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• What Is Peer Review? | Types & Examples

What Is Peer Review? | Types & Examples

Published on December 17, 2021 by Tegan George . Revised on June 22, 2023.

Peer review, sometimes referred to as refereeing , is the process of evaluating submissions to an academic journal. Using strict criteria, a panel of reviewers in the same subject area decides whether to accept each submission for publication.

Peer-reviewed articles are considered a highly credible source due to the stringent process they go through before publication.

There are various types of peer review. The main difference between them is to what extent the authors, reviewers, and editors know each other’s identities. The most common types are:

• Single-blind review
• Double-blind review
• Triple-blind review

Collaborative review

Open review.

Relatedly, peer assessment is a process where your peers provide you with feedback on something you’ve written, based on a set of criteria or benchmarks from an instructor. They then give constructive feedback, compliments, or guidance to help you improve your draft.

Table of contents

What is the purpose of peer review, types of peer review, the peer review process, providing feedback to your peers, peer review example, advantages of peer review, criticisms of peer review, other interesting articles, frequently asked questions about peer reviews.

Many academic fields use peer review, largely to determine whether a manuscript is suitable for publication. Peer review enhances the credibility of the manuscript. For this reason, academic journals are among the most credible sources you can refer to.

However, peer review is also common in non-academic settings. The United Nations, the European Union, and many individual nations use peer review to evaluate grant applications. It is also widely used in medical and health-related fields as a teaching or quality-of-care measure.

Peer assessment is often used in the classroom as a pedagogical tool. Both receiving feedback and providing it are thought to enhance the learning process, helping students think critically and collaboratively.

Prevent plagiarism. Run a free check.

Depending on the journal, there are several types of peer review.

Single-blind peer review

The most common type of peer review is single-blind (or single anonymized) review . Here, the names of the reviewers are not known by the author.

While this gives the reviewers the ability to give feedback without the possibility of interference from the author, there has been substantial criticism of this method in the last few years. Many argue that single-blind reviewing can lead to poaching or intellectual theft or that anonymized comments cause reviewers to be too harsh.

Double-blind peer review

In double-blind (or double anonymized) review , both the author and the reviewers are anonymous.

Arguments for double-blind review highlight that this mitigates any risk of prejudice on the side of the reviewer, while protecting the nature of the process. In theory, it also leads to manuscripts being published on merit rather than on the reputation of the author.

Triple-blind peer review

While triple-blind (or triple anonymized) review —where the identities of the author, reviewers, and editors are all anonymized—does exist, it is difficult to carry out in practice.

Proponents of adopting triple-blind review for journal submissions argue that it minimizes potential conflicts of interest and biases. However, ensuring anonymity is logistically challenging, and current editing software is not always able to fully anonymize everyone involved in the process.

In collaborative review , authors and reviewers interact with each other directly throughout the process. However, the identity of the reviewer is not known to the author. This gives all parties the opportunity to resolve any inconsistencies or contradictions in real time, and provides them a rich forum for discussion. It can mitigate the need for multiple rounds of editing and minimize back-and-forth.

Collaborative review can be time- and resource-intensive for the journal, however. For these collaborations to occur, there has to be a set system in place, often a technological platform, with staff monitoring and fixing any bugs or glitches.

Lastly, in open review , all parties know each other’s identities throughout the process. Often, open review can also include feedback from a larger audience, such as an online forum, or reviewer feedback included as part of the final published product.

While many argue that greater transparency prevents plagiarism or unnecessary harshness, there is also concern about the quality of future scholarship if reviewers feel they have to censor their comments.

In general, the peer review process includes the following steps:

• First, the author submits the manuscript to the editor.
• Reject the manuscript and send it back to the author, or
• Send it onward to the selected peer reviewer(s)
• Next, the peer review process occurs. The reviewer provides feedback, addressing any major or minor issues with the manuscript, and gives their advice regarding what edits should be made.
• Lastly, the edited manuscript is sent back to the author. They input the edits and resubmit it to the editor for publication.

In an effort to be transparent, many journals are now disclosing who reviewed each article in the published product. There are also increasing opportunities for collaboration and feedback, with some journals allowing open communication between reviewers and authors.

It can seem daunting at first to conduct a peer review or peer assessment. If you’re not sure where to start, there are several best practices you can use.

Summarize the argument in your own words

Summarizing the main argument helps the author see how their argument is interpreted by readers, and gives you a jumping-off point for providing feedback. If you’re having trouble doing this, it’s a sign that the argument needs to be clearer, more concise, or worded differently.

If the author sees that you’ve interpreted their argument differently than they intended, they have an opportunity to address any misunderstandings when they get the manuscript back.

Separate your feedback into major and minor issues

It can be challenging to keep feedback organized. One strategy is to start out with any major issues and then flow into the more minor points. It’s often helpful to keep your feedback in a numbered list, so the author has concrete points to refer back to.

Major issues typically consist of any problems with the style, flow, or key points of the manuscript. Minor issues include spelling errors, citation errors, or other smaller, easy-to-apply feedback.

Tip: Try not to focus too much on the minor issues. If the manuscript has a lot of typos, consider making a note that the author should address spelling and grammar issues, rather than going through and fixing each one.

The best feedback you can provide is anything that helps them strengthen their argument or resolve major stylistic issues.

Give the type of feedback that you would like to receive

No one likes being criticized, and it can be difficult to give honest feedback without sounding overly harsh or critical. One strategy you can use here is the “compliment sandwich,” where you “sandwich” your constructive criticism between two compliments.

Be sure you are giving concrete, actionable feedback that will help the author submit a successful final draft. While you shouldn’t tell them exactly what they should do, your feedback should help them resolve any issues they may have overlooked.

As a rule of thumb, your feedback should be:

• Easy to understand
• Constructive

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Below is a brief annotated research example. You can view examples of peer feedback by hovering over the highlighted sections.

Influence of phone use on sleep

Studies show that teens from the US are getting less sleep than they were a decade ago (Johnson, 2019) . On average, teens only slept for 6 hours a night in 2021, compared to 8 hours a night in 2011. Johnson mentions several potential causes, such as increased anxiety, changed diets, and increased phone use.

The current study focuses on the effect phone use before bedtime has on the number of hours of sleep teens are getting.

For this study, a sample of 300 teens was recruited using social media, such as Facebook, Instagram, and Snapchat. The first week, all teens were allowed to use their phone the way they normally would, in order to obtain a baseline.

The sample was then divided into 3 groups:

• Group 1 was not allowed to use their phone before bedtime.
• Group 2 used their phone for 1 hour before bedtime.
• Group 3 used their phone for 3 hours before bedtime.

All participants were asked to go to sleep around 10 p.m. to control for variation in bedtime . In the morning, their Fitbit showed the number of hours they’d slept. They kept track of these numbers themselves for 1 week.

Two independent t tests were used in order to compare Group 1 and Group 2, and Group 1 and Group 3. The first t test showed no significant difference ( p > .05) between the number of hours for Group 1 ( M = 7.8, SD = 0.6) and Group 2 ( M = 7.0, SD = 0.8). The second t test showed a significant difference ( p < .01) between the average difference for Group 1 ( M = 7.8, SD = 0.6) and Group 3 ( M = 6.1, SD = 1.5).

This shows that teens sleep fewer hours a night if they use their phone for over an hour before bedtime, compared to teens who use their phone for 0 to 1 hours.

Peer review is an established and hallowed process in academia, dating back hundreds of years. It provides various fields of study with metrics, expectations, and guidance to ensure published work is consistent with predetermined standards.

• Protects the quality of published research

Peer review can stop obviously problematic, falsified, or otherwise untrustworthy research from being published. Any content that raises red flags for reviewers can be closely examined in the review stage, preventing plagiarized or duplicated research from being published.

• Gives you access to feedback from experts in your field

Peer review represents an excellent opportunity to get feedback from renowned experts in your field and to improve your writing through their feedback and guidance. Experts with knowledge about your subject matter can give you feedback on both style and content, and they may also suggest avenues for further research that you hadn’t yet considered.

• Helps you identify any weaknesses in your argument

Peer review acts as a first defense, helping you ensure your argument is clear and that there are no gaps, vague terms, or unanswered questions for readers who weren’t involved in the research process. This way, you’ll end up with a more robust, more cohesive article.

While peer review is a widely accepted metric for credibility, it’s not without its drawbacks.

• Reviewer bias

The more transparent double-blind system is not yet very common, which can lead to bias in reviewing. A common criticism is that an excellent paper by a new researcher may be declined, while an objectively lower-quality submission by an established researcher would be accepted.

• Delays in publication

The thoroughness of the peer review process can lead to significant delays in publishing time. Research that was current at the time of submission may not be as current by the time it’s published. There is also high risk of publication bias , where journals are more likely to publish studies with positive findings than studies with negative findings.

• Risk of human error

By its very nature, peer review carries a risk of human error. In particular, falsification often cannot be detected, given that reviewers would have to replicate entire experiments to ensure the validity of results.

If you want to know more about statistics , methodology , or research bias , make sure to check out some of our other articles with explanations and examples.

• Normal distribution
• Measures of central tendency
• Chi square tests
• Confidence interval
• Quartiles & Quantiles
• Cluster sampling
• Stratified sampling
• Thematic analysis
• Discourse analysis
• Cohort study
• Ethnography

Research bias

• Implicit bias
• Cognitive bias
• Conformity bias
• Hawthorne effect
• Availability heuristic
• Attrition bias
• Social desirability bias

Peer review is a process of evaluating submissions to an academic journal. Utilizing rigorous criteria, a panel of reviewers in the same subject area decide whether to accept each submission for publication. For this reason, academic journals are often considered among the most credible sources you can use in a research project– provided that the journal itself is trustworthy and well-regarded.

In general, the peer review process follows the following steps: 

• Reject the manuscript and send it back to author, or 
• Send it onward to the selected peer reviewer(s) 
• Next, the peer review process occurs. The reviewer provides feedback, addressing any major or minor issues with the manuscript, and gives their advice regarding what edits should be made. 
• Lastly, the edited manuscript is sent back to the author. They input the edits, and resubmit it to the editor for publication.

Peer review can stop obviously problematic, falsified, or otherwise untrustworthy research from being published. It also represents an excellent opportunity to get feedback from renowned experts in your field. It acts as a first defense, helping you ensure your argument is clear and that there are no gaps, vague terms, or unanswered questions for readers who weren’t involved in the research process.

Peer-reviewed articles are considered a highly credible source due to this stringent process they go through before publication.

Many academic fields use peer review , largely to determine whether a manuscript is suitable for publication. Peer review enhances the credibility of the published manuscript.

However, peer review is also common in non-academic settings. The United Nations, the European Union, and many individual nations use peer review to evaluate grant applications. It is also widely used in medical and health-related fields as a teaching or quality-of-care measure. 

A credible source should pass the CRAAP test  and follow these guidelines:

• The information should be up to date and current.
• The author and publication should be a trusted authority on the subject you are researching.
• The sources the author cited should be easy to find, clear, and unbiased.
• For a web source, the URL and layout should signify that it is trustworthy.

Cite this Scribbr article

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George, T. (2023, June 22). What Is Peer Review? | Types & Examples. Scribbr. Retrieved August 26, 2024, from https://www.scribbr.com/methodology/peer-review/

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• Knowledge Base
• Methodology
• What Is Peer Review? | Types & Examples

What Is Peer Review? | Types & Examples

Published on 6 May 2022 by Tegan George . Revised on 2 September 2022.

Peer review, sometimes referred to as refereeing , is the process of evaluating submissions to an academic journal. Using strict criteria, a panel of reviewers in the same subject area decides whether to accept each submission for publication.

Peer-reviewed articles are considered a highly credible source due to the stringent process they go through before publication.

There are various types of peer review. The main difference between them is to what extent the authors, reviewers, and editors know each other’s identities. The most common types are:

• Single-blind review
• Double-blind review
• Triple-blind review

Collaborative review

Open review.

Relatedly, peer assessment is a process where your peers provide you with feedback on something you’ve written, based on a set of criteria or benchmarks from an instructor. They then give constructive feedback, compliments, or guidance to help you improve your draft.

Table of contents

What is the purpose of peer review, types of peer review, the peer review process, providing feedback to your peers, peer review example, advantages of peer review, criticisms of peer review, frequently asked questions about peer review.

Many academic fields use peer review, largely to determine whether a manuscript is suitable for publication. Peer review enhances the credibility of the manuscript. For this reason, academic journals are among the most credible sources you can refer to.

However, peer review is also common in non-academic settings. The United Nations, the European Union, and many individual nations use peer review to evaluate grant applications. It is also widely used in medical and health-related fields as a teaching or quality-of-care measure.

Peer assessment is often used in the classroom as a pedagogical tool. Both receiving feedback and providing it are thought to enhance the learning process, helping students think critically and collaboratively.

Prevent plagiarism, run a free check.

Depending on the journal, there are several types of peer review.

Single-blind peer review

The most common type of peer review is single-blind (or single anonymised) review . Here, the names of the reviewers are not known by the author.

While this gives the reviewers the ability to give feedback without the possibility of interference from the author, there has been substantial criticism of this method in the last few years. Many argue that single-blind reviewing can lead to poaching or intellectual theft or that anonymised comments cause reviewers to be too harsh.

Double-blind peer review

In double-blind (or double anonymised) review , both the author and the reviewers are anonymous.

Arguments for double-blind review highlight that this mitigates any risk of prejudice on the side of the reviewer, while protecting the nature of the process. In theory, it also leads to manuscripts being published on merit rather than on the reputation of the author.

Triple-blind peer review

While triple-blind (or triple anonymised) review – where the identities of the author, reviewers, and editors are all anonymised – does exist, it is difficult to carry out in practice.

Proponents of adopting triple-blind review for journal submissions argue that it minimises potential conflicts of interest and biases. However, ensuring anonymity is logistically challenging, and current editing software is not always able to fully anonymise everyone involved in the process.

In collaborative review , authors and reviewers interact with each other directly throughout the process. However, the identity of the reviewer is not known to the author. This gives all parties the opportunity to resolve any inconsistencies or contradictions in real time, and provides them a rich forum for discussion. It can mitigate the need for multiple rounds of editing and minimise back-and-forth.

Collaborative review can be time- and resource-intensive for the journal, however. For these collaborations to occur, there has to be a set system in place, often a technological platform, with staff monitoring and fixing any bugs or glitches.

Lastly, in open review , all parties know each other’s identities throughout the process. Often, open review can also include feedback from a larger audience, such as an online forum, or reviewer feedback included as part of the final published product.

While many argue that greater transparency prevents plagiarism or unnecessary harshness, there is also concern about the quality of future scholarship if reviewers feel they have to censor their comments.

In general, the peer review process includes the following steps:

• First, the author submits the manuscript to the editor.
• Reject the manuscript and send it back to the author, or
• Send it onward to the selected peer reviewer(s)
• Next, the peer review process occurs. The reviewer provides feedback, addressing any major or minor issues with the manuscript, and gives their advice regarding what edits should be made.
• Lastly, the edited manuscript is sent back to the author. They input the edits and resubmit it to the editor for publication.

In an effort to be transparent, many journals are now disclosing who reviewed each article in the published product. There are also increasing opportunities for collaboration and feedback, with some journals allowing open communication between reviewers and authors.

It can seem daunting at first to conduct a peer review or peer assessment. If you’re not sure where to start, there are several best practices you can use.

Summarise the argument in your own words

Summarising the main argument helps the author see how their argument is interpreted by readers, and gives you a jumping-off point for providing feedback. If you’re having trouble doing this, it’s a sign that the argument needs to be clearer, more concise, or worded differently.

If the author sees that you’ve interpreted their argument differently than they intended, they have an opportunity to address any misunderstandings when they get the manuscript back.

Separate your feedback into major and minor issues

It can be challenging to keep feedback organised. One strategy is to start out with any major issues and then flow into the more minor points. It’s often helpful to keep your feedback in a numbered list, so the author has concrete points to refer back to.

Major issues typically consist of any problems with the style, flow, or key points of the manuscript. Minor issues include spelling errors, citation errors, or other smaller, easy-to-apply feedback.

The best feedback you can provide is anything that helps them strengthen their argument or resolve major stylistic issues.

Give the type of feedback that you would like to receive

No one likes being criticised, and it can be difficult to give honest feedback without sounding overly harsh or critical. One strategy you can use here is the ‘compliment sandwich’, where you ‘sandwich’ your constructive criticism between two compliments.

Be sure you are giving concrete, actionable feedback that will help the author submit a successful final draft. While you shouldn’t tell them exactly what they should do, your feedback should help them resolve any issues they may have overlooked.

As a rule of thumb, your feedback should be:

• Easy to understand
• Constructive

Below is a brief annotated research example. You can view examples of peer feedback by hovering over the highlighted sections.

Influence of phone use on sleep

Studies show that teens from the US are getting less sleep than they were a decade ago (Johnson, 2019) . On average, teens only slept for 6 hours a night in 2021, compared to 8 hours a night in 2011. Johnson mentions several potential causes, such as increased anxiety, changed diets, and increased phone use.

The current study focuses on the effect phone use before bedtime has on the number of hours of sleep teens are getting.

For this study, a sample of 300 teens was recruited using social media, such as Facebook, Instagram, and Snapchat. The first week, all teens were allowed to use their phone the way they normally would, in order to obtain a baseline.

The sample was then divided into 3 groups:

• Group 1 was not allowed to use their phone before bedtime.
• Group 2 used their phone for 1 hour before bedtime.
• Group 3 used their phone for 3 hours before bedtime.

All participants were asked to go to sleep around 10 p.m. to control for variation in bedtime . In the morning, their Fitbit showed the number of hours they’d slept. They kept track of these numbers themselves for 1 week.

Two independent t tests were used in order to compare Group 1 and Group 2, and Group 1 and Group 3. The first t test showed no significant difference ( p > .05) between the number of hours for Group 1 ( M = 7.8, SD = 0.6) and Group 2 ( M = 7.0, SD = 0.8). The second t test showed a significant difference ( p < .01) between the average difference for Group 1 ( M = 7.8, SD = 0.6) and Group 3 ( M = 6.1, SD = 1.5).

This shows that teens sleep fewer hours a night if they use their phone for over an hour before bedtime, compared to teens who use their phone for 0 to 1 hours.

Peer review is an established and hallowed process in academia, dating back hundreds of years. It provides various fields of study with metrics, expectations, and guidance to ensure published work is consistent with predetermined standards.

• Protects the quality of published research

Peer review can stop obviously problematic, falsified, or otherwise untrustworthy research from being published. Any content that raises red flags for reviewers can be closely examined in the review stage, preventing plagiarised or duplicated research from being published.

• Gives you access to feedback from experts in your field

Peer review represents an excellent opportunity to get feedback from renowned experts in your field and to improve your writing through their feedback and guidance. Experts with knowledge about your subject matter can give you feedback on both style and content, and they may also suggest avenues for further research that you hadn’t yet considered.

• Helps you identify any weaknesses in your argument

Peer review acts as a first defence, helping you ensure your argument is clear and that there are no gaps, vague terms, or unanswered questions for readers who weren’t involved in the research process. This way, you’ll end up with a more robust, more cohesive article.

While peer review is a widely accepted metric for credibility, it’s not without its drawbacks.

• Reviewer bias

The more transparent double-blind system is not yet very common, which can lead to bias in reviewing. A common criticism is that an excellent paper by a new researcher may be declined, while an objectively lower-quality submission by an established researcher would be accepted.

• Delays in publication

The thoroughness of the peer review process can lead to significant delays in publishing time. Research that was current at the time of submission may not be as current by the time it’s published.

• Risk of human error

By its very nature, peer review carries a risk of human error. In particular, falsification often cannot be detected, given that reviewers would have to replicate entire experiments to ensure the validity of results.

Peer review is a process of evaluating submissions to an academic journal. Utilising rigorous criteria, a panel of reviewers in the same subject area decide whether to accept each submission for publication.

For this reason, academic journals are often considered among the most credible sources you can use in a research project – provided that the journal itself is trustworthy and well regarded.

Peer review can stop obviously problematic, falsified, or otherwise untrustworthy research from being published. It also represents an excellent opportunity to get feedback from renowned experts in your field.

It acts as a first defence, helping you ensure your argument is clear and that there are no gaps, vague terms, or unanswered questions for readers who weren’t involved in the research process.

Peer-reviewed articles are considered a highly credible source due to this stringent process they go through before publication.

In general, the peer review process follows the following steps:

• Reject the manuscript and send it back to author, or
• Lastly, the edited manuscript is sent back to the author. They input the edits, and resubmit it to the editor for publication.

Many academic fields use peer review , largely to determine whether a manuscript is suitable for publication. Peer review enhances the credibility of the published manuscript.

Cite this Scribbr article

If you want to cite this source, you can copy and paste the citation or click the ‘Cite this Scribbr article’ button to automatically add the citation to our free Reference Generator.

George, T. (2022, September 02). What Is Peer Review? | Types & Examples. Scribbr. Retrieved 26 August 2024, from https://www.scribbr.co.uk/research-methods/peer-reviews/

Is this article helpful?

Tegan George

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The peer review process

The peer review process can be broadly summarized into 10 steps, although these steps can vary slightly between journals. Explore what’s involved, below.

Editor Feedback: “Reviewers should remember that they are representing the readers of the journal. Will the readers of this particular journal find this informative and useful?”

1. Submission of Paper

The corresponding or submitting author submits the paper to the journal. This is usually via an online system such as ScholarOne Manuscripts. Occasionally, journals may accept submissions by email.

2. Editorial Office Assessment

The Editorial Office checks that the paper adheres to the requirements described in the journal’s Author Guidelines. The quality of the paper is not assessed at this point.

3. Appraisal by the Editor-in-Chief (EIC)

The EIC checks assesses the paper, considering its scope, originality and merits. The EiC may reject the paper at this stage.

4. EIC Assigns an Associate Editor (AE)

Some journals have Associate Editors ( or equivalent ) who handle the peer review. If they do, they would be assigned at this stage.

5. Invitation to Reviewers

The handling editor sends invitations to individuals he or she believes would be appropriate reviewers. As responses are received, further invitations are issued, if necessary, until the required number of reviewers is secured– commonly this is 2, but there is some variation between journals.

6. Response to Invitations

Potential reviewers consider the invitation against their own expertise, conflicts of interest and availability. They then accept or decline the invitation to review. If possible, when declining, they might also suggest alternative reviewers.

7. Review is Conducted

The reviewer sets time aside to read the paper several times. The first read is used to form an initial impression of the work. If major problems are found at this stage, the reviewer may feel comfortable rejecting the paper without further work. Otherwise, they will read the paper several more times, taking notes to build a detailed point-by-point review. The review is then submitted to the journal, with the reviewer’s recommendation (e.g. to revise, accept or reject the paper).

8. Journal Evaluates the Reviews

The handling editor considers all the returned reviews before making a decision. If the reviews differ widely, the editor may invite an additional reviewer so as to get an extra opinion before making a decision.

9. The Decision is Communicated

The editor sends a decision email to the author including any relevant reviewer comments. Comments will be anonymous if the journal follows a single-anonymous or double-anonymous peer review model. Journals with following an open or transparent peer review model will share the identities of the reviewers with the author(s).

10. Next Steps

An editor's perspective.

Listen to a podcast from Roger Watson, Editor-in-Chief of Journal of Advanced Nursing, as he discusses 'The peer review process'.

If accepted , the paper is sent to production. If the article is rejected or sent back for either major or minor revision , the handling editor should include constructive comments from the reviewers to help the author improve the article. At this point, reviewers should also be sent an email or letter letting them know the outcome of their review. If the paper was sent back for revision , the reviewers should expect to receive a new version, unless they have opted out of further participation. However, where only minor changes were requested this follow-up review might be done by the handling editor.

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What is peer review?

Reviewers play a pivotal role in scholarly publishing. The peer review system exists to validate academic work, helps to improve the quality of published research, and increases networking possibilities within research communities. Despite criticisms, peer review is still the only widely accepted method for research validation and has continued successfully with relatively minor changes for some 350 years.

Elsevier relies on the peer review process to uphold the quality and validity of individual articles and the journals that publish them.

Peer review has been a formal part of scientific communication since the first scientific journals appeared more than 300 years ago. The Philosophical Transactions opens in new tab/window of the Royal Society is thought to be the first journal to formalize the peer review process opens in new tab/window under the editorship of Henry Oldenburg (1618- 1677).

Despite many criticisms about the integrity of peer review, the majority of the research community still believes peer review is the best form of scientific evaluation. This opinion was endorsed by the outcome of a survey Elsevier and Sense About Science conducted in 2009 opens in new tab/window and has since been further confirmed by other publisher and scholarly organization surveys. Furthermore, a  2015 survey by the Publishing Research Consortium opens in new tab/window , saw 82% of researchers agreeing that “without peer review there is no control in scientific communication.”

To learn more about peer review, visit Elsevier’s free e-learning platform  Researcher Academy opens in new tab/window and see our resources below.

The peer review process

Types of peer review.

Peer review comes in different flavours. Each model has its own advantages and disadvantages, and often one type of review will be preferred by a subject community. Before submitting or reviewing a paper, you must therefore check which type is employed by the journal so you are aware of the respective rules. In case of questions regarding the peer review model employed by the journal for which you have been invited to review, consult the journal’s homepage or contact the editorial office directly.  

Single anonymized review

In this type of review, the names of the reviewers are hidden from the author. This is the traditional method of reviewing and is the most common type by far. Points to consider regarding single anonymized review include:

Reviewer anonymity allows for impartial decisions, as the reviewers will not be influenced by potential criticism from the authors.

Authors may be concerned that reviewers in their field could delay publication, giving the reviewers a chance to publish first.

Reviewers may use their anonymity as justification for being unnecessarily critical or harsh when commenting on the authors’ work.

Double anonymized review

Both the reviewer and the author are anonymous in this model. Some advantages of this model are listed below.

Author anonymity limits reviewer bias, such as on author's gender, country of origin, academic status, or previous publication history.

Articles written by prestigious or renowned authors are considered based on the content of their papers, rather than their reputation.

But bear in mind that despite the above, reviewers can often identify the author through their writing style, subject matter, or self-citation – it is exceedingly difficult to guarantee total author anonymity. More information for authors can be found in our  double-anonymized peer review guidelines .

Triple anonymized review

With triple anonymized review, reviewers are anonymous to the author, and the author's identity is unknown to both the reviewers and the editor. Articles are anonymized at the submission stage and are handled in a way to minimize any potential bias towards the authors. However, it should be noted that: 

The complexities involved with anonymizing articles/authors to this level are considerable.

As with double anonymized review, there is still a possibility for the editor and/or reviewers to correctly identify the author(s) from their writing style, subject matter, citation patterns, or other methodologies.

Open review

Open peer review is an umbrella term for many different models aiming at greater transparency during and after the peer review process. The most common definition of open review is when both the reviewer and author are known to each other during the peer review process. Other types of open peer review consist of:

Publication of reviewers’ names on the article page 

Publication of peer review reports alongside the article, either signed or anonymous 

Publication of peer review reports (signed or anonymous) with authors’ and editors’ responses alongside the article 

Publication of the paper after pre-checks and opening a discussion forum to the community who can then comment (named or anonymous) on the article 

Many believe this is the best way to prevent malicious comments, stop plagiarism, prevent reviewers from following their own agenda, and encourage open, honest reviewing. Others see open review as a less honest process, in which politeness or fear of retribution may cause a reviewer to withhold or tone down criticism. For three years, five Elsevier journals experimented with publication of peer review reports (signed or anonymous) as articles alongside the accepted paper on ScienceDirect ( example opens in new tab/window ).

Read more about the experiment

More transparent peer review

Transparency is the key to trust in peer review and as such there is an increasing call towards more  transparency around the peer review process . In an effort to promote transparency in the peer review process, many Elsevier journals therefore publish the name of the handling editor of the published paper on ScienceDirect. Some journals also provide details about the number of reviewers who reviewed the article before acceptance. Furthermore, in order to provide updates and feedback to reviewers, most Elsevier journals inform reviewers about the editor’s decision and their peers’ recommendations. 

Article transfer service: sharing reviewer comments

Elsevier authors may be invited to  transfer  their article submission from one journal to another for free if their initial submission was not successful. 

As a referee, your review report (including all comments to the author and editor) will be transferred to the destination journal, along with the manuscript. The main benefit is that reviewers are not asked to review the same manuscript several times for different journals. 

Tools & resources

Elsevier researcher academy modules.

The certified peer reviewer course opens in new tab/window

Transparency in peer review opens in new tab/window

Reviewers’ Update articles

Peer review using today’s technology

Lifting the lid on publishing peer review reports: an interview with Bahar Mehmani and Flaminio Squazzoni

How face-to-face peer review can benefit authors and journals alike

Innovation in peer review: introducing “volunpeers”

Results masked review: peer review without publication bias

Interesting reads

"Is Peer Review in Crisis?" Perspectives in Publishing No 2, August 2004, by Adrian Mulligan opens in new tab/window

“The history of the peer-review process” Trends in Biotechnology, 2002, by Ray Spier opens in new tab/window

Publishing Research Consortium Peer review survey . 2015. Elsevier; 2015 

Peer review process

Introduction to peer review, what is peer review.

Peer review is the system used to assess the quality of a manuscript before it is published. Independent researchers in the relevant research area assess submitted manuscripts for originality, validity and significance to help editors determine whether a manuscript should be published in their journal.

How does it work?

When a manuscript is submitted to a journal, it is assessed to see if it meets the criteria for submission. If it does, the editorial team will select potential peer reviewers within the field of research to peer-review the manuscript and make recommendations.

There are four main types of peer review used by BMC:

Single-blind: the reviewers know the names of the authors, but the authors do not know who reviewed their manuscript unless the reviewer chooses to sign their report.

Double-blind: the reviewers do not know the names of the authors, and the authors do not know who reviewed their manuscript.

Open peer: authors know who the reviewers are, and the reviewers know who the authors are. If the manuscript is accepted, the named reviewer reports are published alongside the article and the authors’ response to the reviewer.

Transparent peer: the reviewers know the names of the authors, but the authors do not know who reviewed their manuscript unless the reviewer chooses to sign their report. If the manuscript is accepted, the anonymous reviewer reports are published alongside the article and the authors’ response to the reviewer.

Different journals use different types of peer review. You can find out which peer-review system is used by a particular journal in the journal’s ‘About’ page.

Why do peer review?

Peer review is an integral part of scientific publishing that confirms the validity of the manuscript. Peer reviewers are experts who volunteer their time to help improve the manuscripts they review. By undergoing peer review, manuscripts should become:

More robust - peer reviewers may point out gaps in a paper that require more explanation or additional experiments.

Easier to read - if parts of your paper are difficult to understand, reviewers can suggest changes.

More useful - peer reviewers also consider the importance of your paper to others in your field.

For more information and advice on how to get published, please see our blog series here .

How peer review works

The peer review process can be single-blind, double-blind, open or transparent.

You can find out which peer review system is used by a particular journal in the journal's 'About' page.

N. B. This diagram is a representation of the peer review process, and should not be taken as the definitive approach used by every journal.

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Understanding Peer Review in Science

Peer review is an essential element of the scientific publishing process that helps ensure that research articles are evaluated, critiqued, and improved before release into the academic community. Take a look at the significance of peer review in scientific publications, the typical steps of the process, and and how to approach peer review if you are asked to assess a manuscript.

What Is Peer Review?

Peer review is the evaluation of work by peers, who are people with comparable experience and competency. Peers assess each others’ work in educational settings, in professional settings, and in the publishing world. The goal of peer review is improving quality, defining and maintaining standards, and helping people learn from one another.

In the context of scientific publication, peer review helps editors determine which submissions merit publication and improves the quality of manuscripts prior to their final release.

Types of Peer Review for Manuscripts

There are three main types of peer review:

• Single-blind review: The reviewers know the identities of the authors, but the authors do not know the identities of the reviewers.
• Double-blind review: Both the authors and reviewers remain anonymous to each other.
• Open peer review: The identities of both the authors and reviewers are disclosed, promoting transparency and collaboration.

There are advantages and disadvantages of each method. Anonymous reviews reduce bias but reduce collaboration, while open reviews are more transparent, but increase bias.

Key Elements of Peer Review

Proper selection of a peer group improves the outcome of the process:

• Expertise : Reviewers should possess adequate knowledge and experience in the relevant field to provide constructive feedback.
• Objectivity : Reviewers assess the manuscript impartially and without personal bias.
• Confidentiality : The peer review process maintains confidentiality to protect intellectual property and encourage honest feedback.
• Timeliness : Reviewers provide feedback within a reasonable timeframe to ensure timely publication.

Steps of the Peer Review Process

The typical peer review process for scientific publications involves the following steps:

• Submission : Authors submit their manuscript to a journal that aligns with their research topic.
• Editorial assessment : The journal editor examines the manuscript and determines whether or not it is suitable for publication. If it is not, the manuscript is rejected.
• Peer review : If it is suitable, the editor sends the article to peer reviewers who are experts in the relevant field.
• Reviewer feedback : Reviewers provide feedback, critique, and suggestions for improvement.
• Revision and resubmission : Authors address the feedback and make necessary revisions before resubmitting the manuscript.
• Final decision : The editor makes a final decision on whether to accept or reject the manuscript based on the revised version and reviewer comments.
• Publication : If accepted, the manuscript undergoes copyediting and formatting before being published in the journal.

Pros and Cons

While the goal of peer review is improving the quality of published research, the process isn’t without its drawbacks.

