The top 5 reasons manuscripts get rejected – and how you can prevent them

We have exciting news to share! I have been recently published in the Swiss Medical Journal on how to prevent manuscript rejection. The Swiss Medical Journal is a top-notch publication and is the main source for information on the medical field and healthcare system among Swiss healthcare professionals. Since our article has been published in German, I am happy to share an English version with you here on our blog.

There are many reasons why manuscripts are rejected and many struggle with getting their findings published. As a professional medical communications agency, we are often contracted by clinicians and researchers who need professional guidance for their manuscripts. It can be both a scientific and an ethical problem when manuscripts containing high-quality, clinically relevant research fail to receive due recognition.

The advice offered in the article below, draws upon the shared experiences and expertise of our large team of qualified medical writers and I hope you enjoy it.

swissmedicaljournal-cover The following article is an English version of the article “Abgelehnte Manuskripte – wenn hochwertige Forschung aus den falschen Gründen verloren geht” published in the Swiss Medical Journal:

Rejected manuscripts — quality research lost for all the wrong reasons

If you have ever submitted a manuscript to a biomedical journal and it has been rejected, take heart: you are not alone. In fact, you are in the majority: one study reported that 62% of published manuscripts have been rejected at least once by other journals before eventually being published1, and top journals have an overall rejection rate of around 90-95%2-4. With the number of submissions increasing every year, that makes getting published even more difficult. However, the reasons for rejection are not always what you might think; more often than not, manuscripts are turned away for reasons that are easily fixable — and entirely in your control. Here is an overview of some of the reasons journal editors reject papers, along with advice and solutions for helping your paper to be accepted.


1. The manuscript is out of scope of the journal

As of December 2016, 5,633 journals are currently indexed in MEDLINE5. Choosing one can seem a daunting and imposing task. In addition, many manuscripts are rejected by the editors before they ever make it to peer review, simply because the research does not fit the aim and scope of the journal. Take the time to carefully research and consider journal options. Often a “top down” approach is favoured, particularly in academia; this means journals with high impact factors are often chosen over more appropriate, lower impact factor journals. As such, it may be tempting to submit to a journal with a high impact factor like the Lancet (44.002), Journal of the American Medical Association (37.7), or the New England Journal of Medicine (59.558)2-4. However, with rejection rates of around 95% and scopes which include “original contribution that advances or illuminates medical science or practice (The Lancet)” and “offer new information about the biology of disease (NEJM)”, another journal may be more appropriate.

Indeed, the most common reason for rejection is lack of new or useful information.6 Thus it pays to find a journal whose scope and readership are appropriate for your manuscript.

When choosing a journal, consider the following:

  • What is the topic? Is it, for example, novel and ground-breaking medicine, worthy of media coverage, or is it a surgical technique, a systematic review, a local clinical trial, or guidelines stemming from an expert group?
  • Who should be reading your manuscript? This could be surgeons, general practitioners, travel clinics, nurses, radiographers, pharmacists and so on.
  • What is the appropriate geographic region? Would the data be best presented to a US audience, a European audience, or is a local, regional journal more suitable?
  • What is the format of your manuscript? Is it a review, a case study or a clinical study?

Then create a list of journals and select where to submit. Large, international publishers such as Elsevier, Springer, and Taylor and Francis, offer journal finders, which let authors match manuscript criteria to journal criteria, helping to streamline the process. In addition, there are independent databases such as JournalGuide and open-access publishers such as BioMed Central, which help guide you in selecting from a broader range of journals.

Looking at the author guidelines and requirements of the journal can also impact your choice. Limits on type of manuscript, length, number of tables and figures and numbers of allowed references and even authors on the manuscript, are deciding factors.


2. The quality of writing is below publishable standards

If good research is poorly communicated, whether due to the authors having English as a second language, or simply due to linguistic style, then knowledge is lost if it is not published because of these reasons. Poor writing, manuscript structure and preparation are all key reasons for rejecting papers, even with strong results.6,8–15. Some common problems include: 6,8–15

  • Failure to clearly state the problem and context of the study, to describe the issues, and to explain and interpret results
  • Unclear, overly long or complicated, ungrammatical sentences
  • Typographical, spelling and syntax errors
  • Overuse of jargon, unnecessarily technical terms or regional idioms (e.g. A&E versus ER)
  • Inefficient communication that leads to wordiness
  • Inappropriate or unpersuasive title, abstract or cover letter
  • Poor design of tables, graphs or figures

“I have been involved in some clinical trials and I have written some articles,” says Dr Alessandro Diana, chief medical officer at the Clinique des Grangettes in Geneva and associate physician in paediatric infectious disease at the University Hospitals of Geneva. “I am peer reviewer of two journals, so I often review scientific articles. I have come to the conclusion that there are many articles with important scientific contributions that are not published.” The reasons for this are many, but it is a major problem when articles are refused because of poor language.

