how to write a psychology journal article review

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Writing Research Papers

• Writing a Literature Review

When writing a research paper on a specific topic, you will often need to include an overview of any prior research that has been conducted on that topic.  For example, if your research paper is describing an experiment on fear conditioning, then you will probably need to provide an overview of prior research on fear conditioning.  That overview is typically known as a literature review.  

Please note that a full-length literature review article may be suitable for fulfilling the requirements for the Psychology B.S. Degree Research Paper .  For further details, please check with your faculty advisor.

Different Types of Literature Reviews

Literature reviews come in many forms.  They can be part of a research paper, for example as part of the Introduction section.  They can be one chapter of a doctoral dissertation.  Literature reviews can also “stand alone” as separate articles by themselves.  For instance, some journals such as Annual Review of Psychology , Psychological Bulletin , and others typically publish full-length review articles.  Similarly, in courses at UCSD, you may be asked to write a research paper that is itself a literature review (such as, with an instructor’s permission, in fulfillment of the B.S. Degree Research Paper requirement). Alternatively, you may be expected to include a literature review as part of a larger research paper (such as part of an Honors Thesis). 

Literature reviews can be written using a variety of different styles.  These may differ in the way prior research is reviewed as well as the way in which the literature review is organized.  Examples of stylistic variations in literature reviews include: 

• Summarization of prior work vs. critical evaluation. In some cases, prior research is simply described and summarized; in other cases, the writer compares, contrasts, and may even critique prior research (for example, discusses their strengths and weaknesses).
• Chronological vs. categorical and other types of organization. In some cases, the literature review begins with the oldest research and advances until it concludes with the latest research.  In other cases, research is discussed by category (such as in groupings of closely related studies) without regard for chronological order.  In yet other cases, research is discussed in terms of opposing views (such as when different research studies or researchers disagree with one another).

Overall, all literature reviews, whether they are written as a part of a larger work or as separate articles unto themselves, have a common feature: they do not present new research; rather, they provide an overview of prior research on a specific topic . 

How to Write a Literature Review

When writing a literature review, it can be helpful to rely on the following steps.  Please note that these procedures are not necessarily only for writing a literature review that becomes part of a larger article; they can also be used for writing a full-length article that is itself a literature review (although such reviews are typically more detailed and exhaustive; for more information please refer to the Further Resources section of this page).

Steps for Writing a Literature Review

1. Identify and define the topic that you will be reviewing.

The topic, which is commonly a research question (or problem) of some kind, needs to be identified and defined as clearly as possible.  You need to have an idea of what you will be reviewing in order to effectively search for references and to write a coherent summary of the research on it.  At this stage it can be helpful to write down a description of the research question, area, or topic that you will be reviewing, as well as to identify any keywords that you will be using to search for relevant research.

2. Conduct a literature search.

Use a range of keywords to search databases such as PsycINFO and any others that may contain relevant articles.  You should focus on peer-reviewed, scholarly articles.  Published books may also be helpful, but keep in mind that peer-reviewed articles are widely considered to be the “gold standard” of scientific research.  Read through titles and abstracts, select and obtain articles (that is, download, copy, or print them out), and save your searches as needed.  For more information about this step, please see the Using Databases and Finding Scholarly References section of this website.

3. Read through the research that you have found and take notes.

Absorb as much information as you can.  Read through the articles and books that you have found, and as you do, take notes.  The notes should include anything that will be helpful in advancing your own thinking about the topic and in helping you write the literature review (such as key points, ideas, or even page numbers that index key information).  Some references may turn out to be more helpful than others; you may notice patterns or striking contrasts between different sources ; and some sources may refer to yet other sources of potential interest.  This is often the most time-consuming part of the review process.  However, it is also where you get to learn about the topic in great detail.  For more details about taking notes, please see the “Reading Sources and Taking Notes” section of the Finding Scholarly References page of this website.

4. Organize your notes and thoughts; create an outline.

At this stage, you are close to writing the review itself.  However, it is often helpful to first reflect on all the reading that you have done.  What patterns stand out?  Do the different sources converge on a consensus?  Or not?  What unresolved questions still remain?  You should look over your notes (it may also be helpful to reorganize them), and as you do, to think about how you will present this research in your literature review.  Are you going to summarize or critically evaluate?  Are you going to use a chronological or other type of organizational structure?  It can also be helpful to create an outline of how your literature review will be structured.

5. Write the literature review itself and edit and revise as needed.

The final stage involves writing.  When writing, keep in mind that literature reviews are generally characterized by a summary style in which prior research is described sufficiently to explain critical findings but does not include a high level of detail (if readers want to learn about all the specific details of a study, then they can look up the references that you cite and read the original articles themselves).  However, the degree of emphasis that is given to individual studies may vary (more or less detail may be warranted depending on how critical or unique a given study was).   After you have written a first draft, you should read it carefully and then edit and revise as needed.  You may need to repeat this process more than once.  It may be helpful to have another person read through your draft(s) and provide feedback.

6. Incorporate the literature review into your research paper draft.

After the literature review is complete, you should incorporate it into your research paper (if you are writing the review as one component of a larger paper).  Depending on the stage at which your paper is at, this may involve merging your literature review into a partially complete Introduction section, writing the rest of the paper around the literature review, or other processes.

Further Tips for Writing a Literature Review

Full-length literature reviews

• Many full-length literature review articles use a three-part structure: Introduction (where the topic is identified and any trends or major problems in the literature are introduced), Body (where the studies that comprise the literature on that topic are discussed), and Discussion or Conclusion (where major patterns and points are discussed and the general state of what is known about the topic is summarized)

Literature reviews as part of a larger paper

• An “express method” of writing a literature review for a research paper is as follows: first, write a one paragraph description of each article that you read. Second, choose how you will order all the paragraphs and combine them in one document.  Third, add transitions between the paragraphs, as well as an introductory and concluding paragraph. 1
• A literature review that is part of a larger research paper typically does not have to be exhaustive. Rather, it should contain most or all of the significant studies about a research topic but not tangential or loosely related ones. 2   Generally, literature reviews should be sufficient for the reader to understand the major issues and key findings about a research topic.  You may however need to confer with your instructor or editor to determine how comprehensive you need to be.

Benefits of Literature Reviews

By summarizing prior research on a topic, literature reviews have multiple benefits.  These include:

• Literature reviews help readers understand what is known about a topic without having to find and read through multiple sources.
• Literature reviews help “set the stage” for later reading about new research on a given topic (such as if they are placed in the Introduction of a larger research paper). In other words, they provide helpful background and context.
• Literature reviews can also help the writer learn about a given topic while in the process of preparing the review itself. In the act of research and writing the literature review, the writer gains expertise on the topic .

Downloadable Resources

• How to Write APA Style Research Papers (a comprehensive guide) [ PDF ]
• Tips for Writing APA Style Research Papers (a brief summary) [ PDF ]
• Example APA Style Research Paper (for B.S. Degree – literature review) [ PDF ]

Further Resources

How-To Videos     

• Writing Research Paper Videos
• UCSD Library Psychology Research Guide: Literature Reviews

External Resources

• Developing and Writing a Literature Review from N Carolina A&T State University
• Example of a Short Literature Review from York College CUNY
• How to Write a Review of Literature from UW-Madison
• Writing a Literature Review from UC Santa Cruz  
• Pautasso, M. (2013). Ten Simple Rules for Writing a Literature Review. PLoS Computational Biology, 9 (7), e1003149. doi : 1371/journal.pcbi.1003149

1 Ashton, W. Writing a short literature review . [PDF]     

2 carver, l. (2014).  writing the research paper [workshop]. , prepared by s. c. pan for ucsd psychology.