• Quality assurance : Peer review helps ensure the quality and reliability of published research.
• Error detection : The process identifies errors and flaws that the authors may have overlooked.
• Credibility : The scientific community generally considers peer-reviewed articles to be more credible.
• Professional development : Reviewers can learn from the work of others and enhance their own knowledge and understanding.
• Time-consuming : The peer review process can be lengthy, delaying the publication of potentially valuable research.
• Bias : Personal biases of reviews impact their evaluation of the manuscript.
• Inconsistency : Different reviewers may provide conflicting feedback, making it challenging for authors to address all concerns.
• Limited effectiveness : Peer review does not always detect significant errors or misconduct.
• Poaching : Some reviewers take an idea from a submission and gain publication before the authors of the original research.

Steps for Conducting Peer Review of an Article

Generally, an editor provides guidance when you are asked to provide peer review of a manuscript. Here are typical steps of the process.

• Accept the right assignment: Accept invitations to review articles that align with your area of expertise to ensure you can provide well-informed feedback.
• Manage your time: Allocate sufficient time to thoroughly read and evaluate the manuscript, while adhering to the journal’s deadline for providing feedback.
• Read the manuscript multiple times: First, read the manuscript for an overall understanding of the research. Then, read it more closely to assess the details, methodology, results, and conclusions.
• Evaluate the structure and organization: Check if the manuscript follows the journal’s guidelines and is structured logically, with clear headings, subheadings, and a coherent flow of information.
• Assess the quality of the research: Evaluate the research question, study design, methodology, data collection, analysis, and interpretation. Consider whether the methods are appropriate, the results are valid, and the conclusions are supported by the data.
• Examine the originality and relevance: Determine if the research offers new insights, builds on existing knowledge, and is relevant to the field.
• Check for clarity and consistency: Review the manuscript for clarity of writing, consistent terminology, and proper formatting of figures, tables, and references.
• Identify ethical issues: Look for potential ethical concerns, such as plagiarism, data fabrication, or conflicts of interest.
• Provide constructive feedback: Offer specific, actionable, and objective suggestions for improvement, highlighting both the strengths and weaknesses of the manuscript. Don’t be mean.
• Organize your review: Structure your review with an overview of your evaluation, followed by detailed comments and suggestions organized by section (e.g., introduction, methods, results, discussion, and conclusion).
• Be professional and respectful: Maintain a respectful tone in your feedback, avoiding personal criticism or derogatory language.
• Proofread your review: Before submitting your review, proofread it for typos, grammar, and clarity.
• Couzin-Frankel J (September 2013). “Biomedical publishing. Secretive and subjective, peer review proves resistant to study”. Science . 341 (6152): 1331. doi: 10.1126/science.341.6152.1331
• Lee, Carole J.; Sugimoto, Cassidy R.; Zhang, Guo; Cronin, Blaise (2013). “Bias in peer review”. Journal of the American Society for Information Science and Technology. 64 (1): 2–17. doi: 10.1002/asi.22784
• Slavov, Nikolai (2015). “Making the most of peer review”. eLife . 4: e12708. doi: 10.7554/eLife.12708
• Spier, Ray (2002). “The history of the peer-review process”. Trends in Biotechnology . 20 (8): 357–8. doi: 10.1016/S0167-7799(02)01985-6
• Squazzoni, Flaminio; Brezis, Elise; Marušić, Ana (2017). “Scientometrics of peer review”. Scientometrics . 113 (1): 501–502. doi: 10.1007/s11192-017-2518-4

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What is the Purpose of Peer Review?

What makes a good peer reviewer, how do you decide whether to review a paper, how do you complete a peer review, limitations of peer review, conclusions, research methods: how to perform an effective peer review.

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Elise Peterson Lu , Brett G. Fischer , Melissa A. Plesac , Andrew P.J. Olson; Research Methods: How to Perform an Effective Peer Review. Hosp Pediatr November 2022; 12 (11): e409–e413. https://doi.org/10.1542/hpeds.2022-006764

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Scientific peer review has existed for centuries and is a cornerstone of the scientific publication process. Because the number of scientific publications has rapidly increased over the past decades, so has the number of peer reviews and peer reviewers. In this paper, drawing on the relevant medical literature and our collective experience as peer reviewers, we provide a user guide to the peer review process, including discussion of the purpose and limitations of peer review, the qualities of a good peer reviewer, and a step-by-step process of how to conduct an effective peer review.

Peer review has been a part of scientific publications since 1665, when the Philosophical Transactions of the Royal Society became the first publication to formalize a system of expert review. 1 , 2   It became an institutionalized part of science in the latter half of the 20 th century and is now the standard in scientific research publications. 3   In 2012, there were more than 28 000 scholarly peer-reviewed journals and more than 3 million peer reviewed articles are now published annually. 3 , 4   However, even with this volume, most peer reviewers learn to review “on the (unpaid) job” and no standard training system exists to ensure quality and consistency. 5   Expectations and format vary between journals and most, but not all, provide basic instructions for reviewers. In this paper, we provide a general introduction to the peer review process and identify common strategies for success as well as pitfalls to avoid.

Modern peer review serves 2 primary purposes: (1) as “a screen before the diffusion of new knowledge” 6   and (2) as a method to improve the quality of published work. 1 , 5  

As screeners, peer reviewers evaluate the quality, validity, relevance, and significance of research before publication to maintain the credibility of the publications they serve and their fields of study. 1 , 2 , 7   Although peer reviewers are not the final decision makers on publication (that role belongs to the editor), their recommendations affect editorial decisions and thoughtful comments influence an article’s fate. 6 , 8  

As advisors and evaluators of manuscripts, reviewers have an opportunity and responsibility to give authors an outside expert’s perspective on their work. 9   They provide feedback that can improve methodology, enhance rigor, improve clarity, and redefine the scope of articles. 5 , 8 , 10   This often happens even if a paper is not ultimately accepted at the reviewer’s journal because peer reviewers’ comments are incorporated into revised drafts that are submitted to another journal. In a 2019 survey of authors, reviewers, and editors, 83% said that peer review helps science communication and 90% of authors reported that peer review improved their last paper. 11  

Expertise: Peer reviewers should be up to date with current literature, practice guidelines, and methodology within their subject area. However, academic rank and seniority do not define expertise and are not actually correlated with performance in peer review. 13  

Professionalism: Reviewers should be reliable and objective, aware of their own biases, and respectful of the confidentiality of the peer review process.

Critical skill : Reviewers should be organized, thorough, and detailed in their critique with the goal of improving the manuscript under their review, regardless of disposition. They should provide constructive comments that are specific and addressable, referencing literature when possible. A peer reviewer should leave a paper better than he or she found it.

Is the manuscript within your area of expertise? Generally, if you are asked to review a paper, it is because an editor felt that you were a qualified expert. In a 2019 survey, 74% of requested reviews were within the reviewer’s area of expertise. 11   This, of course, does not mean that you must be widely published in the area, only that you have enough expertise and comfort with the topic to critique and add to the paper.

Do you have any biases that may affect your review? Are there elements of the methodology, content area, or theory with which you disagree? Some disagreements between authors and reviewers are common, expected, and even helpful. However, if a reviewer fundamentally disagrees with an author’s premise such that he or she cannot be constructive, the review invitation should be declined.

Do you have the time? The average review for a clinical journal takes 5 to 6 hours, though many take longer depending on the complexity of the research and the experience of the reviewer. 1 , 14   Journals vary on the requested timeline for return of reviews, though it is usually 1 to 4 weeks. Peer review is often the longest part of the publication process and delays contribute to slower dissemination of important work and decreased author satisfaction. 15   Be mindful of your schedule and only accept a review invitation if you can reasonably return the review in the requested time.

Once you have determined that you are the right person and decided to take on the review, reply to the inviting e-mail or click the associated link to accept (or decline) the invitation. Journal editors invite a limited number of reviewers at a time and wait for responses before inviting others. A common complaint among journal editors surveyed was that reviewers would often take days to weeks to respond to requests, or not respond at all, making it difficult to find appropriate reviewers and prolonging an already long process. 5  

Now that you have decided to take on the review, it is best of have a systematic way of both evaluating the manuscript and writing the review. Various suggestions exist in the literature, but we will describe our standard procedure for review, incorporating specific do’s and don’ts summarized in Table 1 .

Dos and Don’ts of Peer Review

First, read the manuscript once without making notes or forming opinions to get a sense of the paper as whole. Assess the overall tone and flow and define what the authors identify as the main point of their work. Does the work overall make sense? Do the authors tell the story effectively?

Next, read the manuscript again with an eye toward review, taking notes and formulating thoughts on strengths and weaknesses. Consider the methodology and identify the specific type of research described. Refer to the corresponding reporting guideline if applicable (CONSORT for randomized control trials, STROBE for observational studies, PRISMA for systematic reviews). Reporting guidelines often include a checklist, flow diagram, or structured text giving a minimum list of information needed in a manuscript based on the type of research done. 16   This allows the reviewer to formulate a more nuanced and specific assessment of the manuscript.

Next, review the main findings, the significance of the work, and what contribution it makes to the field. Examine the presentation and flow of the manuscript but do not copy edit the text. At this point, you should start to write your review. Some journals provide a format for their reviews, but often it is up to the reviewer. In surveys of journal editors and reviewers, a review organized by manuscript section was the most favored, 5 , 6   so that is what we will describe here.

As you write your review, consider starting with a brief summary of the work that identifies the main topic, explains the basic approach, and describes the findings and conclusions. 12 , 17   Though not universally included in all reviews, we have found this step to be helpful in ensuring that the work is conveyed clearly enough for the reviewer to summarize it. Include brief notes on the significance of the work and what it adds to current knowledge. Critique the presentation of the work: is it clearly written? Is its length appropriate? List any major concerns with the work overall, such as major methodological flaws or inaccurate conclusions that should disqualify it from publication, though do not comment directly on disposition. Then perform your review by section:

Abstract : Is it consistent with the rest of the paper? Does it adequately describe the major points?

Introduction : This section should provide adequate background to explain the need for the study. Generally, classic or highly relevant studies should be cited, but citations do not have to be exhaustive. The research question and hypothesis should be clearly stated.

Methods: Evaluate both the methods themselves and the way in which they are explained. Does the methodology used meet the needs of the questions proposed? Is there sufficient detail to explain what the authors did and, if not, what needs to be added? For clinical research, examine the inclusion/exclusion criteria, control populations, and possible sources of bias. Reporting guidelines can be particularly helpful in determining the appropriateness of the methods and how they are reported.

Some journals will expect an evaluation of the statistics used, whereas others will have a separate statistician evaluate, and the reviewers are generally not expected to have an exhaustive knowledge of statistical methods. Clarify expectations if needed and, if you do not feel qualified to evaluate the statistics, make this clear in your review.

Results: Evaluate the presentation of the results. Is information given in sufficient detail to assess credibility? Are the results consistent with the methodology reported? Are the figures and tables consistent with the text, easy to interpret, and relevant to the work? Make note of data that could be better detailed in figures or tables, rather than included in the text. Make note of inappropriate interpretation in the results section (this should be in discussion) or rehashing of methods.

Discussion: Evaluate the authors’ interpretation of their results, how they address limitations, and the implications of their work. How does the work contribute to the field, and do the authors adequately describe those contributions? Make note of overinterpretation or conclusions not supported by the data.

The length of your review often correlates with your opinion of the quality of the work. If an article has major flaws that you think preclude publication, write a brief review that focuses on the big picture. Articles that may not be accepted but still represent quality work merit longer reviews aimed at helping the author improve the work for resubmission elsewhere.

Generally, do not include your recommendation on disposition in the body of the review itself. Acceptance or rejection is ultimately determined by the editor and including your recommendation in your comments to the authors can be confusing. A journal editor’s decision on acceptance or rejection may depend on more factors than just the quality of the work, including the subject area, journal priorities, other contemporaneous submissions, and page constraints.

Many submission sites include a separate question asking whether to accept, accept with major revision, or reject. If this specific format is not included, then add your recommendation in the “confidential notes to the editor.” Your recommendation should be consistent with the content of your review: don’t give a glowing review but recommend rejection or harshly criticize a manuscript but recommend publication. Last, regardless of your ultimate recommendation on disposition, it is imperative to use respectful and professional language and tone in your written review.

Although peer review is often described as the “gatekeeper” of science and characterized as a quality control measure, peer review is not ideally designed to detect fundamental errors, plagiarism, or fraud. In multiple studies, peer reviewers detected only 20% to 33% of intentionally inserted errors in scientific manuscripts. 18 , 19   Plagiarism similarly is not detected in peer review, largely because of the huge volume of literature available to plagiarize. Most journals now use computer software to identify plagiarism before a manuscript goes to peer review. Finally, outright fraud often goes undetected in peer review. Reviewers start from a position of respect for the authors and trust the data they are given barring obvious inconsistencies. Ultimately, reviewers are “gatekeepers, not detectives.” 7  

Peer review is also limited by bias. Even with the best of intentions, reviewers bring biases including but not limited to prestige bias, affiliation bias, nationality bias, language bias, gender bias, content bias, confirmation bias, bias against interdisciplinary research, publication bias, conservatism, and bias of conflict of interest. 3 , 4 , 6   For example, peer reviewers score methodology higher and are more likely to recommend publication when prestigious author names or institutions are visible. 20   Although bias can be mitigated both by the reviewer and by the journal, it cannot be eliminated. Reviewers should be mindful of their own biases while performing reviews and work to actively mitigate them. For example, if English language editing is necessary, state this with specific examples rather than suggesting the authors seek editing by a “native English speaker.”

Peer review is an essential, though imperfect, part of the forward movement of science. Peer review can function as both a gatekeeper to protect the published record of science and a mechanism to improve research at the level of individual manuscripts. Here, we have described our strategy, summarized in Table 2 , for performing a thorough peer review, with a focus on organization, objectivity, and constructiveness. By using a systematized strategy to evaluate manuscripts and an organized format for writing reviews, you can provide a relatively objective perspective in editorial decision-making. By providing specific and constructive feedback to authors, you contribute to the quality of the published literature.

Take-home Points

FUNDING: No external funding.

CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no potential conflicts of interest to disclose.

Dr Lu performed the literature review and wrote the manuscript. Dr Fischer assisted in the literature review and reviewed and edited the manuscript. Dr Plesac provided background information on the process of peer review, reviewed and edited the manuscript, and completed revisions. Dr Olson provided background information and practical advice, critically reviewed and revised the manuscript, and approved the final manuscript.

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What Is Peer Review and Why Is It Important?

It’s one of the major cornerstones of the academic process and critical to maintaining rigorous quality standards for research papers. Whichever side of the peer review process you’re on, we want to help you understand the steps involved.

This post is part of a series that provides practical information and resources for authors and editors.

Peer review – the evaluation of academic research by other experts in the same field – has been used by the scientific community as a method of ensuring novelty and quality of research for more than 300 years. It is a testament to the power of peer review that a scientific hypothesis or statement presented to the world is largely ignored by the scholarly community unless it is first published in a peer-reviewed journal.

It is also safe to say that peer review is a critical element of the scholarly publication process and one of the major cornerstones of the academic process. It acts as a filter, ensuring that research is properly verified before being published. And it arguably improves the quality of the research, as the rigorous review by like-minded experts helps to refine or emphasise key points and correct inadvertent errors.

Ideally, this process encourages authors to meet the accepted standards of their discipline and in turn reduces the dissemination of irrelevant findings, unwarranted claims, unacceptable interpretations, and personal views.

If you are a researcher, you will come across peer review many times in your career. But not every part of the process might be clear to you yet. So, let’s have a look together!

Types of Peer Review

Peer review comes in many different forms. With single-blind peer review , the names of the reviewers are hidden from the authors, while double-blind peer review , both reviewers and authors remain anonymous. Then, there is open peer review , a term which offers more than one interpretation nowadays.

Open peer review can simply mean that reviewer and author identities are revealed to each other. It can also mean that a journal makes the reviewers’ reports and author replies of published papers publicly available (anonymized or not). The “open” in open peer review can even be a call for participation, where fellow researchers are invited to proactively comment on a freely accessible pre-print article. The latter two options are not yet widely used, but the Open Science movement, which strives for more transparency in scientific publishing, has been giving them a strong push over the last years.

If you are unsure about what kind of peer review a specific journal conducts, check out its instructions for authors and/or their editorial policy on the journal’s home page.

Why Should I Even Review?

To answer that question, many reviewers would probably reply that it simply is their “academic duty” – a natural part of academia, an important mechanism to monitor the quality of published research in their field. This is of course why the peer-review system was developed in the first place – by academia rather than the publishers – but there are also benefits.

Are you looking for the right place to publish your paper? Find out here whether a De Gruyter journal might be the right fit.

Besides a general interest in the field, reviewing also helps researchers keep up-to-date with the latest developments. They get to know about new research before everyone else does. It might help with their own research and/or stimulate new ideas. On top of that, reviewing builds relationships with prestigious journals and journal editors.

Clearly, reviewing is also crucial for the development of a scientific career, especially in the early stages. Relatively new services like Publons and ORCID Reviewer Recognition can support reviewers in getting credit for their efforts and making their contributions more visible to the wider community.

The Fundamentals of Reviewing

You have received an invitation to review? Before agreeing to do so, there are three pertinent questions you should ask yourself:

• Does the article you are being asked to review match your expertise?
• Do you have time to review the paper?
• Are there any potential conflicts of interest (e.g. of financial or personal nature)?

If you feel like you cannot handle the review for whatever reason, it is okay to decline. If you can think of a colleague who would be well suited for the topic, even better – suggest them to the journal’s editorial office.

But let’s assume that you have accepted the request. Here are some general things to keep in mind:

Please be aware that reviewer reports provide advice for editors to assist them in reaching a decision on a submitted paper. The final decision concerning a manuscript does not lie with you, but ultimately with the editor. It’s your expert guidance that is being sought.

Reviewing also needs to be conducted confidentially . The article you have been asked to review, including supplementary material, must never be disclosed to a third party. In the traditional single- or double-blind peer review process, your own anonymity will also be strictly preserved. Therefore, you should not communicate directly with the authors.

When writing a review, it is important to keep the journal’s guidelines in mind and to work along the building blocks of a manuscript (typically: abstract, introduction, methods, results, discussion, conclusion, references, tables, figures).

After initial receipt of the manuscript, you will be asked to supply your feedback within a specified period (usually 2-4 weeks). If at some point you notice that you are running out of time, get in touch with the editorial office as soon as you can and ask whether an extension is possible.

Some More Advice from a Journal Editor

• Be critical and constructive. An editor will find it easier to overturn very critical, unconstructive comments than to overturn favourable comments.
• Justify and specify all criticisms. Make specific references to the text of the paper (use line numbers!) or to published literature. Vague criticisms are unhelpful.
• Don’t repeat information from the paper , for example, the title and authors names, as this information already appears elsewhere in the review form.
• Check the aims and scope. This will help ensure that your comments are in accordance with journal policy and can be found on its home page.
• Give a clear recommendation . Do not put “I will leave the decision to the editor” in your reply, unless you are genuinely unsure of your recommendation.
• Number your comments. This makes it easy for authors to easily refer to them.
• Be careful not to identify yourself. Check, for example, the file name of your report if you submit it as a Word file.

Sticking to these rules will make the author’s life and that of the editors much easier!

Explore new perspectives on peer review in this collection of blog posts published during Peer Review Week 2021

[Title image by AndreyPopov/iStock/Getty Images Plus

David Sleeman

David Sleeman worked as a Senior Journals Manager in the field of Physical Sciences at De Gruyter.

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Understanding the peer review process

What is peer review a guide for authors.

The peer review process starts once you have submitted your paper to a journal.

After submission, your paper will be sent for assessment by independent experts in your field. The reviewers are asked to judge the validity, significance, and originality of your work.

Below we expand on what peer review is, and how it works.

What is peer review? And why is important?

Peer review is the independent assessment of your research paper by experts in your field. The purpose of peer review is to evaluate the paper’s quality and suitability for publication.

As well as peer review acting as a form of quality control for academic journals, it is a very useful source of feedback for you. The feedback can be used to improve your paper before it is published.

So at its best, peer review is a collaborative process, where authors engage in a dialogue with peers in their field, and receive constructive support to advance their work.

Use our free guide to discover how you can get the most out of the peer review process.

Why is peer review important?

Peer review is vitally important to uphold the high standards of scholarly communications, and maintain the quality of individual journals. It is also an important support for the researchers who author the papers.

Every journal depends on the hard work of reviewers who are the ones at the forefront of the peer review process. The reviewers are the ones who test and refine each article before publication. Even for very specialist journals, the editor can’t be an expert in the topic of every article submitted. So, the feedback and comments of carefully selected reviewers are an essential guide to inform the editor’s decision on a research paper.

There are also practical reasons why peer review is beneficial to you, the author. The peer review process can alert you to any errors in your work, or gaps in the literature you may have overlooked.

Researchers consistently tell us that their final published article is better than the version they submitted before peer review. 91% of respondents to a  Sense about Science peer review survey  said that their last paper was improved through peer review. A  Taylor & Francis study  supports this, finding that most researchers, across all subject areas, rated the contribution of peer review towards improving their article as 8 or above out of 10.

Enlarge the infographic

Choose the right journal for your research: Think. Check. Submit

We support Think. Check. Submit. , an initiative launched by a coalition of scholarly communications organizations. It provides the tools to help you choose the right journal for your work.

Think. Check. Submit. was established because there are some journals which do not provide the quality assurance and services that should be delivered by a reputable journal. In particular, many of these journals do not make sure there is thorough peer review or editor feedback process in place.

That means, if you submit to one of these journals, you will not benefit from helpful article feedback from your peers. It may also lead to others being skeptical about the validity of your published results.

You should therefore make sure that you submit your work to a journal you can trust. By using the checklist provided on the Think. Check. Submit. website , you can make an informed choice.

Peer review integrity at Taylor & Francis

Every full research article published in a Taylor & Francis journal has been through peer review, as outlined in the journal’s aims & scope information. This means that the article’s quality, validity, and relevance has been assessed by independent peers within the research field.

We believe in the integrity of peer review with every journal we publish, ascribing to the following statement:

All published research articles in this journal have undergone rigorous peer review, based on initial editor screening, anonymous refereeing by independent expert referees, and consequent revision by article authors when required.

Different types of peer review

Peer review takes different forms and each type has pros and cons. The type of peer review model used will often vary between journals, even of the same publisher. So, check your chosen journal’s peer-review policy before you submit , to make sure you know what to expect and are comfortable with your paper being reviewed in that way.

Every Taylor & Francis journal publishes a statement describing the type of peer review used by the journal within the aims & scope section on Taylor & Francis Online.

Below we go through the most common types of peer review.

Common types of peer review

Single-anonymous peer review.

This type of peer review is also called ‘single-blind review’. In this model, the reviewers know that you are the author of the article, but you don’t know the identities of the reviewers.

Single-anonymous review is most common for science and medicine journals.

Find out more about the pros and cons of  single-anonymous peer review .

Double-anonymous peer review

In this model, which is also known as ‘double-blind review’, the reviewers don’t know that you are the author of the article. And you don’t know who the reviewers are either. Double-anonymous review is particularly common in humanities and some social sciences’ journals.

Discover more about the pros and cons of  double-anonymous peer review .

If you are submitting your article for double-anonymous peer review, make sure you know  how to make your article anonymous .

Open peer review

There is no one agreed definition of open peer review. In fact,  a recent study  identified 122 different definitions of the term. Typically, it will mean that the reviewers know you are the author and also that their identity will be revealed to you at some point during the review or publication process.

Find out more about  open peer review .

Post-publication peer review

In post-publication peer review models, your paper may still go through one of the other types of peer review first. Alternatively, your paper may be published online almost immediately, after some basic checks. Either way, once it is published, there will then be an opportunity for invited reviewers (or even readers) to add their own comments or reviews.

You can learn about the pros and cons of  post-publication peer review here.

Registered Reports

The  Registered Reports  process splits peer review into two parts.

The first round of peer review takes place after you’ve designed your study, but before you’ve collected or analyzed any data. This allows you to get feedback on both the question you’re looking to answer, and the experiment you’ve designed to test it.

If your manuscript passes peer review, the journal will give you an in-principle acceptance (IPA). This indicates that your article will be published as long as you successfully complete your study according to the pre-registered methods and submit an evidence-based interpretation of the results.

Explore Registered Reports at Taylor & Francis .

F1000 Research: Open and post-publication peer review

F1000Research  is part of the Taylor & Francis Group. It operates an innovative peer review process which is fully transparent and takes place after an article has been published.

How it works

Before publication, authors are asked to  suggest at least five potential reviewers  who are experts in the field. The reviewers also need to be able to provide unbiased reports on the article.

Submitted articles are published rapidly, after passing a series of pre-publication checks that assess, originality, readability, author eligibility, and compliance with F1000Research’s policies and ethical guidelines.

Once the article is published, expert reviewers are formally invited to review.

The peer review process is entirely open and transparent. Each peer review report, plus the approval status selected by the reviewer, is published with the reviewer’s name and affiliation alongside the article.

Authors are encouraged to respond openly to the peer review reports and can publish revised versions of their article if they wish. New versions are clearly linked and easily navigable, so that readers and reviewers can quickly find the latest version of an article.

The article remains published regardless of the reviewers’ reports. Articles that pass peer review are indexed in Scopus, PubMed, Google Scholar and other bibliographic databases.

How our publishing process works for articles

1. Article submission

Submitting an article is easy with our single-page submission system.

The in-house editorial team carries out a basic check on each submission to ensure that all policies are adhered to.

2. Publication and data deposition

Once the authors have analysed the manuscript, the article (with its associated source data) is published within a week, enabling immediate viewing and caution.

3. Open peer review & user commenting

Expert reviewers are selected and invited. Their reports and names are published alongside the article, together with the authors’ responses and comments from registered users.

4. Article revision

Authors are encouraged to publish revised versions of their article. All versions of an article are linked and independently citable.

Articles that pass peer review are indexed in external databases such as PubMed, Scopus and Google Scholar.

Discover more about how the F1000Research model works .

Get to know the peer review process

Peer review follows a number of steps, beginning with submitting your article to a journal.

Step 1: Editor assessment

When your manuscript arrives at the journal’s editorial office it will receive an initial desk assessment by the journal’s editor or editorial office. They will check that it’s broadly suitable for the journal.

They will ask questions such as:

Is this the right journal for this article?

Does the paper cover a suitable topic according to the journal’s  aims & scope ?

Has the author followed the journal’s guidelines in the  instructions for authors ? They will check that your paper meets the basic requirements of the journal, such as word count, language clarity, and format.

Has the author included everything that’s needed for peer review? They will check that there is an abstract, author affiliation details, any figures, and research-funder information.

Does it make a significant contribution to the existing literature?

If your article doesn’t pass these initial checks the editor might reject the article immediately. This is known as a ‘desk reject’ and it is a decision made at the editor’s discretion, based on their substantial experience and subject expertise. By having this initial screening in place, it can enable a quick decision if your manuscript isn’t suitable for the journal. This means you can submit your article to another journal quickly.

If your article does pass the initial assessment, it will move to the next stage, and into peer review.

“As an editor, when you first get a submission, at one level you’re simply filtering. A fairly small proportion do not get sent out by me for review. Sometimes they simply fall outside the scope of the journal.”

– Michael Reiss, Founding Editor of Sex Education

Step 2: First round of peer review

Next, the editor will find and contact other researchers who are experts in your field, and will ask them to review the paper. A minimum of two independent reviewers is normally required for every research article. The aims and scope of each journal will outline their peer review policy in detail.

The reviewers will be asked to read and comment on your article. They may also be invited to advise the editor whether your article is suitable for publication in that journal.

So, what are the reviewers looking for?

This depends on the subject area, but they will be checking that:

Your work is original or new.

The study design and methodology are appropriate and described so that others could replicate what you have done.

You’ve engaged with all the relevant current scholarship.

The results are appropriately and clearly presented.

Your conclusions are reliable, significant, and supported by the research.

The paper fits the scope of the journal.

The work is of a high enough standard to be published in the journal.

If you have not already  shared your research data publicly , peer reviewers may request to see your datasets, to support validation of the results in your article.

Once the editor has received and considered the reviewer reports, as well as making their own assessment of your work, they will let you know their decision. The reviewer reports will be shared with you, along with any additional guidance from the editor.

If you get a straight acceptance, congratulations, your article is ready to move to publication. But, please note, that this isn’t common. Very often, you will need to revise your article and resubmit it. Or it may be that the editor decides your paper needs to be rejected by that journal.

Please note that the final editorial decision on a paper and the choice of who to invite to review is always the editor’s decision. For further details on this, please see  our peer review appeals and complaints policy.

Step 3: Revise and resubmit

It is very common for the editor and reviewers to have suggestions about how you can improve your paper before it is ready to be published. They might have only a few straightforward recommendations (‘minor amendments’) or require more substantial changes before your paper will be accepted for publication (‘major amendments’). Authors often tell us that the reviewers’ comments can be extremely helpful, to make sure that their article is of a high quality.

During this stage of the process you will have time to amend your article based on the reviewers’ comments, resubmitting it with any or all changes made. Make sure you know how to respond to reviewer comments, we cover this in the next section.

Once you resubmit your manuscript the editor will look through the revisions. They will often send it out for a second round of peer review, asking the reviewers to assess how you’ve responded to their comments.

After this, you may be asked to make further revisions, or the paper might be rejected if the editor thinks that the changes you’ve made are not adequate. However, if your revisions have now brought the paper up to the standard required by that journal, it then moves to the next stage.

If you do not intend to make the revisions suggested by the journal and resubmit your paper for consideration, please make sure you formally withdraw your paper from consideration by the journal before you submit elsewhere.

Make sure you resubmit

If you have not already shared your research data publicly , peer reviewers may request to see your datasets to support the validation of the results in your article.

Step 4: Accepted

And that’s it, you’ve made it through peer review. The next step is  production

How long does peer review take?

Editorial teams work very hard to progress papers through peer review as quickly as possible. But it is important to be aware that this part of the process can take time.

The first stage is for the editor to find suitably qualified expert reviewers who are available. Given the competing demands of research life, nobody can agree to every review request they receive. It’s therefore not uncommon for a paper to go through several cycles of requests before the editor finds reviewers who are both willing and able to accept.

Then, the reviewers who do accept the request, have to find time alongside their own research, teaching, and writing, to give your paper thorough consideration.

Please do keep this in mind if you don’t receive a decision on your paper as quickly as you would like. If you’ve submitted your paper via an online system, you can use it to track the progress of your paper through peer review. Otherwise, if you need an update on the status of your paper, please get in touch with the editor.

Many journals publish key dates alongside new articles, including when the paper was submitted, accepted, and published online. While you’re at the stage of choosing a journal to submit to, take a look at these dates for a range of recent articles published in the journals you’re considering. While each article will have a slightly different timeline, this may help you to get an idea of how long publication may take.

A 360⁰ view of peer review

Peer review is a process that involves various players – the author, the reviewer and the editor to name a few. And depending on which of these hats you have on, the process can look quite different.

To help you uncover the 360⁰ peer review view,  read these interviews  with an editor, author, and reviewer.

How to respond to reviewer comments

If the editor asks you to revise your article, you will be given time to make the required changes before resubmitting.

When you receive the reviewers’ comments, try not to take personal offence to any criticism of your article (even though that can be hard).

Some researchers find it helpful to put the reviewer report to one side for a few days after they’ve read it for the first time. Once you have had chance to digest the idea that your article requires further work, you can more easily address the reviewer comments objectively.

When you come back to the reviewer report, take time to read through the editor and reviewers’ advice carefully, deciding what changes you will make to your article in response. Taking their points on board will make sure your final article is as robust and impactful as possible.

Please make sure that you address all the reviewer and editor comments in your revisions.

It may be helpful to resubmit your article along with a two-column grid outlining how you’ve revised your manuscript. On one side of the grid list each of the reviewers’ comments and opposite them detail the alterations you’ve made in response. This method can help you to order your thoughts, and clearly demonstrate to the editor and reviewers that you’ve considered all of their feedback.

If there are any review comments which you don’t understand or don’t know how to respond to, please get in touch with the journal’s editor and ask for their advice.

What if you don’t agree with the reviewers’ comments?

If there’s a review comment that you don’t agree with, it is important that you don’t ignore it. Instead, include an explanation of why you haven’t made that change with your resubmission. The editor can then make an assessment and include your explanation when the amended article is sent back to the reviewers.

You are entitled to defend your position but, when you do, make sure that the tone of your explanation is assertive and persuasive, rather than defensive or aggressive.

“Where possible, a little constructive advice on how to make use of the views of the referees can make all the difference, and the editor has the responsibility of deciding when and how to do this.”

– Gary McCulloch, Editor, British Journal of Educational Studies

What if my paper is rejected?

Nobody enjoys having their paper rejected by a journal, but it is a fact of academic life. It happens to almost all researchers at some point in their career. So, it is important not to let the experience knock you back. Instead, try to use it as a valuable learning opportunity.

Take time to understand why your paper has been rejected

If a journal rejects your manuscript, it may be for one of many reasons. Make sure that you understand why your paper has been rejected so that you can learn from the experience. This is especially important if you are intending to submit the same article to a different journal.

Are there fundamental changes that need to be made before the paper is ready to be published, or was this simply a case of submitting to the wrong journal? If you are unsure why your article has been rejected, then please contact the journal’s editor for advice.

