BMJ 'Under Review': What Each Status Means and When to Expect a Decision

Source: BMJ editorial process documentation and ScholarOne Manuscript Central, April 2026.

Note on "Awaiting PRM Assignment": PRM stands for Peer Review Manager, BMJ's internal editorial coordination role. This is an administrative routing step, not a substantive editorial decision. Papers move through this stage within 1 to 2 days. If you see this status for more than 3 business days, it may indicate an assignment delay, but it is not cause for concern before that.

This is the desk screen. A BMJ editor reads the manuscript and decides whether to send it for external review. About 70% of submissions are rejected at this stage.

The editor is asking:

• does the study address a question that matters for clinical practice?
• is the study design strong enough to support the conclusions?
• will the findings change how doctors treat patients?
• is the topic relevant to BMJ's broad international clinical readership?

If you receive a desk rejection, it typically arrives within 5 to 7 days. The feedback is usually brief but indicates whether the issue was scope, significance, or design.

The editor is finding and confirming reviewers. BMJ sends papers to 2 to 3 clinical experts plus a statistical reviewer. Finding qualified reviewers who are available can take time, especially for specialized topics.

The status may alternate between "Awaiting Reviewer Selection" and "Awaiting Reviewer Assignment" as the editor invites and re-invites potential reviewers. This is normal and does not mean anything is wrong.

Reviewers have accepted and are actively evaluating your paper. BMJ asks reviewers to return reports within 2 weeks. Most do, which is why BMJ's overall decision time is faster than many comparable journals.

Reviewers evaluate:

• scientific validity and methodological rigor
• clinical significance and practice implications
• appropriateness of statistical methods
• quality of reporting (CONSORT, STROBE, etc.)
• clarity and accessibility for a general medical audience

BMJ also sends papers for independent statistical review. The statistical reviewer checks the analytical methods, sample size justification, and reporting of results. This review runs in parallel with the clinical reviews.

If the two primary reviewers have conflicting assessments, the editor may invite a third reviewer. This adds 1 to 2 weeks to the process. If you see this status, it means the decision is not straightforward, which can go either way.

The editor has received all reviewer reports (including statistical review) and is preparing the final decision. This stage typically takes 3 to 5 days. The editor weighs the reviews, considers the statistical review, and makes a recommendation that a senior editor signs off on.

Accept

Rare on first round at BMJ. Almost all acceptances follow at least one revision. If you receive an outright acceptance, the paper was exceptionally clean.

Minor Revision

Specific, addressable changes. You have 6 weeks to respond. The revision may or may not return to reviewers. This is a strong position.

Major Revision

Substantive concerns about the study or its presentation. You have 3 months. The statistical review results are included in the decision letter. The revised paper returns to the original reviewers and statistical reviewer.

Reject After Review

The reviewers found problems that the editor does not believe can be adequately addressed through revision. The decision letter includes the full reviewer reports, which are often detailed and constructive even in rejection.

Reject at Desk

The most common outcome (roughly 70%). This is not a quality judgment. BMJ receives far more strong papers than it can publish. The editor may suggest resubmission to BMJ Open or another BMJ-family journal.

In our pre-submission review work with manuscripts targeting BMJ, three failure patterns generate the most consistent desk rejections. We find these across manuscripts we've reviewed through our BMJ desk-rejection risk check, and they predict which papers will stall at the "With Editor" stage.

The study with a valid finding that doesn't change clinical behavior. We observe this in roughly 40% of BMJ desk rejections we see. The study is well-designed and the statistics are sound, but the finding is confirmatory rather than practice-changing. BMJ editors specifically ask whether this result changes what a doctor does for patients. A study showing that a known intervention works in a new subgroup is interesting but not sufficient; a study showing that the standard treatment performs worse than an alternative in a specific patient population, with evidence a doctor could act on, is what BMJ is looking for. We find that papers which frame the clinical implication explicitly in the abstract's final sentence clear the desk at a higher rate.

Reporting checklist items completed generically. We observe that BMJ editors check CONSORT, STROBE, and ARRIVE checklist completion at the desk, not just during review. We find that many manuscripts complete these checklists with "N/A" or "see methods" for items that are actually relevant to the study. BMJ's statistical reviewer also specifically looks for whether the completed checklist items are reflected in the methods section. Papers whose checklist items say "page 7" and actually direct reviewers to specific text clear this screen; papers that complete checklists perfunctorily generate desk concerns.

International relevance asserted but not demonstrated. BMJ's readership is global, not US-focused. We find that papers from single-country health systems that claim international applicability without discussing generalizability limitations get flagged. The fix is adding one paragraph in the discussion addressing what readers in other health systems would need to know to apply these findings. SciRev community data for BMJ consistently shows editors asking for this when it is missing.

BMJ's editorial office is professional and responsive to author inquiries. Use the manuscript tracking system for status questions.

How this page was created: sources used include BMJ Author Hub tracking guidance, BMJ author resources, BMJ editorial policies and checklist pages, BMJ reviewer guidance, SciRev author-reported timing, and Manusights internal analysis of general-medicine submissions prepared for BMJ, BMJ Open, JAMA, The Lancet, and NEJM. We did not test a private live BMJ ScholarOne account for this page; status interpretation is based on public BMJ materials, documented author experience, and pre-submission review patterns.

Why this page exists: "BMJ under review" is a status-interpretation query. Authors are not primarily asking for a submission guide; they want to know whether the status means the paper passed triage, how long to wait, and when follow-up is reasonable.

In our analysis of BMJ status cases, the recurring failure pattern is treating every status as a prediction of acceptance. BMJ's tracking tools are designed to make process and contact points clearer, but the useful interpretation still depends on stage: "With Editor" is a desk-risk window, "Under Review" is a positive routing signal, and "Decision Pending" means the editor is synthesizing reports.

What BMJ's tracking system does well: BMJ's Where Is My Paper? tool gives authors consolidated status context across BMJ journals and makes contact points clearer than a raw ScholarOne dashboard.

Where status data falls short: It does not tell you whether the statistical reviewer is positive, whether reviewers disagree, or whether the editor sees the clinical implication as strong enough for BMJ's broad audience.

Alternative pages depend on the question. Use this page for status meaning. Use BMJ review timeline for timing-only planning, BMJ submission process for upload workflow, and the BMJ journal overview for fit and metrics.