't really care to write this article, I wrote it.
I wrote it.
And I have to say it was hard to write.
It was hard to write because I was pulling from something I hadn't thought about for
years.
And it was hard because they were asking me to write about a topic that would be considered
controversial.
So I knew that it was going to be criticized, but I didn't know how much it was going to
be criticized.
So when the criticisms came, I have to tell you, they felt overwhelming.
One reviewer had 56 points.
56 points.
And I'm not talking about 56 minor points.
Actually, to be honest, I feel like a lot of them are minor.
A lot of them are phrasing, but 56, holy cow.
Didn't you have left some for the copy editor?
Okay, I'm coming back home.
I'm coming back home.
I need to be nice and objective.
But anyway, the point I'm making is that there were a lot of criticisms.
And to be honest, just even working through each point, so that was one reviewer, right?
56 criticisms from one reviewer.
The other reviewer, a little bit more reasonable in my perspective, about 15 to 17.
I can handle that.
And then a third reviewer actually wouldn't review the manuscript because the topic was
too controversial and they felt that perhaps the way it was addressed was not appropriate.
That's interesting, right?
Anyway, I want to talk about that too.
And I will shortly.
But this is the context in which I am bringing you this reason to rejoice, to celebrate when
you get reviewers criticize your manuscript or really want you to rejoice and celebrate.
Okay.
So the first thing I want to share is that criticism is the sign that something notable
has happened.
That something significant happened.
That is why criticism comes.
Now if I said, no, thank you.
I will not write this manuscript.
Guess what?
No criticism.
Yes.
Life feels great when there's no criticism.
But criticism is the sign that I took up the challenge and I said, hey, this is a controversial
topic and I'm going to write about it.
Right?
So something notable happened.
And it's not just notable because criticism came, but criticism is the evidence.
Right?
Well, sitting there on this paper didn't exist.
No one's written about this before in this way.
And then someone says, hey, people are interested in this.
Will you write about it?
So I created something out of nothing and nothing became something.
And then people started criticizing what was what I created.
But until I created, nothing could be criticized.
And so criticism, first of all, is the sign that I did something noteworthy.
I stood up and I opened my mouth or I stood up and wrote on a document that was now passed
on to reviewers.
And so I want you to stop.
If you were in the middle of revisions or you've been criticized before by reviewers,
especially the kind of reviewers that make you so mad, I want you to celebrate and say,
hey, I've been criticized because I stood up and I made something happen.
Good for me.
Absolutely worth celebrating.
Because the opposite is that there is no criticism because you're making nothing, saying nothing,
doing nothing.
And I want to celebrate you for every time you are courageous enough to submit a manuscript
because you are courageous enough to invite the criticism that improves the manuscript.
So that is number one.
Criticism is a sign that something notable has happened.
Number two is that criticism is the evidence that people actually care about what you're
saying.
Now, the pathway for all manuscripts is not exactly criticism from the reviewers, right?
The pathway may be outright rejection.
Like, oh, we read it.
We don't even have anything to say, reject.
It's the sign that nobody cares.
And so when people say, we're not going to just throw this manuscript in the trash, we're
actually going to read it.
I'm going to tell you about it.
That is the sign that you are writing about something that other people care about.
Now, don't get me wrong.
There are different reasons why manuscripts are rejected by journals.
Sometimes it's political.
Someone just submitted something and they have a bigger name than you.
Oh, it's just priorities.
Like right now we are very focused on this hot new area related, say, to COVID, right?
A few years ago, if you weren't submitting anything related to COVID, you were likely
to get triaged.
And so it's not always about the importance of what you're writing.
Therefore, please don't take a desk rejection as a reason to stop moving your work forward.
Take it as a sign that you need to go find the people who care, right?
But if you are submitting a manuscript that has been returned to you with criticisms,
this journal, this group is saying, we care about this work.
We want to see this work done.