Most major publishing houses provide links to English language services, companies that specialise in English language checks. However, this is sometimes not enough to ensure that a manuscript will be accepted. To correct linguistic and particularly stylistic, content or formatting issues, it is important to perform several rounds of revisions prior to submission, and to seek help from people who have excellent English writing skills, who possess advanced medical vocabulary, who have a keen eye for detail, and who are experienced in publishing in multiple journals. Often an English language check is not enough – a professional Medical Writer can also check the formatting, content and presentation of the data, errors in manuscript preparation can be corrected before being picked up by the editors of the journal.


3. The manuscript is not formatted correctly

One of the main reasons for an immediate return of a manuscript, or a rejection, is because the manuscript is not formatted for the journal. Each journal follows its own style guide, which dictates everything from use of compound adjectives, prepositions, and commas in lists, to whether page or line numbers are used, the length of a figure legend, and the overall structure. What may seem trivial can be a reason for an immediate return. Even word counts have paramount importance – one must be aware that different journals require different lengths, for different reasons. If the journal is only available online, then word counts are much less restrictive than for a journal which is still in weekly print circulation. In this case, the journal itself is restricted by the number of pages, which impacts the number articles and type of articles that they can print per issue. Even using colour graphics can become an issue if the manuscript is going to be printed in just black and white. These are all small issues which are actually incredibly important, and which have to be adapted and changed for every resubmission to a different journal in the case of a rejection.


4. The guidelines have not been followed

When it comes to writing a manuscript, it is no longer as simple as making sure your manuscript follows the IMRAD format. A demand for increased transparency has led to initiatives which aim to improve the reporting of clinical and biomedical research. As such, the way a manuscript is written has changed. Nowadays, one manuscript has to abide by a number of different guidelines, for different purposes. For example, manuscripts for publication in medical journals need to follow the ICMJE Uniform Requirements for Manuscripts16, to ensure, amongst others, that authors fulfil authorship criteria. If the manuscript reports on a clinical study, then different guidelines are used, depending on what kind of study it was – for example, CONSORT for randomised controlled trials, CONSORT extensions for equivalence or non-inferiority trials, STROBE for observational studies, ARRIVE for animal preclinical studies17 – and then if it was sponsored by industry, suddenly the Good Publication Practice 3 guidelines come into play. If it is a case report, then CARE guidelines can be used; if a systematic review, then PRISMA17 is used. But that is not all, the journals own guidelines then have to be followed: author guidelines, manuscript templates, statistics guidelines and so on. In this way, for example, an industry-sponsored, randomised controlled, non-inferiority trial for publication can follow 5 or more sets of guidelines – which is often overwhelming for anyone wanting to publish.

It is therefore key that, before a manuscript is submitted, care has been taken to ensure that all the relevant guidelines have been followed. The best way of doing this is to start with the author guidelines of the chosen journal, and to make sure that any additional guidelines to which they refer are consulted.

This is another area in which professional medical writers can easily help. Here at we are often approached by doctors who are publishing their first manuscript in years. The way manuscripts are written, or more importantly, the way research is presented, has changed dramatically since they last published. For researchers, it is useful to be able to work with professionals who stay on top of new developments.


5. The peer reviewers’ comments are not properly answered or go unanswered

After a manuscript is submitted and it undergoes peer review, it will most likely be returned with revisions, be it major or minor ones. For issues that can be fixed, this is the point in the process at which revisions and editing take centre stage.

Major and minor revisions do not automatically mean that the manuscript is rejected, more often than not, the journal allows for resubmission after revision. In fact, 75% of published manuscripts end up appearing in the journal to which they were initially submitted.7 Failure to respond to the comments at resubmission is a lost opportunity. All comments should be carefully answered in a detailed rebuttal letter. If the comment can be implemented, then this should be done, and if not, a detailed explanation as to why this is not possible, should be given.


So your paper got rejected, what now?

If a manuscript is rejected, a careful assessment should be made. The letter from the editor is a starting point. Often they give reasons for the rejection: they may be journal-related, such as being out of scope, or the manuscript may be rejected due to language or formatting issues. Other reasons for rejection may lie in the need for further research. For the former, another journal should be carefully chosen, the manuscript reformatted and, if necessary, rewritten and submitted. If further research is required, then an assessment should be made as to whether this is possible.