Back to top

• Research Paper Structure
• Formatting Research Papers
• Using Databases and Finding References
• What Types of References Are Appropriate?
• Evaluating References and Taking Notes
• Citing References
• Writing Process and Revising
• Improving Scientific Writing
• Academic Integrity and Avoiding Plagiarism
• Writing Research Papers Videos

How to Write an Effective Journal Article Review

• First Online: 01 January 2012

Cite this chapter

• Dennis Drotar PhD 2 ,
• Yelena P. Wu PhD 3 &
• Jennifer M. Rohan MA 4  

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The experience of reviewing manuscripts for scientific journals is an important one in professional development. Reviewing articles gives trainees familiarity with the peer review process in ways that facilitate their writing. For example, reviewing manuscripts can help students and early career psychologists understand what reviewers and editors look for in a peer-reviewed article and ways to critique and enhance a manuscript based on peer review. Experiences in review can facilitate early career faculty with early entry into and experience being a reviewer for a professional journal. The experience of journal reviews also gives students a broader connection to the field of science in areas of their primary professional interest. At the same time reviewing articles for scientific journals poses a number of difficult challenges (see Hyman, 1995; Drotar, 2000a, 2009a, 2009b, 2009c, 2009d, 2010, 2011; Lovejoy, Revenson, & France, 2011). The purpose of this chapter is to provide an introduction to the review process and give step by step guidance in conducting reviews for scientific journals. Interested readers might wish to read Lovejoy et al.’s (2011) primer for manuscript review, which contains annotated examples of reviews and an editor’s decision letter.

• Journal Review Article
• Manuscript Review
• Primary Professional Interest
• Faculty Early Career
• Conclusion Let

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Yelena P. Wu PhD

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Jennifer M. Rohan MA

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Drotar, D., Wu, Y.P., Rohan, J.M. (2013). How to Write an Effective Journal Article Review. In: Prinstein, M. (eds) The Portable Mentor. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-3994-3_11

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PSY290 - Research Methods

• Identifying & Locating Empirical Research Articles
• Survey & Test Instruments

Writing a Critical Review

Sample summaries, verbs to help you write the summary, how to read a scholarly article.

• APA Citation Style Help

A critical review is an academic appraisal of an article that offers both a summary and critical comment. They are useful in evaluating the relevance of a source to your academic needs. They demonstrate that you have understood the text and that you can analyze the main arguments or findings. It is not just a summary; it is an evaluation of what the author has said on a topic. It’s critical in that you thoughtfully consider the validity and accuracy of the author’s claims and that you identify other valid points of view.

An effective critical review has three parts:

• APA citation of article
• Clearly summarizes the purpose for the article and identifies the strengths and weaknesses of the research. (In your own words – no quotations.)
• Evaluates the contribution of the article to the discipline or broad subject area and how it relates to your own research.

Steps to Write a Critical Review:

• Create and APA style citation for the article you are reviewing.
• Skim the text: Read the title, abstract, introduction, and conclusion.
• Read the entire article in order to identify its main ideas and purpose.

Q. What were the authors investigating? What is their thesis? Q. What did the authors hope to discover?

        D. Pay close attention to the methods used by the authors to collection information.

Q. What are the characteristics of the participants? (e.g.) Age/gender/ethnicity

Q. What was the procedure or experimental method/surveys used?

Q. Are their any flaws in the design of their study?

  E. Review the main findings in the “Discussion” or “Conclusion” section. This will help you to evaluate the validity of their evidence, and the credibility of the authors.             Q.   Are their conclusions convincing?            Q.   Were their results significant? If so, describe how they were significant.  F. Evaluate the usefulness of the text to YOU in the context of your own research.

Q. How does this article assist you in your research?

Q. How does it enhance your understanding of this issue?

Q. What gaps in your research does it fill?

Good Summary:

Hock, S., & Rochford, R. A. (2010). A letter-writing campaign: linking academic success and civic engagement. Journal  of Community Engagement and Scholarship, 3 (2), 76-82.

Hock & Rochford (2010) describe how two classes of developmental writing students were engaged in a service-learning project to support the preservation of an on-campus historical site. The goal of the assignment was to help students to see how they have influence in their community by acting as engaged citizens, and to improve their scores on the ACT Writing Sample Assessment (WSA) exam. The authors report that students in developmental classes often feel disempowered, especially when English is not their first language. This assignment not only assisted them in elevating their written communication skills, but it also gave real-life significance to the assignment, and by extension made them feel like empowered members of the community. The advancement in student scores serves as evidence to support my research that when students are given assignments which permit local advocacy and active participation, their academic performance also improves.

Bad Summary:

Two ELL classes complete a service-learning project and improve their writing scores. This article was good because it provided me with lots of information I can use. The students learned a lot in their service-learning project and they passed the ACT exam.  

Remember you're describing what someone else has said. Use verbal cues to make this clear to your reader.  Here are some suggested verbs to use: 

* Adapted from: http://www.laspositascollege.edu/raw/summaries.php

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How to Write an Article Critique

Tips for Writing a Psychology Critique Paper

Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Emily is a board-certified science editor who has worked with top digital publishing brands like Voices for Biodiversity, Study.com, GoodTherapy, Vox, and Verywell.

Cultura RM / Gu Cultura / Getty Images

• Steps for Writing a Critique

Evaluating the Article

• How to Write It
• Helpful Tips

An article critique involves critically analyzing a written work to assess its strengths and flaws. If you need to write an article critique, you will need to describe the article, analyze its contents, interpret its meaning, and make an overall assessment of the importance of the work.

Critique papers require students to conduct a critical analysis of another piece of writing, often a book, journal article, or essay . No matter your major, you will probably be expected to write a critique paper at some point.

For psychology students, critiquing a professional paper is a great way to learn more about psychology articles, writing, and the research process itself. Students will analyze how researchers conduct experiments, interpret results, and discuss the impact of the results.

At a Glance

An article critique involves making a critical assessment of a single work. This is often an article, but it might also be a book or other written source. It summarizes the contents of the article and then evaluates both the strengths and weaknesses of the piece. Knowing how to write an article critique can help you learn how to evaluate sources with a discerning eye.

Steps for Writing an Effective Article Critique

While these tips are designed to help students write a psychology critique paper, many of the same principles apply to writing article critiques in other subject areas.

Your first step should always be a thorough read-through of the material you will be analyzing and critiquing. It needs to be more than just a casual skim read. It should be in-depth with an eye toward key elements.

To write an article critique, you should:

• Read the article , noting your first impressions, questions, thoughts, and observations
• Describe the contents of the article in your own words, focusing on the main themes or ideas
• Interpret the meaning of the article and its overall importance
• Critically evaluate the contents of the article, including any strong points as well as potential weaknesses

The following guidelines can help you assess the article you are reading and make better sense of the material.

Read the Introduction Section of the Article

Start by reading the introduction . Think about how this part of the article sets up the main body and how it helps you get a background on the topic.

• Is the hypothesis clearly stated?
• Is the necessary background information and previous research described in the introduction?

In addition to answering these basic questions, note other information provided in the introduction and any questions you have.

Read the Methods Section of the Article

Is the study procedure clearly outlined in the methods section ? Can you determine which variables the researchers are measuring?

Remember to jot down questions and thoughts that come to mind as you are reading. Once you have finished reading the paper, you can then refer back to your initial questions and see which ones remain unanswered.

Read the Results Section of the Article

Are all tables and graphs clearly labeled in the results section ? Do researchers provide enough statistical information? Did the researchers collect all of the data needed to measure the variables in question?

Make a note of any questions or information that does not seem to make sense. You can refer back to these questions later as you are writing your final critique.

Read the Discussion Section of the Article

Experts suggest that it is helpful to take notes while reading through sections of the paper you are evaluating. Ask yourself key questions:

• How do the researchers interpret the results of the study?
• Did the results support their hypothesis?
• Do the conclusions drawn by the researchers seem reasonable?

The discussion section offers students an excellent opportunity to take a position. If you agree with the researcher's conclusions, explain why. If you feel the researchers are incorrect or off-base, point out problems with the conclusions and suggest alternative explanations.

Another alternative is to point out questions the researchers failed to answer in the discussion section.

Begin Writing Your Own Critique of the Paper

Once you have read the article, compile your notes and develop an outline that you can follow as you write your psychology critique paper. Here's a guide that will walk you through how to structure your critique paper.

Introduction

Begin your paper by describing the journal article and authors you are critiquing. Provide the main hypothesis (or thesis) of the paper. Explain why you think the information is relevant.