And so you can celebrate because criticism is the evidence that people actually care
about what you're writing about.
They don't care.
They won't say anything.
They'll send it away for somebody else to criticize.
But if they care, then they criticize.
And so you can test how important the topic is based on the level of criticism sometimes
that comes back from it.
Because the alternative is that they just reject it.
OK.
Criticism also helps you discover what people care about.
OK, you're writing about this topic.
And the reviewer comes back and says, well, I can't believe you didn't mention XYZ.
Well, you know, XYZ was not in your list of priorities when you wrote the paper.
But here you go.
This reviewer is now telling you that this is a priority for them.
And if you hear it from a second or a third reviewer, then you really know that you should
take the time to address it.
But what people criticize is not so much what you wrote, but what you wrote in the way that
it resonates with them.
So sometimes people don't care about certain parts of your paper.
They won't even mention it at all.
But there are parts that they really care about and they will mention.
And that helps you understand what people want to hear about more or what people really
want like improved upon.
Right.
So it tells you what people care about because people don't criticize what they don't
care about.
And so in a whole manuscript, there are very certain sections, there are certain sections
that people criticize.
And that is a sign to you that these are the sections they care about.
And so it helps you focus as you prepare your response to the reviewers comments.
OK.
Criticism also helps you.
This is number four.
Criticism also helps you recognize what people are going to complain about or likely to complain
about.
Now, you'll create a piece of work, you're putting it out there.
And of course, every piece of work that's worth its salt is going to have people who
are like, oh, my gosh, I love this.
It's so awesome.
And other people who are going to say, this is absolute crap, who allowed this thing to
see the light of day?
Right.
There will always be people in different camps.
And yes, it's not just the two extremes.
Clearly, it's all along the spectrum.
There will always be people who think differently about your work, people who love it, people
who hate it, and all the people in between.
Now, criticism helps you get a taste of those who hate your work.
Right.
And like, this is what those who hate your work are going to say.
So get ready.
And it's very helpful because it doesn't keep them from hating your work when they finally
read the final product.
But what it does is it allows you to say, hey, all you haters of this work, here's what
you're going to say.
And here's what I say to it.
Hey, you just kind of cut short the complaints that are going to come to you after the manuscript
is published, the 300 letters to the editor that say, I cannot believe this author did
not cover XYZ.
You're going to cut that short because when the reviewers tell you what they hate about
your manuscript, you can say, oh, great.
Here's what you hate about my manuscript.
And you can decide, well, OK, OK, I'll change this.
Or you can decide, no, no, no, no, no, no, not changing that.
But I'm going to explain why I'm not changing that.
For example, we had a manuscript recently that we wrote a systematic review and we submitted
it as a systematic review.
And the reviewer comes back and says, this is not a systematic review.
This is a scoping review.
Now I need to tell you that a scoping review is different from a systematic review.
You don't start a systematic review and end up with a scoping review or vice versa.
They're two different things.
And clearly, there is a gap in the knowledge of this particular reviewer as far as the
difference between scoping review methodology and systematic review methodology.
Now the wonderful people that I was writing the paper with, with me as senior author,
said, well, the reviewer says it's a scoping review.
Let's change all the terminology in the paper to a scoping review.
And I have to stop and ask them, hey, did you do a scoping review?
And if the answer is no, you cannot now just because you're knee jerk responding to the
reviewer change everything to scoping review because it's actually not true.
So you're not going to agree with everything the reviewer is saying and you shouldn't agree
with everything the reviewer say.
But when they say something, you're going to comment.
And so for example, in that paper, we said while a scoping review may have been the better
methodologic strategy.
So do you hear that?
We use the term that other people might be thinking this paper is a scoping review, right?
We said it may be the better methodology, but we were limited or we did the systematic
review.
So it is so helpful because you take the complaints and you put it in your paper and then you
can maybe decrease the number of complaints that come after the manuscript is published.