Some of the common reasons manuscripts are rejected

The author has submitted their paper to the wrong journal: it doesn’t fit the  aims & scope  or fails to engage with issues addressed by the journal.

The manuscript is not a true journal article, for instance it is too journalistic or clearly a thesis chapter.

The manuscript is too long or too short.

There is poor regard of the journal’s conventions, or for academic writing in general.

Poor style, grammar, punctuation or English throughout the manuscript. Get  English language editing  assistance.

The manuscript does not make any new contribution to the subject.

The research has not been properly contextualized.

There is a poor theoretical framework used. There are  actio nable recommendations to improve your manuscript .

The manuscript is poorly presented.

The manuscript is libelous or unethical.

Carefully consider where to submit next

When you made your original submission, you will probably have had a shortlist of journals you were considering. Return to that list but, before you move to your second choice, you may wish to assess whether any feedback you’ve received during peer review has changed your opinion. Your article may also be quite different if it has been through any rounds of revision. It can be helpful at this stage to re-read the  aims & scope  statements of your original shortlisted journals.

Once you have selected which journal to submit to next, make sure that you read through its information for authors and reformat your article to fit its requirements. Again, it is important to use the feedback from the peer review process to your advantage as you rewrite and reformat the manuscript.

Is ‘transferring’ an option?

A growing number of publishers offer a  transfer or cascade service  to authors when their paper is rejected. This process is designed for papers which aren’t suitable for the journal they were originally submitted to.

If your article falls into this category then one or more alternative journals from the same publisher will be suggested. You will have the option either to submit to one of those suggested journals for review or to withdraw your article.

If you choose to transfer your article this will usually save you time. You won’t need to enter all of the details into a new submission system. Once you’ve made any changes to your paper, bearing in mind previous editor or reviewer comments, the article will be submitted to the new journal on your behalf.

We have some more information about  article transfers, and also some FAQs about the Taylor & Francis transfer process.

Why you should become a peer reviewer

When you’re not in the middle of submitting or revising your own article, you should consider becoming a reviewer yourself.

There are many demands on a researcher’s time, so it is a legitimate question to ask why some of that precious time should be spent reviewing someone else’s work. How does being a reviewer help you in your career? Here are some of the benefits.

Keep up with the latest thinking As a reviewer you get an early view of the exciting new research being done in your field. Not only that, peer review gives you a role in helping to evaluate and improve this new work.

Improve your own writing Carefully reviewing articles written by other researchers can give you an insight into how you can make your own work better. Unlike when you are reading articles as part of your research, the process of reviewing encourages you to think critically about what makes an article good (or not so good). This could be related to writing style, presentation, or the clarity of explanations.

Boost your career While a lot of reviewing is anonymous, there are schemes to recognize the important contribution of reviewers. You can also include reviewing work on your resume. Your work as a reviewer will be of interest to appointment or promotion committees who are looking for evidence of service to the profession.

Become part of a journal’s community Many journals act as the center of a network of researchers who are in conversation about key themes and developments in the field. Becoming a reviewer is a great way to get involved with that group. This can give you the opportunity to build new connections for future collaborations. Being a regular reviewer may also be the first step to becoming a member of the journal’s editorial board.

Your research community needs you

Of course, being a reviewer is not just about the benefits it can bring you. The  Taylor & Francis peer review survey  found that these are the top 3 reasons why researchers choose to review:

Being an active member of the academic community Peer review is the bedrock of academic publishing. The work of reviewers is essential in helping every piece of research to become as good as it can be. By being a reviewer, you will play a vital part in advancing the research area that you care about.

Reciprocating the benefit Researchers regularly talk about the benefits to their own work from being reviewed by others. Gratitude to the reviewers who have improved your work is a great motivation to make one’s own contribution of service to the community.

Enjoying being able to help improve papers Reviewing is often anonymous, with only the editor knowing the important contribution you’ve made. However, many reviewers attest that it is work that makes them feel good, knowing that they have been able to support a fellow researcher.

How to be an effective peer reviewer

Our popular  guide to becoming a peer reviewer  covers everything you need to know to get started, including:

How to become a peer reviewer

Writing review reports: step-by-step

Ethical guidelines for peer reviewers

Reviewer recognition

Read the  Taylor & Francis reviewer guidelines .

“Reviewers are the lifeblood of any journal”

– Mike J. Smith, Editor-in-Chief of Journal of Maps

Further reading

We hope you’ve found this short introduction to peer review helpful. For further useful advice check out the following resources.

Further resources

Peer Review: the nuts and bolts A guide to peer review written by early career researchers, for early career researchers and published by Sense about Science.

A guide to becoming a peer reviewer An overview of what’s involved in becoming a reviewer for a Taylor & Francis journal.

Ethical guidelines for peer reviewer Produced by COPE, the Committee on Publication Ethics, setting out the standards all peer reviewers should follow.

Using peer review effectively: quick tips Advice available to staff and students at institutions with a Vitae membership.

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Insights topic: Peer review

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• Published: 26 February 2016

Improving the peer-review process from the perspective of an author and reviewer

• C. M. Faggion Jr 1  

British Dental Journal volume  220 ,  pages 167–168 ( 2016 ) Cite this article

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• Peer review

Discusses limitations of the peer-review process.

Suggests conflict of interests can interfere with peer-review quality.

Proposes ideas to improve the peer-review process.

The peer-review process is a fundamental component in the advancement of science. In this process, independent reviewers evaluate the quality of a manuscript and its suitability for publication in a particular scientific journal. Thus, to favour the publication of the highest-level information, the peer-review system should be as unbiased as possible. Although the peer-review system is the most commonly used method to select manuscripts for publication, it has several potential limitations. The main objective of this manuscript is to discuss some limitations of the peer-review system and suggest potential solutions from the perspective of an author and reviewer. This article may contribute to the always-dynamic development of the peer-review process.

In high-level scientific journals, manuscripts are published usually after a careful assessment of their quality and suitability for the journal through a system known as peer-review. Although some controversy exists about the rationale of the peer-review process, 1 it is the most commonly used method of selecting scientific manuscripts for publication. Given the importance of this issue for the advancement of science, editors of eminent medical journals have supported the notion of an international congress where various topics related to improving the peer-review process can be discussed. 2 , 3 This opinion article discusses real-life information about the peer-review process from the perspective of an author and reviewer for scientific journals, with the aim of improving the peer-review process.

The peer review process

Although peer-review systems may differ slightly across different journals, they all possess a similar structure. Initially, the paper is submitted to a journal's editor-in-chief (EIC), or sometimes an associate editor (AE), for initial assessment of whether the paper should be forwarded for further review, as described below, or rejected immediately (the so-called desk rejection) ( Fig. 1 ).

Scheme of the usual peer review process (EIC: Editor-in-Chief; AE: Associate Editor)

Communication between reviewers

Editors normally invite more than one reviewer to evaluate a scientific manuscript. Accordingly, editors may receive more unbiased opinions to inform their decision of whether to accept or reject a paper. Generally, invited reviewers do not know how many peers are involved in the review process and there is no interaction between reviewers. This scenario sometimes leads to reviewers providing diametrically opposed opinions on a manuscript. These divergent opinions create difficulty both for the authors, who need to address sometimes incompatible, opposite reviews; and for the editors, who must decide the fate of the manuscript. One possible solution would be to make reviewers' comments available to all reviewers. In this way, reviewers would be able to discuss the heterogeneities in their evaluations, helping to clarify whether an update of the manuscript by the authors is, in fact, a reasonable task. Moreover, points of strong disagreement could be resolved by consensus among reviewers before the comments are sent back to the authors. A potential disadvantage of this solution would be a longer peer-review process.

Peer-review should be focused on the original idea only

Sometimes reviewers recommend that the authors update a manuscript in the way they 'would do' the manuscript, instead of analysing the quality of the manuscript per se . For example, one of the options for the EIC's decision in some scientific journals is a 'reject and resubmit' option. This option means that the manuscript was rejected because of pivotal flaws, but a new version, usually totally changed (sometimes including new eligibility criteria), would be considered for further review. Moreover, these changes sometimes require further analysis and even the incorporation of new data to please the reviewers/editors. In other words, 'reject and resubmit' means, in many cases, a largely new project. One may ask whether a new project induced by reviewers or editors creates a great source of bias in the future manuscript. Furthermore, one could argue that reviewers who suggest pivotal changes to a study should be acknowledged in the updated manuscript. To avoid this conundrum, editors can recommend that reviewers focus on the quality and relevance of the original project, and not be allowed to request the change of pivotal aspects of the project, such as eligibility criteria. This limitation would prevent the review process from changing the core of the work, and reviewer bias would be reduced. Alternatively, it may be prudent for editors to eliminate the 'reject and resubmit' option from the peer-review process altogether.

No chance for dispute

Journals receive a great many submissions each day or month and it is likely that some manuscripts of good quality will be not evaluated in depth. Some scientific journals do not allow any chance for dispute with the EIC's initial decision being final. The refusal of any chance for dispute may contribute to important research being overlooked. 4 Hence, a dispute procedure should be a standard option for any journal. Authors should have the opportunity to explain in detail why they think their manuscript would be suitable for publication in the journal. Obviously the chance for dispute does not give certainty of acceptance, but in some cases the true value of the manuscript would be recognised and the material published, reducing reporting bias. 5

Suggesting reviewers

During the online submission process, many journals ask or even require the nomination of preferred and non-preferred reviewers. This procedure is very likely to add bias to the review process. If authors suggest preferred reviewers, they are apt to recommend reviewers they know or reviewers who share their way of thinking. At the very least, they will try to suggest reviewers who may provide positive comments about their manuscript. In contrast, authors will suggest non-preferred reviewers who have some kind of conflict of interest, or reviewers whom authors anticipate will provide potentially negative comments. Journal editors indicate that they are not obligated to accept author recommendations regarding reviewers. Nevertheless, this potential bias in reviewer selection could be removed by journal editors selecting reviewers without any recommendations from authors.

Paper acceptance

Often, it is difficult for authors to understand how a manuscript was accepted or rejected based on reviewers' comments. Sometimes the EIC ignores the recommendations of the reviewers completely and makes a decision that contradicts reviewers' suggestions, for example, in the situation where two reviewers provide positive reviews on the manuscript. In other cases the opinions of reviewers may be contradictory and, therefore, a third reviewer is contacted to resolve the dispute. Nevertheless, an EIC may act as the third reviewer and make the final decision by taking into account his/her personal view on the manuscript. One may argue whether some bias is introduced when the EIC interferes in the 'field' of reviewers by using his/her own review to make the decision. Anyway, if this policy is used by an AE or EIC, it should be clearly stated in the journal´s information to authors and readers.

Single-blind or double-blind peer-review process?

A large study evaluated the opinions of more than 4,000 reviewers on the peer-review process. 6 Among other questions, the reviewers were asked about advantages and disadvantages of blinding or double-blinding the peer-review process. Some reviewers answered that, in the single-blind review (when reviewers know the identity of authors, but authors do not know the identity of reviewers), more prestigious group researchers may be favoured in the peer-review process. Nevertheless, some authors argue that there is in fact no true double-blind peer-review because reviewers can 'guess' the identity of the authors by checking the writing style, self-citations etc. I believe that the double-blind approach is the most ethical approach, because the policy of blinding is fair for both sides. One may argue that the identity of the authors will not be recognised in a percentage of submissions. Thus, the evaluation will be less biased, at least when compared to the single-blind review where the identity of the authors is always recognised. Thus, for these cases, where reviewers recognise the identity of authors in the double-blind peer-review process, editors should recommend reviewers to inform them about any potential conflict of interest (COI).

To Open or not to Open the peer-review process?

Making the whole peer-review process public may bring advantages and disadvantages. For example, some junior reviewers could be inhibited to perform a detailed and judicious review to not challenge senior researchers due to their own COIs. 6 On the other hand, some evidence suggests that the quality of the review might not be affected by making the signed review public. 7 The logistics, however, would be more complicated because an open peer-review process might be associated with a low acceptance rate of potential reviewers. Furthermore, those reviewers who accept the task may take longer to complete their reviews. 7 Finally, some reviewers may feel uncomfortable to expose some personal limitations such as poor written English. Therefore, editors should try to identify potential reasons for the low rate of acceptance of reviewers (in the open peer-review process) to provide better assistance and support to reviewers. For instance, in this specific situation, the journal could provide English professional editing for the review to be published along with the paper. In an ethical perspective, an open peer-review would be the best alternative for a more transparent peer-review process.

Conclusions

This opinion article describes some common situations that arise in the peer-review process that have the potential to interfere with peer-review quality. Many of these situations are related to potential conflicts of interest of the parties involved in the process. Some suggestions for dealing with these situations are described.

Birukou A, Wakeling J R, Bartolini C et al. Alternatives to peer review: novel approaches for research evaluation. Front Comput Neurosci 2011; 5 : 56.

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NIH Clarifies Prohibition on the Use of AI Tools in Peer Review Processes

Why This Matters: The Role of Confidentiality in Peer Review

Key provisions of the notice: what reviewers need to know, implementation and broader impact.

The National Institutes of Health (NIH) has issued an important notice aimed at maintaining the integrity and confidentiality of its peer review process. This new directive builds upon the existing guidance in NOT-OD-22-044, which outlines the rules, responsibilities, and possible consequences associated with NIH peer reviews. Specifically, this notice introduces a clear prohibition on the use of natural language processors, large language models, or other generative Artificial Intelligence (AI) technologies in the peer review process.

Peer review is a cornerstone of the scientific research process, ensuring that grant applications and R&D contract proposals are evaluated fairly and rigorously. Confidentiality is critical to this process, allowing reviewers to share candid opinions and evaluations without fear of unauthorized disclosure or misuse of the information. When reviewers analyze a proposal, they are entrusted with privileged information that must remain secure.

The use of AI tools in this context raises significant concerns. These technologies often require detailed input data to generate critiques or analyses. However, where this data goes and how it is stored or used by AI systems is largely opaque. This lack of transparency poses a substantial risk to the confidentiality and integrity of the NIH peer review process.

The NIH’s notice makes several key clarifications:

• Prohibition on AI Tools: NIH explicitly prohibits peer reviewers from using AI tools to analyze and formulate critiques of grant applications and R&D contract proposals. This prohibition is in place to prevent any potential breaches of confidentiality and to protect the integrity of the peer review process.
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• Consequences for Violations: Reviewers are reminded that uploading or sharing content from an NIH grant application or contract proposal to online AI tools is a violation of NIH’s confidentiality requirements. Such actions could have serious consequences, including disqualification from the peer review process.

Moving forward, all NIH Peer Reviewers will be required to sign a modified Security, Confidentiality, and Nondisclosure Agreement before participating in the review process. This agreement will affirm their understanding of the prohibition on using AI tools and their commitment to upholding the confidentiality of the review process.

Moreover, NIH is extending this policy beyond peer reviewers to include members of NIH National Advisory Councils and Boards. These individuals will also be required to certify similar agreements, reinforcing the importance of maintaining confidentiality across all levels of the NIH’s operations.

This latest notice from the NIH serves as a crucial reminder of the responsibilities that come with participating in the peer review process. By explicitly prohibiting the use of AI tools, the NIH is taking a strong stance on protecting the confidentiality and integrity of its reviews. As the landscape of scientific research evolves, it is imperative that the methods used to evaluate and support this research evolve as well—while safeguarding the fundamental principles of security and trust that underpin the entire system.

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Designing near-peer mentoring for work integrated learning outcomes: a systematic review

• Merrolee Penman 1 , 2 ,
• Joanna Tai 3 ,
• Gretel Evans 2 , 4 ,
• Jennie Brentnall 2 &
• Belinda Judd 2  

BMC Medical Education volume  24 , Article number:  937 ( 2024 ) Cite this article

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Work-integrated learning (WIL) is a core aspect of allied health education. WIL placements typically focus on developing clinical skills, with broader conceptions of work readiness a secondary consideration. Near-peer mentoring (NPM), where senior students mentor junior students, is one WIL placement model that holds promise for developing students’ work readiness, along with additional benefits for educators and service users. While there is emerging evidence of the benefits of NPM in allied health, a more comprehensive understanding of the design and outcomes of NPM WIL placements for allied health students, their educators and service users is needed.

A systematic search of seven electronic databases (CINAHL, ERIC, ProQuest Education, Medline, PsychInfo, EMBASE and Scopus) from 2003 to 2022 was conducted with 4195 records reviewed. Included studies reported on near-peer mentoring between at least one of the identified 11 allied health professionals providing services to real people (i.e. not simulation). Data extracted included pedagogical approaches, type of service model and relationship of peers to each other and educator, objectives for implementing the NPM, and effects for students. Quality appraisal was undertaken using the Standards for Reporting of Qualitative Research (SRQR).

Fourteen studies met the inclusion criteria. The majority were North American in origin, from the disciplines of pharmacy, physiotherapy, psychology and occupational therapy, and used a range of research designs. Four types of placement design were observed from incidental co-location of students and observing outcomes through to deliberate preparation of students and/or educators for their roles in a NPM placement. Outcomes for junior students included lowered anxiety leading to increased confidence and motivation to learn and thus enhanced clinical skills. Senior student outcomes included development of educator skills, increased confidence, and enhanced professional reasoning. Service users and educators also benefited from NPM; however, evidence was sparse in these areas.

The evidence supports near-peer mentoring as a valuable WIL model to support work readiness, and several general pedagogical designs are evident. Future research should design NPM WIL with a greater integration of educational theory and evaluate outcomes beyond satisfaction and self-reported experiences.

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Introduction

In general, many allied health professionals are considered eligible to directly enter practice upon completion of their degrees (i.e., without any further requirements such as a postgraduate internship or residency). Thus, adequate preparation and subsequent achievement of professional competencies is essential to ensure graduates are ready for the demands of the workplace. ‘Work readiness’ is a multidimensional concept, [ 1 ] defined as “the extent to which graduates are perceived to possess the attitudes and attributes that render them prepared or ready for success in the workplace” [[ 2 ], p12]. It encompasses both technical or discipline-specific and generic or soft skills [ 3 ] that support the use of professional judgement in complex situations [ 4 ]. Beyond clinical proficiency, work readiness for allied health professionals includes personal characteristics or social intelligences such as confidence, responsibility, maturity, resilience, flexibility, self-awareness and stress management, and non-technical skills such as effective communication with service users and colleagues, clinical reasoning, interprofessional teamwork, and organisational skills, [ 5 , 6 ] along with participation in the education of others [ 5 , 6 ].

Work-integrated learning (WIL) is often identified as an appropriate arena for the development of non-technical capabilities, [ 1 ] yet in the health professions, WIL, in the form of individual placements, has traditionally focussed on the development of clinical acumen through service user Footnote 1 /client contact [ 7 , 8 ]. Simultaneously, education providers are forced to deal with capacity limitations in workplace-based learning, and it is recognised that individual apprenticeship models of clinical education are unlikely to be viable in the longer term [ 7 , 8 ]. Individual apprenticeships also limit opportunities for students to develop teaching skills prior to graduation. This may in turn compound limited placement capacity since graduates must first further develop their skills before becoming placement educators [ 9 ]. Presently, the predominance of the apprenticeship model means there is often limited focus on students and educators implementing innovative placement models, and where innovations do occur, these studies are often of poor methodological quality [ 7 , 10 , 11 ]. Evidence for WIL models that support all aspects of work readiness – especially the development of educator skills – is therefore required to ensure that allied health graduates are indeed prepared for practice.

Preparedness for practice, or work readiness has been explored in health professions [ 12 , 13 , 14 ] generally, with some studies specifically focussing on the unique contribution of WIL [ 13 , 15 ]. Much of this literature comes from the professions of nursing and medicine and, given that these professions share a common purpose of healthcare service delivery with allied health, findings could be interpreted as being applicable to all health professions. However, even between nursing and medicine, cultural differences in hospital-based teaching and learning practices have been identified, [ 16 ] challenging the assumption that WIL placement research findings are applicable across health professions. Attrill et al., [ 4 ] argues that generalisation of findings is also impacted by context, since medical and nursing work readiness research is primarily based in hospital settings. This contrasts with allied health professionals who increasingly work in a diversity of practice settings such as disability services, community organisations and private practices in addition to tertiary healthcare. The relative absence of the voice of allied health professionals in health professions educational research to date points to a need for research on WIL models focussing on the development of educator skills involving a range of allied health professions. In this paper, we firstly summarise the pedagogical contribution of one WIL model, near-peer mentoring, investigating the impacts of near-peer mentoring in allied health WIL placements through a systematic review of the literature.

Near-peer mentoring (NPM)

NPM is particularly applicable to workplace-based settings for learning and the development of the associated work readiness skills. Variously referred to as near-peer mentoring, near-peer tutoring, layered learning model, [ 17 ] tiered learning or cross-peer assisted learning, [ 18 ] it involves students who are one or more academic year levels apart. It is a subset of peer-assisted learning (PAL), which is a well-established educational approach in which students learn from and with each other [ 19 , 20 ]. This learning occurs in very small groups (1:1 to 1:2 ratios of senior:junior students [ 19 ]), with more experienced peer/s also role modelling and reinforcing the learning of less experienced peer/s and in turn learning by teaching [ 21 ].

The pedagogical underpinnings of near-peer mentoring in WIL

NPM is broadly considered a pedagogical approach that is aligned with a social constructivist paradigm, whereby knowledge is constructed by individuals from experiences that are integrated into their own understandings, rather than being absolute and transferrable [ 22 , 23 ]. This combines well in WIL where the context promotes experiential learning; that is, learning in context from authentic experiences and through interaction with others [ 22 ]. Important to such learning in WIL is deliberate practice where students have the opportunities for repetition, feedback and reflection to improve their performance [ 24 ]. In NPM, these opportunities are enhanced by the availability of peers. Participating in roles of both performer and observer, feedback receiver and feedback provider, also enhances students’ metacognitive awareness and self-regulation [ 25 ].

Learning together in NPM, students have opportunities to develop their knowledge, skills, and professional identities within their zone of proximal development (ZPD) where substantial seniority or expertise is not required, and learning can occur with the guidance and support of anyone who is more advanced in the area [ 26 ]. Supporting this belief is the idea that students, even of differing levels are both cognitively and socially congruent [ 27 ]. They share a similar knowledge base which enables the more advanced student to explain difficult topics or share how they learned a complex technical skill or concept. In relation to social congruence, they have both adopted student roles, sharing similar experiences, problems and demands [ 28 ]. NPM also provides opportunities for senior students to fulfil relatively senior roles such as supervision to support development of their educator skills prior to graduation. In the process, junior students may feel more comfortable to be vulnerable for new learning and development, [ 27 ] and in NPM, senior students may gain confidence in the extent of their knowledge and skill [ 15 ] relative to peers at a level of their own recent experience, as well as reinforcement of knowledge and skill through interaction with others and teaching [ 15 , 21 , 29 ].

Through the process of constructivist and experiential learning in WIL settings, students are developing the knowledge, values, and attitudes of professionals in their field in a process of professional socialisation [ 30 ]. In NPM, students have opportunities for exposure to, and internalisation of, the norms and practices of their profession with peers who are more advanced as well as with educators [ 31 ]. They also have opportunities to see the process of professional entrustment in progress whereby students are entrusted by educators with increasing levels of independence based on an evaluation of the risk involved considering their knowledge, skill and attributes [ 32 ]. Similarly, NPM harnesses the tendency for social comparison as a means for self-evaluation [ 20 ] as students progress in their professional socialisation and identity formation. Finally, with senior students, junior students, and/or educators interacting and learning together in the workplace, there is also the opportunity for the formation of communities of practice [ 33 ] and consequently the motivation and reward of working towards membership of the profession [ 34 ].

Evidence for effectiveness of peer-assisted learning

The use of various forms of PAL in health professions WIL are identified in the literature dating back to the 1980s, [ 35 , 36 , 37 ] in a number of health professions education systematic reviews [ 7 , 11 , 20 , 21 , 38 ]. These reviews vary as to who was included (medicine, nursing, or all health professions) and the inclusion or exclusion of a near peer versus same level PAL. Overall, these reviews demonstrate that students benefit from increased opportunities for discussion, reflection, and peer support in PAL models [ 7 , 11 ] with students in NPM also finding learning from a near peer lower pressure than learning from an educator [ 15 ]. Generally, students’ increased confidence also leads to reduced educator supervision needs [ 7 , 11 ]. Improved outcomes are often noted in collaborative, non-technical, work readiness skills and attributes such as communication, teamwork, time management, and leadership, as well as autonomy and clinical reasoning [ 10 , 11 , 15 , 38 , 39 ]. Challenges arise when there is perceived competition between students, or students feel that learning from peers competes with their learning from ‘expert’ educators, especially as they approach the end of their placements [ 7 , 11 , 15 , 39 ]. When paired with junior students, however, senior students gain confidence and teamwork skills thought to be beneficial in the transition to graduate practitioner [ 15 , 39 ]. Despite these generally positive outcomes for students identified in previous reviews of PAL, the quality of included studies was criticised, especially since study designs focus on student and educator satisfaction rather than learning, behaviour and/or impact levels [ 10 , 11 ]. Reviews also do not distinguish the difference in allied health professions contexts from nursing and medical contexts, meaning contextual outcomes and experiences may be neglected [ 7 , 10 ]. Though research quality has improved over time, even recent reviews across all health professions concluded there is insufficient evidence to recommend any particular placement model [ 11 , 15 ]. While outcomes evidenced to date are reasonably consistent [ 7 ] and align with what may be expected given the theoretical foundations of PAL, there has been limited consideration of such explanations for the outcomes observed in allied health, [ 10 ] in contrast to medicine [ 20 ] or nursing [ 40 ].

In the placement setting, it is also important to consider the benefits and impacts for other stakeholders such as service users, educators and employers. It has been noted that PAL and NPM placement models can be challenging for educators to implement, particularly if students have different learning needs or a student is underperforming or requires support in managing peer relations [ 11 , 15 , 38 , 39 ]. Educator training regarding the facilitation of PAL is therefore recommended, [ 7 , 39 ] though it is also challenging if placement models are prescriptive of PAL activities [ 15 ]. On the other hand, educators can find that peer interactions during the placement can decrease the time educators spend in instructing and supervising students and increase the service productivity when accounting for student inputs [ 10 , 38 , 39 ]. Educators may also have opportunities to gain additional skills related to instruction, teamwork, and clinical management [ 39 ]. The balance of these challenges and benefits do vary, and findings regarding the time commitments for PAL placements are mixed, [ 11 , 15 , 38 ] which may lead educators to perceive that PAL placements will be time consuming [ 39 ]. Organisation is certainly required, including to schedule students together and for advance preparation of the placement, educators, and students, with a degree of tailoring to students’ goals and individual needs [ 7 , 10 , 15 , 38 , 39 ]. It has also been noted that there is little evidence regarding the impact of PAL and NPM placements on service users, despite the argument that such placements should improve quality and outcomes in healthcare [ 39 ].

The evidence gaps for allied health NPM placements

The use of NPM in allied health WIL has the potential to address the quality of learning experiences for students, enhance outcomes for service users, improve educator productivity and increase placement capacity. WIL, like clinical practice, should be based on evidence [ 39 ]. The lack of focus on and supporting evidence for the impacts of NPM on allied health service users and educators is perhaps a reason why there has been limited uptake of these placement models. While considerable evidence exists for NPM PAL placement models in medicine and nursing, [ 39 ] there is limited evidence beyond 2:1 placement models and insufficient evidence to recommend any specific PAL placement model in allied health [ 11 , 15 ]. Recent systematic reviews have mostly failed to consider the underlying pedagogies used to inform placement design while recommending that future studies collect further evidence beyond student and/or educator satisfaction to consider outcomes for student learning, behaviour and/or impact [ 41 ]. Presently, allied health educators are unable to determine how to effectively design and implement NPM to achieve desired learning outcomes for students. Therefore, this study sought to address the following questions:

What are the outcomes of near-peer mentored work integrated learning placements for allied health students, their educators and service users?

How are near-peer mentored placements in allied health designed to achieve those outcomes?

This review was conducted using a systematic approach to literature searching and data analysis. Details of the protocol for this systematic review were registered on PROSPERO (CRD42018102790) [ 42 ].

Search strategy

Seven databases were searched: Cumulative Index to Nursing and Allied Health Literature (CINAHL via EBSCO), Educational Resources Information Center (ERIC via EBSCO), Proquest Education (via Proquest), Medline (via OVID SP), PsychInfo (via OVID SP) EMBASE (via OVID SP) and Scopus for English-only sources dated between January 2003 and December 2022. The years 2003 to 2022 were selected to both overlap with an earlier near-peer learning in WIL-specific systematic review [ 43 ] while capturing the most recent literature, with the search first undertaken in March 2018, updated in October 2019 and last repeated on 21 November 2022.

Search terms

Previous systematic reviews [ 10 , 18 , 44 ] provided insight into the breadth of search terms needed to capture NPM in work integrated learning placements. Search terms included combinations of the terms student, clinical, education, placement, clerkship, practicum, and professional education; terms to capture peer learning included near-peer, peer-assisted, peer mentoring, cross peer, paired, collaborative or cooperative learning; and allied health related terms. To determine which professions to include in the search, the list published by Allied Health Professions Australia [ 45 ] was used with the following professions included: occupational therapy, physiotherapy, speech pathology, social work, pharmacy, dietetics, audiology, podiatry, exercise physiology and paramedicine as well as their various international derivatives (for example, physiotherapy or physical therapy and exercise physiology or exercise science professional). The criteria for inclusion/exclusion is outlined in Table  1 .

Screening and selection of studies

Covidence [ 46 ] was used to manage the review process (refer to Fig.  1 ). The first 300 articles (sorted according to title) were independently reviewed by title and abstract by the lead author (MP), with two additional authors (JT and GE) reviewing 50% each. Where differences were identified, all three reviewed the title and abstract together to establish concordance. With agreement reached on the interpretation of the criteria through this process, the team moved to single reviewer screening (MP) with a tendency to include rather than exclude as outlined by Tai et al. [ 20 ] Where it was not clear whether to include based on title/abstract, MP consulted with JT and GE and a final decision was made.

PRISMA identification, screening and inclusion process

Full-text screening of studies found across the three search dates was undertaken on 198 papers independently by a combination of two of MP, GE and JT, with the third screener providing conflict resolution. Of note, is the addition of three papers [ 47 , 48 , 49 ] found in the final search, being the only ones published after October 2019 that met the inclusion criteria. In total, this process identified 19 papers as potentially meeting all criteria for inclusion in the review. Given the differing nature of the papers, and to ensure that all relevant information was located and reported, MP, GE and JT scrutinised each article in depth. Data extraction was completed separately using a simple data extraction tool [ 20 ] with headings aligned to the review questions. Findings were compared and compiled into final descriptions. Through this process a further five studies were excluded as it became evident that these studies did not fully meet the criteria. Specifically, participants were not purposefully paired for the purposes of learning, or minimal research data was presented.

Quality review was then undertaken on the final 14 papers using the Standards for Reporting of Qualitative Research (SRQR), [ 50 ] which was designed for holistic judgement as befits a qualitative approach, instead of a quantifying score. Each paper was assessed for quality across 21 standards of the SRQR. Two researchers (MP and GE) applied the SRQR standards separately, deeming the quality of meeting each standard to be high if the majority of elements were adequately described and justified, low if substantial elements were described but not adequately justified, or unclear if substantial elements were not described in adequate detail (refer to Supplementary Material). MP and GE then compared these judgements with the aim of reaching consensus. The overall judgement of the quality of each paper was discussed and agreed to by MP, GE and JT with more weighting placed on the standards relating to methodology than other standards. For most papers, quality was difficult to judge due to insufficient information provided in the articles resulting in many unclear ratings. No papers were excluded based on the quality assessment given the small number of papers overall and the descriptive nature of this review. Instead, study quality was considered when considering the weighting of the evidence.

Description of studies

The final 14 papers, (henceforth called studies; see Table  2 ) described 12 NPM placement interventions. Two studies were represented by pairs of papers. One of the NPM placement interventions was reported first from the student learner [ 49 ] and then educator [ 47 ] perspectives. The second study was undertaken with pharmacy students [ 51 ] with the design of the NPM intervention and research methods appearing to be replicated in a later comparative study [ 52 , 57 ] between medical and pharmacy students in the same hospital. Although these studies appear to be paired and each group of authors references the earlier study, for the purposes of the results they are reported as individual studies.

Studies were from the United States ( n  = 6), Canada ( n  = 7) and the United Kingdom ( n  = 1). Disciplines represented included pharmacy, physiotherapy, psychology and occupational therapy, with 12 studies involving students from the same discipline, [ 6 , 9 , 17 , 47 , 48 , 49 , 51 , 52 , 53 , 54 , 55 , 56 ] and two pairing related but distinct roles within the same disciplines (e.g., occupational therapy with occupational therapy assistants and physiotherapy students with physiotherapy assistants) [ 57 , 58 ]. Across the 14 studies, placement lengths varied from four weeks [ 51 ] through to nine- to twelve-month programs, [ 53 , 55 ] with some being part-time only for the junior [ 6 , 9 , 53 , 56 ] and/or senior students [ 6 , 53 , 55 , 56 ]. Five studies were based in university owned and operated clinics, [ 6 , 9 , 53 , 55 , 56 ] six in adult hospital settings, [ 17 , 48 , 49 , 51 , 52 , 58 ] one in mixed hospital/community settings [ 47 ], and one in a residential aged care setting [ 54 ]. One study did not provide sufficient data to determine the placement setting [ 57 ].