Thesis Statement

The final part of your introduction should include your thesis statement. Your thesis statement is the main idea of your critique. Your thesis should briefly sum up the main points of your critique.

Article Summary

Provide a brief summary of the article. Outline the main points, results, and discussion.

When describing the study or paper, experts suggest that you include a summary of the questions being addressed, study participants, interventions, comparisons, outcomes, and study design.

Don't get bogged down by your summary. This section should highlight the main points of the article you are critiquing. Don't feel obligated to summarize each little detail of the main paper. Focus on giving the reader an overall idea of the article's content.

Your Analysis

In this section, you will provide your critique of the article. Describe any problems you had with the author's premise, methods, or conclusions. You might focus your critique on problems with the author's argument, presentation, information, and alternatives that have been overlooked.

When evaluating a study, summarize the main findings—including the strength of evidence for each main outcome—and consider their relevance to key demographic groups.  

Organize your paper carefully. Be careful not to jump around from one argument to the next. Arguing one point at a time ensures that your paper flows well and is easy to read.

Your critique paper should end with an overview of the article's argument, your conclusions, and your reactions.

More Tips When Writing an Article Critique

• As you are editing your paper, utilize a style guide published by the American Psychological Association, such as the official Publication Manual of the American Psychological Association .
• Reading scientific articles can be challenging at first. Remember that this is a skill that takes time to learn but that your skills will become stronger the more that you read.
• Take a rough draft of your paper to your school's writing lab for additional feedback and use your university library's resources.

What This Means For You

Being able to write a solid article critique is a useful academic skill. While it can be challenging, start by breaking down the sections of the paper, noting your initial thoughts and questions. Then structure your own critique so that you present a summary followed by your evaluation. In your critique, include the strengths and the weaknesses of the article.

Archibald D, Martimianakis MA. Writing, reading, and critiquing reviews .  Can Med Educ J . 2021;12(3):1-7. doi:10.36834/cmej.72945

Pautasso M. Ten simple rules for writing a literature review . PLoS Comput Biol . 2013;9(7):e1003149. doi:10.1371/journal.pcbi.1003149

Gülpınar Ö, Güçlü AG. How to write a review article?   Turk J Urol . 2013;39(Suppl 1):44–48. doi:10.5152/tud.2013.054

Erol A. Basics of writing review articles .  Noro Psikiyatr Ars . 2022;59(1):1-2. doi:10.29399/npa.28093

American Psychological Association.  Publication Manual of the American Psychological Association  (7th ed.). Washington DC: The American Psychological Association; 2019.

By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

How to write a journal article review: Do the writing

• What's in this Guide
• What is a journal article?
• Create a template
• Choose your article to review
• Read your article carefully

Do the writing

• Remember to edit
• Additional resources

Start to write. Follow the instructions of your assessment, then structure your writing accordingly.

The four key parts of a journal article review are:

3. A critique, or a discussion about the key points of the journal article.

A critique is a discussion about the key points of the journal article. It should be a balanced discussion about the  strengths and weaknesses of the key points and structure of the article.

You will also need to discuss if the author(s) points are valid (supported by other literature) and robust (would you get the same outcome if the way the information was gathered was repeated).

Example of part of a critique

4. A conclusion - a final evaluation of the article

1. Give an overall opinion of the text.

2. Briefly summarise key points and determine if they are valid, useful, accurate etc.

3. Remember, do not include new ideas or opinions in the conclusion.

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How to Review a Journal Article

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For many kinds of assignments, like a  literature review , you may be asked to offer a critique or review of a journal article. This is an opportunity for you as a scholar to offer your  qualified opinion  and  evaluation  of how another scholar has composed their article, argument, and research. That means you will be expected to go beyond a simple  summary  of the article and evaluate it on a deeper level. As a college student, this might sound intimidating. However, as you engage with the research process, you are becoming immersed in a particular topic, and your insights about the way that topic is presented are valuable and can contribute to the overall conversation surrounding your topic.

IMPORTANT NOTE!!

Some disciplines, like Criminal Justice, may only want you to summarize the article without including your opinion or evaluation. If your assignment is to summarize the article only, please see our literature review handout.

Before getting started on the critique, it is important to review the article thoroughly and critically. To do this, we recommend take notes,  annotating , and reading the article several times before critiquing. As you read, be sure to note important items like the thesis, purpose, research questions, hypotheses, methods, evidence, key findings, major conclusions, tone, and publication information. Depending on your writing context, some of these items may not be applicable.

Questions to Consider

To evaluate a source, consider some of the following questions. They are broken down into different categories, but answering these questions will help you consider what areas to examine. With each category, we recommend identifying the strengths and weaknesses in each since that is a critical part of evaluation.

Evaluating Purpose and Argument

• How well is the purpose made clear in the introduction through background/context and thesis?
• How well does the abstract represent and summarize the article’s major points and argument?
• How well does the objective of the experiment or of the observation fill a need for the field?
• How well is the argument/purpose articulated and discussed throughout the body of the text?
• How well does the discussion maintain cohesion?

Evaluating the Presentation/Organization of Information

• How appropriate and clear is the title of the article?
• Where could the author have benefited from expanding, condensing, or omitting ideas?
• How clear are the author’s statements? Challenge ambiguous statements.
• What underlying assumptions does the author have, and how does this affect the credibility or clarity of their article?
• How objective is the author in his or her discussion of the topic?
• How well does the organization fit the article’s purpose and articulate key goals?

Evaluating Methods

• How appropriate are the study design and methods for the purposes of the study?
• How detailed are the methods being described? Is the author leaving out important steps or considerations?
• Have the procedures been presented in enough detail to enable the reader to duplicate them?

Evaluating Data

• Scan and spot-check calculations. Are the statistical methods appropriate?
• Do you find any content repeated or duplicated?
• How many errors of fact and interpretation does the author include? (You can check on this by looking up the references the author cites).
• What pertinent literature has the author cited, and have they used this literature appropriately?

Following, we have an example of a summary and an evaluation of a research article. Note that in most literature review contexts, the summary and evaluation would be much shorter. This extended example shows the different ways a student can critique and write about an article.

Chik, A. (2012). Digital gameplay for autonomous foreign language learning: Gamers’ and language teachers’ perspectives. In H. Reinders (ed.),  Digital games in language learning and teaching  (pp. 95-114). Eastbourne, UK: Palgrave Macmillan.

Be sure to include the full citation either in a reference page or near your evaluation if writing an  annotated bibliography .

In Chik’s article “Digital Gameplay for Autonomous Foreign Language Learning: Gamers’ and Teachers’ Perspectives”, she explores the ways in which “digital gamers manage gaming and gaming-related activities to assume autonomy in their foreign language learning,” (96) which is presented in contrast to how teachers view the “pedagogical potential” of gaming. The research was described as an “umbrella project” consisting of two parts. The first part examined 34 language teachers’ perspectives who had limited experience with gaming (only five stated they played games regularly) (99). Their data was recorded through a survey, class discussion, and a seven-day gaming trial done by six teachers who recorded their reflections through personal blog posts. The second part explored undergraduate gaming habits of ten Hong Kong students who were regular gamers. Their habits were recorded through language learning histories, videotaped gaming sessions, blog entries of gaming practices, group discussion sessions, stimulated recall sessions on gaming videos, interviews with other gamers, and posts from online discussion forums. The research shows that while students recognize the educational potential of games and have seen benefits of it in their lives, the instructors overall do not see the positive impacts of gaming on foreign language learning.

The summary includes the article’s purpose, methods, results, discussion, and citations when necessary.

This article did a good job representing the undergraduate gamers’ voices through extended quotes and stories. Particularly for the data collection of the undergraduate gamers, there were many opportunities for an in-depth examination of their gaming practices and histories. However, the representation of the teachers in this study was very uneven when compared to the students. Not only were teachers labeled as numbers while the students picked out their own pseudonyms, but also when viewing the data collection, the undergraduate students were more closely examined in comparison to the teachers in the study. While the students have fifteen extended quotes describing their experiences in their research section, the teachers only have two of these instances in their section, which shows just how imbalanced the study is when presenting instructor voices.

