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Recommendations for the Conduct, Reporting, Editing, and
Publication of Scholarly Work in Medical Journals
Updated December 2021
I. About the Recommendations
A. Purpose of the Recommendations
B. Who Should Use the Recommendations?
C. History of the Recommendations
II. Roles and Responsibilities of Authors, Contributors,
Reviewers, Editors, Publishers, and Owners
A. De?ning the Role of Authors and Contributors
1. Why Authorship Matters
2. Who Is an Author?
3. Non-Author Contributors
B. Disclosure of Financial and Non-Financial Relationships and Activities, and Con?icts of Interest
1. Participants
a. Authors
b. Peer Reviewers
c. Editors and Journal Staff
2. Reporting Relationships and Activities
C. Responsibilities in the Submission and Peer-Review
Process
1. Authors
a. Predatory or Pseudo-Journals
2. Journals
a. Con?dentiality
b. Timeliness
c. Peer Review
d. Integrity
e. Diversity and Inclusion
f. Journal Metrics
3. Peer Reviewers
D. Journal Owners and Editorial Freedom
1. Journal Owners
2. Editorial Freedom
E. Protection of Research Participants
III. Publishing and Editorial Issues Related to Publication
in Medical Journals
A. Corrections, Retractions, Republications, and
Version Control
B. Scienti?c Misconduct, Expressions of Concern,
and Retraction
C. Copyright
D. Overlapping Publications
1. Duplicate Submission
2. Duplicate and Prior Publication
3. Preprints
a. Choosing a Preprint Archive
b. Submitting Manuscripts That Are in Preprint
Archives to a Peer-Reviewed Journal
c. Referencing Preprints in Submitted Manuscripts
4. Acceptable Secondary Publication
5. Manuscripts Based on the Same Database
E. Correspondence
F. Fees
G. Supplements, Theme Issues, and Special Series
H. Sponsorship and Partnerships
I. Electronic Publishing
J. Advertising
K. Journals and the Media
L. Clinical Trials
1. Registration
2. Data Sharing
IV. Manuscript Preparation and Submission
A. Preparing a Manuscript for Submission to a
Medical Journal
1. General Principles
2. Reporting Guidelines
3. Manuscript Sections
a. Title Page
b. Abstract
c. Introduction
d. Methods
i. Selection and Description of Participants
ii. Technical Information
iii. Statistics
e. Results
f. Discussion
g. References
i. General Considerations
ii. Style and Format
h. Tables
i. Illustrations (Figures)
j. Units of Measurement
k. Abbreviations and Symbols
B. Sending the Manuscript to the Journal
I. ABOUT THE RECOMMENDATIONS
A. Purpose of the Recommendations
ICMJE developed these recommendations to review
best practice and ethical standards in the conduct and
reporting of research and other material published in
medical journals, and to help authors, editors, and others
involved in peer review and biomedical publishing create and distribute accurate, clear, reproducible, unbiased medical journal articles. The recommendations may
also provide useful insights into the medical editing and
publishing process for the media, patients and their families, and general readers.
B. Who Should Use the Recommendations?
These recommendations are intended primarily for
use by authors who might submit their work for publication
to ICMJE member journals. Many non-ICMJE journals voluntarily use these recommendations (see www.icmje.org/
journals-following-the-icmje-recommendations/). The ICMJE
encourages that use but has no authority to monitor or
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Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals
enforce it. In all cases, authors should use these recommendations along with individual journals’ instructions to
authors. Authors should also consult guidelines for the
reporting of speci?c study types (e.g., the CONSORT
guidelines for the reporting of randomized trials); see
www.equator-network.org.
Journals that follow these recommendations are encouraged to incorporate them into their instructions to authors and to make explicit in those instructions that
they follow ICMJE recommendations. Journals that wish to be identi?ed on the ICMJE website as following these
recommendations should notify the ICMJE secretariat at www. icmje.org/journals-following-the-icmje-recommendations/
journal-listing-request-form/. Journals that in the past have requested such identi?cation but who no longer follow ICMJE
recommendations should use the same means to request removal from this list.