Studies were also varied in their research design. Six were program evaluations, [ 6 , 17 , 53 , 55 , 57 , 58 ] one mixed methods research, [ 56 ] two drew on ethnographic principles, [ 51 , 58 ] two were case study research, [ 9 , 54 ] with one of these also utilising action research [ 54 ] and three studies used a retrospective design, [ 47 , 48 , 49 ] being either survey and/or individual semi-structured interviews. Sample sizes ranged vastly for both students ( n  = 4–130) and educators ( n  = 1–20). In one study, service users’ experiences ( n  = 16) were also reported [ 53 ].

The aims and objectives of the studies were also heterogenous, with research designs reflecting the variety of positioning of the research in relation to the rationales for including NPM. For example, some studies described placement structures where, due to the curriculum design and resulting overlapping placement across different year groups, near-peer mentoring was already occurring. The focus of these studies was to evaluate what had been ongoing for some time [ 51 ] or to explore the value of additional introduced elements [ 53 , 58 ]. Several studies focused on student and/or educator perspectives of evaluating the introduction of NPM for the first time, with evaluations undertaken on placement completion, [ 54 ] within 3 years of graduating, [ 49 ] or at times not explicitly reported [ 47 , 48 ]. Other studies had more specific goals for introducing NPM; for example, to explore whether NPM could assist students in the acquisition of skills required to be effective educators, [ 47 , 48 ] or to ensure students from differing roles within the same discipline (e.g., physiotherapists and physiotherapy assistants) were better prepared for working collaboratively [ 57 ].

Overall, the quality of the papers was difficult to discern and therefore to weight in the evidence when also considering different designs and aims. There were, however, exemplars [ 6 , 9 , 52 , 53 , 54 , 55 , 57 ] that adequately described and justified most of the elements for the quality standards pertaining to the methodology and results. Most of the papers had multiple sections scored as ‘unclear’ due to limited reported details about the study, with those deemed of lower quality not providing adequate justification and often not clearly being aligned to a research framework.

Placement design

The catalyst for adoption of a NPM model varied across the studies. Analysis of the placement designs described provided insight into the underpinning educational theories and/or learning strategies utilised. The placement designs could be organised into four main groupings: the first related primarily to co-locating the students and observing outcomes, the second to preparing students to achieve expected learning outcomes, and the third to preparing educators for their role in placement design. The fourth group consisted of retrospective studies of whole student cohorts, where the emphasis was on the student and academic experiences, with no specific information provided about placement design.

Co-location of students

Three studies [ 53 , 54 , 58 ] primarily drew on the theories of collaborative learning and experiential learning [ 53 , 54 ] to inform placement design. Examples of learning strategies included introducing Grand Rounds to provide better continuity of care and stronger learning experience for students [ 53 ] or joint tutorials between related disciplines to discuss interprofessional issues [ 58 ]. The underlying premise in these studies was that by co-locating students in a collaborative peer relationship, mutual learning would occur through the sharing of experiences and knowledge, with junior students also learning from observing their senior peers. In these studies, there appeared to be minimal to no preparation of students for their roles as mentor/mentees or even co-learners. While the authors reported that students found the experience satisfying and gained confidence in some skills, [ 53 , 54 ] it was not clear the degree to which this could be attributed to the near peer relationship as opposed to the placement learning experiences generally. Outcomes from these studies included recommendations related to the need for improved preparation of students, including clarity of senior and junior roles [ 54 ].

Deliberate student preparation

Studies in this group [ 6 , 9 , 17 , 55 , 56 ] included those where the authors deliberately designed their placement models to meet specified student learning outcomes, such as developing senior students’ educator skills with the view that they eventually become formal educators of others, or for fostering interdisciplinary teamwork. Whilst drawing from experiential learning theory, [ 9 , 55 ] these authors also applied learning theories or models such as cognitive apprenticeship [ 6 ] and transformative learning [ 6 ] in a layered learning [ 17 ] or progressive curricular model [ 56 ]. In these five studies, senior and junior students were specifically prepared for their roles. Junior students were primarily prepared for aspects of direct service delivery and in one study also for their role in providing feedback to senior students [ 9 ]. Senior students were specifically prepared for their role as educators, mentors or coaches. While the senior students may initially have a greater clinical role (e.g., to model practice behaviours/skills), in some studies [ 6 ] this was reduced over time to enable increased opportunity for junior student involvement in service delivery. For all studies in this group, senior students were prepared for their mentoring role during classes occurring in parallel with the placement, [ 6 ] or within the placement itself [ 17 , 55 , 56 ]. For the within-placement model, learning experiences were deliberately scaffolded, with ongoing coaching/education sessions and/or educator modelling to support the development of the senior students’ mentoring role. Several of these studies [ 6 , 17 , 56 ] implemented a progressive circular or layered learning model where students experience firstly the junior, then senior role, in the same context. Three of these studies were pro-bono university clinics [ 6 , 9 , 56 ] the other two university managed clinics, either in the academic medical centre [ 55 ] or ambulatory clinic in a local hospital [ 17 ]. Thus, for students entering the senior role in these studies, some had already experienced being a junior student and were familiar with the placement context, educators and service delivery models.

Compared with the first group, where students were co-located with the aim of learning from each other, studies in this group deliberately designed for specific outcomes. With targeted preparation and some degree of ongoing coaching (either in class or in the placement), a different range of outcomes were reached. For example, students were seen to have a greater degree of confidence in not only their educator skills, but in their clinical skills as well, with one study suggesting the model assisted with readiness for the final placement and postgraduate clinical experience, [ 17 ] and another that students demonstrated increased confidence and sense of capability [ 6 ]. Students and their educators perceived that students developed clinical skills in communication, problem-solving and clinical reasoning and were able to identify growth both in themselves and junior students, [ 6 , 17 , 56 ] with participants in one study reporting knowledge being reinforced through the instruction of junior peers [ 17 ]. In studies where the learning was explicitly scaffolded, where the educators modelled how to educate, and where students rotated through from junior to senior student, the findings suggested that these senior students emerged from the experience feeling confident in the educator skills they had developed, positioning themselves as lifelong learners and being inspired for, and feeling prepared for future educator roles [ 6 , 9 , 55 , 56 ].

Deliberate educator preparation

One study incorporating deliberate educator preparation [ 57 ] was identified, being otherwise similar to the studies with deliberate student preparation designed to achieve student learning outcomes. This study drew from learning theories such as collaborative learning within a reciprocal peer coaching model. However, the preparation focus in this study was on the educators who were encouraged to use guidelines for collaborative practice to create optimal learning experiences for student pairs. Outcomes of this model were similar to those studies where students were co-located with minimal to no preparation for their educator roles.

Retrospective perspectives

The final and most recent group of studies [ 47 , 48 , 49 ] had a retrospective approach to investigating the use of NPM placements and did not explicitly state either the educational theory or learning strategies implemented in the original placements. These studies employed survey and semi-structured interview methods to understand student and educator perspectives on past experiences with NPM models of placement. Findings from these three studies reiterated outcomes for students and educators found in the other groups of studies, such as building educator skills, student autonomy and student enjoyment [ 47 , 48 , 49 ]. Additionally, MacDonald et al. [ 48 ] gathered suggestions from educators on strategies to mitigate specific challenges encountered in future implementation of the model.

Observed outcomes

A collation of reported outcomes reported in included studies is reported in Table  3 . Outcomes for each stakeholder group are briefly summarised below.

Overall, the NPM model was well received by most students [ 17 , 55 ]. Many of the studies supported that the model facilitated development in students’ personal growth, skill acquisition and well-being. As discussed above, outcomes varied across the studies, depending on the intent and educational approaches to student placement. Skills such as communication, confidence and collaborative practice were observed to be developed, including reports of student motivation and inspiration for the roles of clinician [ 9 ] and educator in the future [ 6 , 48 , 49 , 56 ]. Outcomes observed by students and educators were different between senior and junior groups with predominantly positive outcomes reported. A few studies described challenges of the model for students with reports of some anxiety, repetition of information, difficulties managing time, competitiveness and role confusion [ 48 , 52 ].

Outcomes for educators

Six studies [ 6 , 47 , 48 , 51 , 54 , 57 ] commented specifically on the educator impacts of implementing this model at their sites. Educators further developed their supervision skills and support for each other in this model [ 54 ]. Educators also felt rewarded in facilitating this integration of near-peer student placement models with client care [ 6 ] and in one study reported the logistical benefits of project-funded relief time from duties to prepare for the placement [ 57 ]. Challenges reported for educators included the balancing of different learner needs and time commitment for tasks such as preparation and assessment [ 47 , 48 , 49 ].

Outcomes for service users

Five studies mentioned an impact on service users and health care delivery, [ 17 , 47 , 48 , 51 , 53 ] with only one of these [ 53 ] including service users as direct participants contributing their own perspectives. None of the impacts on service users were measured; all were reported from the perspectives of participants. In the one study that included service users as participants, those service users did not overtly recognise the students as delivering a service [ 53 ]. Students and educators were more positive about the impacts on service users, with participants perceiving the team learning approach in NPM improved service users’ care and progression, [ 17 , 51 ] and educators feeling the model assisted with continuity of service for service users. [ 53 ] It was also reported that more service users were able to be receive a service when senior students were assisting the junior students in the NPM but this was not quantified [ 51 ].

This review has identified clear benefits for allied health students from participating in NPM placement models, across a modest number of papers. Due to the evaluative rather than comparative nature of the research, it is uncertain whether all of the findings are substantial additional benefits over a traditional placement model. However, it is unlikely that students would enjoy the same development of educator skills without opportunities to practise these in the mentoring role. To be considered work ready, graduates must be able to practice not only service user care, but also other capabilities that are considered core components of professional practice in allied health, such as working collaboratively in teams [ 4 , 59 ] and participating in the education of students and peers [ 5 , 6 ]. In alignment with previous reviews, there remains sparse evidence for educator and service user benefits. However, this should not prevent the implementation of NPM, rather, we echo previous recommendations that further investigation and more elaborate reporting of outcomes is required, when NPM is utilised.

Given that the evidence from these studies does not provide a strong basis for implementation of any particular placement model, we now propose and discuss three aspects of intervention design and/or research that would facilitate the generation of higher quality NPM research and implementation.

Design NPM with work readiness in mind

Several studies in the review [ 53 , 54 ] reported that NPM came about as a by-product of circumstances related to the increased need for placements. This impetus has previously been noted in systematic reviews of same level PAL [ 5 , 10 ]. Rather than selecting this model to only address placement capacity, we suggest that intentionally designing NPM into the learning experience, as was done in the deliberate student preparation group of interventions, will lead to better outcomes for students. Further, additional to the aim of developing students’ clinical skills, there should be explicit goals to support the development of work readiness attributes [ 14 ] including: interpersonal capabilities such as confidence in developing professional relationships; practical wisdom or confidence in making deliberate, effective and appropriate decisions; organisational acumen or the navigation of administrative and cultural elements of the workplace; as well as supporting the development of personal attributes such as resilience, flexibility, adaptability and having a growth mindset for themselves and others [ 3 , 4 , 14 , 59 ]. Whilst acknowledging that it is not feasible to design a single placement to address students’ needs to develop the full gamut of work ready attributes, the findings of our review suggest it is possible for a well-designed NPM placement to offer a range of learning opportunities to support the development of work readiness of both senior and junior students.

NPM placements can be designed in a way that ensures experiences exist to scaffold learning, where educators understand the theoretical basis for such approaches. For example, pro-bono university-based clinics can be carefully structured to ensure opportunities for lower-risk service activities by having senior students who are already familiar with the service and placement model support junior students to take responsibility for these activities. Entrustment of lower risk activities to the senior-junior student dyad builds a sense of responsibility in both senior and junior students [ 32 ]. It also creates a culture of preparing students for future educator roles, where senior students are supported and expected to develop and exercise educator skills as part of their degree. As reported in some of the studies in this review, acting in an educator role also appears to develop senior students’ sense of clinical competence, professional reasoning, and independent practice [ 6 , 47 , 48 , 49 , 58 ]. It appears that with more responsibility for service user care, comes a growing sense of agency by senior students as they move towards being a fully-fledged clinician. Designing for learning moves beyond the co-location models reviewed in this study that, although generating perceptions of safety and collaborative learning, are less intentional in developing students’ educator skills. As has been recommended in same level PAL, [ 10 ] achieving these outcomes requires the preparation of both educators and students in the theory and application of NPM education strategies as part of deliberate design for learning.

Evaluate beyond student and/or educator satisfaction

For student outcomes, more elaborate evaluation is needed, beyond Kirkpatrick’s Level 1, satisfaction with education interventions [ 41 ]. Future studies could focus on student performance on relevant assessments, and/or tracking students longitudinally to understand what types of future mentoring, leadership and educator roles they engage with as graduates, and how NPM experiences have shaped their educator and professional practice, that is, Kirkpatrick’s Level 4 [ 41 ]. Furthermore, teamwork and collaborative capabilities developed in NPM might influence how graduates work in multidisciplinary teams with peers and how they engage in supervision relationships and lifelong learning i.e. Kirkpatrick’s Levels 2 and 3 [ 41 ]. While some of these aspects have been revealed through qualitative, open-ended studies included in this review, [ 9 , 51 , 55 , 56 ] they should be more systematically investigated across cohorts.

Beyond students, there might be efficiencies in investigating educator and service user outcomes simultaneously, since they overlap. While service user [ 60 ] and educator satisfaction is important, additional metrics might usefully focus on occasions of service (how many times a service was utilised), clinician time-use, service staffing profile (where students become integral to the service enabling existing staff to be deployed elsewhere) along with meeting service key performance indicators (KPIs) such as progression along clinical care pathways, and/or waitlist lengths and discharge destination (e.g. rehabilitation, care facility or home). In addition, career progression for educators (such as formal leadership, supervision and educator roles) could also be investigated. Some of these metrics have been examined for allied health placements in general, [ 61 , 62 ] but not for NPM placements in this review.

Finally, it was apparent that few studies followed any reporting guidelines for qualitative studies, for example using the Standards for Reporting of Qualitative Research (SRQR) [ 50 ]. The use of such standards when reporting on studies undertaken not only support high quality publications but may also assist researchers in planning and undertaking higher quality research, the findings of which can be confidently applied in the practice context.

Use learning theories to interpret NPM outcomes

In recommending further research be conducted in this area, we echo recent exhortations to more explicitly adopt and incorporate learning theory within health professions education in both framing the phenomenon or intervention of interest and developing relevant and appropriate research designs [ 63 , 64 , 65 ]. Authors of the studies identified a number of educational theories that informed the design of the NPM placements including communities of practice (with legitimate peripheral participation [ 33 , 66 ]), peer learning theories, [ 26 , 67 ] cognitive apprenticeship, [ 68 ] social constructivist [ 23 ] and experiential learning [ 22 ]. What is not clear from this review is which of these theories are core to the design of NPM placements or which contributes most to which learning outcomes. Further research could assist placement designers to select the most appropriate learning theory or theories to inform the design of their placement models to achieve the desired learning outcomes.

Whilst it can be challenging for researchers, the use of theory and theoretical frameworks in health professions education supports understanding of the mechanics and meaning of complex phenomena such as learning environments, learning relationships and learning outcomes [ 64 , 65 ]. It also assists educators and WIL placement providers to identify the usefulness, relevance and application of findings from individual studies as they work to implement innovative placement models such as NPM [ 63 , 64 ]. Conversely, failing to engage with theory in this domain risks the implementation of ineffective education programs that do not meet the goals of placement design, and research that lacks transparency, integrity and rigor [ 63 , 64 ].

Limitations

This systematic review aimed to examine the design and outcomes of NPM WIL placements for allied health students. The findings presented draw only from peer-reviewed articles published in English with no searching of the grey literature or citation tracking. Thus, we acknowledge that this narrower focus may have excluded studies across the globe and informal reports, particularly where professions may still be establishing, and a paucity of educators may lead to more creative placement models. The search was also restricted from 2003 to 2022, with the aim of capturing studies not found by Burch et al. [ 43 ] in their earlier systematic review on the same topic. It is possible that our selection of search teams and databases may have led to some studies being omitted, however the use of a range of professions, along with a broader use of descriptions for the placement model has addressed this potential limitation. Finally, we acknowledge that a degree of individual judgement was exercised when searching the included articles for the educational pedagogy and/or teaching/learning methods. Having multiple authors involved in the screening, data extraction and data analysis, working independently before comparing and clarifying, mitigated this limitation.

There is growing evidence for positive student outcomes of NPM in terms of both satisfaction and opportunities to further develop work ready attributes and characteristics. However, the evidence for educator and service user outcomes remains sparse. Based on the findings of this review, there are two clear actions for universities, their partner site educators and health profession education researchers to consider. Firstly, to continue to use NPM solely as a means of addressing placement shortages is a disservice to health professions education, and this model specifically. If the objectives of a placement are to support students’ development of work-ready attributes and discipline-specific knowledge and skills, then NPM could be the placement model of choice. Secondly, in specifically designing for these outcomes, suitable educational theories should be used to inform the design of both the placement and research to address the evidence gaps. Making careful and deliberate choices in educational and research design and reporting will increase the potential for richer, evidence-based learning experiences for students as well as improved outcomes for educators and service users.

Availability of data and materials

The datasets used and/or analysed during this study are available from the corresponding author on reasonable request.

Across healthcare, a range of terms are used for the person accessing the service including patient, client, consumer or service user. In this paper, service user will be used.

Abbreviations

Bachelor of Science in Pharmacy

Near-peer mentor/mentoring

Occupational therapy

Occupational Therapy Assistants

• Peer-assisted learning

Doctor of Pharmacy

Physiotherapy or Physical Therapy

Physical Therapy Assistants

Work Integrated Learning

Zone of Proximal Development

Key Performance Indicators

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The authors acknowledge the valuable feedback provided by Professor Lynn Monrouxe on earlier draft of this manuscript.

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Penman, M., Tai, J., Evans, G. et al. Designing near-peer mentoring for work integrated learning outcomes: a systematic review. BMC Med Educ 24 , 937 (2024). https://doi.org/10.1186/s12909-024-05900-6

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Introduction

Ofsted was asked by the government to carry out a rapid review of sexual abuse in schools and colleges. This report summarises our findings and recommendations.

We were asked to report on the following:

Safeguarding and curriculum

Is the existing safeguarding framework and guidance for inspectors strong enough to properly assess how schools and colleges safeguard and promote the welfare of children.

How can schools and colleges be supported further to successfully deliver the new RSHE (relationships, sex and health education) curriculum, including in teaching about sexual abuse, cyber bullying and pornography as well as healthy relationships and consent?

Multi-agency safeguarding arrangements

How well are safeguarding guidance and processes understood and working between schools, colleges and local multi-agency partners?

Does working between schools, colleges and local safeguarding partners ( LSPs ), including local authority children’s social care, the police, health services and other support, need to be strengthened?

Victims’ voice and reporting

How does the current system of safeguarding in schools and colleges listen to the voices of children when reporting sexual abuse whether occurring within or outside school?

What prevents children from reporting sexual abuse?

Do victims receive timely and appropriate support from the right place?

Have inspections by ISI (the Independent Schools Inspectorate) and Ofsted been robust enough in relation to the issues raised?

Other considerations

In addition to what the government asked us to report on, we have also considered:

the range, nature, location and severity of allegations and incidents, together with context

the extent of schools’/colleges’ (and other agencies’ and adults’) knowledge of specific incidents and more general problems

schools’ safeguarding responses to known incidents and wider social and cultural problems, including:

their immediate response to specific incidents, including referrals to LSPs and victim support (and liaison with other schools/colleges, where those involved attend different schools/colleges from abusers)

schools’/colleges’ use of sanctions

any factors that have limited any immediate or subsequent response

schools’ safeguarding knowledge, culture and effectiveness, including their willingness to function as part of the wider safeguarding system with other partners

the adequacy of schools’ RSHE / PSHE (personal, social, health and economic) curriculum and teaching

the extent to which recent inspections explored relevant cases and issues

Executive summary and recommendations

The review included visits to 32 schools and colleges. In these, we spoke to over 900 children and young people about the prevalence of peer-on-peer sexual harassment and sexual violence, including online, in their lives and the lives of their peers. [footnote 1] We also spoke to leaders, teachers, governors, LSPs , parents and stakeholders. Finally, we reviewed the extent to which inspection has given sufficient oversight of this issue and considered how statutory guidance could be strengthened.

This rapid review does not report on individual schools and colleges or cases, all of which remain anonymous. We made a number of visits to schools named on the Everyone’s Invited website, as well as others not named. But this should not be assumed to be a fully representative sample of all schools and colleges nationally. It presents a picture of strong and weaker practice across participating schools and colleges, from which we have drawn our conclusions. Our conclusions reflect the strengths and limitations of the evidence. They focus on what we were asked to report on. You can find a full description of the methodology at the end of this report.

This rapid thematic review has revealed how prevalent sexual harassment and online sexual abuse are for children and young people. It is concerning that for some children, incidents are so commonplace that they see no point in reporting them. This review did not analyse whether the issue is more or less prevalent for different groups of young people, and there may well be differences, but it found that the issue is so widespread that it needs addressing for all children and young people. It recommends that schools, colleges and multi-agency partners act as though sexual harassment and online sexual abuse are happening, even when there are no specific reports.

On our visits, girls told us that sexual harassment and online sexual abuse, such as being sent unsolicited explicit sexual material and being pressured to send nude pictures (‘nudes’), are much more prevalent than adults realise. For example, nearly 90% of girls, and nearly 50% of boys, said being sent explicit pictures or videos of things they did not want to see happens a lot or sometimes to them or their peers. Children and young people told us that sexual harassment occurs so frequently that it has become ‘commonplace’. For example, 92% of girls, and 74% of boys, said sexist name-calling happens a lot or sometimes to them or their peers. The frequency of these harmful sexual behaviours means that some children and young people consider them normal.

When we asked children and young people where sexual violence occurred, they typically talked about unsupervised spaces outside of school, such as parties or parks without adults present, although some girls told us they also experienced unwanted touching in school corridors.

Children and young people, especially girls, told us that they do not want to talk about sexual abuse for several reasons, even where their school encourages them to. For example, the risk of being ostracised by peers or getting peers into trouble is not considered to be worth it for something perceived by children and young people to be commonplace. They worry about how adults will react, because they think they will not be believed, or that they will be blamed. They also think that once they talk to an adult, the process will be out of their control.

Children and young people were rarely positive about the RSHE they had received. They felt that it was too little, too late and that the curriculum was not equipping them with the information and advice they needed to navigate the reality of their lives. Because of these gaps, they told us they turned to social media or their peers to educate each other, which understandably made some feel resentful. As one girl put it, ‘It shouldn’t be our responsibility to educate boys’.

In the schools and colleges we visited, some teachers and leaders underestimated the scale of the problem. They either did not identify sexual harassment and sexualised language as problematic or they were unaware they were happening. They were dealing with incidents of sexual violence when they were made aware of them, and following statutory guidance. But professionals consistently underestimated the prevalence of online sexual abuse, even when there was a proactive whole-school approach to tackling sexual harassment and violence.

In light of this, even where school and college leaders do not have specific information that indicates sexual harassment and online sexual abuse are problems for their children and young people, they should act on the assumption that they are. Leaders should take a whole-school/college approach to developing a culture where all kinds of sexual harassment and online sexual abuse are recognised and addressed. To achieve this, schools and colleges need to create an environment where staff model respectful and appropriate behaviour, where children and young people are clear about what is acceptable and unacceptable behaviour, and where they are confident to ask for help and support when they need it. Central to this should be a carefully planned and implemented RSHE curriculum, sanctions and interventions to tackle poor behaviour and provide support for children and young people who need it, training and clear expectations for staff and governors, and listening to pupil voice. Further guidance on many of these aspects can be found in ‘Keeping children safe in education’. [footnote 2]

When it comes to sexual violence, it appears that school and college leaders are increasingly having to make difficult decisions that guidance does not equip them to make. For example, some school and college leaders told us that they are unsure how to proceed when criminal investigations do not lead to a prosecution or conviction. Schools and colleges should not be left to navigate these ‘grey areas’ without sufficient guidance. Furthermore, the current guidance does not clearly differentiate between different types of behaviour or reflect the language that children and young people use, particularly for online sexual abuse.

Schools and colleges cannot tackle sexual harassment and sexual violence, including online, on their own, and neither should they. For example, the prevalence of children and young people seeing explicit material they do not want to see and being pressured to send ‘nudes’ is a much wider problem than schools can address. While they can play their part, it is not only their responsibility to solve it. The government will need to tackle this issue through the Online Safety Bill, and other interventions.

The LSPs that we met had varying levels of oversight and understanding of the issues for children and young people in their area. Some LSPs had been working closely with schools to track and analyse data from schools, and understood children’s experiences of sexual harassment and violence, including online. However, a small number told us that they were not aware that sexual harassment and violence, including online, in schools and colleges were significant problems in their local area. In light of what children and young people told us, they almost certainly are significant problems in every area. Gaining an overview of the issues requires effective joint working between LSPs and all schools and colleges, something that is not currently happening consistently. Some schools and colleges also reported that working across a number of local authorities presented challenges, as the level of support varied from area to area. Clearer guidance would help to overcome some of these difficulties, as would more learning and sharing of practice across LSPs , schools and colleges.

A review of Ofsted and Independent Schools Inspectorate ( ISI ) frameworks, training and handling of complaints found that safeguarding is generally well covered on inspection, inspectors are prepared, and complaints are generally dealt with well. However, there are improvements that can be made. As a result of this review, both Ofsted and ISI will update training, inspection handbooks and inspection practices where necessary to strengthen inspectors’ ability to inspect how schools and colleges are tackling sexual harassment and sexual violence, including online. Ofsted will follow up the publication of this report with a series of webinars and events for schools and colleges to discuss the findings of this review. ISI will also provide a series of webinars and events for schools about the findings of this review.

As a result of the findings of this review, we recommend the following.

Recommendations for school and college leaders

School and college leaders should create a culture where sexual harassment and online sexual abuse are not tolerated, and where they identify issues and intervene early to better protect children and young people.

In order to do this, they should assume that sexual harassment and online sexual abuse are happening in their setting, even when there are no specific reports, and put in place a whole-school approach to address them. This should include:

a carefully sequenced RSHE curriculum, based on the Department for Education’s ( DfE ’s) statutory guidance, that specifically includes sexual harassment and sexual violence, including online. This should include time for open discussion of topics that children and young people tell us they find particularly difficult, such as consent and the sending of ‘nudes’

high-quality training for teachers delivering RSHE

routine record-keeping and analysis of sexual harassment and sexual violence, including online, to identify patterns and intervene early to prevent abuse

a behavioural approach, including sanctions when appropriate, to reinforce a culture where sexual harassment and online sexual abuse are not tolerated

working closely with LSPs in the area where the school or college is located so they are aware of the range of support available to children and young people who are victims or who perpetrate harmful sexual behaviour

support for designated safeguarding leads ( DSLs ), such as protected time in timetables to engage with LSPs

training to ensure that all staff (and governors, where relevant) are able to:

better understand the definitions of sexual harassment and sexual violence, including online sexual abuse

identify early signs of peer-on-peer sexual abuse

consistently uphold standards in their responses to sexual harassment and online sexual abuse

Recommendations for multi-agency partners

Multi-agency partners should:

• work to improve engagement with schools of all types in their local area, tailoring their approach to what their analysis (produced in partnership with schools/colleges and wider safeguarding partners) indicates are the risks to children and young people in their local area

Recommendations for government

The government should:

take into account the findings of this review as it develops the Online Safety Bill, so it can strengthen safeguarding controls for children and young people to protect them from viewing online explicit material and engaging in harmful sexual behaviour using social media platforms

establish better coordinated arrangements between the Education and Skills Funding Agency ( ESFA ), Ofsted and ISI for how to deal with complaints that inspectorates receive about schools

strengthen the ‘Working together to safeguard children’ guidance to make the involvement of all state and independent schools and colleges with LSPs more explicit, including their engagement in multi-agency safeguarding audits

produce clearer guidance for schools and colleges to help them make decisions when there are long-term investigations of harmful sexual behaviour, or when a criminal investigation does not lead to a prosecution or conviction

review and update the definitions of sexual abuse, including peer-on-peer, to better reflect the experiences of children and young people

develop an online hub where all safeguarding guidance is in one place, with any updates clearly visible and ideally made in good time in the school year to aid planning

in partnership with others:

develop a guide that helps children and young people know what might happen next when they talk to an adult in school or college about sexual harassment and sexual violence, including online sexual abuse

develop national training for DSLs

develop resources to help schools and colleges shape their RSHE curriculum

launch a communications campaign about sexual harassment and online sexual abuse, which should include advice for parents and carers

Actions for the inspectorates

This review has identified a number of areas where Ofsted and ISI can sharpen practice and, in doing so, focus schools’ and colleges’ attention on this important area of their work.

Peer-on-peer sexual harassment and sexual violence, including online, have been considered during inspection as part of safeguarding in schools and colleges over the last few years. However, changes to government guidance and some inconsistencies in inspection documentation across education remits mean that updating of inspection handbooks is required. For example, from September, Ofsted’s inspection handbook for further education and skills will include the same references to peer-on-peer sexual abuse as the current school inspection handbook. Inspectors for Ofsted and ISI will also consider how well schools fulfil the new duties to deliver the compulsory RSHE curriculum.

For 2021/22 and beyond, Ofsted and ISI will work together to produce and jointly deliver further training on inspecting safeguarding in education settings, including looking at issues of peer-on-peer sexual abuse.

In line with our practice for schools, Ofsted will request that college leaders supply records and analysis of sexual harassment and sexual violence, including online, to inspectors. ISI will also specifically request for schools to provide the same records on notification of inspection, in addition to its current practice. There will be additional training for inspectors from both inspectorates to ensure that they record how they have followed up this information on inspection. Additionally, inspectors will hold discussions with single-sex groups of pupils where this helps to understand better a school’s or college’s approach to tackling sexual harassment and sexual violence, including online.

Definitions

In this report, we use the DfE ’s definitions of sexual abuse and peer-on-peer abuse. [footnote 3]

Peer-on-peer sexual abuse

The term ‘peer-on-peer’ sexual abuse includes:

sexual violence, such as rape, assault by penetration and sexual assault

sexual harassment, such as sexual comments, remarks, jokes and online sexual harassment, which may be stand-alone or part of a broader pattern of abuse

upskirting, which typically involves taking a picture under a person’s clothing without them knowing, with the intention of viewing their genitals or buttocks to obtain sexual gratification, or to cause the victim humiliation, distress or alarm

sexting (also known as ‘youth-produced sexual imagery’) [footnote 4]

There were a wide variety of behaviours that children and young people told us happen online. These include:

receiving unsolicited explicit photographs or videos, for example ‘dick pics’

sending, or being pressured to send, nude and semi-nude photographs or videos (‘nudes’)

being sent or shown solicited or unsolicited online explicit material, such as pornographic videos

Typical platforms for sharing material between peers tended to be WhatsApp or Snapchat.

‘Keeping children safe in education’ says that all staff should be aware that children are capable of abusing their peers and that they should be clear about their relevant policies and procedures to address peer-on-peer abuse.

We acknowledge that the term ‘peer-on-peer’ does not refer only to sexual abuse, but also to other forms of child-on-child abuse, such as bullying. The term ‘peer-on-peer abuse’ is helpful in focusing professionals’ attention on the fact that children can abuse other children. However, in the context of sexual abuse it could lead to professionals dismissing potentially harmful sexual behaviour as simply ‘developmental’, when there are power dynamics, age imbalances and other aspects that would warrant further investigation. In this report, we use the term ‘peer-on-peer’ while recognising its limitations.

Harmful sexual behaviour

When we refer to harmful sexual behaviour, we use the same definition as the DfE : [footnote 5]

Sexual behaviours expressed by children and young people under the age of 18 years old that are developmentally inappropriate, may be harmful towards self or others, or abusive towards another child, young person or adult.

When we refer to sexual harassment and sexual violence, including online, we use the definitions and the language of victim and perpetrator in the DfE ’s guidance. [footnote 6] We recognise that there are many different ways to describe children who have been subjected to sexual harassment and/or sexual violence. There are also many ways to describe those who are alleged to have carried out any form of abuse. Therefore, we are using the terms that are most widely recognised and understood. It is important to recognise that not everyone who has been subjected to sexual harassment and/or sexual violence, including online, considers themselves a victim or would want to be described in this way.

Any child or young person who exhibits harmful sexual behaviour may need a safeguarding response or intervention. Professionals should respond with interventions that address the behaviour of the perpetrator, while also providing an appropriate level of support. Professionals involved should be aware that harmful sexual behaviour may be an indicator that the child has been abused. [footnote 7] , [footnote 8]

It is also important to note that, although professionals’ awareness of the vulnerability of children and young people could be helpful, it could also contribute to stereotypes about how a victim and survivor of child sexual abuse should look or behave. This may run the risk of victims who differ from that picture being overlooked or unwilling to come forward for fear of not being believed. [footnote 9]

The following model is used to explain the continuum of sexual behaviours presented by children and young people, from normal to violent. Harmful sexual behaviour encompasses a range of behaviour, which can be displayed towards younger children, peers, older children or adults. It can occur online and offline or a mixture of both.

Figure 1. Definition: Sexual behaviours across a continuum

Source: Hackett, S, ‘Children, young people and sexual violence’ in ‘Children behaving badly? Exploring peer violence between children and young people’, 2010.

