Without readers, the Journal of the Norwegian Medical Association is not viable. Without peer reviewers, the Journal will lose its position as a scientific publication.
Photo: Sturlason
Membership of the Norwegian Medical Association recently surpassed 40 000 and the Journal has more readers than ever before. Moreover, as a general medical science journal in Norwegian, we have never had so many potential peer reviewers. This is gratifying. Peer review entails independent academic review of a manuscript to ensure quality in scientific publishing (1) . A peer reviewer is a professional who has the same status as the co-authors of the manuscript, and is an expert in the field.
As doctors in Norway, you are unparalleled as peer reviewers for columns in the Journal such as Short case report, Educational case report, Images in medicine and Clinical review . These scientific articles address clinical issues, and as specialists, you possess the medical expertise needed to review them (2) . In addition, you are well versed in and contribute to Norwegian medical language, while having in-depth knowledge of the Norwegian health service.
As doctors in Norway, you are unparalleled as peer reviewers
In the case of scientific original contributions received by the Journal, we will tend to contact physicians with research competence and researchers in other academic fields such as health economics, nutrition, statistics and psychology.
From the point of view of the editorial staff, the peer review process can feel like a never-ending search: sometimes in the dark and off the mark. How can an editor, within a reasonable period of time, efficiently identify, target and establish contact with the right expert – who at the same time is unbiased, available and willing?
In taking on peer reviewing and thus contributing to the scientific community, you may feel that you are undervalued. Peer review recognition is significantly less than the effort and expertise invested in the task. However, many doctors find it professionally rewarding and important (3) , and this is also clearly revealed by the many thorough peer reviews received by the Journal.
During the pandemic, global research communities showed that new and vital knowledge can be obtained far more quickly than usual, with the COVID-19 vaccine as the primary example. Medical journals, including the Journal of the Norwegian Medical Association, received far more manuscripts than before (4) . Peer reviews had to be carried out swiftly, and we hope that you also found the extra effort important.
Even several years before COVID-19, 'peer review fatigue' was reported internationally
The increase in research and publication activity may have contributed to a post-COVID-19 fatigue among peer reviewers (4) . The medical manuscripts that now need to be reviewed are perhaps viewed as less important: the pandemic is officially over, and other crises take precedence. However, even several years before COVID-19, 'peer review fatigue' was reported internationally. There can be several explanations for this. The most obvious is that the number of peer reviewers has not increased in line with the number of scientific publications. The former editor of the British Medical Journal, Richard Smith, believes that the peer review system is a slow, resource-intensive and random process (5) . It is not well-suited to detecting errors and is structured in a way that innovative research has less chance of being published. A further argument is that peer review does not function well in terms of quality assurance as scientific misconduct is often only revealed after publication (6) .
Smith has even called for a peer reviewer rebellion, while others believe that peer review should now be considered to be a poorly executed experiment (5, 6) . It is not known to what extent the weaknesses of the system demotivate peer reviewers.
Even if there is no good alternative, it does not mean continuing in the same old rut. Based on research on peer reviewers and experiences with various measures for greater recognition and transparency, the editorial staff can take steps that suit their journal (3, 7) . Needs and solutions will vary here. The Journal of the Norwegian Medical Association focuses attention on both the group of authors and the peer reviewers by inviting the latter to write an accompanying comment when a research article is published. Moreover, all the Journal's peer reviews can be registered with ORCID. Nevertheless, there are many well-qualified colleagues that we have no contact with as yet, and we are always grateful for new suggestions.
Conversely, the need for increased diversity and inclusion appears to be a general area for improvement for scientific journals (8) . Increased diversity in terms of broader demographics and a wider geographic scope must also apply to peer reviewers (9, 10) .
The greater the number of those with ownership in our academic community, the closer we are to ensuring sustainable and inclusive medicine. The more people who take ownership of peer reviewing, the greater the opportunity to avoid peer review fatigue and maintain the Journal's academic position.
It is up to us as editorial staff to take responsibility for this – in the hope that you will accept the next invitation to contribute as a peer reviewer.