The ICMJE encourages wide dissemination of these recommendations and reproduction of this document in its entirety for educational, not-for-pro?t purposes without regard for copyright, but all uses of the recommendations and document should direct readers to www. icmje.org for the of?cial, most recent version, as the
ICMJE updates the recommendations periodically when new issues arise.
C. History of the Recommendations
The ICMJE has produced multiple editions of this document, previously known as the Uniform Requirements for Manuscripts Submitted to Biomedical Journals
(URMs). The URM was ?rst published in 1978 as a way of standardizing manuscript format and preparation across
journals. Over the years, issues in publishing that went well beyond manuscript preparation arose, resulting in
the development of separate statements, updates to the document, and its renaming as “Recommendations for
the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals” to re?ect its broader
scope. Previous versions of the document may be found in the “Archives” section of www.icmje.org.
II. ROLES AND RESPONSIBILITIES OF AUTHORS,
CONTRIBUTORS, REVIEWERS, EDITORS,
PUBLISHERS, AND OWNERS
A. De?ning the Role of Authors and Contributors
1. Why Authorship Matters
Authorship confers credit and has important academic, social, and ?nancial implications. Authorship also
implies responsibility and accountability for published work. The following recommendations are intended to
ensure that contributors who have made substantive intellectual contributions to a paper are given credit as authors, but also that contributors credited as authors
understand their role in taking responsibility and being accountable for what is published.
Because authorship does not communicate what contributions quali?ed an individual to be an author, some journals now request and publish information 2 about the contributions of each person named as having
participated in a submitted study, at least for original
research. Editors are strongly encouraged to develop and implement a contributorship policy. Such policies remove much of the ambiguity surrounding contributions, but leave unresolved the question of the quantity
and quality of contribution that qualify an individual for authorship. The ICMJE has thus developed criteria for
authorship that can be used by all journals, including those that distinguish authors from other contributors.
2. Who Is an Author?
The ICMJE recommends that authorship be based on the following 4 criteria:
1. Substantial contributions to the conception or design
of the work; or the acquisition, analysis, or interpretation of data for the work; AND
2. Drafting the work or revising it critically for important intellectual content; AND
3. Final approval of the version to be published; AND
4. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
In addition to being accountable for the parts of the work he or she has done, an author should be able to identify which co-authors are responsible for speci?c other parts of the work. In addition, authors should have
con?dence in the integrity of the contributions of their co-authors.
All those designated as authors should meet all four criteria for authorship, and all who meet the four criteria
should be identi?ed as authors. Those who do not meet
all four criteria should be acknowledged—see Section II.
A.3 below. These authorship criteria are intended to reserve the status of authorship for those who deserve
credit and can take responsibility for the work. The criteria are not intended for use as a means to disqualify colleagues from authorship who otherwise meet authorship
criteria by denying them the opportunity to meet criterion #s 2 or 3. Therefore, all individuals who meet the
?rst criterion should have the opportunity to participate
in the review, drafting, and ?nal approval of the manuscript.
The individuals who conduct the work are responsible for identifying who meets these criteria and ideally
should do so when planning the work, making modi?cations as appropriate as the work progresses. We encourage collaboration and co-authorship with colleagues in the locations where the research is conducted. It is the
collective responsibility of the authors, not the journal to which the work is submitted, to determine that all people named as authors meet all four criteria; it is not the role
of journal editors to determine who quali?es or does not qualify for authorship or to arbitrate authorship con?icts.
If agreement cannot be reached about who quali?es for authorship, the institution(s) where the work was performed, not the journal editor, should be asked to investigate. The criteria used to determine the order in which authors are listed on the byline may vary, and are to be
decided collectively by the author group and not by www.icmje.org
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editors. If authors request removal or addition of an
author after manuscript submission or publication, journal editors should seek an explanation and signed statement of agreement for the requested change from all
listed authors and from the author to be removed or
added.