Some research methods, like the recorded gaming sessions, were only used with students whereas teachers were only asked to blog about their gaming experiences. This creates a richer narrative for the students while also failing to give instructors the chance to have more nuanced perspectives. This lack of nuance also stems from the emphasis of the non-gamer teachers over the gamer teachers. The non-gamer teachers’ perspectives provide a stark contrast to the undergraduate gamer experiences and fits neatly with the narrative of teachers not valuing gaming as an educational tool. However, the study mentioned five teachers that were regular gamers whose perspectives are left to a short section at the end of the presentation of the teachers’ results. This was an opportunity to give the teacher group a more complex story, and the opportunity was entirely missed.

Additionally, the context of this study was not entirely clear. The instructors were recruited through a master’s level course, but the content of the course and the institution’s background is not discussed. Understanding this context helps us understand the course’s purpose(s) and how those purposes may have influenced the ways in which these teachers interpreted and saw games. It was also unclear how Chik was connected to this masters’ class and to the students. Why these particular teachers and students were recruited was not explicitly defined and also has the potential to skew results in a particular direction.

Overall, I was inclined to agree with the idea that students can benefit from language acquisition through gaming while instructors may not see the instructional value, but I believe the way the research was conducted and portrayed in this article made it very difficult to support Chik’s specific findings.

Some professors like you to begin an evaluation with something positive but isn’t always necessary.

The evaluation is clearly organized and uses transitional phrases when moving to a new topic.

This evaluation includes a summative statement that gives the overall impression of the article at the end, but this can also be placed at the beginning of the evaluation.

This evaluation mainly discusses the representation of data and methods. However, other areas, like organization, are open to critique.

Psychology - How to Write a Literature Review

Subject guide.

What is a literature review? 

A literature review discusses published research studies on a specific topic or subject area.  

What is the purpose of writing it?

The goal of the lit review is to describe, summarize, and evaluate previous research in a given area.  It should explain important conclusions about your topic as well as identify any gaps in the research or areas for future study.

Choose a Topic and Find Articles

Choose a topic that interests you and remember to keep an open mind.  Depending on how much research there is, you may need to narrow or broaden your topic.  

• PsycArticles This link opens in a new window Scholarly journal articles on psychology topics.
• ProQuest Central This link opens in a new window The largest single periodical resource available, bringing together complete databases across all major subject areas, including Business, Health and Medical, Social Sciences, Education, Science and Technology, and Humanities.
• Google Scholar Search for scholarly articles and books. Be aware that the full text may not always be available.

Read the Articles

You want to read and understand each of your articles.  A good starting point is to answer these 3 questions about each article:

1. What was the study's research question?  In other words, what were they trying to find out?

2. What was the study's method?  Briefly describe HOW they collected data and WHO their participant group was.

3. What do the results mean?  Or what conclusions can we draw from the results?

Write the Lit Review

Connect:   Think about what YOUR research question is for your lit review.  Each article you found should connect to your topic/theme in some way and you should be able to describe your topic as a research question and your articles as answers to that question.  Your summary for each article should show how they further our knowledge in relation to your topic.

Organize:   Can you organize your articles into a few distinct groups?  It could be by treatment method or age/ethnic group or other factor.  The way you organize will depend on your topic and the research, but it will help you if you can group articles in some way.  

Analyze:  Think beyond just summary and about what we still don't know about this topic.  Are there gaps in the research?  Do too many studies use just one method of gathering data?  What else is important to know?  The "Discussion" section of your articles may help guide you in your analysis.

Additional Sources

• College Drinking Games Literature Review Lit Review published in a scholarly journal. Good example of how lit reviews work in the field.
• How to Write a Literature Review from Psychology in Action Good advice on choosing a topic and searching for articles.
• Writing a Literature Review in Psychology from University of Washington Helpful info on all aspects of writing a lit review. Great resource.
• Literature Reviews from UNC Chapel Hill Writing Center This is not specific to Psychology, but has good tips on organizing your paper.
• Next: APA >>
• Last Updated: Oct 18, 2023 11:21 AM
• URL: https://bergen.libguides.com/litreview

Write a Critical Review of a Scientific Journal Article

1. identify how and why the research was carried out, 2. establish the research context, 3. evaluate the research, 4. establish the significance of the research.

• Writing Your Critique

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Read the article(s) carefully and use the questions below to help you identify how and why the research was carried out. Look at the following sections: 

Introduction

• What was the objective of the study?
• What methods were used to accomplish this purpose (e.g., systematic recording of observations, analysis and evaluation of published research, assessment of theory, etc.)?
• What techniques were used and how was each technique performed?
• What kind of data can be obtained using each technique?
• How are such data interpreted?
• What kind of information is produced by using the technique?
• What objective evidence was obtained from the authors’ efforts (observations, measurements, etc.)?
• What were the results of the study? 
• How was each technique used to obtain each result?
• What statistical tests were used to evaluate the significance of the conclusions based on numeric or graphic data?
• How did each result contribute to answering the question or testing the hypothesis raised in the introduction?
• How were the results interpreted? How were they related to the original problem (authors’ view of evidence rather than objective findings)? 
• Were the authors able to answer the question (test the hypothesis) raised?
• Did the research provide new factual information, a new understanding of a phenomenon in the field, or a new research technique?
• How was the significance of the work described?
• Do the authors relate the findings of the study to literature in the field?
• Did the reported observations or interpretations support or refute observations or interpretations made by other researchers?

These questions were adapted from the following sources:  Kuyper, B.J. (1991). Bringing up scientists in the art of critiquing research. Bioscience 41(4), 248-250. Wood, J.M. (2003). Research Lab Guide. MICR*3260 Microbial Adaptation and Development Web Site . Retrieved July 31, 2006.

Once you are familiar with the article, you can establish the research context by asking the following questions:

• Who conducted the research? What were/are their interests?
• When and where was the research conducted?
• Why did the authors do this research?
• Was this research pertinent only within the authors’ geographic locale, or did it have broader (even global) relevance?
• Were many other laboratories pursuing related research when the reported work was done? If so, why?
• For experimental research, what funding sources met the costs of the research?
• On what prior observations was the research based? What was and was not known at the time?
• How important was the research question posed by the researchers?

These questions were adapted from the following sources: Kuyper, B.J. (1991). Bringing up scientists in the art of critiquing research. Bioscience 41(4), 248-250. Wood, J.M. (2003). Research Lab Guide. MICR*3260 Microbial Adaptation and Development Web Site . Retrieved July 31, 2006.

Remember that simply disagreeing with the material is not considered to be a critical assessment of the material.  For example, stating that the sample size is insufficient is not a critical assessment.  Describing why the sample size is insufficient for the claims being made in the study would be a critical assessment.

Use the questions below to help you evaluate the quality of the authors’ research:

• Does the title precisely state the subject of the paper?
• Read the statement of purpose in the abstract. Does it match the one in the introduction?

Acknowledgments

• Could the source of the research funding have influenced the research topic or conclusions?
• Check the sequence of statements in the introduction. Does all the information lead coherently to the purpose of the study?
• Review all methods in relation to the objective(s) of the study. Are the methods valid for studying the problem?
• Check the methods for essential information. Could the study be duplicated from the methods and information given?
• Check the methods for flaws. Is the sample selection adequate? Is the experimental design sound?
• Check the sequence of statements in the methods. Does all the information belong there? Is the sequence of methods clear and pertinent?
• Was there mention of ethics? Which research ethics board approved the study?
• Carefully examine the data presented in the tables and diagrams. Does the title or legend accurately describe the content? 
• Are column headings and labels accurate? 
• Are the data organized for ready comparison and interpretation? (A table should be self-explanatory, with a title that accurately and concisely describes content and column headings that accurately describe information in the cells.)
• Review the results as presented in the text while referring to the data in the tables and diagrams. Does the text complement, and not simply repeat data? Are there discrepancies between the results in the text and those in the tables?
• Check all calculations and presentation of data.
• Review the results in light of the stated objectives. Does the study reveal what the researchers intended?
• Does the discussion clearly address the objectives and hypotheses?
• Check the interpretation against the results. Does the discussion merely repeat the results? 
• Does the interpretation arise logically from the data or is it too far-fetched? 
• Have the faults, flaws, or shortcomings of the research been addressed?
• Is the interpretation supported by other research cited in the study?
• Does the study consider key studies in the field?
• What is the significance of the research? Do the authors mention wider implications of the findings?
• Is there a section on recommendations for future research? Are there other research possibilities or directions suggested? 