The DfE has published guidance for schools and colleges to help them to respond to sexual harassment and sexual violence, including online, between children. This explains that it is an offence for anyone to have any sexual activity with a person under the age of 16 and provides specific protection for children aged 12 and under who cannot legally give their consent to any form of sexual activity. The guidance acknowledges that professionals may be required to make complex decisions in situations of peer-on-peer sexual harassment and sexual violence, including online. It stresses the importance of effective training and clear policies for staff to help them take a considered and appropriate response.

Therefore, when schools and colleges [footnote 10] are made aware of sexual activity involving a child under the age of 13, they should always refer this to the police and children’s social care. They should use the statutory guidance and their professional curiosity to establish whether risk factors are present before making a decision on whether to engage external agencies if the children are aged 13 to 17.

What did we find out about the scale and nature of sexual abuse in schools?

What existing research and data tell us.

Data on this topic largely focuses on child sexual abuse in general, not specifically peer-on-peer. We know that issues of under-reporting and inconsistency in how professionals define harmful sexual behaviour mean that accurate data collection is difficult. [footnote 11] We explore the issues of under-reporting and data tracking in later sections of this report.

Nationally collected statistics show that there has been a sharp increase in reporting of child sexual abuse to the police in recent years. Figures that include all child sexual abuse cases show that the police recorded over 83,000 child sexual abuse offences (including obscene publications) in the year ending March 2020. [footnote 12] , [footnote 13] This is an increase of approximately 267% since 2013. Research estimates indicate that approximately one quarter of cases of all child sexual abuse involve a perpetrator under the age of 18. [footnote 14]

Although anyone can experience sexual harassment and violence, research indicates that girls are disproportionately affected. For example, 90% of recorded offences of rape in 2018–19 of 13- to 15-year-olds were committed against girls. [footnote 15] , [footnote 16] In the past year, girls aged between 15 and 17 reported the highest annual rates of sexual abuse for young people and children aged 25 and younger. [footnote 17]

It is hard to get an accurate picture of the scale and nature of sexual harassment and violence between children and young people in schools and colleges, as there is no centralised data collection of incidents and crime statistics are not published with a level of analysis to shed any light on this. It would be helpful if this information was available routinely.

In 2016, the Women and Equalities Select Committee highlighted a number of surveys reporting that girls were experiencing high levels of sexual harassment and sexual violence, including online, in schools and colleges. [footnote 18] Similarly, a survey of children and young people in 2017 found that over a third of female students at mixed-sex secondary schools have personally experienced some form of sexual harassment at school. [footnote 19]

Three sources of information that were available for this review are: published school exclusions data, [footnote 20] Ofsted complaints data and an FOI request made to the police in 2015 by the BBC.

Published school exclusions data shows:

In the 5 academic years to 2018/19, permanent exclusions for which the primary reason was sexual misconduct averaged 91 per year, 1.3% of all permanent exclusions.

Most of these permanent exclusions were from secondary schools. There are approximately 3,400 mainstream state-funded secondary schools, so, if evenly spread, this would mean on average around 2% of secondaries currently make a permanent exclusion for this reason in any given year.

While the total number of permanent exclusions increased during that period, there was no clear trend in the number of exclusions for sexual misconduct.

In the same 5-year period, suspensions for which the primary reason was sexual misconduct averaged 2,100 per year, 0.6% of all suspensions.

Again, most of these exclusions were from secondary schools. As stated above, there are approximately 3,400 mainstream state-funded secondary schools. So again, if evenly spread, this would mean on average 55% of secondaries currently make a suspension for this reason in any given year.

In the latest reported year (2018/19), suspension for sexual misconduct fell by 13% relative to the average of the previous 4 years.

Ofsted receives complaints from pupils and parents who have been unable to resolve complaints through local routes. Between September 2019 and March 2021, we received 291 complaints about schools that referred to peer-on-peer sexual harassment or violence, including online sexual abuse, out of 13,834 complaints (2% of the total). ISI reports that between the same dates, it received 37 complaints about schools that referred to peer-on-peer sexual harassment or violence, out of 618 complaints (6% of the total).

In 2015, the police responded to an FOI request and reported that nearly 4,000 alleged physical sexual assaults and more than 600 rapes in schools had been reported in the preceding 3 years. [footnote 21] Further discussions with the police showed that the data included incidents involving adults and may also include some incidents reported by schools but that took place outside school. The police have told Ofsted that this data should therefore not be taken as an estimate of sexual assaults and rapes by pupils in schools.

The scope of this review was such that we cannot say anything about which children and young people are most likely to be targeted for sexual harassment and/or violence or about which are most likely to abuse others.

What did children, young people and professionals tell us about sexual harassment and violence between peers and where did perceptions differ?

During our visits, we gathered the views of approximately 900 children and young people in focus groups. Of those, we surveyed just over 800 children and young people aged 13 and above about their perceptions of sexual harassment and sexual violence, including online sexual abuse.

Children and young people tended to talk to us about the issues that were the most common in their lives, which were typically sexual harassment and online sexual abuse. However, we are aware of the significant impact that sexual violence has on some children and young people’s lives and we heard several distressing examples from DSLs as part of this review. While this section focuses largely on what children and young people told us was most common, we do not want to minimise or ignore other experiences that children told us about. Where we can, we reference these experiences and use wider literature to supplement our findings where there are gaps.

The girls who responded to our questionnaire indicated that, in order of prevalence, the following types of harmful sexual behaviours happened ‘a lot’ or ‘sometimes’ between people their age:

Non-contact forms, but face-to-face:

sexist name-calling (92%)

rumours about their sexual activity (81%)

unwanted or inappropriate comments of a sexual nature (80%)

Non-contact forms, online or on social media:

being sent pictures or videos they did not want to see (88%)

being put under pressure to provide sexual images of themselves (80%)

having pictures or videos that they sent being shared more widely without their knowledge or consent (73%)

being photographed or videoed without their knowledge or consent (59%)

having pictures or videos of themselves that they did not know about being circulated (51%)

Contact forms:

sexual assault of any kind (79%)

feeling pressured to do sexual things that they did not want to (68%)

unwanted touching (64%)

These findings are strongly supported by existing research into harmful sexual behaviour between peers. [footnote 22] , [footnote 23]

Boys were much less likely to think these things happened, particularly contact forms of harmful sexual behaviour, as shown in the chart below:

Figure 2. These things happen ‘a lot’ or ‘sometimes’ between people my age (%)

Note: around 790 pupils answered the question for each type of harmful sexual behaviour. The number varies slightly by question because a few children and young people skipped some questions.

In the focus groups, many children and young people talked about teachers not ‘knowing the reality’ of their lives, or being ‘out of date’. In general, they reported much higher incidences of sexual harassment, online sexual abuse and bullying behaviours than teachers and leaders tended to be aware of.

In some schools, leaders’ estimation of the scale of the problem was more aligned with that of the children and young people’s perceptions than that of teachers. This may be explained by the fact that leaders and DSLs typically deal with confidential safeguarding cases. However, it does point to the need for development and training for all school staff on prevalence and what constitutes harmful sexual behaviour. For example, in one school, children and young people told us that the sharing of ‘nudes’ was widespread and that ‘body shaming’ and ‘slut shaming’ were also common. However, staff in this school thought that incidents largely happened outside school. One male member of staff said that there were ‘high levels of mutual respect’ between children and young people in school. Leaders were more aware of issues in the school, and the need to change what they referred to as the ‘rugby culture’, but this did not translate to all staff recognising the scale of the problem.

More positively, in some schools, staff and leaders’ perceptions of the extent of harmful sexual behaviour seemed to be fairly aligned with those of children and young people. This appears to be the case in schools where the topic has been – and continues to be – openly discussed and challenged, and where records of incidents are kept and analysed.

Generally, older teens (aged 16 and above) were more likely to say that sexual harassment and violence, including online, between peers was prevalent than younger teens (aged 13 to 15) were. For example, 79% of young people aged 16 to 17 and 86% of those aged 18 and above said that rumours about sexual activity occurred a lot or sometimes between peers compared with 61% of those aged 13 to 15. Similarly, 54% of those aged 16 and above said unwanted touching occurred a lot or sometimes, compared with 40% of 13- to 15-year-olds. While figures are high for both groups, this increase could suggest that sexual harassment and violence, including online, happen more as children and young people grow older, or that they become more aware of them.

In terms of sexualised language, children and young people told us that ‘slag’ and ‘slut’ were commonplace and that homophobic language was also used in school. Many felt that staff either were not aware of this language, dismissed it as ‘banter’ or simply were not prepared to tackle it. Many also commented that they would be wary of tackling their peers’ use of this language, even when they did not feel comfortable with such terms. Sometimes, children and young people themselves saw the use of derogatory language as ‘banter’ or ‘just a joke’. In one school, the girls spoke of lots of ‘cat calling’, often focused on their bodies, their hair colour, their size or whether they were wearing glasses. In another, girls said that boys used terms such as ‘flat, curvy or sick’ to describe them and girls found this derogatory. In another, children and young people reported boys giving girls marks out of 10 based on their physical appearance while they were travelling to and from school together.

Some children, young people and staff mentioned sexual and sexist comments happening in corridors. Some girls felt uncomfortable when boys walked behind them up stairs and in stairwells where people can see up their skirts from below. Boys in another school said that they felt anxious when walking behind girls or women, including out of school, as they did not want the girls to feel at risk, so tended to cross the road or move away. In another school, girls said that they were ‘touched up’ regularly in crowded corridors. Some named the areas of the college or school where they felt wary of being – either because they were out of sight of staff or because they felt uncomfortable with the people who ‘hang around’ there.

Other areas or situations were school-specific. For example, we heard cases of boys’ toilets with no locks, a swimming pool changing room where a single door meant that girls believed people could see them naked as they walked by, and a male teacher who gave girls compliments about their appearance.

Overall, children and young people tended to say that they felt physically safe at college or school, although there was a clear emotional impact on girls who experienced regular sexual harassment or other harmful sexual behaviour. This highlights the need for school leaders to take an approach to tackling sexual harassment and bullying behaviours that goes beyond tackling incidents in isolation. Given that children and young people talked in particular about sexual harassment happening in unsupervised spaces, such as in corridors between lessons, school leaders should identify where there might be ‘hot-spots’ of poor behaviour and act accordingly. When children and young people talked about feeling physically unsafe, this generally related to situations that occurred outside school.

Boys and girls sometimes, though not always, had different perspectives and concerns. In one school, for example, girls told us that sexual harassment was ‘a big deal’ but boys did not recognise that it was happening or identify it as abuse. Girls in this school described routine name-calling, sexual comments and objectification. Boys described jokes and compliments – but said that, for them, homophobia and racism were concerns. In another example, girls thought that things like sexist or sexualised language were common and that being asked to share inappropriate images happened regularly, but boys did not see this as an issue. Boys recognised some of the behaviours described but did not see them as widespread.

Some schools on our visits had existing LGBT+ pupil groups that were willing to speak to us. LGBT+ children and young people in those groups also reported a big gap between staff’s knowledge of incidents and their daily experience of harmful sexual behaviour. Homophobic and transphobic insults and bullying in corridors and classrooms and at social times were mentioned as issues in several schools. Some LGBT+ children and young people reported constant verbal abuse and occasional physical assault, which left them feeling physically unsafe. One teacher reported that she frequently heard both homophobic and sexist language but did not challenge this as she did not think she would be supported by other staff and her challenges would be disregarded. Literature on the experiences of LGBT+ young people also indicates that they are more likely to experience child sexual abuse and less likely to report sexual abuse than their peers. [footnote 24]

What did children, young people and professionals tell us about sexual abuse between peers online?

Previous research indicated that children and young people who are sending nudes and semi-nudes are in the minority. For example, research in 2017 indicated that 26% of young people had sent a nude image to someone they were interested in and 48% had received one of someone else. [footnote 25] However, more recent data on youth-produced sexual imagery for under-18s indicates that they are increasingly taking photos and videos of themselves to send to others. This includes incidents where they are groomed by adults to do so.

Data from the Internet Watch Foundation ( IWF ) shows a sharp increase in online sexual abuse images involving young people, which it partially attributes to a rise in the sharing of ‘self-generated’ content. [footnote 26] In the first 6 months of 2020, 44% of all child sexual abuse content dealt with by the IWF was assessed as containing self-generated images or videos, compared with 29% in 2019. The proliferation of online imagery makes it a challenge for researchers, multi-agency partners and schools to keep up, despite recent government guidance. [footnote 27]

Children and young people told us that online forms of sexual abuse were prevalent, especially being sent sexual pictures or videos that they did not want to see. The vast majority of girls said being sent sexual images, being coerced into sharing images, or having their images reshared were common. A significant proportion of boys agreed. In terms of definitions, being sent sexual pictures of images that children and young people do not want to see includes both explicit online material, such as pornographic videos, or self-generated images or videos, such as ‘dick pics’.

Images and videos were typically shared on platforms such as WhatsApp or Snapchat. Some DSLs told us that children and young people were sometimes added to large groups of peers on WhatsApp without their permission, where graphic material was shared without them properly knowing who they were interacting with.

Figure 3. These things happen ‘a lot’ or ‘sometimes’ between people my age (%)

Note: the number of both boys and girls who answered the question for each type of harmful sexual behaviour is around 790, and slightly different for each. This is because a few children and young people skipped some questions.

Although some school leaders defined online sexual harassment as ‘happening out of school’, we saw some clear evidence of how online sexual harassment has a significant impact on the normalisation of harmful sexual behaviour and unhealthy cultures within school. This was something that the victims’ groups we spoke to also highlighted. In one school, for example, children and young people told inspectors that ‘boys talk about whose “nudes” they have and share them among themselves – it’s like a collection game’. Many children and young people told inspectors that this behaviour was so commonplace that they just saw it as a ‘part of life’. One Year 12 student said, ‘The problem is that it’s so widespread it’s like playing whack-a-mole.’

Girls talked about boys being very persistent when asking for images – ‘they just won’t take no for an answer’ – some explained that if you block them on social media ‘they just create multiple accounts to harass you’. In one school, the girls spoken to by inspectors reported that some girls can be contacted by up to 10 or 11 different boys a night to be asked for nude/semi-nude images. Some children and young people thought that it was ‘ok’ and ‘acceptable’ to ask someone for a nude picture, but had been taught to think about who else might see the pictures apart from the original recipient, and not to share them further.

Some girls expressed frustration that there was not explicit teaching of what was acceptable and unacceptable behaviour. They felt that the need to educate peers had been left to them. One girl said: ‘It shouldn’t be our responsibility to educate boys.’ A minority of boys felt that gender stereotyping meant that they were being made to ‘feel guilty all the time’ and that they were being unfairly blamed for things they had not done. Nearly half of boys also said that being sent sexual images or videos they did not want to see was something that happened ‘a lot’ or ‘sometimes’ to them or their peers.

Research in this area indicates that, while most secondary school pupils recognise the harm that sexual approaches from adult strangers online bring, there is less clarity about what constitutes sexual harm within the context of peer relationships or existing online networks. [footnote 28] This shows the need for a whole-school approach that tackles sexual harassment and online sexual abuse proactively. This should include a well-sequenced RSHE curriculum, which incorporates time for open discussion of areas that children and young people tell us they are finding particularly difficult.

There is some evidence that suggests access to technology and the sharing of inappropriate images and videos are also issues in primary schools. For example, in one all-through school, leaders have identified a trend of cases in the primary school that are linked to social media. There is a no-phone policy in this school, so incidents are likely taking place outside school. Incidents cited include viewing pornography, requests to look up pornography websites and viewing inappropriate images on social media. There was an example from another school of children in Years 6 and 7 sending nudes.

Leaders we spoke to also highlighted the problems that easy access to pornography had created and how pornography had set unhealthy expectations of sexual relationships and shaped children and young people’s perceptions of women and girls. Evidence suggests that nearly half (48%) of 11- to 16-year-olds in the UK have viewed pornography. Of these, boys were approximately twice as likely as girls to have actively searched for it. [footnote 29] However, 60% of 11- to 13-year-olds who had seen pornography said their viewing of pornography was mostly unintentional. [footnote 30]

A recent survey of over 1,000 undergraduates found that one third said they have ‘learned more about sex from pornography than from formal education’. [footnote 31] While research indicates that most children and young people recognise that pornography is unrealistic, a high percentage of them reported that they had used pornography as a source of information to learn about sex and sexual relationships in the past 12 months (60% of young men and 41% of young women). This is problematic when research indicates that much pornography depicts men as aggressive and controlling and women as submissive and sexually objectified. [footnote 32]

Although there is insufficient evidence to demonstrate that viewing pornography leads directly to harmful sexual behaviours, there is evidence to suggest that young people appear to become desensitised to its content over time and that it can shape unhealthy attitudes, such as acceptance of sexual aggression towards women. [footnote 33] , [footnote 34] More frequent consumption of pornography is also associated with victim-blaming attitudes. For example, it may lead to the belief that if a woman is affected by alcohol or drugs, she is at least partly responsible for whatever happens to her. [footnote 35]

When children and young people talked to us about online sexual abuse, they did not use the terms that government guidance did. It can be difficult to address issues when the definitions are not up to date or are grouped unhelpfully. For example, ‘Keeping children safe in education’ uses the phrase ‘sexting’ for online sexual abuse. None of the children and young people we spoke to used this phrase and it appears to be out of date. In any future updates of government guidance, the full range of children and young people’s experiences should be reflected in the language used. Clearer categories of the types of sexual harassment and online sexual abuse would also be helpful for professionals.

What did children, young people and professionals tell us about sexual abuse outside school?

Children and young people in several schools told us that harmful sexual behaviour happens at house parties, without adults present, and that alcohol and drugs are often involved. In one school, leaders talked about parties that have happened when parents have left children and young people unsupervised and they ‘are allowed to see, do and hear what they want’. In another, governors talked about a culture of ‘affluent neglect’ and leaders said that some parents bought alcohol for their children to have at parties when they were away. It is important to note, however, that incidents of harmful sexual behaviour or unhealthy cultures were certainly not confined to ‘affluent’ children or young people.

An analysis of key words in the 2,030 publicly available testimonies on the Everyone’s Invited website found that a third (670) mentioned drugs or alcohol. Of these, words equating to ‘drunk’, ‘party’, alcohol or names of different types of alcohol and ‘drinking’ featured in the most testimonies. [footnote 36] These findings should be treated with caution as they are not representative. They do, however, give an insight into the experiences of some children and young people.

Some children, young people and leaders also identified parks as places where sexual harassment and violence took place.

In a minority of schools, children, young people and leaders talked specifically about cultural factors that contributed to boys’ harmful sexual behaviour. One Year 12 boy talking about other boys told inspectors: ‘Essentially, they only spend time with boys, then hit puberty and start going to parties with booze and drugs and girls, and they don’t know how to handle it. And some of the boys are very wealthy and have never been told “no” before.’ In another school, girls similarly told inspectors that some of the boys had a sense of entitlement and had never ‘been told no’. They talked about a sense of ‘male superiority’ in the school. In another school, children and young people said that harmful sexual behaviours occurred outside school at parties but that victims did not want to disclose it because of the ‘power and money culture’ within which they live. As one girl put it, ‘victims do not want to commit social or career suicide’. These findings point to the power dynamics that are often present where there are sexual harassment and sexual violence, including online. These dynamics and social hierarchies are present across all school types.

Not many children and young people spoke about sexual abuse in relationships, although in one school they mentioned that incidents sometimes occurred between peers in established relationships, where ‘things go too far’ or ‘go over the line’. Some children and young people also talked about wanting to know more about issues around consent in established relationships. Textual analysis of the publicly available testimonies on the Everyone’s Invited website indicates that, where a relationship to the perpetrator is named, around two thirds of the testimonies say that the perpetrator was known to them and around a fifth was a boyfriend. [footnote 37] Evidence suggests that early experience of dating and relationship violence is associated with subsequent adverse outcomes, such as suicidal behaviours, other mental health problems and low educational attainment. [footnote 38]

Girls talked about feeling uncomfortable because of behaviour from peers on bus journeys (including school buses), where they said they experienced the kind of sexual harassment and bullying behaviour that happened in school. Girls in one school, for example, said that boys often made ‘rape jokes’ on the school bus. More widely, some children and young people said they did not feel safe from strangers on trains or in parks, alleys, car parks and side streets. Some girls in particular said that feeling unsafe in these situations was pervasive. One girl said that a man had deliberately brushed her younger sister’s leg recently and another girl had told her sister to get used to it as ‘this is what happens’. Younger girls aged 12 to 13 in another school said that they felt uncomfortable walking through town in their uniforms. Evidence from other research also indicates that this is an issue. A recent survey of girls and young women aged 13 to 21 found that more than half have felt unsafe walking home alone and had experienced harassment or know someone who has, and nearly half feel unsafe using public transport. [footnote 39]

How does the current system of safeguarding listen to the voices of children and young people?

In this section, we outline what children and young people told us about why they do not speak to adults about sexual harassment and sexual violence, including online. We also share the practices that we identified in schools that both enable and act as barriers to children and young people telling adults about their experiences.

On our visits, we found that children and young people rarely speak to adults about sexual harassment and sexual violence, including online, even though they told us that sexual harassment and online sexual abuse are prevalent in their daily lives.

The reasons why children and young people significantly under-report sexual abuse are well documented. Although research indicates that one of the main reasons for this is a misplaced sense of shame and embarrassment, there are many other complex factors at play. For example, children and young people may have a fear of social exclusion by peers, worry about how adults will react, and feel that once they talk about abuse, the next steps will be out of their control. [footnote 40] Research also indicates that children and young people are even less likely to tell someone about abuse when it is perpetrated by peers. [footnote 41]

Research indicates that, even when some children and young people attempt to tell someone about abuse, they are not always listened to or believed. For example, NSPCC research on young adults who experienced abuse and family violence as a child found that 80% had to make more than one attempt to tell someone about the abuse before they were listened to and taken seriously. Ninety per cent of the young people who told someone had a negative experience at some point, mostly where those they told had not responded appropriately. [footnote 42] Our joint targeted area inspection into child sexual abuse in the family also found that some groups of children, such as boys, disabled children and children from some minority ethnic groups face greater barriers to talking about abuse and are less likely be believed when they do. [footnote 43] The ‘Beyond referrals’ research into harmful sexual behaviour in schools found that, even where schools had provided a range of ways for children and young people to talk to staff about peer abuse, there remained significant barriers to them reporting abuse. [footnote 44]

On our visits, we found that professionals still rely too much on children telling someone about abuse instead of recognising other indicators, such as emotional or behavioural changes. We also found this in our joint targeted area inspection on the theme of child sexual abuse in the family.

In some schools we visited, teachers recognised that they needed to do much more than rely on children and young people’s verbal reports of sexual violence or sexual harassment, including online. In these schools, they had taken steps to create a culture where it is clear what acceptable and unacceptable behaviour is for staff, children and young people. Teachers were encouraged to log indicators of concern on a centralised recording system so that DSLs could ‘build a picture’ and decide whether further investigation was required.

Professionals’ and victims’ groups we spoke to also said that it is rare that children and young people talk about abuse as a ‘one-off’ and that this may be a process that happens over time. Victims’ groups we spoke to also considered that children and young people are much more likely to talk about abuse when secure and trusting relationships have been developed within a supportive culture.

Who, if anyone, do children and young people talk to about sexual harassment and violence?

Most children and young people we surveyed told us they would feel able to tell someone about their experiences of sexual harassment or sexual violence, including online (either inside or outside school). In order of most likely to least likely, they said they would tell:

a parent or carer

another family member

an adult at their school or college

a helpline/charity

someone else, including a social worker, coach or religious leader

Most of the children and young people said they would feel most comfortable talking to friends, something that was also highlighted in our discussions with victims’ groups. This emphasises the importance of schools teaching acceptable and unacceptable behaviours, with clear guidance and support, so that children and young people can support each other to bring issues to trusted adults.

The children and young people we asked said that, if they were to talk to an adult, it would be a parent or someone in their family. Lower numbers of children and young people said they would talk to adults in their school. When children and young people said they would talk to someone in school about sexual harassment and sexual violence, including online, they tended to identify senior staff. Research indicates that when children and young people do tell a professional about these issues, it is most likely to be a teacher or leader at their school. [footnote 45] This highlights the importance of training leaders and teachers on good practice in this area and supporting children to bring issues to trusted adults. It also shows that taking time to build trusting relationships with children and young people can help them talk about abuse.

Inspectors found that, in more than half of the schools they visited, procedures were clear and safeguarding teams were visible and known to children and young people. Children and young people were aware of the procedure for reporting concerns and, in this respect, schools were supporting them to tell them about sexual harassment and sexual violence, including online sexual abuse. However, staff, children and young people told us that, even with this good practice, children and young people do not always report incidents for a variety of reasons.

This illustrates that schools cannot rely on children talking about sexual harassment and sexual violence, including online abuse. Just having clear procedures and visible staff are not sufficient to support children and young people to talk about these issues.

What prevents children and learners from reporting sexual harassment and violence?

Children and young people in the surveys and focus groups told us that there is a range of barriers that prevent them from talking about sexual abuse and harassment, including online. These included:

worry that what happened next would be out of their control

worry that they would be branded by their peers as a ‘snitch’ who got a peer into trouble

worry that they would be ostracised from friendship groups

worry that there would be damage to their reputation, for example through sexual rumours being circulated about them

feeling that they would not be believed

feeling that they might be blamed for doing things they were told not to do, for example sending nudes, even if they were pressured to do so

feeling that nothing would be done

feeling that things were so commonplace ‘there’s no point’ in raising it

feeling embarrassment and shame when talking to someone from a different generation about sex

The most common reason that the children and young people who answered our survey gave for not reporting an experience was not knowing what would happen next. Victims’ groups also told us that a poor response by professionals can leave children and young people feeling out of control. In one school, the DSL was aware of this issue and had educated children and young people about what would happen if they told someone about abuse, emphasising how children’s best interests were at the heart of any investigation. In the same school, the DSL took the time to develop a trusting relationship with a victim of sexual violence. This helped the victim get to the point where they could talk about the incident fully to the school, the police and other multi-agency partners.

In focus groups, children and young people told us that deciding whether to report an incident depends on the perceived severity of the incident. For example, children and young people thought they would be listened to if they reported ‘serious’ incidents but would be less likely to report what they see as ‘common’ incidents, such as ‘being asked for nudes’ and ‘comments from boys in corridors’. This is largely because they feel that some of the incidents are so commonplace ‘there’s no point’ reporting them. Some forms of sexual harassment and online sexual abuse have become so normalised for children that they do not see the point in reporting and challenging this behaviour.

Some children and young people talked about previous incidents that have been reported, which in their view had ‘come to nothing’. Consequently, they did not believe that the school would do anything if they did report abuse, especially if incidents took place outside school. Some DSLs told us that, at times, this view was compounded when criminal investigations did not lead to a prosecution or conviction. DSLs also told us that the confidential nature of investigations left some victims or children and young people perceiving that ‘nothing had been done’. Again, this led to them thinking that there was little point in telling someone about abuse.

Schools and multi-agency partners need to strike the right balance. Over-criminalisation of children and young people is not desirable or helpful. This means that, when dealing with peer-on-peer abuse, multi-agency partners, including the police, may decide to provide intervention and support for the perpetrator. They may find this the best way of preventing further abuse, instead of criminalising the child. However, this can sometimes lead to the victim feeling that agencies have not responded appropriately. Furthermore, as safeguarding investigations must be confidential, it can also feel to some children and young people as though nothing has been done, when in reality action has been taken.

Our visits found that, in a minority of schools, there were unhealthy cultures that prevented children and young people from talking to adults about sexual harassment and online sexual abuse. They did not think anything would be done as a result. In these schools, many children and young people talked about not being believed. They also thought that teachers were willing to condone sexualised name-calling and harassment. Worryingly, one governor reported that ‘blokeish banter’ was just part of growing up. This is in line with previous research on the topic, where children and young people reported that some teachers dismiss sexual harassment as ‘banter’ or ‘messing around’. [footnote 46] , [footnote 47]

Reputational damage and social consequences

In more than half of schools, children and young people said worry about ‘reputational damage’, for example being ostracised from a social group or damage to a sexual reputation, stopped them reporting. They were also worried about being labelled as a ‘snitch’ who got their peers into trouble. Some said that by the time incidents were shared on social media it was too late for leaders to address reputational damage. As one pupil put it, although leaders were trying to help, they ‘wouldn’t be able to – it’d be too late’. Feedback from victims’ groups also supported this finding.

In these discussions, it was clear that, while their sense of embarrassment and shame was a common reason for not reporting, children and young people also weighed up other complex issues. This included the social consequences for them if they did report, relative to the severity of the incident. Previous research on this topic identified that, when children and young people did talk about sexual harassment and sexual violence, including online, this resulted in social isolation and the victim being stigmatised and harassed by peers. [footnote 48]

Some children and young people had a clear desire for justice, but this was at odds with others who told us that harsh sanctions for their peers put them off talking to an adult about abuse. These children and young people told us that sometimes the consequences of reporting abuse have been so ‘punitive’ for the perpetrator that, rather than acting as a ‘deterrent’ to harmful sexual behaviour, the result is to ‘put off’ children and young people from reporting incidents. They were also worried about police involvement. They said that they would prefer a pastoral and supportive approach without the immediate threat of police involvement.

Some children and young people told us that their perceptions of the behaviour policy can be a barrier to reporting incidents to staff if, in their view, the policy is ‘unfair’. These children and young people do not feel confident that staff would ‘deal with things sensitively’. Some said that school leaders are not as interested in their ‘personal well-being’ as they are in the ‘outward appearances’ of the school.

This highlights the complexity for schools and multi-agency partnerships in managing peer-on-peer sexual harassment and sexual violence, including online. Children and young people need to feel confident that staff will respond in a proportionate and fair way to incidents. They also need to be told the different potential consequences of reporting. Schools need to have a range of responses to different forms of behaviour and intervene in a proportionate way at the right time.

We are aware of some research that explores how schools tackle sexual harassment and sexual violence, including online. [footnote 49] However, the terms of reference of this review did not include a consideration of which systems of consequences deter children and young people from future harmful sexual behaviour. It is an area that warrants further research.

We recognise that it can be challenging for school leaders to get their approach right and that, sometimes, what children and young people say they want is not necessarily in line with what statutory guidance requires. Schools are often the place that parents, children and young people turn to first in cases of sexual violence before going to the police. Professionals must follow statutory guidance. But they also have a responsibility to explain to children and young people what will happen if they do report abuse. Better dialogue in schools about the different forms of behaviours and likely responses to such behaviours may mean children feel better informed to make decisions about reporting. Ultimately, it is for schools (with the support of multi-agency partners where relevant) to decide the appropriate course of action.

Reaction from adults and worry about what would happen next

Some children and young people told us that they felt that if they did tell an adult about abuse, they could be ‘blamed or not taken seriously’. These children and young people were worried that they would be judged and would feel embarrassed by the inevitable questioning.

Being blamed or parents finding out were the third and fourth most common reasons that children and young people who answered our survey gave for not talking about harmful sexual behaviour. In the focus groups, they said being worried about their parents finding out would be a reason for them not to talk to an adult about abuse. This was especially the case where drugs and alcohol were involved. Some also said that they feared they would be blamed for doing something they had explicitly been told not to do, for example sending nudes, even when they had been pressured into doing so. They were also worried they would have to show images to staff members and that they would feel embarrassed and ashamed when talking to someone from a different generation about sex.

These findings emphasise the need for adults, including parents, to be better educated and informed about sexual harassment and sexual violence, including online, between peers. It is also vital that adults are supported by professionals to provide appropriate, non-judgemental responses to children and young people who talk about abuse. Children and young people need reassurance and open discussion in schools about what they can expect, and what will happen if they do need to report concerns. They also need trusted adults they can talk to.

Understanding confidentiality

Pupils’ concerns about confidentiality can be a barrier to reporting. Children and young people know that schools cannot always keep everything confidential and may need to share information with other agencies. But they want assurance that there are some things that are ‘not to be passed on’. Children and young people do not always know ‘what will be done with the information’. They are also worried that responses such as a whole-school assembly would just set the ‘rumour mills going’ and could undermine the anonymity of those involved.

While all the professionals we spoke to highlighted the need for confidentiality when a child reports sexual harassment and/or violence, including online abuse, some children and young people gave examples of how they could be made aware that an investigation was ongoing. As one pupil put it, ‘sometimes if you report something in school everybody quickly knows about it. A teacher takes you out of a lesson. Everyone is like, “What was that about?” when you come back into the classroom’. Confidentiality may also be compromised if a pupil speaks to a friend first, as many told us they would, or if an incident is shared on social media before the child or young person has spoken to an adult about it.

In light of this, all schools should take a whole-school approach to tackling sexual harassment and online sexual abuse because it is likely that they are underestimating the scale of the problem. This should include speaking to children, and listening to their views and experiences and using these to inform a preventative approach to sexual harassment and sexual violence, including online sexual abuse.

What does good practice look like?