The corresponding author is the one individual who
takes primary responsibility for communication with the
journal during the manuscript submission, peer-review,
and publication process. The corresponding author typically ensures that all the journal’s administrative requirements, such as providing details of authorship, ethics
committee approval, clinical trial registration documentation, and disclosures of relationships and activities, are
properly completed and reported, although these duties
may be delegated to one or more co-authors. The corresponding author should be available throughout the
submission and peer-review process to respond to editorial queries in a timely way, and should be available after publication to respond to critiques of the work and
cooperate with any requests from the journal for data or
additional information should questions about the paper
arise after publication. Although the corresponding
author has primary responsibility for correspondence
with the journal, the ICMJE recommends that editors
send copies of all correspondence to all listed authors.
When a large multi-author group has conducted the
work, the group ideally should decide who will be an
author before the work is started and con?rm who is an
author before submitting the manuscript for publication.
All members of the group named as authors should meet all four criteria for authorship, including approval of the ?nal manuscript, and they should be able to take
public responsibility for the work and should have full con?dence in the accuracy and integrity of the work of other group authors. They will also be expected as individuals to complete disclosure forms.
Some large multi-author groups designate authorship by a group name, with or without the names of individuals. When submitting a manuscript authored by a group, the corresponding author should specify the
group name if one exists, and clearly identify the group members who can take credit and responsibility for the
work as authors. The byline of the article identi?es who is directly responsible for the manuscript, and MEDLINE
lists as authors whichever names appear on the byline. If the byline includes a group name, MEDLINE will list the
names of individual group members who are authors or who are collaborators, sometimes called non-author contributors, if there is a note associated with the byline
clearly stating that the individual names are elsewhere in the paper and whether those names are authors or
collaborators.
3. Non-Author Contributors
Contributors who meet fewer than all 4 of the above criteria for authorship should not be listed as authors,
but they should be acknowledged. Examples of activities that alone (without other contributions) do not qualify a
contributor for authorship are acquisition of funding;
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general supervision of a research group or general administrative support; and writing assistance, technical editing, language editing, and proofreading. Those
whose contributions do not justify authorship may be acknowledged individually or together as a group under
a single heading (e.g., “Clinical Investigators” or
“Participating Investigators”), and their contributions
should be speci?ed (e.g., “served as scienti?c advisors,”
“critically reviewed the study proposal,” “collected data,”
“provided and cared for study patients,” “participated in
writing or technical editing of the manuscript”).
Because acknowledgment may imply endorsement by acknowledged individuals of a study’s data and conclusions, editors are advised to require that the corresponding author obtain written permission to be
acknowledged from all acknowledged individuals.
B. Disclosure of Financial and Non-Financial
Relationships and Activities, and Con?icts of
Interest
Public trust in the scienti?c process and the credibility of published articles depend in part on how transparently an author’s relationships and activities, directly or
topically related to a work, are handled during the planning, implementation, writing, peer review, editing, and
publication of scienti?c work.
The potential for con?ict of interest and bias exists when professional judgment concerning a primary interest (such as patients’ welfare or the validity of research)
may be in?uenced by a secondary interest (such as ?nancial gain). Perceptions of con?ict of interest are as important as actual con?icts of interest.
Individuals may disagree on whether an author’s relationships or activities represent con?icts. Although
the presence of a relationship or activity does not always indicate a problematic in?uence on a paper’s content,
perceptions of con?ict may erode trust in science as much as actual con?icts of interest. Ultimately, readers
must be able to make their own judgments regarding whether an author’s relationships and activities are pertinent to a paper’s content. These judgments require
transparent disclosures. An author’s complete disclosure demonstrates a commitment to transparency and helps
to maintain trust in the scienti?c process.
Financial relationships (such as employment, consultancies, stock ownership or options, honoraria, patents,
and paid expert testimony) are the most easily identi?able, the ones most often judged to represent potential
con?icts of interest and thus the most likely to undermine the credibility of the journal, the authors, and science itself. Other interests may also represent or be perceived as con?icts, such as personal relationships or rivalries, academic competition, and intellectual beliefs.
Authors should avoid entering into agreements with study sponsors, both for-pro?t and nonpro?t, that interfere with authors’ access to all of the study’s data or that interfere with their ability to analyze and interpret the data and to prepare and publish manuscripts independently when and where they choose. Policies that dictate
where authors may publish their work violate this
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Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals
principle of academic freedom. Authors may be required
to provide the journal with the agreements in con?dence.