New developments: free online preprint servers and archives

However, some papers — for one reason or another — cannot find a publication home.  Sometimes, regardless of how well a manuscript is written, the science is not strong enough, or further research is needed.

There is an increasing trend for publishing a preprint — a manuscript that is either not submitted or has been submitted to a journal, but is not yet accepted for publication — to online archives such as biorXiv18 or PeerJ Preprints19. There is also an example from Switzerland; Dr Diana has developed an online platform called Unpublished Articles in Science (UNAIS)20 to publish abandoned scientific papers along with the reasons given by the reviewers for rejection.

For these online archives, there is no peer review, but the manuscript will be read by other readers who may comment. For authors, this can be advantageous if mistakes are noticed, or feedback is given which may help to improve the manuscript before submission. Furthermore, if the manuscript is not accepted by a journal, the research is still presented in the public domain, making it accessible to other researchers to build upon. The majority of publishing houses accept submissions of manuscripts even when posted to an online archive, but it is still sensible to check each journal’s preprint policy, as there are some for whom uploading of a preprint precludes publication in their journal.


Preventing lost research

It is unethical if good quality research is lost to the public domain because it fails to be published. Following the guidelines presented above may help increase the amount of quality research being published. Fewer rejected papers would help progress medical research. Being aware of the issues surrounding publications can help to ensure that your manuscript is eventually published. In addition, professional medical writing services can offer assistance in developing and refining manuscripts, increasing the chance of a successful publication. They can strengthen both the language and the rationale, improve data presentation in figures and tables, and provide input on guidelines.

Ultimately, the collection of clinical data represents large investments of both time and money, in addition to the goodwill and consent of the patients. Don’t let language or formatting mistakes cause unnecessary rejections.


  1. Hall SA, Wilcox AJ. The fate of epidemiologic manuscripts: a study of papers submitted to epidemiology. Epidemiology. 2007;18:262-5.
  2. The Lancet. How The Lancet handles your paper. Accessed July 2016 at:
  3. The Journal of the Americal Medical Association. About JAMA. Accessed July 2016 at:
  4. The New England Journal of Medicine. Author center. Accessed July 2016 at:
  5. Accessed December 2016 at:
  6. Ehara S, Takahashi K. Reasons for rejection of manuscripts submitted to AJR by international authors. AJR Am J Roentgenol. 2007;188:W113–6.
  7. Calcagno V, Demoinet E, Gollner K, et al. Flows of research manuscripts among scientific journals reveal hidden submission patterns. Science. 2012;338:1065–9.
  8. Coronel R. The role of the reviewer in editorial decision-making. Cardiovasc Res. 1999;43:261–4.
  9. Byrne DW. Common reasons for rejecting manuscripts at medical journals: A survey of editors and peer reviewers. Science Editor. 2000;23:39–44.
  10. Bordage G. Reasons reviewers reject and accept manuscripts: The strengths and weaknesses in medical education reports. Acad Med. 2001;76(9):889–96.
  11. Wyness T, McGhee CN, Patel DV. Manuscript rejection in ophthalmology and visual science journals: Identifying and avoiding the common pitfalls. Clin Experiment Ophthalmol. 2009;37:864–7.
  12. Pierson DJ. The top 10 reasons why manuscripts are not accepted for publication. Respir Care. 2004;49:1246–52.
  13. Ajao OG. Some reasons for manuscript rejection by peer-reviewed journals. Ann Ibadan Postgrad Med. 2005;3:9–12.
  14. Ali J. Manuscript rejection: Causes and remedies. Journal Young Pharmacist. 2010;2:3–6.
  15. Thrower P. Eight reasons I rejected your article. 12 September 2012. Accessed June 2016 at:
  16. ICMJE Recommendations. Accessed July 2016 at:
  17. Equator Network. Essential resources for writing and publishing health research. Accessed July 2016 at:
  18. Accessed July 2016 at:
  19. PeerJ Preprints. Accessed July 2016 at:
  20. Unpublished Articles in Science. Accessed July 2016 at:


About Frank Waaga

Frank has a passion for medical communications and over 12 years of experience providing professional and reliable support to product teams in the pharmaceutical, biotech and medical device industry.
0 replies

Leave a Reply

Want to join the discussion?
Feel free to contribute!

Leave a Reply

Your email address will not be published. Required fields are marked *