So criticism is helpful because it helps you discover what people are likely to complain
about and to address it from the beginning.
Okay.
Number five, criticism gives you the words that create the masterpiece that is the final
paper.
I'm really excited about this one.
Okay, I'm going to say it again.
Criticism gives you the words that help you create the final version that is a masterpiece.
Yeah, I said it differently, but you know what I'm saying.
But here's what I mean about that.
Reviewers will say, well, for example, in this paper, they said, well, there is no,
you can't make a recommendation.
What you can say is that the clinical practice would suggest that this is a strategy that
can be used.
I love it.
Maybe you just gave me the words or she, right?
This reviewer just gave me the words that I'm going to just take and put in my paper.
How beautifully said.
Okay.
This strategy helps me recognize that there are clinical, there's clinical practice that
supports the strategy, right?
I kind of mixed it up, but you get what I'm saying.
The reviewer said something and I literally just lift the words and put it on my paper.
And you know what?
It's really exciting.
I think when the reviewer sees that you have used their words in the paper, because it's
also flattering.
It's like, oh, okay.
You used my words.
Thank you so much.
Now, are you obligated to use the reviewers' words?
No, but it is helpful because they're bringing up important things.
I recognize what they're saying.
They're like, well, you're in a controversial area.
There is not data to back you up in any recommendations.
Great.
Here, though, you can say there is clinical, there's evidence of clinical practice.
I love it.
So where I'm thinking, I should be making a recommendation.
They're saying, don't make a recommendation.
Say there's evidence of clinical practice.
And they've given me the words and I just lift it and put it in my paper.
Now, you know, I'm finessing the words because it's still my paper and it's still got to
speak in my language.
So I'm not going to necessarily take their words verbatim throughout the paper and then
make it look like a paper somebody else wrote.
But I'm going to use their words and I'm going to incorporate it into the manuscript.
And I can do that and create a masterpiece because they gave me the words to say.
They made it easy for me in revising the Spanish script.
So number five is that criticism gives you the words that help you create the final masterpiece.
OK, number six.
And I alluded to this upfront.
Criticism is the sign that your work has value.
Now, if you're thinking to yourself, I don't even know if my work is worthy.
I have no idea if this really matters.
Yes.
Now, you know, you have the evidence.
Somebody criticized your work.
They said, this is this is awful.
This is what you should say instead.
And it's not awful.
You know, people are just people.
They're going to say those words are going to say this is the worst paper ever written.
And to be honest, the worst paper ever written is the worst paper is the paper that was never
written.
Your paper has been written.
It's no longer the worst.
It's it's important because it's it's actually spoken for for a while.
You were silent and then you finally spoke and therefore your work has value.
I mean, if something didn't have value, people wouldn't even give it the time or the light
of day.
They wouldn't even take time to read it because it's like they'll pick it up.
They'll look at it and say, this is total nonsense.
I am not even going to read it.
And to the reviewer who wouldn't review my manuscript because they thought the topic
was so controversial, my work didn't have value to the other reviewers who actually
took time to give me feedback.
And thank you so much to reviewer number one with 56 comments.
That means, wow, this is so valuable that this person took time.
I have to tell you that if you are going to review a manuscript, 2500 words, this is not
a book.
If you're going to review a 2500 word manuscript and give 56 points of feedback, holy cow,
that is a lot of homework for any one person.
And if you took that much time to do the work that allows my paper to be improved.
Okay, clearly there is something to this paper because the alternative is to say, yeah, nonsense,
make three comments and be done.
But to make 56 comments, okay, I now know that this work has value.
And that is the sign to me that this is going to be a highly cited paper because if people
have written about it, it wouldn't really be a topic that was of interest.
And definitely there probably wouldn't be 56 comments because it's been written about,
you know, you're not saying anything new.
But I know that this paper is going to be really important and it really elevates the
value of my work.
Now, I think my work, all of my work is valuable.