There are several good practice models that encourage children and young people to tell someone about abuse. The ‘Beyond referrals’ project includes several recommendations to help schools develop an environment where children and young people can talk to professionals about abuse. These recommendations include:

engaging students in small-group sessions to discuss different forms of harmful sexual behaviour

mapping the school and out-of-school spaces to identify where harmful sexual behaviour takes place

using a curriculum-based approach to tackle a culture where reporting is perceived as ‘snitching’ [footnote 50]

The project also highlights the following as important:

children having a trusting and positive relationship with an individual staff member

children being aware of previous positive experiences of school responses

teachers showing that they respect students, listen and respond subtly

having staff with a specialist role not linked to teaching or behaviour

This last point was raised by some children and young people on our visits. They were worried that they would get into trouble if they spoke to the DSL when this individual had a dual role as the deputy headteacher for behaviour. Some schools we visited countered this by having a small number of trained staff who can deal with safeguarding matters in collaboration with the DSLs . However, we recognise that in some schools, especially small ones, it is not possible to manage this. Schools should consider the DSL ’s role carefully, including how children and young people may perceive it. They should try to avoid any negative associations that might compound children’s misplaced sense of shame, embarrassment or ‘being in trouble’.

The NSPCC has also developed guidance for professionals to support children and young people when they talk about abuse. This highlights the importance of:

demonstrating to a child that you are listening

putting a child in charge of the conversation

reassuring a child and showing empathy [footnote 51]

The recent guidance from the UK Council for Internet Safety outlines some good practice in dealing specifically with incidents of youth-produced sexual imagery. [footnote 52]

In our visits, we found promising practice that places the voices of children and young people at the heart of the approach to safeguarding. For example, one school had held ‘listening events’ to help children and young people share worries and speak to adults in a safe environment. Another school used an anonymous questionnaire to ask children and young people what the issues for their age group were and what language they used when discussing sexual harassment and online sexual abuse. Responses were built into staff training and helped build a culture where children and young people, leaders and teachers had a shared understanding of what sexual harassment and sexual violence, including online, were. One leader explained:

So often, nobody is talking to young people about these things – including or especially their parents. These conversations are awkward so there has almost been a tacit agreement not to have them. This means that we risk not knowing what young people do, or think, and how what they do is affecting them.

In some schools, we also found evidence of how RSHE lessons had helped children and young people’s understanding of these issues. This had led to a culture where children and young people felt able to talk to someone about sexual harassment and sexual violence, including online, or to raise concerns about their peers. The victims’ groups we spoke to also outlined the importance of creating this kind of supportive and open culture.

In some schools, leaders were reflecting on the testimonies on the Everyone’s Invited website to critically evaluate and strengthen their processes. For example, in one school, there was a ‘changing the narrative’ pupil group. The group sensitively gathered information from other children and young people, talked about issues and informed leaders of their findings. In another school, leaders were trialling different reporting methods such as private messages through Teams chat. There was a whole-school approach to educating children and young people and encouraging them to come forward, delivered through assemblies, tutor time, posters and leaflets. They were also actively engaging parents and alumni to discuss concerns and address them where possible.

While it is too early for leaders to talk about the impact of such initiatives, children and young people in these schools told us that they can see that leaders are trying to respond in positive ways to the Everyone’s Invited testimonies. They told us that they feel confident in talking about sexual harassment and sexual violence, including online, when there is a positive and open school culture.

To what extent do schools know about sexual abuse? When they do know, how do they respond?

In this section, we outline schools’ understanding of the prevalence of sexual harassment and sexual violence, including online, and how they respond when they do know about it. We also share what approaches schools are taking to tackle these issues and where there are still gaps.

Responding to incidents

There were many examples where incidents of sexual violence were dealt with appropriately and school policies and statutory guidance such as ‘Keeping children safe in education’ were informing practice. Examples of practice in these schools often included:

involving other agencies where appropriate

providing support for all children and young people involved (victims and perpetrators) through pastoral teams and professional counselling

informing and working with parents

However, our visits highlighted some inconsistencies in responses where professionals had interpreted guidance differently. There was also variability in DSLs ’ understanding of which incidents needed be referred to the police and children’s social care, meaning that some historical incidents that should have been referred were not. Some of the schools in our visits used different mechanisms to strengthen their own decision-making processes. For example, they were part of wider networks of DSLs or would call on the local authority to ‘sense check’ decisions when unsure.

In around two fifths of the schools visited, inspectors noted that leaders had recently adapted either their safeguarding protocols, systems for monitoring or staff training on harmful sexual behaviours. This was in reaction to the Everyone’s Invited website.

As we outlined earlier, many professionals tended to underestimate the scale of sexual harassment and online sexual abuse. DSLs and leaders in schools assessed the extent of the problem more accurately than teachers, although they acknowledged that reported incidents of sexual harassment and sexual violence, including online were the ‘tip of the iceberg’, as one DSL put it.

Furthermore, some schools were dealing with incidents of sexual harassment and sexual violence, including online, in an isolated way, without considering the context and wider safeguarding risks. This meant that they were not considering factors such as:

whether other children and young people were at risk

whether there were spaces in or outside school where children and young people were at particular risk

where power dynamics in peer relationships were creating unhealthy cultures

In these schools, incidents were dealt with reactively instead of proactively. In some cases, we found evidence that behaviours were not monitored well enough following an incident.

In addition, in about a quarter of schools, sexual harassment such as inappropriate sexualised language was not always addressed and identified early enough. In other instances where school leaders were aware of the problem, there was a limited and ineffective response to support children with this issue. Children and young people reported to inspectors that this behaviour had become normalised in their schools.

In one positive example, a group of girls raised issues with the headteacher after the Sarah Everard case about the normalisation of harmful sexual behaviour, which they felt needed to be addressed. Leaders updated the RSHE curriculum following this. The girls reported that, since this intervention, there had been a reduction in unwanted sexual language. The boys in this school also said they appreciated the changes to the curriculum and would like more time to discuss these kind of issues as they are so important.

Recent government advice for those in education on how to tackle the sharing of nudes and semi-nudes talks specifically about how individual case management impacts on school-wide culture: [footnote 53]

Individual incidents of peer abuse and sexual behaviour (the sharing of nudes and semi-nudes can fall under this category) can lead to unhealthy or damaging cultures within the school community. How these incidents – including incidents of ‘low level’ harmful sexual behaviour – are responded to directly affects the culture of the school. If handled poorly, an unsafe and unhealthy set of norms can be created which enable peer-on-peer abuse and this can also prevent other children and young people from disclosing. It must be recognised that the individual case management can affect school-wide culture, peer response and all children’s ability to speak out.

The government’s expectation of schools and colleges and how they should respond to all forms of sexual harassment and violence is clearly set out in advice and guidance. [footnote 54] Ofsted has also previously written about peer-on-peer abuse and how education providers should respond. [footnote 55]

It is a concern that this review has identified that many instances of sexual harassment, including the pressure to share nudes and the sharing of youth-produced sexual imagery without consent, are going unrecognised or unchallenged by school staff. We are especially concerned that for some children and young people this is so commonplace that they see no point in raising it as a concern with staff.

How schools perceive their responsibility in the context of sexual harassment and sexual violence, including online sexual abuse

Schools are in a difficult position when it comes to navigating responsibility and subsequent decisions when there is an incident of harmful sexual behaviour that occurs between peers outside school. When they are made aware of incidents, schools have a duty to inform multi-agency partners and work with them to prevent further abuse and ensure that children and young people are safe. In the schools we visited, it was clear that schools were following the guidance in this respect.

However, some leaders talked to us about how hard it is to take decisions when investigations are ongoing over a significant period of time or when the police do not have the basis to act. They reported feeling left with difficult decisions to make, such as whether to separate the peers when criminal investigations did not lead to a prosecution or conviction.

Leaders in some schools said they were unclear about the scope of their safeguarding responsibilities and about how and when they could intervene. They reported some of the challenges they faced as:

supporting children and young people to trust professionals enough to talk about harmful sexual behaviour that happened outside school

parents’ lack of understanding about what their children were doing outside school

their ability to protect children and young people outside school, for example when parties take place with parents’ consent and incidents happen there

the role of exclusion when there has been a serious incident of sexual violence and how this intersects with any criminal investigation and action (some leaders say that this has caused them great anxiety and further guidance on it would be welcome)

how they could help children and young people to be safe when using rapidly changing social media outside school

While recognising these challenges, it is interesting to note the different approaches of some school leaders. Clearly, if children are at risk, whether within or outside the school gates, schools have a responsibility to work with multi-agency partners to share information where appropriate and refer children on for support and protection. However, it is important to note that, while sometimes multi-agency work may continue, the ‘aftermath’ of any investigation is often left with school leaders, who have little guidance to support their decision-making. Some leaders also talked about how difficult it was to make effective decisions when police and other lengthy multi-agency investigations were ongoing.

In-school approaches to address sexual harassment and violence

In the schools we visited, leaders told us that they used a wide variety of sanctions for perpetrators of sexual harassment and sexual violence, including online sexual abuse. They intended these to be proportionate and to take account of individual circumstances. Examples included fixed-term exclusions, detentions, internal referrals and removal of privileges. Schools also included parents and carers as part of any response. Some children and young people were moved permanently to a different class or form. Some leaders said they found it more difficult to issue sanctions for incidents taking place outside school than inside school because they consider that their behaviour policy does not apply to these incidents.

Some children and young people, particularly girls, believe that sanctions are often not tough enough or that the wrong person is sanctioned. In one school, for example, girls felt that boys who pressured others to send ‘nudes’ were punished less than the girls who sent the images. In another, girls felt that the lack of severe sanctions meant that the harmful sexual behaviour continued. This suggests that, in some schools, the threat of being caught and punished is a much weaker influence on behaviour than an underlying culture where sexual harassment and online sexual abuse can thrive. In some schools, inspectors noted that children and young people did not seem to know enough about the range of sanctions that could be used and that this seemed to affect children and young people’s willingness to talk to adults about sexual harassment and sexual violence, including online sexual abuse.

In addition to sanctions, many schools told us that they offered support to the victim and the perpetrator to prevent future incidents and tackle any underlying causes of harmful sexual behaviour. This included counselling, pastoral support, educative approaches and the involvement of families, social care and external agencies, such as child and adolescent mental health services and specialist services. Many schools recognised the importance of family involvement and the need to support parents and carers. In some schools, leaders said they would appreciate more support services for perpetrators of harmful sexual behaviour, especially at an early stage, when inappropriate and problematic behaviours are first identified.

The extent to which leaders evaluate whether sanctions and/or interventions are effective varies, as does the evidence of ongoing monitoring of children and young people who have perpetrated harmful sexual behaviour. For example, in one school, records state that perpetrators should have received education following an incident. But there was no evidence that this happened or what the content was. In other schools, leaders reported checking regularly with victims and perpetrators to ensure that support systems were having the desired effect.

Staff training and development

Most staff receive annual safeguarding training, which includes updates on ‘Keeping children safe in education’. This training aims to ensure that staff understand the latest guidance, and there were examples where it included an understanding of different forms of harmful sexual behaviour.

In most schools we visited, leaders understood the continuum of harmful sexual behaviours, but not all of them appeared to have shared this understanding with all staff. For example, only a handful of schools had provided detailed training for staff on the continuum of harmful sexual behaviour and how to address the context behind incidents of harmful sexual behaviour, such as peer group dynamics or unsupervised spaces where poor behaviour occurred. Where this training was in place, it was part of a wider school ethos and long-term strategy for preventing abuse. Evidence from previous research indicates that this is the most effective way to tackle sexual harassment and sexual violence, including online. [footnote 56]

Most staff training on harmful sexual behaviours tended to be piecemeal. This was often because it was incorporated into training on other important aspects of safeguarding. For example, in one school, information on peer-on-peer abuse was confined to one slide in a much longer presentation on safeguarding. In a few schools, there was no training on peer-on-peer sexual harassment and sexual violence, including online. These schools expected staff to read the guidance instead.

It is important that, in any school, governors have a good understanding of sexual harassment and sexual violence, including online, so that they can provide the right level of support and challenge for school leaders and DSLs . In just over a quarter of the schools we visited, inspectors reported that governors had some sort of safeguarding training, although it was not always clear that this included specific training on harmful sexual behaviour. Evidence indicates that there are gaps in governors’ knowledge of online safety issues in particular. [footnote 57] Around a quarter of the schools we visited had a specific safeguarding governor, and some of those met regularly with the DSL . In around a third of the schools, inspectors highlighted that governors are involved in reviewing incidents, safeguarding logs, behaviour logs or procedures related to harmful sexual behaviour. This could be to help identify wider patterns, or to check that school policies and procedures have been adhered to. Our visits indicate that governors could receive better training and be more involved in tackling harmful sexual behaviours.

Training and development for DSLs

Being a DSL requires regular training and additional support to help with the emotional impact of the role and the expertise that is required. In some schools, we saw good practice. DSLs were engaging fully with the LSPs and forming support networks locally with other DSLs . They had protected time on timetables, opportunities for supervision and regular training from LSPs . However, some DSLs talked about a lack of high-level training at LSP level in how to address, manage and follow up on allegations of a serious sexual nature.

Some DSLs said it was hard to keep up with guidance, and that publishing updates before the summer holidays instead of September would allow them to plan staff inset days in September accordingly. The Home Office’s ‘Tackling child sexual abuse strategy’ includes a commitment from the DfE to provide high-quality resources on addressing child sexual abuse. [footnote 58] These will be held on a digital support platform for DSLs . Once released, this should help to upskill professionals and help with some of the training needs that DSLs identified.

Learning from incidents

Inspectors noted there were inconsistencies in how staff were defining and recording instances of sexual abuse, including recording of discussions with multi-agency partners and the outcome of referrals. Without an agreed and shared system of recording, schools are limiting their ability to track and monitor concerns and appropriately plan their response to sexual harassment and violence in order to reduce risk. Some schools had systems in place for recording incidents, but they did not all then analyse the data and information to identify any patterns or trends that could inform their response.

A few schools had enhanced systems in place to record concerns and track patterns of behaviour. These, together with systems to gather information about pupils’ concerns, for example through surveys, gave schools a better understanding and oversight of issues. DSLs were able to build a better picture of low-level changes in behaviour or incidents that may indicate a response is required, either at pupil, peer group or school level, instead of just referring on to multi-agency partners. These schools used the RSHE curriculum and assemblies, for example, to address concerning patterns of behaviour.

How are schools successfully delivering the new RSHE curriculum and how can they be supported further?

The terms of reference of this review asked us to consider the new RSHE curriculum. However, the disruption of the last year means that schools’ ability to plan and deliver the new curriculum will have been significantly affected. Most children and young people talked about their previous experience of RSHE and PSHE , which we know does not necessarily address how the curriculum will support them in future. Where we can, we point to how schools and colleges are implementing the new RSHE curriculum and where they can be supported further. The DfE ’s research into schools that adopted the RSHE curriculum early also provides insights. [footnote 59] We recognise that RSHE is just one part of a whole-school approach to tackling sexual harassment and sexual violence, including online. Other factors, and the role of parents, are also vital.

Our visits identified a number of issues that meant that children and young people were not getting the quality of education in this subject that they should be. These included weak implementation of RSHE , poor teacher subject knowledge, and significant gaps in curriculum coverage. The children and young people we spoke to were seldom positive about their RSHE and PSHE lessons. They felt that the quality of the input varied according to who was teaching them and that the lessons were not relevant to their daily experiences and the reality of their lives. Some teachers also talked about not feeling prepared to teach outside their subject specialism and receiving resources too late to prepare for sessions.

In half of the schools visited, leaders had developed an RSHE curriculum. This commonly involved expertise from a trained RSHE / PSHE lead in planning and organising the curriculum. Inspectors viewed detailed planning in these schools that showed clear examples of a strong curriculum narrative. Emphasis was placed on the importance of respect and prioritised teaching about consent and healthy relationships. Concepts were generally sequenced and interwoven in an ‘age and stage’ manner, allowing for content to be revisited and built on in further depth at appropriate points in children and young people’s learning. Many leaders spoke knowledgeably about the content of their RSHE curriculum.

However, inspectors also noted that in many of these schools, despite a well-planned curriculum, there were often constraints in place that impacted on its implementation. Similar to our findings in other subjects, [footnote 60] some of the main weaknesses in the delivery of RSHE were linked to the lack of subject knowledge that teachers had on topics like consent, healthy relationships and sharing of sexual images.

In a few schools, planning was almost non-existent. Leaders did not value the importance of the subject. In others, leaders were confident in the delivery of some areas of PSHE , such as cyber-bullying and respecting differences, but were less assured when it came to including relationships and sex education. This meant that, in many of these schools, teachers were not teaching about consent, healthy relationships and the use of sexual imagery. These findings reflect the picture from our last PSHE subject survey. [footnote 61] In that report, we found some schools focused on the mechanics of reproduction and not enough on understanding healthy sexual relationships.

In a few schools, teaching about sexual relationships was covered in science or, in faith schools, religious education lessons, but this did not commonly address same-sex relationships. Some children and young people noted that RSHE lessons were not inclusive enough and only focused on heterosexual relationships. In a few schools, planning was piecemeal. Inspectors found that these schools treated it as a tick-box process to ensure that some coverage was provided over all the statutory requirements. It is a concern that in a few schools, children and young people told us that they had learned more about sexuality ‘from social media than from school’ or had got their education about relationships from their peers and social media.

In around half of the schools, teachers, who were often expected to deliver content through tutorial time, had not received any formal training on RSHE . Several teachers reported that resources for the lesson were sent late, sometimes too late for them to look through fully before having to teach the lesson. Others expressed resentment that they had to teach relationships and sex education beyond their own subject specialism. As children and young people from the focus groups suggested:

It’s like a task that teachers have to do, they don’t take it seriously, so it’s not a good environment to learn about it. How can any of us take it seriously if they don’t? You can tell they don’t want to do the PowerPoint. It’s always stuff we’ve done before anyway.

This meant they were less keen to discuss sensitive issues and speak to them about sexual harassment and sexual violence, including online. They were unsure what the reactions of less confident teachers would be.

Many leaders confirmed that staff were generally not very confident to deliver the curriculum in areas related to sexual harassment and sexual violence, including online. On this basis, there was in-school variation in the consistency of how RSHE was delivered. Children and young people from the same schools reported both positive and negative experiences, depending on teachers’ level of subject knowledge and confidence. These findings indicate that additional resources to support non-subject specialists to teach RSHE would be beneficial for schools to help them successfully implement the new RSHE curriculum.

In some schools, leaders did not regularly or systematically check on the effectiveness and impact of teaching. This meant they were unaware that some staff lacked knowledge or confidence in delivering content. Leaders also did not seek feedback from children and young people. This left them unaware that children and young people were not getting the rich discussion required to fully understand complex concepts, such as consent.

In some of the schools with a more secure curriculum plan, leaders tended to alleviate this variation in teachers’ expertise by allocating discrete curriculum time to RSHE , rather than delivering it through a class tutor system. Leaders in these schools had carefully considered which staff should deliver the RSHE curriculum and provided appropriate training, rather than placing expectations on all staff. They also invited trusted external speakers with specialist knowledge to talk to children and young people and delivered aspects of the curriculum through assemblies. However, some mentioned that aligning speakers’ availability with the curriculum was tricky. One school also used external speakers to hold remote sessions on aspects of the RSHE curriculum for parents, carers and their children.

Some leaders told us that finding space in the timetable for RSHE was problematic. The actual hours set aside for it were sometimes minimal and did not meet the requirements set out in the curriculum plan to teach content fully. Therefore, teachers and tutors often struggled to cover the curriculum in the detail in which it had been planned. Several children and young people also identified that the time planned for RSHE was not always valued, particularly by some teachers, and was often ‘taken for other things’. This was particularly the case for older children and young people who had other pressures, such as revision or catch-up interventions.

Children and young people were generally concerned that the curriculum did not take account of their level of maturity. They felt that they could deal with more challenging content than teachers realised. This was particularly raised as an issue in the teaching of issues around consent. Older children and young people accepted that teaching about consent through analogies made sense in younger years. But this became jarring and patronising for them when the same or similar content was repeated in their later years of school. Some said that the popular ‘cup of tea’ consent video could only go so far.

Year 6 pupils we spoke to had a good understanding of friendships and relationships. However, in one faith school, the Year 6 children said they were taught about being a good friend in an indirect way (through religious teachings) and would value something more direct.

When planning the RSHE curriculum, it is essential that schools work closely with parents and carers to talk them through areas covered, address any gaps in their understanding and equip them with the confidence to be able to have open discussions with their children. Research indicates that there is a particular gap in parents’ understanding of issues around online sexual abuse. Many parents are interested in learning more about the issue through schools and online resources. They also want more support in understanding how to talk about these issues with their children. [footnote 62]

How well are multi-agency safeguarding arrangements working?

We held discussions with 12 LSPs to seek their views on how well multi-agency safeguarding arrangements to tackle sexual harassment and violence were working between LSPs , schools and colleges. We did not review the work of the LSPs as part of this thematic review. This section reflects their views, alongside the views of school and college leaders.

Some LSPs we spoke to took a strategic approach to tackling sexual harassment and sexual violence, including online. For some, this was part of wider work on peer-on-peer abuse and extra-familial safeguarding. These LSPs reported that they had been working closely with schools and colleges to collate and analyse data on sexual harassment and sexual violence, including online. They could speak fluently about the experiences of children and young people, ranging from criminal cases to sexual harassment. They reported working closely with schools and colleges through the multi-agency audits and had systems in place to understand children and young people’s experiences. They were aware that some of these issues were so common that may become somewhat normalised, a view that was also supported by the victims’ groups we spoke to.

However, not all LSPs took this approach. A small number of LSPs told us that sexual harassment and sexual violence, including online, in schools and colleges were not significant problems for children and young people in their area. It was not clear whether this was because a clear assessment had been made or because they were underestimating the problems. Given what children and young people have told us about the prevalence of sexual harassment and online sexual abuse in their lives, it is likely to be the latter.

We were presented with a mixed picture of partnership working from schools, colleges and LSPs . There were examples of LSPs reporting effective engagement with a range of schools and colleges, including local authority, academy, independent and faith schools. But this was not the case in all areas. LSPs told us that some schools and colleges do not always engage as fully with them as they are required to as a ‘relevant agency’. For example, LSPs reported that independent schools may commission outside training rather than accessing partnership training, which makes it hard for them to know and understand what is being delivered in these schools and harder for the schools to link into an early help offer. Some LSPs also reported that independent schools may be less likely to complete audits commissioned by the LSP . They described this as a ‘significant barrier’ to their ability to have oversight of safeguarding practices in these schools, and to provide support where it is needed. However, some LSPs did report effective working relationships with independent schools as a result of proactive and persistent strategic partnership arrangements.

Some schools and colleges have reported to us, in previous inspections and as part of these visits, that they struggle to engage with LSPs and get the support they need. This may be why some are choosing to commission training elsewhere. One DSL at an independent single-sex school we spoke to also emphasised that while a network of other DSLs in the LSP was helpful more broadly, it was particularly useful to be part of a network of DSLs from other corresponding single-sex independent schools in the local area to help identify patterns and trends of behaviour and intervene early.

In the current guidance, once the LSP names a school or college as a ‘relevant agency’, that places the school or college under a duty to cooperate with the LSP arrangements. However, some LSPs raised concerns that changes to ‘Working together to safeguard children’ did not make clear how the engagement of schools and colleges as ‘relevant agencies’ should work in practice. They were concerned that leaving LSPs to reach their own conclusions on how best locally to engage individual institutions was too vague. Therefore, the wording in the statutory guidance could be made more explicit so that it clearly outlines the relationship between LSPs and schools and colleges, and their individual responsibilities.

Both LSPs and some DSLs said that centralised training for DSLs from LSPs was useful. They used this training to then train others in schools and colleges on how to identify and address sexual harassment and sexual violence, including online. They also identified training and meetings as being routes for helping schools/colleges to develop a preventative approach. LSPs also highlighted the importance of DSLs having enough time and support from school and college leaders to enable them to engage in partnership planning, training and meetings.

Where arrangements were working well, LSPs found that they provide a forum for the sharing of information, such as patterns and trends in emerging local risks to children and young people. This can then inform clear preventative approaches within individual schools and colleges that take account of local risks. Some of the schools and colleges we spoke to also talked about how helpful their LSP and local authority were, not just for helping with specific cases, but also for the training and networks they provided.

However, some school and college leaders told us it was a challenge for them to access the right information or support from multi-agency partners as it can vary across local authorities. Some also mentioned the difficulties of having different thresholds across different areas. This becomes a particular challenge when their school or college population comes from a wide area, such as schools in London, independent schools and some faith schools. LSPs also recognised that it was important that schools and colleges had clear support from them on how to manage sexual harassment and sexual violence, including online. They recognised that it was their responsibility to ensure that school and college leaders are supported to understand local thresholds and pathways for referral into services.

Inspection is a critical lever in the accountability system. It provides a ‘point in time’ snapshot of an education provider, including its approach to tackling sexual harassment and sexual violence, including online. Inspection evidence can be aggregated to provide insights at a system level and to influence behaviour. While it provides broad assurance, the inspection model is not designed or resourced to investigate or address specific incidents in schools and colleges. If the government wishes to support schools to develop their approach to tackling sexual harassment and violence, it will need to employ a range of approaches, of which inspection is just one.

Statutory guidance sets clear expectations for schools and colleges to safeguard and promote the welfare of children and young people. Generally, school and college leaders tell us that the guidance is clear, although they would appreciate all guidance being in one easily accessible place and updates to be made in good time before the school year starts so they can plan training accordingly. The phrasing in ‘Working together to safeguard children’ could also be updated to explicitly state that all types of schools and colleges are expected to be one of the ‘relevant agencies’ that LSPs need to engage with and that multi-agency audits should be completed regularly.

There is a gap in guidance for how schools and colleges should respond when there are lengthy investigations or no prosecution or conviction. Some school and college leaders also want clearer guidance on where their responsibilities start and end, for example with incidents of harmful sexual behaviour that happen outside school. Developing clearer guidance in this area would help school and college leaders assure parents, children and young people that they are making decisions in their best interests and in line with guidance.

To assess whether the current safeguarding framework and guidance for Ofsted and ISI inspectors were strong enough, we carried out an internal review of:

both inspection frameworks and Ofsted’s schools and further education and skills inspection handbooks

evidence bases gathered on inspection of 108 schools and colleges, including state-funded schools, independent non-association schools that Ofsted inspects and independent schools that ISI inspects

safeguarding guidance and training for inspectors of both inspectorates, with a particular focus on peer-on-peer harmful sexual behaviour

We also reviewed our previous handling of complaints about schools and colleges that focused on peer-on-peer sexual harassment and sexual violence, including online. This included complaints about the non-association independent schools that we inspect. You can find further details of this internal review in the methodology .

ISI also carried out a similar review of complaints it has received that focused on sexual harassment and sexual violence, including online, which it shared with the review team.

Frameworks, handbooks, guidance and training

The review looked at our ‘Inspecting safeguarding’ guidance, which covers early years, education and skills settings. [footnote 63] It found that this clearly outlines how inspectors should inspect how well schools and colleges respond to peer-on-peer abuse, such as sexual harassment and sexual violence, including online. Since the introduction of the education inspection framework ( EIF ) in September 2019, the school inspection handbook has also made specific reference to peer-on-peer abuse. All inspectors were trained on how to consider such abuse during inspection earlier that year. The handbook was updated recently to reflect the government’s changes to guidance on RSHE . All school inspectors have received mandatory training on what this means for inspection practice.

However, the review also found that, although Ofsted’s education inspectors are trained using ‘Inspecting safeguarding’, the further education and skills inspection handbook does not specifically refer to sexual violence and sexual harassment, including online. We will therefore update it to include this.

ISI inspects independent schools’ compliance with The Independent School Standards Regulations. [footnote 64] ISI reports on the extent to which the independent school standards are being met. The ISI inspection framework provides for 2 types of routine inspection: regulatory compliance only or educational quality with focused compliance. Both inspection types always consider whether the school meets the expected independent school standards in welfare, health and safety. These standards include whether a school is meeting the statutory standards, which includes safeguarding expectations as set out by the government. Although the independent school standards do not make explicit reference to peer-on-peer sexual violence and harassment, they require the school’s leaders to actively promote the well-being of the pupils. Leaders must also follow all statutory guidance relating to safeguarding, which includes peer-on-peer abuse. When inspecting compliance with the relevant standards, ISI inspectors record whether the school’s safeguarding policy sets out its response to peer-on-peer abuse and whether it includes procedures to minimise the risk of peer-on-peer abuse.

In the visits we did as part of this review, inspectors found that talking to single-sex groups was an effective way to gather evidence about sexual harassment and violence. Therefore, both Ofsted and ISI will make it explicit to inspectors that they should do this during future inspections wherever possible. This will help inspectors to understand how a school’s or college’s approach to tackling sexual harassment and sexual violence, including online, is working.

The review of Ofsted’s training showed that all school and further education and skills inspectors were trained in 2018 and 2019 on peer-on-peer abuse. This included sexual harassment and sexual violence, including online. The training is covered in different modules for education and social care inspectors. For example, further education and skills inspectors do not complete the same training as school inspectors.

ISI provided Ofsted with a chronology of training since 2017. It also showed us examples of its inspector training materials relating to safeguarding and peer-on-peer abuse. Most training was mandatory. Some was optional, such as a workshop on peer-on-peer abuse delivered at a conference held for all ISI inspectors in January 2019. Training materials referenced government statutory guidance on safeguarding, including guidance relating to peer-on-peer abuse, sexual harassment and violence. ISI reported that it held follow-up discussions to make sure that inspectors understood the implications for inspection activity.

For 2021/22 and beyond, Ofsted and ISI will work together to produce and jointly deliver further training on inspecting safeguarding in education settings. This will include issues of peer-on-peer abuse.

State-funded and independent schools and colleges have to implement statutory guidance. This should ensure that they have a common approach to safeguarding, including peer-on-peer abuse. Ofsted and ISI will continue to work together to prioritise a consistent standard of inspection practice in this area.

Previous inspections

We reviewed the evidence bases for 93 inspections under Ofsted’s EIF . The inspections all took place between September 2019 and March 2020, when routine inspections were suspended due to the pandemic.

The review found that evidence bases demonstrated that inspectors have a good knowledge of ‘Keeping children safe in education’. They use this knowledge to determine the questions they will ask on inspection. Scrutiny of inspection evidence found that inspectors had explored children and young people’s experiences of sexting and upskirting, and what school and college staff had done in response.

Following notification of a school inspection, school leaders are asked to present their records and analysis of sexual violence and sexual harassment, including online, in school by 8am on the first day of the inspection. This is set out as a requirement in our school inspection handbook.

In September 2019, when this requirement was brought in, we expected to see a substantial flow of evidence about these issues, given that there was already considerable information about their prevalence in schools. In fact, this has not been the case. It is surprising that, in the inspections we looked at for the review, only 6% of schools gave evidence of sexual violence and sexual harassment, including online, in response to the request. Forty-six per cent of the schools provided a nil return. These figures may reflect the gap between staff’s and children and young people’s knowledge and perceptions, as discussed earlier. The remaining 48% of schools neither provided information nor a statement that there was no relevant information. In most of the inspections where no information was provided, inspectors did not record how they followed up with leaders to determine whether a nil return was an accurate picture.

As a result, we cannot yet say that EIF inspections are sufficiently assessing the extent and nature of sexual harassment and sexual violence, including online, between peers in schools. We will mandate that, in future, inspectors should follow up and record schools’ responses to the request. We will quality assure future evidence bases to make sure that this happens. We will also reiterate this through inspector training.

The requirement for leaders to provide records and analysis of sexual violence and sexual harassment, including online, is not currently in our further education and skills inspection handbook. We will amend this. In future, on notification of college inspections, leaders will be asked to supply this information to inspectors. Inspectors will also be mandated to follow this up with college leaders. ISI will also ask for this information from schools on notification.

The review also found that inspectors seek evidence from a variety of sources to triangulate their findings about safeguarding. For example, they speak to staff, children and young people, governors, senior leaders, support staff and external colleagues such as local authority representatives. When a safeguarding issue emerges on inspection, they follow it up.

Furthermore, the scrutiny of Ofsted inspection evidence shows that when inspectors have focused on the PSHE curriculum (known as a ‘deep dive’) in EIF inspections, they examine relationships and sex education very effectively. However, unless there is a deep dive into PSHE , there is little time on inspection to look closely at a school’s or college’s approach to creating a culture of safeguarding around peer-on-peer sexual harassment and violence. Inspection resource constraints limit the number of deep dives to 3 or 4 per inspection. Ofsted’s inspectors cover a sample of curriculum areas rather than every subject in depth. It is therefore not possible to review PSHE fully on every inspection.

We also reviewed 15 evidence bases of ISI inspections. We found that they included appropriate consideration and clear evaluation of how well schools managed their procedures and policies related to safeguarding and handling complaints. The review also found careful pre-inspection planning and appropriate recording of evidence in relation to the independent school standards. However, the inspection evidence did not always identify how the curriculum developed children and young people’s understanding of acceptable and unacceptable behaviours. It also did not always show how inspectors cross-referenced leaders’ and pupils’ views with other evidence, such as record-keeping. In a few evidence bases, inspectors appeared to give weight to the views of leaders, who responded that reporting systems and effective pastoral care were in place, rather than to those of pupils, where a significant minority had concerns.

Handling of complaints about schools that refer to peer-on-peer sexual harassment and violence

A review of Ofsted’s handling of complaints about schools we inspect found that they are dealt with comprehensively. We also review annually how we handle them. All complaints about independent schools were referred on to the DfE , and those about colleges to ESFA . When a complaint about a school or college refers to sexual abuse, we may notify the local authority for a maintained school or ESFA for an academy, free school or college. We may also inspect immediately or use the information to inform the school’s or college’s next routine inspection.

