Peer review plays a vital role in evidence-based medicine as the initial mechanism through which research is evaluated on the pathway to publication. Peer review is simultaneously a privilege and an extraordinary responsibility with which we should all be engaged. The practice of peer review has become completely integrated and essential for validating our medical literature. Our current system is designed to provide integrity and accuracy in published material, especially with our contemporary challenges of unethical practices such as nefarious use of artificial intelligence and the propagation of papermills.

Our current iteration of peer review is an inherently human endeavor. Authors anticipate and deserve a fair and unbiased critique to improve their manuscript and correct any errors prior to publication. However, the entire system relies on the volunteer efforts of engaged stakeholders and historical concepts relying on the memory of a handful of dedicated content experts guiding the decisions of editors, as a filter that allows promising research to pass, seems quaint. It is well understood that the inter-rater reliability between reviewers is modest at best and just because a publication claims peer review it does not mean that is without flaws in analysis or message. Indeed, as discussed below, structural racism, bias, conflict of interest, and fraud must be recognized and then intentionally and actively addressed to manifest a dynamic shift in culture for the betterment of our literature, and ultimately our patients.

To mitigate concerns with our current peer review process several proposed solutions have emerged. Preprint servers, such as bioRxiv, allow for public review and discussion prior to formal peer review processes and have become mainstream for many disciplines. The Journal of Urology^® has incorporated preprints into our workflow although overall penetrance in the urological publishing world remains low. Some journals have experimented with compensation for peer reviewers, and others avoid formal peer review altogether in favor of continuous “public” adjudication and debate. The traditional single anonymous peer review model has been challenged by “blinding” of reviewers and authors alike as double-anonymous endeavors. At The Journal or Urology^®, we have over a year’s experience with enhancing transparency and inclusivity for our peer review process. After submission, the manuscript is evaluated by the in-house editorial team to detect major flaws and triage the manuscript to determine suitability for the mission of the journal prior to dissemination for peer review. Additionally, manuscripts moving through the peer review process undergo an in-depth statistical review. Given the breadth of scope in urology, these complex tasks require a deep lineup of editorial board members and reviewers with diverse voices and experiences. Over the last year we have expanded and diversified our editorial board at The Journal of Urology^®, including an open call for engaged members to apply, particularly researchers with specific expertise and interest in diversity and equity initiatives. As mentioned above, The Journal of Urology^® has additionally instituted an open peer review process to promote transparency with allowance for reviewer concerns of anonymity in select situations. Actively collecting demographic data from our authors and reviewers to define our deficiencies and develop strategies to enhance diversity is also underway.

Today, the critical importance of diversity in peer review within scientific literature cannot be overstated. Introducing diversity among peer reviewers is essential to embrace individuals with varied perspectives, backgrounds, and experiences. This diversity fosters a broader range of insights and evaluations, leading to more comprehensive and well-rounded assessments of submitted papers. In a system of limited diversity, bias may intrude regarding the content and social context of the manuscript, affirmation or declination of the reviewer’s beliefs, publication bias favoring positive outcomes, conflicts of interest, as well as conservatism against innovative research. When different viewpoints converge in the peer review process, it reduces the risk of such biases and promotes decisions based on scientific merit rather than personal preferences/experiences.

A diverse peer review process directly enhances the quality and relevance of scientific literature. Different cultures, regions, and disciplines offer unique insights and approaches to problem-solving. By involving experts from diverse backgrounds, research is more likely to address global challenges comprehensively and incorporate perspectives that otherwise might be overlooked. Additionally, diversity in peer review helps identify potential limitations or blind spots in our research, leading to more robust conclusions and recommendations. This, in turn, strengthens the overall scientific knowledge base and promotes more meaningful advancements.

Moreover, our efforts to advocate for diversity in peer review are crucial to model inclusivity and equity for the scientific community. Historically, we are all aware of underrepresentation and marginalization in society and therefore science, often culminating in a biased evaluation process. By actively involving a diverse pool of peer reviewers, we can address these disparities and work toward a more inclusive scientific environment. As an academic exercise, participating in peer review provides a curated opportunity to stay current with the latest advancements and research trends in one’s field. Manuscript evaluation also hones critical evaluation skills. As a reviewer, one must carefully analyze the strengths and weaknesses of research papers, identify methodological flaws, and offer constructive feedback to authors. These skills are transferable and can be applied to one’s own research, improving the quality and rigor of their own manuscripts and grant applications. Finally, opportunities to excel at peer review enhance one’s expertise and credibility in the academic community. The recognition of knowledge and competence in a field can bolster one’s reputation and provide collaboration opportunities, invitations to lecture at conferences, and potential leadership roles in academic or research institutions. This inclusivity encourages a broader range of researchers to participate in scientific discourse, fostering innovation and breakthroughs from a wider array of perspectives. As we continue to advance our insights into the traditional limitations of our own perspectives in urology, intentional efforts embracing diversity in peer review must remain a top priority to optimize ethically sustainable service for the entirety of our discipline and patient population.