Purposeful failure to report those relationships or
activities speci?ed on the journal’s disclosure form is a
form of misconduct, as is discussed in Section III.B.
1. Participants
All participants in the peer-review and publication process—not only authors but also peer reviewers, editors, and
editorial board members of journals—must consider and
disclose their relationships and activities when ful?lling their
roles in the process of article review and publication.
a. Authors
When authors submit a manuscript of any type or format they are responsible for disclosing all relationships
and activities that might bias or be seen to bias their
work. The ICMJE has developed a Disclosure Form to
facilitate and standardize authors’ disclosures. ICMJE
member journals require that authors use this form, and
ICMJE encourages other journals to adopt it.
•
Sources of support for the work, including sponsor
names along with explanations of the role of those
sources if any in study design; collection, analysis,
and interpretation of data; writing of the report; any
restrictions regarding the submission of the report
for publication; or a statement declaring that the supporting source had no such involvement or restrictions regarding publication; and
• Whether the authors had access to the study data,
with an explanation of the nature and extent of
access, including whether access is ongoing.
To support the above statements, editors may
request that authors of a study sponsored by a funder
with a proprietary or ?nancial interest in the outcome
sign a statement, such as “I had full access to all of the
data in this study and I take complete responsibility for
the integrity of the data and the accuracy of the data
analysis.”
C. Responsibilities in the Submission and
Peer-Review Process
1. Authors
b. Peer Reviewers
Reviewers should be asked at the time they are
asked to critique a manuscript if they have relationships
or activities that could complicate their review. Reviewers
must disclose to editors any relationships or activities
that could bias their opinions of the manuscript, and
should recuse themselves from reviewing speci?c manuscripts if the potential for bias exists. Reviewers must not
use knowledge of the work they’re reviewing before its
publication to further their own interests.
c. Editors and Journal Staff
Editors who make ?nal decisions about manuscripts
should recuse themselves from editorial decisions if they
have relationships or activities that pose potential con?icts related to articles under consideration. Other editorial staff members who participate in editorial decisions
must provide editors with a current description of their
relationships and activities (as they might relate to editorial judgments) and recuse themselves from any decisions in which an interest that poses a potential con?ict
exists. Editorial staff must not use information gained
through working with manuscripts for private gain.
Editors should regularly publish their own disclosure
statements and those of their journal staff. Guest editors
should follow these same procedures.
Journals should take extra precautions and have a
stated policy for evaluation of manuscripts submitted by
individuals involved in editorial decisions. Further guidance
is available from COPE (https://publicationethics.org/?les/
A_Short_Guide_to_Ethical_Editing.pdf) and WAME (http://
wame.org/con?ict-of-interest-in-peer-reviewed-medicaljournals).
Authors should abide by all principles of authorship
and declaration of relationships and activities detailed in
Sections II.A and II.B of this document.
a. Predatory or Pseudo-Journals
A growing number of entities are advertising themselves as “scholarly medical journals” yet do not function
as such. These journals (“predatory” or “pseudo-journals”) accept and publish almost all submissions and
charge article processing (or publication) fees, often
informing authors about this after a paper’s acceptance
for publication. They often claim to perform peer review
but do not and may purposefully use names similar to
well-established journals. They may state that they are
members of ICMJE but are not (see www.icmje.org for
current members of the ICMJE) and that they follow the
recommendations of organizations such as the ICMJE,
COPE, and WAME. Researchers must be aware of the existence of such entities and avoid submitting research to
them for publication. Authors have a responsibility to
evaluate the integrity, history, practices, and reputation
of the journals to which they submit manuscripts.
Guidance from various organizations is available to help
identify the characteristics of reputable peer-reviewed
journals (www.wame.org/identifying-predatory-or-pseudojournals and www.wame.org/principles-of-transparencyand-best-practice-in-scholarly-publishing).
Seeking the assistance of scienti?c mentors, senior
colleagues, and others with many years of scholarly publishing experience may also be helpful.
Authors should avoid citing articles in predatory or
pseudo-journals.
2. Journals
2. Reporting Relationships and Activities
a. Con?dentiality
Articles should be published with statements or supporting documents, such as the ICMJE Disclosure Form,
declaring:
• Authors’ relationships and activities; and
Manuscripts submitted to journals are privileged
communications that are authors’ private, con?dential
property, and authors may be harmed by premature disclosure of any or all of a manuscript’s details.