I only do work that's valuable.
And sometimes I do work that's valuable and other people say not valuable, doesn't make
it any less valuable.
However, it is helpful when other people take time and invest time to critique my work because
I recognize that, okay, okay, this has value to other people too, not just me.
Good to know.
And I wouldn't know except that the reviewers invested all this time in telling me that,
hey, your work has value.
And that's why I'm taking all this time to critique it.
Okay, all right.
Number seven is that criticism is the sign that you've got to keep showing up.
Sometimes when we get critiques for our manuscripts, our grants, whatever it is that we submit
our talks, we wither, we shrink away and we're like, I'm not going to do this again.
The criticism is too strong.
But here's the thing.
The fact that you got criticized is the evidence that you need to show up again and again and
again and again, because you're not here really to impress the reviewers.
You're here for your work to be amplified.
And if people are saying that they're going to give you words to amplify your work, but
that they think your work is worthy to be amplified because it's criticized so much,
then you should show up and say your work or present your work again.
You don't shrink back and say, I'm never going to do this again, because honestly, the critiques
that you get from reviewers is not about you personally.
They don't even know you.
They don't know anything about you.
They've never seen you before.
They don't even know your name.
Okay, so by the time you've written 300 papers, by now the reviewers know who you are.
But for many of us, especially as we're starting out, people don't even know who they are.
We are.
They don't know what we like to eat for breakfast.
They don't know how many hours we slept last night.
They don't know what's going on in our families.
They don't know us.
So if they are criticizing, it's not personal.
And I invite you not to take it personally, because nobody who doesn't know you can give
a critique that's personal.
It's not personal if they don't know you personally.
End of story.
But it's a sign that the work is valuable and it's valuable because you put it out there
and then they gave critiques that show you it's valuable.
And so, hey, you've got to show up again.
And yeah, you're going to show up again and get another set of criticisms, and then you
got to show up again.
You keep showing up, not so that you keep getting less criticisms, but because your
work matters.
You as the creator of the work are an important person to our community.
And if you don't speak, we can't hear you.
If you don't write, we can't read what you write.
This paper didn't exist.
And I took up the challenge and I wrote it.
And then people criticized me.
It's a sign that I got to take up more challenges and I had to write more.
Not the sign for me to shrink back.
So I want to invite you today.
Maybe there was a manuscript that's sitting under your desk that you said, I'm not going
to resubmit this because the criticisms were too harsh.
I want you to look at that manuscript again.
I want you to recognize the criticism and the value of the critiques for what they are.
Evidence that your work matters, that people care enough to give you feedback, whether
good or bad.
They care enough to vilify this manuscript because it needs to have value and it has
potential.
So I invite you to dust off your old manuscript that is waiting for the revise and resubmit.
I want to invite you to revise and resubmit it.
And for those of you who have said writing is not for me because the criticism is too
much, I want to invite you to put the criticism aside from your personhood.
And I want you to take up the manuscript and write again.
We need you writing because a silent voice has no power.
The more we hear your voice, whether audibly like you're hearing mine or in writing, the
more power you are demonstrating.
So please take up your power.
Don't let the reviewers get to you and submit your manuscript.
All right, I'm going to summarize those seven reasons why or how you use review or criticisms
to your advantage.
Number one, take it as a sign that you've done something amazing.
Number two, take it as evidence that people care about what you're saying.
Number three, discover through this criticism what people actually care about.
Number four, discover through the criticisms what people are likely to complain about and
do something about it in advance.
Number five, you receive the words to create a masterpiece.
Number six, it's the sign that your work has value.
And number seven, it's the sign that you've got to keep showing up.
You got to keep showing up.
All right, it's been a pleasure talking with you today.
Thank you so much for letting me share with you what I am learning.
I'm going to go back to revising that manuscript now, which is taking a long time.
Have a great day, and I look forward to seeing you again next time on the Clinician Researcher
Podcast.
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