Consider the article as a whole

• Reread the abstract. Does it accurately summarize the article?
• Check the structure of the article (first headings and then paragraphing). Is all the material organized under the appropriate headings? Are sections divided logically into subsections or paragraphs?
• Are stylistic concerns, logic, clarity, and economy of expression addressed?

These questions were adapted from the following sources:  Kuyper, B.J. (1991). Bringing up scientists in the art of critiquing research. Bioscience 41(4), 248-250. Wood, J.M. (2003). Research Lab Guide. MICR*3260 Microbial Adaptation and Development Web Site. Retrieved July 31, 2006.

After you have evaluated the research, consider whether the research has been successful. Has it led to new questions being asked, or new ways of using existing knowledge? Are other researchers citing this paper?

You should consider the following questions:

• How did other researchers view the significance of the research reported by your authors?
• Did the research reported in your article result in the formulation of new questions or hypotheses (by the authors or by other researchers)?
• Have other researchers subsequently supported or refuted the observations or interpretations of these authors?
• Did the research make a significant contribution to human knowledge?
• Did the research produce any practical applications?
• What are the social, political, technological, medical implications of this research?
• How do you evaluate the significance of the research?

To answer these questions, look at review articles to find out how reviewers view this piece of research. Look at research articles and databases like Web of Science to see how other people have used this work. What range of journals have cited this article?

These questions were adapted from the following sources:

Kuyper, B.J. (1991). Bringing up scientists in the art of critiquing research. Bioscience 41(4), 248-250. Wood, J.M. (2003). Research Lab Guide. MICR*3260 Microbial Adaptation and Development Web Site . Retrieved July 31, 2006.

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• Last Updated: Jan 11, 2024 12:42 PM
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• Critical Reviews

How to Write an Article Review

Last Updated: September 8, 2023 Fact Checked

This article was co-authored by Jake Adams . Jake Adams is an academic tutor and the owner of Simplifi EDU, a Santa Monica, California based online tutoring business offering learning resources and online tutors for academic subjects K-College, SAT & ACT prep, and college admissions applications. With over 14 years of professional tutoring experience, Jake is dedicated to providing his clients the very best online tutoring experience and access to a network of excellent undergraduate and graduate-level tutors from top colleges all over the nation. Jake holds a BS in International Business and Marketing from Pepperdine University. There are 13 references cited in this article, which can be found at the bottom of the page. This article has been fact-checked, ensuring the accuracy of any cited facts and confirming the authority of its sources. This article has been viewed 3,089,075 times.

An article review is both a summary and an evaluation of another writer's article. Teachers often assign article reviews to introduce students to the work of experts in the field. Experts also are often asked to review the work of other professionals. Understanding the main points and arguments of the article is essential for an accurate summation. Logical evaluation of the article's main theme, supporting arguments, and implications for further research is an important element of a review . Here are a few guidelines for writing an article review.

Education specialist Alexander Peterman recommends: "In the case of a review, your objective should be to reflect on the effectiveness of what has already been written, rather than writing to inform your audience about a subject."

Things You Should Know

• Read the article very closely, and then take time to reflect on your evaluation. Consider whether the article effectively achieves what it set out to.
• Write out a full article review by completing your intro, summary, evaluation, and conclusion. Don't forget to add a title, too!
• Proofread your review for mistakes (like grammar and usage), while also cutting down on needless information. [1] X Research source

Preparing to Write Your Review

• Article reviews present more than just an opinion. You will engage with the text to create a response to the scholarly writer's ideas. You will respond to and use ideas, theories, and research from your studies. Your critique of the article will be based on proof and your own thoughtful reasoning.
• An article review only responds to the author's research. It typically does not provide any new research. However, if you are correcting misleading or otherwise incorrect points, some new data may be presented.
• An article review both summarizes and evaluates the article.

• Summarize the article. Focus on the important points, claims, and information.
• Discuss the positive aspects of the article. Think about what the author does well, good points she makes, and insightful observations.
• Identify contradictions, gaps, and inconsistencies in the text. Determine if there is enough data or research included to support the author's claims. Find any unanswered questions left in the article.

• Make note of words or issues you don't understand and questions you have.
• Look up terms or concepts you are unfamiliar with, so you can fully understand the article. Read about concepts in-depth to make sure you understand their full context.

• Pay careful attention to the meaning of the article. Make sure you fully understand the article. The only way to write a good article review is to understand the article.

• With either method, make an outline of the main points made in the article and the supporting research or arguments. It is strictly a restatement of the main points of the article and does not include your opinions.
• After putting the article in your own words, decide which parts of the article you want to discuss in your review. You can focus on the theoretical approach, the content, the presentation or interpretation of evidence, or the style. You will always discuss the main issues of the article, but you can sometimes also focus on certain aspects. This comes in handy if you want to focus the review towards the content of a course.
• Review the summary outline to eliminate unnecessary items. Erase or cross out the less important arguments or supplemental information. Your revised summary can serve as the basis for the summary you provide at the beginning of your review.

• What does the article set out to do?
• What is the theoretical framework or assumptions?
• Are the central concepts clearly defined?
• How adequate is the evidence?
• How does the article fit into the literature and field?
• Does it advance the knowledge of the subject?
• How clear is the author's writing? Don't: include superficial opinions or your personal reaction. Do: pay attention to your biases, so you can overcome them.

Writing the Article Review

• For example, in MLA , a citation may look like: Duvall, John N. "The (Super)Marketplace of Images: Television as Unmediated Mediation in DeLillo's White Noise ." Arizona Quarterly 50.3 (1994): 127-53. Print. [10] X Trustworthy Source Purdue Online Writing Lab Trusted resource for writing and citation guidelines Go to source

• For example: The article, "Condom use will increase the spread of AIDS," was written by Anthony Zimmerman, a Catholic priest.

• Your introduction should only be 10-25% of your review.
• End the introduction with your thesis. Your thesis should address the above issues. For example: Although the author has some good points, his article is biased and contains some misinterpretation of data from others’ analysis of the effectiveness of the condom.

• Use direct quotes from the author sparingly.
• Review the summary you have written. Read over your summary many times to ensure that your words are an accurate description of the author's article.

• Support your critique with evidence from the article or other texts.
• The summary portion is very important for your critique. You must make the author's argument clear in the summary section for your evaluation to make sense.
• Remember, this is not where you say if you liked the article or not. You are assessing the significance and relevance of the article.
• Use a topic sentence and supportive arguments for each opinion. For example, you might address a particular strength in the first sentence of the opinion section, followed by several sentences elaborating on the significance of the point.

• This should only be about 10% of your overall essay.
• For example: This critical review has evaluated the article "Condom use will increase the spread of AIDS" by Anthony Zimmerman. The arguments in the article show the presence of bias, prejudice, argumentative writing without supporting details, and misinformation. These points weaken the author’s arguments and reduce his credibility.

• Make sure you have identified and discussed the 3-4 key issues in the article.