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Editors therefore must not share information about
manuscripts, including whether they have been received
and are under review, their content and status in the
review process, criticism by reviewers, and their ultimate
fate, to anyone other than the authors and reviewers.
Requests from third parties to use manuscripts and
reviews for legal proceedings should be politely refused,
and editors should do their best not to provide such con?dential material should it be subpoenaed.
Editors must also make clear that reviewers should
keep manuscripts, associated material, and the information they contain strictly con?dential. Reviewers and editorial staff members must not publicly discuss the authors’
work, and reviewers must not appropriate authors’ ideas
before the manuscript is published. Reviewers must not
retain the manuscript for their personal use and should
destroy paper copies of manuscripts and delete electronic
copies after submitting their reviews.
When a manuscript is rejected, it is best practice for
journals to delete copies of it from their editorial systems
unless retention is required by local regulations. Journals
that retain copies of rejected manuscripts should disclose this practice in their Information for Authors.
When a manuscript is published, journals should
keep copies of the original submission, reviews, revisions, and correspondence for at least three years and
possibly in perpetuity, depending on local regulations,
to help answer future questions about the work should
they arise.
Editors should not publish or publicize peer reviewers’
comments without permission of the reviewer and author.
If journal policy is to blind authors to reviewer identity and
comments are not signed, that identity must not be
revealed to the author or anyone else without the
reviewers’ expressed written permission.
Con?dentiality may have to be breached if dishonesty or fraud is alleged, but editors should notify authors
or reviewers if they intend to do so and con?dentiality
must otherwise be honored.
b. Timeliness
Editors should do all they can to ensure timely processing of manuscripts with the resources available to
them. If editors intend to publish a manuscript, they
should attempt to do so in a timely manner and any
planned delays should be negotiated with the authors. If
a journal has no intention of proceeding with a manuscript, editors should endeavor to reject the manuscript
as soon as possible to allow authors to submit to a different journal.
c. Peer Review
Peer review is the critical assessment of manuscripts
submitted to journals by experts who are usually not part
of the editorial staff. Because unbiased, independent,
critical assessment is an intrinsic part of all scholarly
work, including scienti?c research, peer review is an important extension of the scienti?c process.
The actual value of peer review is widely debated,
but the process facilitates a fair hearing for a manuscript
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among members of the scienti?c community. More practically, it helps editors decide which manuscripts are suitable for their journals. Peer review often helps authors
and editors improve the quality of reporting.
It is the responsibility of the journal to ensure that
systems are in place for selection of appropriate
reviewers. It is the responsibility of the editor to ensure
that reviewers have access to all materials that may be
relevant to the evaluation of the manuscript, including
supplementary material for e-only publication, and to
ensure that reviewer comments are properly assessed
and interpreted in the context of their declared relationships and activities.
A peer-reviewed journal is under no obligation to
send submitted manuscripts for review, and under no
obligation to follow reviewer recommendations, favorable or negative. The editor of a journal is ultimately responsible for the selection of all its content, and editorial
decisions may be informed by issues unrelated to the
quality of a manuscript, such as suitability for the journal.
An editor can reject any article at any time before publication, including after acceptance if concerns arise about
the integrity of the work.
Journals may differ in the number and kinds of
manuscripts they send for review, the number and types
of reviewers they seek for each manuscript, whether the
review process is open or blinded, and other aspects of
the review process. For this reason and as a service to
authors, journals should publish a clear, transparent
description of their peer-review process for all types of
manuscripts.
Journals should notify reviewers of the ultimate decision to accept or reject a paper, and should acknowledge the contribution of peer reviewers to their journal.
Editors are encouraged to share reviewers’ comments
with co-reviewers of the same paper, so reviewers can
learn from each other in the review process.
As part of peer review, editors are encouraged to
review research protocols, plans for statistical analysis if
separate from the protocol, and/or contracts associated
with project-speci?c studies. Editors should encourage
authors to make such documents publicly available at
the time of or after publication, before accepting such
studies for publication. Some journals may require public
posting of these documents as a condition of acceptance
for publication.