When ISI receives complaints about the schools it inspects, it currently refers to the DfE only those that relate to the independent school standards. ISI has told us that all complaints about sexual abuse are referred to the DfE . ISI has recently reviewed its policy and from September 2021, all complaints (whether they refer to the independent school standards or not) will be referred to the DfE .

The DfE , in collaboration with ESFA , Ofsted and ISI , may wish to review how complaints are handled.

As a result of this review, both Ofsted and ISI will update training and inspection handbooks where necessary. This will strengthen inspectors’ ability to inspect how schools and colleges are tackling peer-on-peer sexual harassment and sexual violence, including online.

This rapid thematic review has revealed how prevalent sexual harassment and online sexual abuse are for children and young people. It is concerning that for some children, incidents are so commonplace that they see no point in reporting them. This review did not analyse whether the issues are more or less prevalent for different groups of young people, and there may well be differences, but it found that the issues are so widespread that they need addressing for all children and young people. It recommends that schools, colleges and multi-agency partners act as though sexual harassment and online sexual abuse are happening, even when there are no specific reports.

Methodology

This review has a limited scope, constrained both by the terms of reference given to Ofsted by government and also the time constraints. The findings from our visits are not fully representative of schools or colleges across England.

Our sample sizes are also not big enough to draw any conclusions about the protection of children from minority ethnic groups or those with special educational needs and/or disabilities ( SEND ). Reporting of sexual abuse by these children is thought to be even less common. Further research into the prevalence, experiences and outcomes for these children is crucial.

Visits to schools and colleges

We carried out 32 2-day visits to schools and colleges in April and May 2021. The inspection team had at least one female inspector as part of each visit. ISI inspectors shadowed Ofsted’s inspectors on 13 visits. Before the visits, both ISI and Ofsted inspectors received 2 days of refresher safeguarding training with a specific focus on peer-on-peer sexual harassment and violence.

In selecting the research sample, we sought to include some schools where concerns have been reported. We identified these through complaints made to Ofsted or the publicly available Everyone’s Invited testimonials. We also included others to provide a more balanced cross-section of school/provider types. We sought to ensure a mix of independent and state-funded schools, as well as covering different geographical locations. Given the focus on adequacy of current inspection models, the sample was also weighted in favour of schools/colleges inspected since September 2019. The overall small sample size does not make it possible to compare and contrast different types of schools. But it gives confidence that where we saw patterns of behaviours or experience, they were not limited to one particular type.

The sample included:

14 state-funded schools

14 ISI -inspected independent schools

2 Ofsted-inspected independent schools

2 FE colleges

The majority of the schools were secondary schools or all-through schools. Two were state-funded primary schools.

In one visit, we identified serious safeguarding failures. Inspectors ended the visit and we carried out an initial inspection under section 8 (‘no formal designation’). This led to a full inspection. Findings from the early part of the visit are used in this report.

Focus groups with children and young people

In the visits, we held up to 4 focus groups with children and young people on each visit. These lasted for 45 minutes. In total, we had over 125 focus groups with approximately 900 children and young people participating. Parents were given an ‘opt out’ letter if they did not want their child to take part. Inspectors also gave children and young people the option not to take part on the day. Leaders highlighted where it would not be appropriate for us to talk to children and young people due to ongoing investigations or additional context. Inspectors spoke to the children and young people in single-sex, same-age groups. Where there was an existing LGBT+ pupil group, we asked whether members would like to speak to us. We made time to do so where they agreed.

Activities that inspectors led children and young people through in the focus groups included the following:

colouring in/marking areas on a map of their school according to how safe/unsafe parts of the school were, discussing this among the group as they did so

answering a short questionnaire about the prevalence of sexual abuse among their peers and who they would speak to, if anyone, if they were the victim of abuse or harassment (we did this with those in Year 9 and above only)

choosing from 4 scenarios to use to talk hypothetically about what might be said/done among their peer group in different situations, as well as who they might speak to/tell

explaining what they are taught in school/college about relationships and sex and whether they thought it was enough/well taught

Inspectors summarised the conversations from each focus group and collated the questionnaires, both of which were analysed by the research team.

Discussions with school and college staff

As part of each visit, inspectors spoke to:

the headteacher/principal

the behaviour lead

the lead for PSHE and/or RSHE

2 groups of staff

Inspectors looked at records of sexual harassment and sexual abuse; behaviour records; policies for safeguarding, behaviour, equal opportunities and staff conduct; and the policy and curriculum documentation for PSHE and RSHE .

Inspectors collated all the evidence from each visit, which was analysed by the research team.

Focus groups with multi-agency partners

From our list of 32 schools and colleges, we identified 12 LSPs with whom we held 45-minute focus groups. Each group had a representative from children’s social care, the police and health partners. The discussions were framed around the terms of reference for the review covering the 2 multi-agency safeguarding questions, from the partners’ perspectives:

How well are safeguarding guidance and processes understood and working between schools, colleges and LSPs ?

Does working between schools, colleges and LSPs , including local authority children’s social care, the police, health services and other support, need to be strengthened?

The information from these focus groups was analysed by the research team and triangulated with the perspectives from schools themselves.

Victim/survivor focus groups

Ten individuals from 6 organisations spoke to Ofsted to share their experiences and views from a survivor/victim perspective.

Everyone’s Invited testimonies

As of 6 April 2021, there were 2,340 testimonies publicly available on the Everyone’s Invited website. We extracted this text using web scraping.

Our text analysis then focused on the 2,030 testimonies thought to relate to young people of school or further education age in England. For example, we excluded testimonies that referred to universities or to other countries. The testimonies were analysed using computer-based learning techniques, including key-word searches and topic modelling. This was complemented by textual analysis of 250 random testimonies, which were read in full.

Data from these was recorded, including:

• what the incident was
• where it happened
• the characteristics of the victim and their relationship to the perpetrator
• the response to the incident
• the incident’s impact on the victim

The intention of this analysis was to identify common themes and build a broad picture of the experiences young people are reporting.

Ofsted and ISI complaints

Between September 2019 and March 2021, Ofsted received 291 complaints against schools and colleges about peer-on-peer sexual abuse. All were logged as safeguarding concerns.

In order for Ofsted to consider a complaint against a school as a ‘qualifying complaint’, it must meet certain legislative requirements:

• it must be made in writing
• it must not be a prescribed exception (that is, a concern for which another statutory agency has responsibility for handling)
• it must be a prescribed description (leadership and management, standards of education being achieved, quality of education, how far the education meets the needs of pupils, social, spiritual, moral and cultural development and well-being of pupils)
• it must have been through the local complaints routes

For this report, we reviewed 16 complaints that we chose to meet the following criteria:

they contained an element of alleged sexual abuse, harassment or violence

they came from all Ofsted regions

they involved maintained schools and academies, pupil referral units ( PRUs ), independent schools and colleges

they allowed us to sample complaints about child serious incident notifications, local contextual information, qualifying and non-qualifying complaints and 11A investigations

they were retained for the next inspection, resulted in inspections being brought forward or resulted in a no formal designation inspection under section 8

Between September 2019 and March 2021, ISI reports that it received 37 complaints against schools about peer-on-peer sexual abuse and that all were logged as safeguarding concerns and referred to the DfE .

Review of inspection evidence bases

Ofsted reviewed 93 evidence bases, the majority of which were from inspections carried out between September 2019 and March 2020. This covers the period when the EIF was in place and pauses when routine EIF inspection activity ceased. Another 16 evidence bases from Ofsted-inspected residential special schools and boarding schools were also reviewed. We sampled evidence bases from across all 8 Ofsted regions. We included those from inspections of primary, secondary and special schools and PRUs . Within this sample, there were 30 independent school inspections, 20 emergency inspections and 10 standard inspections.

Ofsted also reviewed ISI evidence bases from 15 inspections that took place between October 2018 and December 2020.

Literature review

The literature that fed into this report covered a broad range of topics, including:

statistics of child peer-on-peer sexual harassment and violence, including the prevalence for children with protected characteristics or from different socio-economic backgrounds, such as LGBT+ or minority ethnic children and young people

definitions of child sexual abuse, including peer-on-peer sexual harassment and violence

barriers that prevent children and young people talking about abuse and good practice

online sexual abuse

pornography

preventative measures in schools

Parent focus groups

Ofsted carried out one focus group with state-school parents and another with independent school parents. The number of parents participating was too small to draw conclusions but we used their comments as part of the wider evidence base for this report.

List of stakeholders we spoke to as part of the review

Reference group members.

Chief Constable Simon Bailey (NPCC lead on child protection)

Geoff Barton (Association of School and College Leaders)

Tom Bennett ( DfE behaviour advisor)

Professor Chris Bonell (Faculty of Public Health, London School of Hygiene and Tropical Medicine)

Dame Rachel de Souza (Children’s Commissioner)

Hilary Garratt (Deputy Chief Nursing Officer for England, NHS)

Sarah Hannafin/James Bowen (National Association of Head Teachers)

David Hughes (Association of Colleges)

John Jolly (ParentKind)

Ian Keating (Local Government Association)

Julia Lagoutte/Rowan Davies (Mumsnet)

Michele Lawrence/Wendy Nicholson (Public Health England)

Charlotte Ramsden (Association of Directors of Children’s Services) Julie Robinson (Independent Schools Council)

Andrea Simon/ Denise Ugur (End Violence Against Women Coalition)

Russell Viner (Professor in Adolescent Health, University College London and former President, Royal College of Paediatrics and Child Health)

Peter Wanless (NSPCC)

Vanessa Ward ( ISI )

Other stakeholders

DfE ministers

Officials from DfE , No 10 and Home Office

Dame Vera Baird (Victims’ Commissioner)

Dan Bell (Men and Boys Coalition)

Mary Bousted (National Education Union)

Leora Cruddas/ Steve Rollett (Confederation of School Trusts)

Helen Earner (Charity Commission)

Anna Glinski (Centre for Expertise on Child Sexual Abuse)

Jonny Gutteridge (Male Survivors Trust)

Amelia Handy (Rape Crisis England)

Emma Hardy MP

Nicole Jacobs (Domestic Abuse Commissioner)

Emma James (Barnardo’s)

Dr Jenny Lloyd (University of Bedfordshire)

Amy Norton (Office for Students)

Jess Phillips MP

Patrick Roach (National Association of Schoolmasters Union of Women Teachers)

Soma Sara/ Wendy Mair (Everyone’s Invited)

Wes Streeting MP

Gail Tolley (London Borough of Brent)

Colin Walker (Safeline)

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In one visit, we identified serious safeguarding failures. Inspectors ended the visit and we carried out an initial inspection under section 8 (‘no formal designation’). This led to a full inspection. Findings from the early part of the visit are used in this report.  ↩

‘Keeping children safe in education’ , DfE , January 2021.  ↩

While adults tend to refer to ‘sexting’, we are aware that some children and young people consider this to mean ‘writing and sharing explicit messages with people they know’ rather than sharing youth-produced sexual images, including sending ‘nudes’ and ‘semi-nudes’.  ↩

S Hackett, ‘Children and young people with harmful sexual behaviours’, Research in Practice, 2014.  ↩

‘Sexual violence and sexual harassment between children in schools and colleges’ , Department for Education, December 2017.  ↩

‘Individual, family and abuse characteristics of 700 British child and adolescent sexual abusers , Simon Hackett and others, 2013.  ↩

‘Key messages from research on children and young people who display harmful sexual behaviour’ , Centre of Expertise on Child Sexual Abuse, Di McNeish and Sara Scott, July 2018.  ↩

‘Tackling child sexual abuse strategy’ , Home Office, January 2021.  ↩

This review included a sample of 2 colleges. Where there are findings that specifically relate to differences in schools and colleges, we refer to them separately but where findings are common across both, we use schools.  ↩

The report ‘Protecting children from harm’ estimates that only 1 in 8 offences comes to the attention of statutory authorities: ‘Protecting children from harm’ , Children’s Commissioner, November 2015.  ↩

Due to the way this data is collected and different sexual offences are defined, these figures do not capture certain sexual offences committed against 16- and 17-year-olds, such as rape.  ↩

‘Protecting children from harm’ , Children’s Commissioner, November 2015.  ↩

‘How safe are our children?’ , NSPCC Learning, 2020.  ↩

In our visits, we talked to groups of boys and girls and LGBT+ groups, where there was an existing group that was happy to speak to us. We predominantly use the language of ‘children and young people’ and ‘girls and boys’ in the report to recognise that girls are disproportionately more likely to experience sexual abuse than boys but have highlighted the experiences of LGBT+ children and young people where it is appropriate and data is available.  ↩

‘Child abuse and neglect in the UK today’ , Radford, L and others, NSPCC, 2011.  ↩

‘Sexual harassment and sexual violence in schools’ , Women and Equalities Committee, September 2016.  ↩

‘It’s just everywhere’ , UK Feminista and NEU, 2017.  ↩

‘Permanent and fixed-period exclusions in England’ , Explore Education Statistics, July 2020.  ↩

‘School sex crime reports in UK top 5,500 in three years’ , BBC News, September 2015.  ↩

‘Sexual harassment and sexual violence in schools’ Women and Equalities Committee Report, September 2016.  ↩

‘Beyond referrals: levers for addressing harmful sexual behaviour in schools’ , Contextual Safeguarding Network, July 2020.  ↩

Yin Xu and Yong Zheng, ‘Prevalence of childhood sexual abuse among lesbian, gay, and bisexual people: a meta-analysis’, in ‘Journal of Child Sexual Abuse’, Volume 24, Issue 3, 2015, pages 315 to 331.  ↩

‘Digital romance’ , Brook and the National Crime Agency’s Child Exploitation and Online Protection Command, December 2017.  ↩

‘The Internet Watch Foundation: Annual Report 2019 , The Internet Watch Foundation, April 2020.  ↩

‘Sharing nudes and semi-nudes: advice for education settings working with children and young people’ , Department for Education, December 2020.  ↩

‘Learning about online sexual harm’ , Helen Beckett and others, November 2019.  ↩

Martellozzo, E. and others, ‘I wasn’t sure it was normal to watch it: a quantitative and qualitative examination of the impact of online pornography on the values, attitudes, beliefs and behaviours of children and young people’, Middlesex University, 2016.  ↩

‘BBFC Research into Children and Pornography’ , British Board of Film Classification, September 2019.  ↩

‘Sex and relationships amongst students , Nick Hillman, Higher Education Policy Institute, April 2021.  ↩

‘Pornography, young people, and preventing violence against women’ , Our Watch, 2020.  ↩

‘The relationship between pornography use and harmful sexual behaviour’ , The Behavioural Architects for the Government Equalities Office, February 2020.  ↩

This analysis only used the testimonies thought to relate to young people of school or further education age in England. For instance, it excluded testimonies that referred to universities or other countries. See the methodology at the end of this report for more information.  ↩

Further details on our analysis of Everyone’s Invited testimonies can be found in the methodology.  ↩

‘Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and non-partner sexual violence’ , World Health Organisation, 2013.  ↩

‘Girls’ Attitudes Survey 2018’ , Girlguiding UK, 2018.  ↩

‘Child sexual abuse in England and Wales: year ending March 2019’ , ONS, January 2020.  ↩

Allnock, D. and Miller, P. ‘No one noticed, no one heard: a study of disclosures of childhood abuse.’ , NSPCC, 2013  ↩

‘A multi-agency response to child sexual abuse in the family environment’ , Ofsted, Care Quality Commission, HM Inspectorate of Probation, and HM Inspectorate of Constabulary and Fire & Rescue Services, February 2020.  ↩

Allnock, D. and Miller, P., ‘No one noticed, no one heard: a study of disclosures of childhood abuse.’ , NSPCC, 2013.  ↩

‘Girls’ Attitudes Survey 2014’ , Girlguiding UK, 2018.  ↩

‘Sexual harassment and sexual violence in schools’ , Women and Equalities Committee Report, September 2016.  ↩

‘Harmful sexual behaviour in schools: a briefing on the findings, implications and resources for schools and multi-agency partners’ , Jenny Lloyd and others, University of Bedfordshire, June 2020.  ↩

Baker, H. and others, ‘Let children know you’re listening: the importance of an adult’s interpersonal skills in helping to improve the child’s experiences of disclosure.’ , NSPCC, 2019.  ↩

‘Sharing nudes and semi-nudes: advice for education settings working with children and young people’ , UK Council for Internet Safety, December 2020.  ↩

‘Sharing nudes and semi-nudes: advice for education settings working with children and young people’ , Department for Digital, Culture, Media and Sport, December 2020.  ↩

‘What is peer-on-peer abuse?’ , Ofsted, October 2019.  ↩

‘UK schools online safety policy and practice assessment 2020’ , Prof Andy Phippen and Prof Emma Bond, February 2020.  ↩

‘ RSHE : school practice in early adopter schools research report’ , DfE , May 2021.  ↩

A series of reviews by Ofsted looking at the research evidence currently available about different curriculum subjects: ‘Curriculum research reviews’ .  ↩

‘ PSHE in schools: strengths and weaknesses’ , Ofsted, May 2013.  ↩

‘Children’s online activities, risks and safety: A literature review by the UKCCIS Evidence Group’ , Prof Sonia Livingstone and others, UK Council for Internet Safety, October 2017.  ↩

‘Inspecting safeguarding in early years, education and skills’ , Ofsted, September 2019.  ↩

The Education (Independent School Standards) Regulations 2014 .  ↩

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• Open access
• Published: 27 August 2024

Identification of RCAN1’s role in hepatocellular carcinoma using single-cell analysis

• Ziqi Yang 1 , 2   na1 ,
• Xiwei Deng 1 , 2 , 3   na1 ,
• Didi Wen 1 ,
• Lijun Sun 1 , 2 ,
• Rui An 1 , 2 &
• Jian Xu 1 , 2  

BMC Cancer volume  24 , Article number:  1056 ( 2024 ) Cite this article

Metrics details

The regulator of calcineurin 1 (RCAN1) is expressed in multiple organs, including the heart, liver, brain, and kidney, and is closely linked to the pathogenesis of cardiovascular diseases, Down syndrome, and Alzheimer’s disease. It is also implicated in the development of various organ tumors; however, its potential role in hepatocellular carcinoma (HCC) remains poorly understood. Therefore, the objective of this study was to investigate the potential mechanisms of RCAN1 in HCC through bioinformatics analysis.

We conducted a joint analysis based on the NCBI and TCGA databases, integrating both bulk transcriptome and single-cell analyses to examine the principal biological functions of RCAN1 in HCC, as well as its roles related to phenotype, metabolism, and cell communication. Subsequently, an RCAN1-overexpressing cell line was established, and the effects of RCAN1 on tumor cells were validated through in vitro experiments. Moreover, we endeavored to identify potential related drugs using molecular docking and molecular dynamics simulations.

The expression of RCAN1 was found to be downregulated in 19 types of cancer tissues and upregulated in 11 types of cancer tissues. Higher levels of RCAN1 expression were associated with improved patient survival. RCAN1 was predominantly expressed in hepatocytes, macrophages, endothelial cells, and monocytes, and its high expression not only closely correlated with the distribution of cells related to the HCC phenotype but also with the distribution of HCC cells themselves. Additionally, Rcan1 may directly or indirectly participate in metabolic pathways such as alanine, aspartate, and glutamate metabolism, as well as butanoate metabolism, thereby influencing tumor cell proliferation and migration. In vitro experiments confirmed that RCAN1 overexpression promoted apoptosis while inhibiting proliferation and invasion of HCC cells. Through molecular docking of 1615 drugs, we screened brompheniramine as a potential target drug and verified our results by molecular dynamics.

In this study, we revealed the relationship between RCAN1 and HCC through bioinformatics methods, verified that RCAN1 can affect the progress of the disease through experiments, and finally identified potential therapeutic drugs through drug molecular docking and molecular dynamics.

Peer Review reports

Introduction

Cancer Statistics (2023) indicates that liver cancer has experienced the most rapid increase in mortality rates in recent years. The incidence of liver cancer reached 8.6/100,000 between 2015 and 2019, and the mortality reached 6.6/100,000 between 2016 and 2020. In 2023, it is estimated that there will be 41,210 new cases of liver cancer in the United States, with 29,380 deaths. The 5‐year survival rate for liver cancer has increased to 21% for the patients diagnosed during 2012 through 2018 [ 1 ]. Hepatocellular carcinoma (HCC) accounts for around 90% of all instances of primary liver cancer and is the second most common cause of cancer-related fatalities worldwide [ 2 ]. Although the understanding of the molecular mechanisms underlying the development of HCC has deepened among researchers, the number of developed targeted drugs remains low, and their efficacy is limited, which cannot meet the increasing treatment expectations. Therefore, in order to discover more specific and sensitive biomarkers and lay a solid foundation for the development of more targeted drugs, we need to further explore the mechanisms underlying the development and metastasis of HCC.

Calcineurin, a calcium and calmodulin-dependent serine/threonine protein phosphatase, is associated with multiple cellular and tissue physiological functions [ 3 ]. As an inhibitor of calcineurin, regulator of calcineurin 1 (RCAN1) is expressed in multiple organs such as the heart, liver, brain, and kidneys, and is closely associated with the pathological mechanisms of cardiovascular diseases, Down syndrome, Alzheimer’s disease, etc. [ 4 , 5 , 6 ]. In the field of oncology, as research on RCAN1 deepens, it has been found to play a role in inhibiting tumor growth in many organ tumors, such as esophageal squamous cell carcinoma, lymphoma, osteosarcoma, thyroid cancer, liver cancer, etc. [ 7 , 8 , 9 , 10 , 11 ].

Current research indicates that in HCC, RCAN1 can inhibit tumor growth and metastasis by suppressing calcineurin activity and nuclear translocation of NFAT1 [ 11 , 12 ]. There is still limited research on the mechanism of action of this gene. Here, in order to provide more insights into the mechanistic analysis of this gene, we attempted to utilize bioinformatics to investigate the internal connection between RCAN1 and HCC, starting from transcriptomics and single-cell analysis. Additionally, we conducted cellular functional experiments to explore the role of RCAN1 in HCC cell proliferation and invasion. This approach aims to provide a more comprehensive understanding of the association between RCAN1 and HCC.

Material and method

Data retrieval and download.

We conducted a search on National Center for Biotechnology Information (NCBI, https://www.ncbi.nlm.nih.gov/ ), for hepatocellular carcinoma using the search terms “ Hepatocellular Carcinoma”, “Array expression analysis,” and “High-throughput sequencing expression analysis”. We ultimately selected two datasets, GSE149614 and GSE151530 for our analysis, the former comprises 10 tumor samples and 18 normal samples, while the latter includes 46 tumor samples. Additionally, employing the same search criteria, we sourced a single-cell dataset, CNP0000650, from the China National Center for Bioinformation (CNCB, https://www.cncb.ac.cn/ ), which consists of 18 tumor samples and 1 normal sample. The bulk RNA-Seq data was downloaded from the The Cancer Genome Atlas Program (TCGA https://www.cancer.gov/ccg/research/genome-sequencing/tcga ), comprising 50 normal samples and 374 tumor samples.

Pan-cancer analysis

Pan-cancer analysis refers to the comprehensive study of multiple cancer types collectively, aiming to identify common molecular alterations and pathways across different cancers. To analyze the importance of RCAN1, we conducted a pancancer analysis using the TCGAplot R package [ 13 ].

Single-cell sequencing data processing

We processed the GSE149614 data (There are 18 samples in total, including 10 tumor samples and 8 normal samples) using Seurat version 4.3 [ 14 ]. We selected cells based on the following criteria: features greater than 500, UMI counts less than 15,000, and mitochondrial percentage proportion below 25%, We standardize the dataset through ‘SCTransform’. Finally, we obtained 63,100 cells. For the data set GSE149614, we use the R package ‘Harmony’ [ 15 ] to process it in batches, the parameter is set to max.iter.harmony = 30, lambda = 1. Pc.num were set to 10 and resolution to 0.5 for PCA dimensionality reduction and visualized the data using UMAP. For the annotation of single-cell datasets, we divided the entire dataset into nine types of cells, namely Hepatocyte, Macrophage, T/NK, Endothelial, Monocyte, Fibroblast, Plasma B, Mature B, and DC. For the single-cell datasets GSE151530 and CNP0000650, the original authors had already processed the data. Therefore, we did not subject them to any additional processing.

Disease phenotype analysis

To analyze the relationship between cells, genes, and disease phenotypes, we used the Scissor R package to perform a joint analysis of the single-cell dataset GSE149614 and CNP0000650, respectively, and the Bulk dataset downloaded from TCGA with parameters of “family = binary, alpha = 0.01” [ 16 ].

Single-cell metabolic analysis

To discern the metabolic difference between tumor and control in snRNA-seq datasets, we used the R package scMetabolism [ 17 ] to quantify the metabolic differences between normal and tumor samples, using the ‘VISON’ method and selecting the Kyoto Encyclopedia of Genes and Genomes (KEGG) metabolic dataset,statistical analyses of metabolic pathways across different groups are provided in Supplementary file 1 .

To further explore malignant cells in the overall single-cell data, we used the copykat package to analyze and visualize all single-cell data [ 18 ]. The parameter is set as ngene.chr = 5, LOW.DR = 0.05, UP.DR = 0.1, win. size = 25, KS.cut = 0.1, distance set to ‘euclidean’, genome set to ‘hg20’.

To quantify and visualize cell signaling and communication networks between cells, we conducted analysis using the Cellchat package [ 19 ]. We choose secret signaling for analysis of cellchat’s database. All results of the cellular communication analysis can be found in Supplementary file 2 .

Cell culture

The HepG2 cell line was purchased from the Chinese Academy of Sciences (Shanghai) and cultured in DMEM medium containing 10% FBS and 1% penicillin at 37 °C in 5% CO2.

Construction of RCAN1 Overexpression cell lines

To investigate the role of RCAN1 in cellular processes, we generated cell lines that overexpressed RCAN1. We collaborated with Hao Yang Biotechnology (Xi’an, China) to synthesize the overexpression plasmid vector for RCAN1, denoted as OE-RCAN1. The detailed information of the plasmid vector is provided in Supplementary file 3 . Subsequently, the synthesized plasmid vector was transfected into HepG2 cells following the manufacturer’s protocol. The transfection was carried out using Lipofectamine 2000 reagent (11,668–019, Invitrogen). The infected cells were then selected with puromycin to establish stable cell lines that overexpressed RCAN1.

Quantitative RT–PCR

Total RNA was isolated following the recommended protocol provided by the manufacturer (Thermo Fisher, USA) using TRIzol reagent. Subsequently, cDNA synthesis was performed using the HiScript® II Q Select RT SuperMix for qPCR (R233, VAZYME, China). The resulting cDNA served as the template for quantitative RT–PCR, which was carried out using the ABI (ViiA-7) 7500 apparatus (Applied Biosystems). The primer sequences for RT–PCR can be found in Supplementary file 4 .

Western blot

Total protein was extracted using SDS-PAGE, followed by transfer onto a PVDF membrane (Millipore, China). Subsequently, the membrane was incubated with primary antibodies, including β-actin (T0022, Affinity, China), Bcl2 (3498 T, CST, USA), Caspase3 (9665S, CST, USA), and Bax (ab32503, abcam, UK). To detect the target proteins, the membrane was further incubated with a 1:10,000 dilution of horseradish peroxidase-conjugated goat anti-rabbit (Beyotime, China) or goat anti-mouse (Proteintech, China) secondary antibodies.

Cell function assays

To examine the alterations in the biological behaviors and functions of liver cancer cells resulting from the overexpression of RCAN1, we conducted three experiments. In the CCK8 experiment, we specifically selected cells in logarithmic growth phase with robust growth status and seeded them at a density of 5 × 103 cells/well in a 96-well cell culture plate. The plate was subsequently incubated overnight at 37 °C with 5% CO2. After the required culture time, we added 10 μl of enhanced CCK-8 reagent (QS-S321, Keycell, China) to each well and incubated them for 2 h at 37 °C. The absorbance of each well was measured at 450 nm using a microplate reader (C22.2NO.1010.1, BioTek, USA).

For the cell invasion experiment, we added 800 μl of pre-cooled 10% FBS MEM culture medium (containing double antibiotics) to a 24-well plate, which was then placed in a transwell chamber (353,097, Falcon, USA). Subsequently, 100 μl of 0.5 mg/ml Matrigel (356,234, Corning, USA) was added to the center of the bottom chamber of the transwell, and it was allowed to solidify at 37 °C. Once the Matrigel had solidified, 200 μl of cell suspension from each group was added to the upper chamber of the transwell, and the plate was incubated at 37 °C with 5% CO2. After a period of 3 days, the cells were fixed with 70% ice-cold ethanol for 1 h and stained with 0.5% crystal violet staining solution (G1014, Servicebio, China), and scanned at × 200 magnification [ 20 ].

To detect cell apoptosis, we employed the fluorescence TUNEL assay [ 21 ]. Following the manufacturer’s instructions, we fixed the cells with 4% paraformaldehyde, permeabilized them with 0.2% Triton X-100 (diluted in 1 × PBS) (ST795, Beyotime, China), and allowed them to equilibrate at room temperature for 5 min. Subsequently, we added 1 × Equilibration Buffer (diluted 1:10 with deionized water) to the permeabilized cells and incubated them at room temperature for 15 min. The excess Equilibration Buffer was removed using absorbent paper, and the reaction working solution was added to the cells, which were then incubated at 37 °C for 60 min. Following incubation of the coverslips in darkness for 5 min with DAPI, nuclear staining was performed and excess DAPI was washed away. Finally, the sealed slides were observed and images were captured using a fluorescence microscope after applying an anti-fluorescence quenching mounting medium (0100–01, Southernbiotech, USA) on the slides.

Drug screen

We downloaded the protein structure of RCAN1 from the Alphafold [ 22 ] and predicted the active sites of the protein using deepSite [ 23 ]. Next, we downloaded 1615 FDA-approved drugs from the ZINC database [ 24 ], and then converted the target drugs into three-dimensional structures using ADFRsuite [ 25 ]. Based on the obtained three-dimensional structures of the drugs and the RCAN1 protein, we sequentially screened molecular docking using Autodock [ 26 ].

Following docking results, the drug with the lowest binding energy was selected for molecular dynamics simulation with RCAN1 using Gromacs (v2022.3) [ 27 , 28 ]. The small molecule was pre-processed with AmberTools22 to append the GAFF force field and subjected to hydrogen addition and RESP charge calculation using Gaussian 16W, with the resulting electrostatic potential data integrated into the molecular dynamics system topology. Simulations were conducted at a constant temperature of 300 K and pressure of 1 Bar, utilizing the Amber99sb-ildn force field, with water molecules represented by the Tip3p model, and the system’s net charge was neutralized by the addition of Na + ions as necessary. Energy minimization was initially performed using the steepest descent method, followed by equilibration in the canonical (NVT) ensemble for 100,000 steps and the isobaric-isothermal (NPT) ensemble for an equal number of steps, both with a coupling constant of 0.1 ps over a duration of 100 ps. The free molecular dynamics simulation was executed for a total of 5,000,000 steps with a time step of 2 fs, culminating in a 100 ns trajectory. The structures of the drugs used for molecular docking, the docking outcomes, and the results of the molecular dynamics simulations are available in the Supplementary file 5 .

Statistical analysis

Statistical analysis was conducted using GraphPad Prism 7, Seurat (version 4.3), and R (version 4.2.3). Survival curves were generated using the Kaplan–Meier method. All experiments were independently performed at least three times. Quantitative data were presented as mean ± standard deviation. The t-test was employed to analyze differences between two groups, while analysis of variance (ANOVA) was utilized for differences among multiple groups. A significance level of P  < 0.05 was considered statistically significant.

Comprehensive pan-cancer analysis

Utilizing the TCGAplot package, we have conducted an extensive pan-cancer analysis encompassing gene expression, immune infiltration, functional enrichment, and survival-related assessments.

We obtained pan-cancer data from the TCGA database and compared the expression differences of RCAN1 between tumor and normal groups using the R package. The results showed that among the 33 cancer types, RCAN1 expression was decreased in 14 cancer tissues, increased in 3, and showed no statistical significance in 16. Specifically, the expression of RCAN1 in HCC cells is lower than normal tissue. The results were visualized using a grouped box plot (Fig. 1 A). Utilizing the R package, we conducted a prognostic analysis on the acquired pan-cancer data. The K-M survival curve (Fig. 1 B) shows that both the 2.5-year overall survival (OS) rate and the 5-year OS rate are higher in the RCAN1 high-expression group compared to the low-expression group. The mOS was 6.8 years in the RCAN1 high-expression group, while 3.8 years in the RCAN1 low-expression group. This indicates that high expression of RCAN1 is associated with improved patient survival and reflects its excellent anti-tumor effect.

RCAN1 expression and its association with LIHC survival time. A  Differential expression of RCAN1 among different types of cancer; B  Survival curve based on the expression level of RCAN1 in patients with liver cancer

There is a significant correlation between RCAN1 expression and immune cell infiltration in most types of cancer, suggesting that RCAN1 may play a crucial role in these tumors (Fig. 2 A). Based on the expression of RCAN1, tumor samples from the bulk RNA-Seq data were further divided into high-expression and low-expression groups. We identified differentially expressed genes (DEGs) between these two groups. Subsequently, we performed Gene Ontology (GO) functional enrichment analysis based on genes co-expressed with RCAN1 (Fig. 2 B). Additionally, we utilized Gene Set Enrichment Analysis (GSEA), including GSEA-GO (Fig. 2 C) and GSEA-KEGG (Kyoto Encyclopedia of Genes and Genomes) (Fig. 2 D), for pathway enrichment. The top five pathways from each enrichment method are displayed in the figures.