Sample Article Reviews

Expert Q&A

You Might Also Like

• ↑ https://writing.wisc.edu/handbook/grammarpunct/proofreading/
• ↑ https://libguides.cmich.edu/writinghelp/articlereview
• ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4548566/
• ↑ Jake Adams. Academic Tutor & Test Prep Specialist. Expert Interview. 24 July 2020.
• ↑ https://guides.library.queensu.ca/introduction-research/writing/critical
• ↑ https://www.iup.edu/writingcenter/writing-resources/organization-and-structure/creating-an-outline.html
• ↑ https://writing.umn.edu/sws/assets/pdf/quicktips/titles.pdf
• ↑ https://owl.purdue.edu/owl/research_and_citation/mla_style/mla_formatting_and_style_guide/mla_works_cited_periodicals.html
• ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4548565/
• ↑ https://writingcenter.uconn.edu/wp-content/uploads/sites/593/2014/06/How_to_Summarize_a_Research_Article1.pdf
• ↑ https://www.uis.edu/learning-hub/writing-resources/handouts/learning-hub/how-to-review-a-journal-article
• ↑ https://writingcenter.unc.edu/tips-and-tools/editing-and-proofreading/

About This Article

If you have to write an article review, read through the original article closely, taking notes and highlighting important sections as you read. Next, rewrite the article in your own words, either in a long paragraph or as an outline. Open your article review by citing the article, then write an introduction which states the article’s thesis. Next, summarize the article, followed by your opinion about whether the article was clear, thorough, and useful. Finish with a paragraph that summarizes the main points of the article and your opinions. To learn more about what to include in your personal critique of the article, keep reading the article! Did this summary help you? Yes No

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How to Write a Peer Review

When you write a peer review for a manuscript, what should you include in your comments? What should you leave out? And how should the review be formatted?

This guide provides quick tips for writing and organizing your reviewer report.

Review Outline

Use an outline for your reviewer report so it’s easy for the editors and author to follow. This will also help you keep your comments organized.

Think about structuring your review like an inverted pyramid. Put the most important information at the top, followed by details and examples in the center, and any additional points at the very bottom.

Here’s how your outline might look:

1. Summary of the research and your overall impression

In your own words, summarize what the manuscript claims to report. This shows the editor how you interpreted the manuscript and will highlight any major differences in perspective between you and the other reviewers. Give an overview of the manuscript’s strengths and weaknesses. Think about this as your “take-home” message for the editors. End this section with your recommended course of action.

2. Discussion of specific areas for improvement

It’s helpful to divide this section into two parts: one for major issues and one for minor issues. Within each section, you can talk about the biggest issues first or go systematically figure-by-figure or claim-by-claim. Number each item so that your points are easy to follow (this will also make it easier for the authors to respond to each point). Refer to specific lines, pages, sections, or figure and table numbers so the authors (and editors) know exactly what you’re talking about.

Major vs. minor issues

What’s the difference between a major and minor issue? Major issues should consist of the essential points the authors need to address before the manuscript can proceed. Make sure you focus on what is  fundamental for the current study . In other words, it’s not helpful to recommend additional work that would be considered the “next step” in the study. Minor issues are still important but typically will not affect the overall conclusions of the manuscript. Here are some examples of what would might go in the “minor” category:

• Missing references (but depending on what is missing, this could also be a major issue)
• Technical clarifications (e.g., the authors should clarify how a reagent works)
• Data presentation (e.g., the authors should present p-values differently)
• Typos, spelling, grammar, and phrasing issues

3. Any other points

Confidential comments for the editors.

Some journals have a space for reviewers to enter confidential comments about the manuscript. Use this space to mention concerns about the submission that you’d want the editors to consider before sharing your feedback with the authors, such as concerns about ethical guidelines or language quality. Any serious issues should be raised directly and immediately with the journal as well.

This section is also where you will disclose any potentially competing interests, and mention whether you’re willing to look at a revised version of the manuscript.

Do not use this space to critique the manuscript, since comments entered here will not be passed along to the authors.  If you’re not sure what should go in the confidential comments, read the reviewer instructions or check with the journal first before submitting your review. If you are reviewing for a journal that does not offer a space for confidential comments, consider writing to the editorial office directly with your concerns.

Get this outline in a template

Giving Feedback

Giving feedback is hard. Giving effective feedback can be even more challenging. Remember that your ultimate goal is to discuss what the authors would need to do in order to qualify for publication. The point is not to nitpick every piece of the manuscript. Your focus should be on providing constructive and critical feedback that the authors can use to improve their study.

If you’ve ever had your own work reviewed, you already know that it’s not always easy to receive feedback. Follow the golden rule: Write the type of review you’d want to receive if you were the author. Even if you decide not to identify yourself in the review, you should write comments that you would be comfortable signing your name to.

In your comments, use phrases like “ the authors’ discussion of X” instead of “ your discussion of X .” This will depersonalize the feedback and keep the focus on the manuscript instead of the authors.

General guidelines for effective feedback

• Justify your recommendation with concrete evidence and specific examples.
• Be specific so the authors know what they need to do to improve.
• Be thorough. This might be the only time you read the manuscript.
• Be professional and respectful. The authors will be reading these comments too.
• Remember to say what you liked about the manuscript!

Don’t

• Recommend additional experiments or  unnecessary elements that are out of scope for the study or for the journal criteria.
• Tell the authors exactly how to revise their manuscript—you don’t need to do their work for them.
• Use the review to promote your own research or hypotheses.
• Focus on typos and grammar. If the manuscript needs significant editing for language and writing quality, just mention this in your comments.
• Submit your review without proofreading it and checking everything one more time.

Before and After: Sample Reviewer Comments

Keeping in mind the guidelines above, how do you put your thoughts into words? Here are some sample “before” and “after” reviewer comments

✗ Before

“The authors appear to have no idea what they are talking about. I don’t think they have read any of the literature on this topic.”

✓ After

“The study fails to address how the findings relate to previous research in this area. The authors should rewrite their Introduction and Discussion to reference the related literature, especially recently published work such as Darwin et al.”

“The writing is so bad, it is practically unreadable. I could barely bring myself to finish it.”

“While the study appears to be sound, the language is unclear, making it difficult to follow. I advise the authors work with a writing coach or copyeditor to improve the flow and readability of the text.”

“It’s obvious that this type of experiment should have been included. I have no idea why the authors didn’t use it. This is a big mistake.”

“The authors are off to a good start, however, this study requires additional experiments, particularly [type of experiment]. Alternatively, the authors should include more information that clarifies and justifies their choice of methods.”

Suggested Language for Tricky Situations

You might find yourself in a situation where you’re not sure how to explain the problem or provide feedback in a constructive and respectful way. Here is some suggested language for common issues you might experience.

What you think : The manuscript is fatally flawed. What you could say: “The study does not appear to be sound” or “the authors have missed something crucial”.

What you think : You don’t completely understand the manuscript. What you could say : “The authors should clarify the following sections to avoid confusion…”

What you think : The technical details don’t make sense. What you could say : “The technical details should be expanded and clarified to ensure that readers understand exactly what the researchers studied.”

What you think: The writing is terrible. What you could say : “The authors should revise the language to improve readability.”

What you think : The authors have over-interpreted the findings. What you could say : “The authors aim to demonstrate [XYZ], however, the data does not fully support this conclusion. Specifically…”

What does a good review look like?

Check out the peer review examples at F1000 Research to see how other reviewers write up their reports and give constructive feedback to authors.

Time to Submit the Review!

Be sure you turn in your report on time. Need an extension? Tell the journal so that they know what to expect. If you need a lot of extra time, the journal might need to contact other reviewers or notify the author about the delay.

Tip: Building a relationship with an editor

You’ll be more likely to be asked to review again if you provide high-quality feedback and if you turn in the review on time. Especially if it’s your first review for a journal, it’s important to show that you are reliable. Prove yourself once and you’ll get asked to review again!

• Getting started as a reviewer
• Responding to an invitation
• Reading a manuscript
• Writing a peer review

The contents of the Peer Review Center are also available as a live, interactive training session, complete with slides, talking points, and activities. …

The contents of the Writing Center are also available as a live, interactive training session, complete with slides, talking points, and activities. …

There’s a lot to consider when deciding where to submit your work. Learn how to choose a journal that will help your study reach its audience, while reflecting your values as a researcher…

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• v.12(3); 2021 Jun

Writing, reading, and critiquing reviews

Écrire, lire et revue critique, douglas archibald.

