Challenges of the peer review process are:
1. The increasing need for reviewers due to an increasing number of peer-review requests, because promotions are obtained based on the number of publications or “publish or perish” syndrome and due to various online and hard copy publishers 1).
2. Increasing demands from the reviewers primary jobs, related to clinical demands, financial constraints, or more time spent on their research program.
3. Heterogeneous quality of reviews and different methods used to analyze the manuscript, sometimes because of insufficient training 2) 3).