RCAN1 pan cancer analysis. A  Analysis of the association and statistical differences between RCAN1 and 22 different immune cells in 33 types of cancer. * P <0.05 ** P <0.001; B  Enrichment analysis and differential gene heatmap drawing were performed separately by grouping RCAN1 expression differences; C  GSEA-GO analysis of the DEGs between RCAN1 high- and low-expression groups in HCC, and the top 5 GO pathways were shown; D  GSEA-KEGG analysis of the DEGs between RCAN1 high- and low-expression groups in HCC, and the top 5 KEGG pathways were shown

Single-cell sequencing results of RCAN1 expression

Based on the single-cell sequencing dataset GSE149614, we utilized the UMAP algorithm for data dimensionality reduction, resulting in 9 cellular subtypes, namely Hepatocyte, Macrophage, T/NK, Endothelial, Monocyte, Fibroblast, Plasma B, Mature B, DC. The results are displayed in the dimensionality reduction plot (Fig. 3 A). We then extracted the representative genes of these 9 cellular subtypes from the dataset and compared them with the well-established and traditional marker genes of these cellular subtypes, finding a high degree of concordance (Fig. 3 B).

Visualization of single cell dataset GSE149614, malignant cell and disease phenotypic correlation analysis. A  UMAP dimensionality reduction visualization of single-cell liver cancer; B  Bubble plot for annotation of single-cell liver cancer data; C  Visualization of RCAN1 expression distribution in different cells; D  Scissor analysis to calculate cell types positively or negatively correlated with liver cancer phenotypes; E  Malignant cell analysis in single-cell liver cancer data; F  The expression difference of RCAN1 in different cell cycles

We observed that RCAN1 is predominantly expressed in Hepatocyte, Macrophage, Endothelial, and Monocyte (Fig. 3 C). Subsequently, we used the scissors algorithm to accurately identify cells associated with HCC and normal cell phenotypes from the single-cell data, and we found that the distribution of cells with high expression of RCAN1 closely matched the distribution of cells associated with HCC phenotypes (Fig. 3 D). Therefore, we have reason to believe that RCAN1 is closely associated with HCC phenotypes. By analyzing the dataset using the copycat algorithm, tumor cells are primarily distributed in liver cells and some lymphocytes (Fig. 3 E). We found that the distribution of RCAN1 is also consistent with the distribution of tumor cells, indicating that Rcan1 is expressed in most liver tumor cells. Additionally, upon grouping the single-cell dataset GSE149614 according to cell cycle stages, we observed an upregulation of RCAN1 expression during the G1 phase. This elevation in expression may suggest that RCAN1 predominantly exerts a suppressive effect on the onset of HCC during the G1 phase (Fig. 3 F).

To validate the results, the datasets GSE151530 and CNP0000650 were analyzed. Based on the GSE151530 dataset and the malignant cells defined by the original authors, we found that the distribution of RCAN1 overlapped with the distribution of malignant cells, similar to the results we studied in the manuscript. The cell expression distribution, cell cycle distribution, and scissor analysis results of RCAN1 in the single-cell dataset CNP0000650 were consistent with those in the single-cell dataset GSE149614. Due to the quality differences between datasets, we have included the specific results in the Supplementary figure .

Differences in inter-group metabolic pathways

Metabolic mechanisms play a crucial role in the mechanism of tumor occurrence and development. In order to investigate the alterations in metabolic pathways between liver cancer and normal tissue, we utilized the R package “scMetabolism” to analyze the metabolic landscape. A total of 85 metabolic pathways were compared between groups, and significant differences were observed in multiple pathways: Alanine, Aspartate and glutamate metabolism, Butanoate metabolism, D-Glutamine and D-glutamate metabolism, Fatty acid degradation, Glycerolipid metabolism, Glycine, serine and threonine metabolism, Nicotinate and nicotinamide metabolism, Nitrogen metabolism, One carbon pool by folate, Synthesis and degradation of ketone bodies, Terpenoid backbone biosynthesis, Tyrosine metabolism, Valine, leucine and isoleucine degradation, etc. We present here a partial display of representative findings in Fig. 4 A. Through observation, we found that all the aforementioned metabolic pathways were expressed as metabolically active in liver cancer tissues and their distribution is consistent with Rcan1, suggesting that the expression of Rcan1 may directly or indirectly associated with the activity of these metabolic pathways, thereby impacting tumor cell proliferation and migration.

Single-cell cell metabolism and cell communication analysis. A  Cellular metabolism analysis in single cell liver cancer data; B  Network diagram of cell communication quantity difference; C  Heat map of cell communication quantity and intensity; D  Histogram of cell communication quantity difference; E  Major differences in cell communication between liver cancer and normal tissue

Interaction between hepatocytes and other cellular subtypes by cell-chat analysis

The differential interaction number and strength among the 9 cell types were analysis by R package “CellChat”. We found strong interactions between hepatocytes and fibroblasts, endothelial cells, and macrophages (Fig. 4 B, C). The overall strength and number of cell subpopulation interactions in HCC tissue are significantly higher than in normal tissue (Fig. 4 D), which further confirms the complexity and diversity of HCC mechanisms [ 29 ]. Additionally, the analysis of ligand-receptor interactions provides further details on intercellular signaling, as shown in Fig. 4 E. We found that the signaling pathways of SPP1, GDF, and PDGF are exclusively present in HCC tissue cells, which may be associated with the specificity of HCC cells. On the other hand, the signaling flow of the CXCL pathway in HCC tissue is significantly lower than in normal tissue, suggesting its potential inhibition by tumor cells. However, further exploration and validation are needed.

RCAN1 inhibits the proliferation and invasion of HCC cells and promotes apoptosis

To investigate the role of RCAN1 in tumor cells, we constructed a RCAN1-overexpressing cell line (OE-RCAN1) (Fig. 5 A, B, C). The expression level of Caspase3, Bax and Bcl2 in OE-RCAN1 group was confirmed by conducting Western blotting analysis (Fig. 6 A). Full uncropped Gels and Blots images can be found in the Supplementary file 6 . In order to evaluate the impact of RCAN1 expression on cell proliferation and invasion in HepG2 cells, the CCK-8 cell proliferation assay and cell invasion assay were employed. The findings demonstrated that the OE-RCAN1 group exhibited significantly diminished cell proliferation and invasion capabilities in comparison to the HepG2 group (Fig. 6 B, C, D).

Cell invasion and proliferation assay. A Representative images of cell invasion assay; B Average number of invading cells within each group; C Cell proliferation ability was detected using the CCK-8 assay in 3 groups

After overexpression of RCAN1, apoptosis in HepG2 cells can be induced. A  The expression level of Caspase3, Bax and Bcl2 conducted by Western blotting; B  The differential expression of Caspase-3 among different groups; C  The differential expression of Bax among different groups; D  The differential expression of Bcl2 among different groups

The results of our study revealed higher protein expression levels of Caspase3 and Bax in the OE-RCAN1 group compared to the HepG2 group. Conversely, the expression level of Bcl2 was lower in the OE-RCAN1 group. Caspase-3 is a crucial effector caspase involved in cell apoptosis, playing an essential role in various processes associated with cell disintegration and apoptotic body formation [ 30 ]. Bcl2, on the other hand, is a significant regulatory factor in the programmed cell death pathway that inhibits cell apoptosis [ 31 ]. Bax, a member of the Bcl-2 gene family, is the most prominent pro-apoptotic gene in the human body. By interacting with mitochondria, Bax exerts an inhibitory effect on Bcl-2, thus regulating cell death [ 32 ]. The observed increase in caspase-3 and Bax expression levels, along with the decrease in Bcl2 expression, provides evidence that RCAN1 promotes cell death in liver cancer cells. To provide a more tangible observation, the fluorescence TUNEL experiment was conducted, revealing that the proportion of TUNEL-positive cells significantly increased in the OE-RCAN1 group compared to the HepG2 group (Fig. 7 ).

Representative images of TUNEL stained cells. Blue represents cell nuclei, while red represents apoptotic cells

Drug screening

We screened drugs based on molecular docking, and finally obtained brompheniramine as a potential binding drug, which has the lowest binding energy among 1615 drugs: -10.2 kcal/mol. Brompheniramine has strong antihistamine effect, short duration, and sedative effect. The subunit that RCAN1 mainly binds to brompheniramine is Asn317 (a) (Fig. 8 A, B). Molecular dynamics simulations were performed on RCAN1 in complex with Brompheniramine, and the stability of the interaction was assessed by plotting the Root Mean Square Deviation (RMSD). The RMSD values for both the protein and the small molecule were observed to be higher during the initial 20 ns, after which they plateaued, indicating a stabilization of the complex overall (Fig. 8 C).

Visualization of docking results based on RCAN1 molecules. A  The combination of RCAN1 and brompheniramine for 3D visualization; B  The combination of RCAN1 and bromphe fniramine for two-dimensional visualization. C  The RMSD graph depicting the dynamic interaction between RCAN1 and brompheniramine based on molecular dynamics simulations

HCC is a significant global health concern, with the incidence and mortality rates on the rise, necessitating the development of effective prevention strategies and improved treatment approaches [ 33 ]. The invasive nature of HCC often leads to rapid disease progression and metastasis, further complicating treatment [ 34 ]. The identification of tumor targets has emerged as a crucial breakthrough in current HCC therapy [ 35 ]. Current research on RCAN1 in the context of cancer primarily centers on the RCAN1.4 isoform. The other subtype, RCAN1.1, is relatively understudied in terms of its role in tumorigenesis. In previous research, RCAN1.2 has been primarily implicated in association with the prognosis of esophageal squamous cell carcinoma [ 7 ]. Therefore, we have also chosen to focus our investigations on RCAN1.4 [ 36 ]. In this study, we employed bioinformatics analysis to establish a correlation between the expression of RCAN1 and overall survival rates in patients, finding that higher RCAN1 expression is associated with improved overall survival. Single-cell analysis revealed a similar distribution pattern of RCAN1 expression as that of HCC cell phenotypes, malignant cell distribution, and related metabolic pathway distribution. Cell functional experiments further validated the significant anti-cancer effect of RCAN1 overexpression, suggesting a strong intrinsic connection between RCAN1 and HCC. Based on our findings, RCAN1 expression prevalent in macrophages, hepatocytes, fibroblasts, and endothelial cells. The literature elucidates that RCAN1 orchestrates the proliferation and migration of malignant endothelial cells and hepatocytes while concurrently diminishing their invasive capabilities [ 12 , 37 ]. Nonetheless, the precise role of RCAN1 in modulating fibroblast and macrophage function necessitates further investigation [ 38 , 39 , 40 ].

RCAN1 is located in the critical region of human chromosome 21q22.12, which is known as the Down syndrome critical region. As an inhibitor of calcineurin, RCAN1 and its isoforms have been found to exert antitumor effects in various organ tumors. Patients with Down syndrome have a lower incidence of breast cancer, and studies have demonstrated that overexpression of RCAN1.4 can block the calcineurin-NFATc1 pathway, thereby inhibiting tumor growth [ 41 ]. Wang et al. confirmed that in thyroid cancer, NFE2L3 has been shown to increase cell invasiveness, and RCAN1, functioning as a growth and metastasis inhibitor, acts through NFE2L3 [ 10 ]. Zhang et al. demonstrated that RCAN1 is a downstream molecule of miR-103a-3p, and the knockout of miR-103a-3p leads to tumor suppression, while silencing RCAN1 reverses this inhibitory effect [ 42 ]. It has been demonstrated by scholars that RCAN1.4 serves as the target of miR-619-5p. Suppression of RCAN1.4 has been shown to facilitate angiogenesis and induce proliferation and metastasis of NSCLC cells [ 43 ]. In this study, CCK-8 and invasion assays confirmed that upregulation of RCAN1 inhibited proliferation and invasion of HCC cells.

Previous studies have established a strong correlation between RCAN1 and apoptosis within the field of medicine. For instance, a study conducted on neuroblastoma demonstrated that the prolonged accumulation of RCAN1.1L in SH-SY5Y cells triggers apoptosis by activating caspase-3 [ 44 ]. Similarly, in the context of renal fibrosis, the overexpression of RCAN1.4 was observed to induce apoptosis in myofibroblasts through the inhibition of the calcineurin/NFAT2 signaling pathway [ 45 ]. Additionally, numerous investigations have illustrated that RCAN1 can impede cancer growth by inhibiting the NF-κB signaling pathway [ 8 , 46 , 47 ], a well-established pathway in cancer biology. Notably, the NF-κB signaling pathway plays a pivotal role in the regulation of cell proliferation and apoptosis [ 48 ]. In this study, we validated the upregulation of RCAN1’s effect on apoptosis in liver cancer cells through Western blot and TUNEL assays. All the assays suggested that RCAN1 may serve as a novel target for anticancer therapy in HCC.

In order to explore the potential interacting drugs of RCAN1, we screened drugs through molecular docking and selected brompheniramine as a potential binding drug. Brompheniramine, an antihistamine, has been commonly used in cardiovascular and respiratory diseases in the past [ 49 , 50 ], but little is known about its research in tumor diseases. What antihistamines can find in tumor research is that it can significantly reduce the probability of transformation from hepatitis patients to cancer [ 51 ]. In addition, antihistamines can significantly affect the survival cycle of the disease in a variety of cancers [ 52 ]. RCAN1 is a potential core gene in the progression of liver cancer disease. Antihistamines screened by molecular docking may be used as therapeutic drugs for liver cancer in the future. A study conducted by the Icahn School of Medicine at Mount Sinai has demonstrated the efficacy of anti-allergy drugs in anti-cancer therapy [ 53 ]. Its researchers discovered an allergic pathway in a mouse model of non-small cell lung cancer (NSCLC) that releases anti-tumor immunity when blocked. Infiltrating immune cells in lung cancer can exhibit characteristics of “type 2” immune responses, which are typically associated with allergic diseases such as eczema and asthma, similar phenomena have also been observed in other cancer studies. What is more astonishing is that a lung cancer patient did not control the growth of his cancer after receiving PD1 inhibitor treatment, but his cancer was effectively controlled after receiving three doses of anti-allergy drugs. Furthermore, the blockade of IL-4 enhanced the response of mice and 6 patients with treatment-resistant lung cancer to checkpoint blockade. Whether brompheniramine has similar anti-tumor cell mechanisms in liver cancer remains to be further verified through in vivo and in vitro experiments.

Although we have identified an association between RCAN1 and HCC through bioinformatic methods and confirmed the antitumor effects of RCAN1 through in vitro experiments, we must acknowledge the limitations of this study. We have not yet delved into the specific mechanism of RCAN1’s action. In addition, considering the existence of multiple isomers of RCAN1, our verification was carried out in a relatively generalized manner, rather than experimentally verified from the perspective of isomers. Although we have successfully screened potential disease therapies through molecular docking and molecular dynamics, unfortunately we have not been able to verify them at the animal or cellular level. Therefore, we urgently need to conduct further comprehensive studies to fully elucidate the complex mechanism of action of RCAN1 in HCC.

Conclusions

This study focuses on the currently popular single-cell analysis methods to investigate the potential intrinsic association between RCAN1 and HCC. All analyses conducted in this study consistently indicate a significant correlation between RCAN1 and HCC, as well as its association with patient prognosis. Furthermore, the inhibitory effect of RCAN1 on HCC tumor cells was further validated through in vitro experiments. These findings suggest that RCAN1 may serve as a novel prognostic marker and therapeutic target for HCC.

Availability of data and materials

The original data in the article can be obtained from the Supplementary Material or online repositories.

Abbreviations

Hepatocellular carcinoma

The regulator of calcineurin 1

Kyoto encyclopedia of genes and genomes

Analysis of variance

Overall survival

Root mean square deviation

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Acknowledgements

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This study was supported by the National Natural Science Foundation of China (grant no.82100297) and the Natural Science Foundation of Shaanxi Province, China (grant no.2021JQ-342).

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Ziqi Yang and Xiwei Deng have contributed equally to this work and share first authorship.

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Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China

Ziqi Yang, Xiwei Deng, Didi Wen, Lijun Sun, Rui An & Jian Xu

Department of Interventional Surgery Center, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China

Ziqi Yang, Xiwei Deng, Lijun Sun, Rui An & Jian Xu

Department of Oncology, Bethune International Peace Hospital, Shijiazhuang, Hebei, China

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The research design and data analysis were conducted by ZY. XD performed experimental verification, while DW and LS were responsible for carrying out image optimization. RA and JX supervised the study. All authors reached a consensus and approved the final manuscript.

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Supplementary Information

Supplementary material 1: supplementary figure. single-cell analysis of cnp0000650 and gse151530., supplementary material 2: supplementary file 1. single cell metabolic results., supplementary material 3: supplementary file 2. single cell cell chat results., supplementary material 4: supplementary file 3. verification and results of overexpression of rcan1., supplementary material 5: supplementary file 4. primer sequences., supplementary material 6: supplementary file 5. molecular docking drugs and molecular dynamics results., supplementary material 7: supplementary file 6. full uncropped gels and blots image., rights and permissions.

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Yang, Z., Deng, X., Wen, D. et al. Identification of RCAN1’s role in hepatocellular carcinoma using single-cell analysis. BMC Cancer 24 , 1056 (2024). https://doi.org/10.1186/s12885-024-12807-4

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A step-by-step guide to peer review: a template for patients and novice reviewers

1 General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

Charlotte Blease

2 Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

3 Harvard Medical School

While relatively novel, patient peer review has the potential to change the healthcare publishing paradigm. It can do this by helping researchers enlarge the pool of people who are welcome to read, understand and participate in healthcare research. Academic journals who are early adopters of patient peer review have already committed to placing a priority on using person-centred language in publicly available abstracts and focusing on translational and practical research.

A wide body of literature has shown that including people with lived experiences in a truly meaningful way can improve the quality and efficiency of health research. Traditionally considered only as ‘subjects’ of research, over the last 10–15 years, patients and care partners have increasingly been invited to contribute to the design and conduct of studies. Established institutions are increasingly recognising the distinctive expertise patients possess—many patients have acquired deep insights about their conditions, symptoms, medical treatments and quality of healthcare delivery. Among some funders, including the views of patients is now a requirement to ensure research proposals are meaningful to persons with the lived experience of illness. Further illustrating these developments, patients are now involved in reviewing and making recommendations as part of funding institutions, setting research agendas and priorities, being funded for and leading their own research and leading or coauthoring scholarly publications, and are now participating in the peer review process for academic journals. 1–5 Patients offer an outsider’s perspective within mainstream healthcare: they have fewer institutional, professional or social allegiances and conflicts of interest—factors recognised as compromising the quality of research. Patient involvement is essential to move away from rhetorical commitments to embrace a truly patient-centred healthcare ecosystem where everyone has a place at the table.

As people with lived health experiences climb a ladder of engagement in patient–researcher partnerships, they may be asked to act as peer reviewers of academic manuscripts. However, many of these individuals do not hold professional training in medicine, healthcare or science and have never encountered the peer review process. Little guidance exists for patients and care partners tasked with reviewing and providing input on manuscripts in search of publication.

In conversation, however, even experienced researchers confess that learning how to peer review is part of a hidden curriculum in academia—a skill outlined by no formal means but rather learnt by mimicry. 6 As such, as they learn the process, novices may pick up bad habits. In the case of peer review, learning is the result of reading large numbers of academic papers, occasional conversations with mentors or commonly “trial by fire” experienced via reviewer comments to their own submissions. Patient reviewers are rarely exposed to these experiences and can be at a loss for where to begin. As a result, some may forgo opportunities to provide valuable and highly insightful feedback on research publications. Although some journals are highly specific about how reviewers should structure their feedback, many publications—including top-tier medical journals—assume that all reviewers will know how to construct responses. Only a few forward-thinking journals actively seeking peer review from people with lived health experiences currently point to review tips designed for experienced professionals. 7

As people with lived health experiences are increasingly invited to participate in peer review, it is essential that they be supported in this process. The peer review template for patients and novice reviewers ( table 1 ) is a series of steps designed to create a workflow for the main components of peer review. A structured workflow can help a reviewer organise their thoughts and create space to engage in critical thinking. The template is a starting point for anyone new to peer review, and it should be modified, adapted and built on for individual preferences and unique journal requirements. Peer reviews are commonly submitted via website portals, which vary widely in design and functionality; as such, reviewers are encouraged to decide how to best use the template on a case-by-case basis. Journals may require reviewers to copy and paste responses from the template into a journal website or upload a clean copy of the template as an attachment. Note: If uploading the review as an attachment, remember to remove the template examples and writing prompts .

Peer review template for patients and other novice reviewers

It is important to point out that patient reviewers are not alone in facing challenges and a steep learning curve in performing peer review. Many health research agendas and, as a result, publications straddle disciplines, requiring peer reviewers with complementary expertise and training. Some experts may be highly equipped to critique particular aspects of research papers while unsuited to comment on other parts. Curiously, however, it is seldom a requirement that invited peer reviewers admit their own limitations to comment on different dimensions of papers. Relatedly, while we do not suggest that all patient peer reviewers will be equipped to critique every aspect of submitted manuscripts—though some may be fully competent to do so—we suggest that candour about limitations of expertise would also benefit the broader research community.

As novice reviewers gain experience, they may find themselves solicited for a growing number of reviews, much like their more experienced counterparts or mentors. 8 Serving as a patient or care partner reviewer can be a rewarding form of advocacy and will be crucial to harnessing the feedback and expertise of persons with lived health experiences. As we move into a future where online searches for information are a ubiquitous first step in searching for answers to health-related questions, patient and novice reviewers may become the much-needed link between academia and the lay public.

Acknowledgments

LS thanks the experienced and novice reviewers who encouraged her to publish this template.

Twitter: @TheLizArmy, @@crblease

Contributors: Both authors contributed substantially to the manuscript. LS conceived the idea and design and drafted the text. CB refined the idea and critically revised the text.

Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests: The authors have read and understood the BMJ policy on declaration of interests and declare the following interests: LS is a member of the BMJ Patient Advisory Panel, serves as a BMJ patient reviewer and is an ad hoc patient reviewer for the Patient-Centered Outcomes Research Institute; CB is a Keane OpenNotes scholar; both LS and CB work on OpenNotes, a philanthropically funded research initiative focused on improving transparency in healthcare.

Provenance and peer review: Commissioned; externally peer reviewed.

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Patient consent for publication.

Not required.

Review: OREO Coca-Cola Sandwich Cookies And Coca-Cola OREO Zero Sugar Is The Pairing Of Your Dreams

If you're anything like me, the moment you saw that Coke and OREO were pairing together for a smashup for some of their products, you were immediately onboard. Not all Coke flavors rank the same , and some OREO flavors rank better than others , too. However, I couldn't imagine how this pairing could go wrong. So, I had to give it a try. Putting the world's favorite soft drink and cookie together seems like something that should have happened a long time ago, but will it match your expectations? In 2024, you get to find out. 

I was able to try the Limited-Edition OREO Coca-Cola Sandwich Cookie and the Coca-Cola OREO Zero Sugar Limited Edition soft drink ahead of their arrival in stores. Not only have I explained what you can expect, but I've managed to find out their ingredients, nutritional information, prices, and where you can find them. Finally, I've left you with a review that I think is going to help you decide whether or not you want to try these for yourself. Although, I'm betting you're going to test them personally just to make sure I've made a fair judgement.  

What you can expect from OREO Coca-Cola Sandwich Cookies and Zero Sugar soft drinks

There was a lot of thought put into the OREO and Coca-Cola team up. The pairing goes two ways, with the creation of an OREO sandwich cookie that features the flavor of Coca-Cola. Plus, there's a Coca-Cola OREO Zero Sugar Limited Edition soft drink that features the flavor of OREOs. Both provide a completely different experience.

The OREO Coca-Cola cookie features colors you know from both brands. It has a black cookie and a red cookie, with a white filling. The black cookie is a regular chocolate OREO cookie with the OREO logo. Not only does it contain chocolate, but it has Coca-Cola syrup and popping candy to make the experience fizzy and more like drinking a Coke. Meanwhile, the red cookie is a golden-style OREO cookie with red coloring. It contains three different Coca-Cola images and also has popping candy baked into it. The middle appears to be an ordinary white creme filling, but it also has popping candies mixed in as well as a cola flavor.

On the other hand, the OREO Coca-Cola Zero Sugar is a fizzy, cookie-flavored soft drink. Like any other flavor of Coke, the idea is to experience both the cola and other flavors simultaneously. So, the expectation would be for an OREO-inspired cookies-and-cream-type flavor for this version of Zero Sugar Coke.

Where you can find OREO Coca-Cola Sandwich Cookies and Zero Sugar soft drinks

If you're trying to find Coke OREOs or OREO Cokes, you can look for them in grocery stores and convenience stores where you normally find Coke or OREO products.

The United States isn't the only place where you'll be able to find OREO Coca-Cola cookies and Coca-Cola OREO Zero Sugar Limited Edition soft drinks. A few more countries will be getting them, too, including nearby countries like Canada and Mexico, along with Brazil and China.

Both items will be available in a variety of stores. However, the 7.5-ounce 10-pack will only be available at Walmart and Target. If you like the idea of a Zero Sugar Coke with OREO flavoring, something else that might interest you is that there will be a Coca-Cola OREO Zero Sugar Slurpee drink available in a few convenience stores. Look for them to make an appearance in Slurpee machines at some 7-Eleven, Speedway, and Stripes locations around the U.S.

When you can expect to find Coke OREOs and OREO Zero Sugar Cokes

If you're anticipating getting your hands on either Coke OREOS or the OREO Cokes, there are two options. You can either wait until they come out in stores or participate in the pre-sale event to get them delivered straight to your door to guarantee that you don't miss them.

There are two pre-sale options. One is through the Walmart website in early September of 2024. So, if you're interested, you can start checking the website when the calendar turns to a new month. The other one is a pre-sale option through the OREO website , which starts September 2, 2024.

On September 9, 2024, both of these products will start hitting store shelves. There will only be a limited number of OREO Coca-Cola cookies and Coca-Cola OREO Zero Sugar Limited Edition soft drinks available. So, the amount of time they will be on the shelf is completely dependent on how big the demand is for the cookies and soft drinks. Once they're gone, they're gone. 

With OREO being the world's best-selling cookie and Coca-Cola being the world's best-selling soft drink that ranks above others , it wouldn't be surprising if customers grabbed multiples. So, don't snooze on this one if it sounds like something you'd like because they're likely not going to last too long. Hopefully, they'll come around again, but you never know. 

The prices you can expect to pay for OREO Coca-Cola Sandwich Cookies and Zero Sugar soft drinks

When you go out looking for the new Coke OREOs and Zero Sugar OREO Cokes, the price shouldn't catch you too much by surprise. While the soft drinks are similar in price to other Coke products on the market, the OREOs are slightly more expensive than normal specialty OREO flavors.

There will be two sizes of Coca-Cola Oreos: a 10.68-ounce package and a 2.04-ounce snack pack of cookies that contains just four cookies. The 10.68-ounce package will cost $5.29, while the 10.68-ounce one will cost $2.49.

When it comes to the Coca-Cola OREO Zero Sugar Limited Editions soft drinks, they will cost the same as other Coke products in similar packaging. There will be three sizes of cans available in a six-pack: 20-ounce cans, 12-ounce slim cans, and 7.5-ounce cans. However, at Walmart and Target, you'll also be able to find a 10-pack of 7.5-ounce cans. I found a current price for a six-pack of 7.5-ounce cans of Cherry Coke for $4.36 at Walmart and a 10-pack of 7.5 ounce cans of Cherry Coke for $6.08 at Walmart. So, the OREO-flavored one should be fairly similar.

The ingredients list for OREO Coca-Cola cookies and Zero Sugar soft drinks

You probably know what ingredients to expect from OREOs and Coke if you've tried them before. However, the main changes relate to adding Coke flavor and popping candies to the cookies and OREO flavor to the soft drink.

Many of the ingredients in Coca-Cola OREOs are ordinary ones you'd not be surprised to see even in homemade cookies: sugar, unbleached enriched flour, salt, baking soda, water, cornstarch, cocoa, and chocolate. However, there are two other sweeteners: corn syrup and high fructose corn syrup. It contains palm oil as well as soybean and/or canola oil as well as soy lecithin as an emulsifier. On the Coca-Cola side of the cookie, you'll find red 40 lake coloring. There are some extra flavors that come from natural and artificial sources. Plus, the cookies contain Coca-Cola syrup, which has additional high fructose corn syrup, phosphoric acid, caramel color, and natural flavors. The fizzy sensation comes from carbon dioxide.

The Limited Edition OREO Coca-Cola Zero Sugar soft drink has a shorter ingredient list. The ingredients that match classic Coca-Cola include carbonated water, caramel color, phosphoric acid, natural flavors, and caffeine. The flavors are somewhat different since this drink has a "fizzy cookie" flavor. You'll find the sugar (or high fructose corn syrup in this case) replaced with three zero-calorie sweeteners: acasulfame potassium, aspartame, and sucralose. Plus, it contains salt as well as sodium citrates (for regulating acidity).

Info about the nutritional content of Coca-Cola OREOs and Zero Sugar OREO Cokes

The nutritional content is pretty much what you would expect for a Zero Sugar Coke and Coke-flavored OREO cookies. However, you'll actually find some values to be slightly better for Coke OREOs than regular OREOs. We're not sure how that happened, but it's good news.

The serving size for Coca-Cola OREOs is two cookies, which are 140 calories. The amount of fat in two cookies is 6 grams, and 2 of those are saturated fat (10% of the daily value). The sodium amount is 85 milligrams. If you're concerned about carbs, you'll end up consuming 21 grams (8% of the daily value) if you eat a serving of these cookies. As a dessert, you of course expect some sugar. Two cookies contain 12 grams of sugar, which is 24% of the daily value. There's no fiber here, but there is a slight amount of protein (less than 1 gram). You can also get a small amount of minerals from this sweet treat: 0.7 milligrams of iron (4% DV) and 20 milligrams of potassium (0% DV).

While Coca-Cola OREO Zero Sugar Limited Edition has no sugar to speak of, it does have one lonely calorie. Oddly enough, the salt content is higher than you'd expect. It's not that bad at 80 milligrams, but it does represent 1% of the daily recommended amount. So, it's not completely insignificant. All of the other nutritional values for this drink are nil.

My verdict on Zero Sugar OREO Coke and Coke OREOs

OREO and Coca-Cola belong together. I knew it from the moment I heard about this pairing, and I wasn't disappointed. The smell is a part of the experience for Coke OREOs. It smells exactly like the ideal fizzy Coke with sweet cookies. But the real question is whether or not the OREOs taste like Coke. They absolutely do. I think it was brilliant to add popping candy because it means the Coke doesn't taste flat. I especially liked the way the popping candy keeps fizzing in my mouth after each bite. While there's popping candy and Coke flavoring in the cookies, there's some in the creme center, too. I honestly think the center is the best part — 10 out of 10.

I'm usually not a big fan of sugar-free drinks because of the aftertaste, but I was pleasantly surprised by the OREO-flavored Zero Sugar Coke. While it doesn't seem to have as much bite as regular Coke, the flavor doesn't suffer from the artificial sweeteners, and I don't detect an unpleasant aftertaste. However, the OREO cookie flavor in it seems weak to me. It's there slightly, but if you had me taste this with a blindfold on and asked me to tell you what flavor it was, I probably couldn't guess. Still, it tastes far better than any Coke with artificial sweetener that I've tried before. So, it's still a big win for me. I give it an 8 out of 10.

The methodology for my review

A representative of the Coca-Cola and OREO team-up sent me a package of the new OREO Coca-Cola Sandwich Cookies and Coca-Cola OREO Zero Sugar Limited Edition soft drink in the mail to try. While I received promotional material explaining information like where and when you can find these products, neither Coca-Cola nor OREO reimbursed me or influenced my review in any way. Having the products available to try, I was able test them out personally. 

However, I do want to mention that, while the Coke OREOs I received were made in the U.S., the OREO Coke sample I tried was made in the U.K. So, there could be a slight difference in flavor from your local bottling company. 

Ultimately, to know how close your experiences might mirror mine, you'll want to give these a try yourself. So, mark your calendar for September 2 (for the pre-sale) or September 9 (for regular sales) if you want to conduct the same flavor experiments I did.

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Title: analysis of the icml 2023 ranking data: can authors' opinions of their own papers assist peer review in machine learning.

Abstract: We conducted an experiment during the review process of the 2023 International Conference on Machine Learning (ICML) that requested authors with multiple submissions to rank their own papers based on perceived quality. We received 1,342 rankings, each from a distinct author, pertaining to 2,592 submissions. In this paper, we present an empirical analysis of how author-provided rankings could be leveraged to improve peer review processes at machine learning conferences. We focus on the Isotonic Mechanism, which calibrates raw review scores using author-provided rankings. Our analysis demonstrates that the ranking-calibrated scores outperform raw scores in estimating the ground truth ``expected review scores'' in both squared and absolute error metrics. Moreover, we propose several cautious, low-risk approaches to using the Isotonic Mechanism and author-provided rankings in peer review processes, including assisting senior area chairs' oversight of area chairs' recommendations, supporting the selection of paper awards, and guiding the recruitment of emergency reviewers. We conclude the paper by addressing the study's limitations and proposing future research directions.

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