1 University of Ottawa, Ontario, Canada;

Maria Athina Martimianakis

2 University of Toronto, Ontario, Canada

Why reviews matter

What do all authors of the CMEJ have in common? For that matter what do all health professions education scholars have in common? We all engage with literature. When you have an idea or question the first thing you do is find out what has been published on the topic of interest. Literature reviews are foundational to any study. They describe what is known about given topic and lead us to identify a knowledge gap to study. All reviews require authors to be able accurately summarize, synthesize, interpret and even critique the research literature. 1 , 2 In fact, for this editorial we have had to review the literature on reviews . Knowledge and evidence are expanding in our field of health professions education at an ever increasing rate and so to help keep pace, well written reviews are essential. Though reviews may be difficult to write, they will always be read. In this editorial we survey the various forms review articles can take. As well we want to provide authors and reviewers at CMEJ with some guidance and resources to be able write and/or review a review article.

What are the types of reviews conducted in Health Professions Education?

Health professions education attracts scholars from across disciplines and professions. For this reason, there are numerous ways to conduct reviews and it is important to familiarize oneself with these different forms to be able to effectively situate your work and write a compelling rationale for choosing your review methodology. 1 , 2 To do this, authors must contend with an ever-increasing lexicon of review type articles. In 2009 Grant and colleagues conducted a typology of reviews to aid readers makes sense of the different review types, listing fourteen different ways of conducting reviews, not all of which are mutually exclusive. 3 Interestingly, in their typology they did not include narrative reviews which are often used by authors in health professions education. In Table 1 , we offer a short description of three common types of review articles submitted to CMEJ.

Three common types of review articles submitted to CMEJ

More recently, authors such as Greenhalgh 4 have drawn attention to the perceived hierarchy of systematic reviews over scoping and narrative reviews. Like Greenhalgh, 4 we argue that systematic reviews are not to be seen as the gold standard of all reviews. Instead, it is important to align the method of review to what the authors hope to achieve, and pursue the review rigorously, according to the tenets of the chosen review type. Sometimes it is helpful to read part of the literature on your topic before deciding on a methodology for organizing and assessing its usefulness. Importantly, whether you are conducting a review or reading reviews, appreciating the differences between different types of reviews can also help you weigh the author’s interpretation of their findings.

In the next section we summarize some general tips for conducting successful reviews.

How to write and review a review article

In 2016 David Cook wrote an editorial for Medical Education on tips for a great review article. 13 These tips are excellent suggestions for all types of articles you are considering to submit to the CMEJ. First, start with a clear question: focused or more general depending on the type of review you are conducting. Systematic reviews tend to address very focused questions often summarizing the evidence of your topic. Other types of reviews tend to have broader questions and are more exploratory in nature.

Following your question, choose an approach and plan your methods to match your question…just like you would for a research study. Fortunately, there are guidelines for many types of reviews. As Cook points out the most important consideration is to be sure that the methods you follow lead to a defensible answer to your review question. To help you prepare for a defensible answer there are many guides available. For systematic reviews consult PRISMA guidelines ; 13 for scoping reviews PRISMA-ScR ; 14 and SANRA 15 for narrative reviews. It is also important to explain to readers why you have chosen to conduct a review. You may be introducing a new way for addressing an old problem, drawing links across literatures, filling in gaps in our knowledge about a phenomenon or educational practice. Cook refers to this as setting the stage. Linking back to the literature is important. In systematic reviews for example, you must be clear in explaining how your review builds on existing literature and previous reviews. This is your opportunity to be critical. What are the gaps and limitations of previous reviews? So, how will your systematic review resolve the shortcomings of previous work? In other types of reviews, such as narrative reviews, its less about filling a specific knowledge gap, and more about generating new research topic areas, exposing blind spots in our thinking, or making creative new links across issues. Whatever, type of review paper you are working on, the next steps are ones that can be applied to any scholarly writing. Be clear and offer insight. What is your main message? A review is more than just listing studies or referencing literature on your topic. Lead your readers to a convincing message. Provide commentary and interpretation for the studies in your review that will help you to inform your conclusions. For systematic reviews, Cook’s final tip is most likely the most important– report completely. You need to explain all your methods and report enough detail that readers can verify the main findings of each study you review. The most common reasons CMEJ reviewers recommend to decline a review article is because authors do not follow these last tips. In these instances authors do not provide the readers with enough detail to substantiate their interpretations or the message is not clear. Our recommendation for writing a great review is to ensure you have followed the previous tips and to have colleagues read over your paper to ensure you have provided a clear, detailed description and interpretation.

Finally, we leave you with some resources to guide your review writing. 3 , 7 , 8 , 10 , 11 , 16 , 17 We look forward to seeing your future work. One thing is certain, a better appreciation of what different reviews provide to the field will contribute to more purposeful exploration of the literature and better manuscript writing in general.

In this issue we present many interesting and worthwhile papers, two of which are, in fact, reviews.

Major Contributions

A chance for reform: the environmental impact of travel for general surgery residency interviews by Fung et al. 18 estimated the CO 2 emissions associated with traveling for residency position interviews. Due to the high emissions levels (mean 1.82 tonnes per applicant), they called for the consideration of alternative options such as videoconference interviews.

Understanding community family medicine preceptors’ involvement in educational scholarship: perceptions, influencing factors and promising areas for action by Ward and team 19 identified barriers, enablers, and opportunities to grow educational scholarship at community-based teaching sites. They discovered a growing interest in educational scholarship among community-based family medicine preceptors and hope the identification of successful processes will be beneficial for other community-based Family Medicine preceptors.

Exploring the global impact of the COVID-19 pandemic on medical education: an international cross-sectional study of medical learners by Allison Brown and team 20 studied the impact of COVID-19 on medical learners around the world. There were different concerns depending on the levels of training, such as residents’ concerns with career timeline compared to trainees’ concerns with the quality of learning. Overall, the learners negatively perceived the disruption at all levels and geographic regions.

The impact of local health professions education grants: is it worth the investment? by Susan Humphrey-Murto and co-authors 21 considered factors that lead to the publication of studies supported by local medical education grants. They identified several factors associated with publication success, including previous oral or poster presentations. They hope their results will be valuable for Canadian centres with local grant programs.

Exploring the impact of the COVID-19 pandemic on medical learner wellness: a needs assessment for the development of learner wellness interventions by Stephana Cherak and team 22 studied learner-wellness in various training environments disrupted by the pandemic. They reported a negative impact on learner wellness at all stages of training. Their results can benefit the development of future wellness interventions.

Program directors’ reflections on national policy change in medical education: insights on decision-making, accreditation, and the CanMEDS framework by Dore, Bogie, et al. 23 invited program directors to reflect on the introduction of the CanMEDS framework into Canadian postgraduate medical education programs. Their survey revealed that while program directors (PDs) recognized the necessity of the accreditation process, they did not feel they had a voice when the change occurred. The authors concluded that collaborations with PDs would lead to more successful outcomes.

Experiential learning, collaboration and reflection: key ingredients in longitudinal faculty development by Laura Farrell and team 24 stressed several elements for effective longitudinal faculty development (LFD) initiatives. They found that participants benefited from a supportive and collaborative environment while trying to learn a new skill or concept.

Brief Reports

The effect of COVID-19 on medical students’ education and wellbeing: a cross-sectional survey by Stephanie Thibaudeau and team 25 assessed the impact of COVID-19 on medical students. They reported an overall perceived negative impact, including increased depressive symptoms, increased anxiety, and reduced quality of education.

In Do PGY-1 residents in Emergency Medicine have enough experiences in resuscitations and other clinical procedures to meet the requirements of a Competence by Design curriculum? Meshkat and co-authors 26 recorded the number of adult medical resuscitations and clinical procedures completed by PGY1 Fellow of the Royal College of Physicians in Emergency Medicine residents to compare them to the Competence by Design requirements. Their study underscored the importance of monitoring collection against pre-set targets. They concluded that residency program curricula should be regularly reviewed to allow for adequate clinical experiences.

Rehearsal simulation for antenatal consults by Anita Cheng and team 27 studied whether rehearsal simulation for antenatal consults helped residents prepare for difficult conversations with parents expecting complications with their baby before birth. They found that while rehearsal simulation improved residents’ confidence and communication techniques, it did not prepare them for unexpected parent responses.