Journal requirements for independent data analysis
and for public data availability are in ?ux at the time of
this revision, re?ecting evolving views of the importance
of data availability for pre- and post-publication peer
review. Some journal editors currently request a statistical analysis of trial data by an independent biostatistician
before accepting studies for publication. Others ask
authors to say whether the study data are available to
third parties to view and/or use/reanalyze, while still
others encourage or require authors to share their data
with others for review or reanalysis. Each journal should
establish and publish their speci?c requirements for data
analysis and post in a place that potential authors can
easily access.
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Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals
Some people believe that true scienti?c peer review
begins only on the date a paper is published. In that spirit,
medical journals should have a mechanism for readers to
submit comments, questions, or criticisms about published
articles, and authors have a responsibility to respond
appropriately and cooperate with any requests from the
journal for data or additional information should questions
about the paper arise after publication (see Section III).
ICMJE believes investigators have a duty to maintain the primary data and analytic procedures underpinning the published results for at least 10 years. The ICMJE
encourages the preservation of these data in a data repository to ensure their longer-term availability.
d. Integrity
Editorial decisions should be based on the relevance of a manuscript to the journal and on the manuscript’s originality, quality, and contribution to evidence about important questions. Those decisions should not be in?uenced by commercial interests, personal relationships or agendas, or ?ndings that are negative or that credibly challenge accepted wisdom. In addition, authors should submit for publication or otherwise make publicly available, and editors should not exclude from consideration for publication, studies with ?ndings that are not statistically signi?cant or that have inconclusive ?ndings. Such studies may provide evidence that, combined with that from other studies through meta-analysis, might still help answer important questions, and a public record of such negative or inconclusive ?ndings may prevent unwarranted replication of effort or otherwise be
valuable for other researchers considering similar work.
Journals should clearly state their appeals process and should have a system for responding to appeals and complaints.
script is published. Reviewers must not retain the manuscript for their personal use and should destroy copies of
manuscripts after submitting their reviews.
Reviewers who seek assistance from a trainee or colleague in the performance of a review should acknowledge these individuals’ contributions in the written
comments submitted to the editor. These individuals must maintain the con?dentiality of the manuscript as outlined above.
Reviewers are expected to respond promptly to requests to review and to submit reviews within the time agreed. Reviewers’ comments should be constructive,honest, and polite.
Reviewers should declare their relationships and activities that might bias their evaluation of a manuscript and recuse themselves from the peer-review process if a con?ict exists.
D. Journal Owners and Editorial Freedom
1. Journal Owners
The journal impact factor is widely misused as a proxy for research and journal quality and as a measure of the importance of speci?c research projects or the merits of individual researchers, including their suitability for hiring, promotion, tenure, prizes, or research funding. ICMJE recommends that journals reduce the emphasis on impact factor as a single measure, but rather provide a range of article and journal metrics relevant to their readers and authors.
Owners and editors of medical journals share a common purpose, but they have different responsibilities,
and sometimes those differences lead to con?icts.
It is the responsibility of medical journal owners to appoint and dismiss editors. Owners should provide editors at the time of their appointment with a contract that
clearly states their rights and duties, authority, the general terms of their appointment, and mechanisms for
resolving con?ict. The editor’s performance may be assessed using mutually agreed-upon measures, including but not necessarily limited to readership, manuscript
submissions and handling times, and various journal metrics.
Owners should only dismiss editors for substantial reasons, such as scienti?c misconduct, disagreement with the long-term editorial direction of the journal, inadequate performance by agreed-upon performance metrics, or inappropriate behavior that is incompatible with a position of trust.
Appointments and dismissals should be based on evaluations by a panel of independent experts, rather
than by a small number of executives of the owning organization. This is especially necessary in the case of dismissals because of the high value society places on
freedom of speech within science and because it is often
the responsibility of editors to challenge the status quo in ways that may con?ict with the interests of the journal’s
owners.
A medical journal should explicitly state its governance and relationship to a journal owner (e.g., a sponsoring society).
3. Peer Reviewers
2. Editorial Freedom
Manuscripts submitted to j