Review Papers and Meta-Analyses

Peer support programs in the fields of medicine and nursing: a systematic search and narrative review by Haykal and co-authors 28 described and evaluated peer support programs in the medical field published in the literature. They found numerous diverse programs and concluded that including a variety of delivery methods to meet the needs of all participants is a key aspect for future peer-support initiatives.

Towards competency-based medical education in addictions psychiatry: a systematic review by Bahji et al. 6 identified addiction interventions to build competency for psychiatry residents and fellows. They found that current psychiatry entrustable professional activities need to be better identified and evaluated to ensure sustained competence in addictions.

Six ways to get a grip on leveraging the expertise of Instructional Design and Technology professionals by Chen and Kleinheksel 29 provided ways to improve technology implementation by clarifying the role that Instructional Design and Technology professionals can play in technology initiatives and technology-enhanced learning. They concluded that a strong collaboration is to the benefit of both the learners and their future patients.

In his article, Seven ways to get a grip on running a successful promotions process, 30 Simon Field provided guidelines for maximizing opportunities for successful promotion experiences. His seven tips included creating a rubric for both self-assessment of likeliness of success and adjudication by the committee.

Six ways to get a grip on your first health education leadership role by Stasiuk and Scott 31 provided tips for considering a health education leadership position. They advised readers to be intentional and methodical in accepting or rejecting positions.

Re-examining the value proposition for Competency-Based Medical Education by Dagnone and team 32 described the excitement and controversy surrounding the implementation of competency-based medical education (CBME) by Canadian postgraduate training programs. They proposed observing which elements of CBME had a positive impact on various outcomes.

You Should Try This

In their work, Interprofessional culinary education workshops at the University of Saskatchewan, Lieffers et al. 33 described the implementation of interprofessional culinary education workshops that were designed to provide health professions students with an experiential and cooperative learning experience while learning about important topics in nutrition. They reported an enthusiastic response and cooperation among students from different health professional programs.

In their article, Physiotherapist-led musculoskeletal education: an innovative approach to teach medical students musculoskeletal assessment techniques, Boulila and team 34 described the implementation of physiotherapist-led workshops, whether the workshops increased medical students’ musculoskeletal knowledge, and if they increased confidence in assessment techniques.

Instagram as a virtual art display for medical students by Karly Pippitt and team 35 used social media as a platform for showcasing artwork done by first-year medical students. They described this shift to online learning due to COVID-19. Using Instagram was cost-saving and widely accessible. They intend to continue with both online and in-person displays in the future.

Adapting clinical skills volunteer patient recruitment and retention during COVID-19 by Nazerali-Maitland et al. 36 proposed a SLIM-COVID framework as a solution to the problem of dwindling volunteer patients due to COVID-19. Their framework is intended to provide actionable solutions to recruit and engage volunteers in a challenging environment.

In Quick Response codes for virtual learner evaluation of teaching and attendance monitoring, Roxana Mo and co-authors 37 used Quick Response (QR) codes to monitor attendance and obtain evaluations for virtual teaching sessions. They found QR codes valuable for quick and simple feedback that could be used for many educational applications.

In Creation and implementation of the Ottawa Handbook of Emergency Medicine Kaitlin Endres and team 38 described the creation of a handbook they made as an academic resource for medical students as they shift to clerkship. It includes relevant content encountered in Emergency Medicine. While they intended it for medical students, they also see its value for nurses, paramedics, and other medical professionals.

Commentary and Opinions

The alarming situation of medical student mental health by D’Eon and team 39 appealed to medical education leaders to respond to the high numbers of mental health concerns among medical students. They urged leaders to address the underlying problems, such as the excessive demands of the curriculum.

In the shadows: medical student clinical observerships and career exploration in the face of COVID-19 by Law and co-authors 40 offered potential solutions to replace in-person shadowing that has been disrupted due to the COVID-19 pandemic. They hope the alternatives such as virtual shadowing will close the gap in learning caused by the pandemic.

Letters to the Editor

Canadian Federation of Medical Students' response to “ The alarming situation of medical student mental health” King et al. 41 on behalf of the Canadian Federation of Medical Students (CFMS) responded to the commentary by D’Eon and team 39 on medical students' mental health. King called upon the medical education community to join the CFMS in its commitment to improving medical student wellbeing.

Re: “Development of a medical education podcast in obstetrics and gynecology” 42 was written by Kirubarajan in response to the article by Development of a medical education podcast in obstetrics and gynecology by Black and team. 43 Kirubarajan applauded the development of the podcast to meet a need in medical education, and suggested potential future topics such as interventions to prevent learner burnout.

Response to “First year medical student experiences with a clinical skills seminar emphasizing sexual and gender minority population complexity” by Kumar and Hassan 44 acknowledged the previously published article by Biro et al. 45 that explored limitations in medical training for the LGBTQ2S community. However, Kumar and Hassen advocated for further progress and reform for medical training to address the health requirements for sexual and gender minorities.

In her letter, Journey to the unknown: road closed!, 46 Rosemary Pawliuk responded to the article, Journey into the unknown: considering the international medical graduate perspective on the road to Canadian residency during the COVID-19 pandemic, by Gutman et al. 47 Pawliuk agreed that international medical students (IMGs) do not have adequate formal representation when it comes to residency training decisions. Therefore, Pawliuk challenged health organizations to make changes to give a voice in decision-making to the organizations representing IMGs.

In Connections, 48 Sara Guzman created a digital painting to portray her approach to learning. Her image of a hand touching a neuron showed her desire to physically see and touch an active neuron in order to further understand the brain and its connections.

Psychology Resources: Peer-Reviewed Journal Articles

• Getting Started
• Reference Books
• Electronic Books
• Peer-Reviewed Journal Articles

What Is a Peer-Reviewed Article?

Peer Review is a process that journals use to ensure the articles they publish represent the best scholarship currently available. When an article is submitted to a peer reviewed journal, the editors send it out to other scholars in the same field (the author's peers) to get their opinion on the quality of the scholarship, its relevance to the field, its appropriateness for the journal, etc.

Publications that don't use peer review (Time, Cosmo, Salon) just rely on the judgement of the editors whether an article is up to snuff or not. That's why you can't count on them for solid, scientific scholarship. --University of Texas at Austin

The databases listed in this Research Guide are available only to Truckee Meadows Community College students, faculty and staff. You will need your TMCC credentials (Username and Password) to access them off-campus.

Examples of a magazine article and a peer-reviewed article (about the ridiculously broad topic "child development"):

• Magazine articles  (and web pages) tend to have lots of pictures and colors -  Giving Back...and Forward
• Peer-reviewed or empirical articles  report original research and have dense text and tables (and have lots of authors and more pages) - Associations Between Publicly Funded Preschool and Low-Income Children's Kindergarten Readiness: The Moderating Role of Child Temperament

Notice the difference?  The Giving Back article  features pictures and newsy content, while  Associations  has a longer title, charts and lots of dense text.

How to Read a Peer-Reviewed Journal Article

Tips for Reading a Research Article

Read the Abstract . It consists of a brief summary of the research questions and methods. It may also state the findings. Because it is short and often written in dense psychological language, you may need to read it a couple of times. Try to restate the abstract in your own nontechnical language. And just skim the Methods section. It is assumed that the audience is familiar with these methods, and it is often filled with highly technical jargon and statistical terminology.

• Read the Introduction . This is the beginning of the article, appearing first after the Abstract. This contains information about the authors' interest in the research, why they chose the topic, their hypothesis , and methods. This part also sets out the operational definitions of variables.
• Skim the Methods section. This section assumes you know what the authors are talking about, and you probably don't. This is graduate-level information.
• Skip the Results section. The language will be too technical and confusing.
• Read the Discussion section. The Discussion section will explain the main findings in great detail and discuss any methodological problems or flaws that the researchers discovered.
• Read the Conclusion/Discussion section. It's written in "mostly" plain English. It's the last section of the report (before any appendices) summarizes the findings, but, more important for social research, it sets out what the researchers think is the value of their research for real-life application and for public policy. This section often contains suggestions for future research, including issues that the researchers became aware of in the course of the study.
• Following the conclusions are appendices, usually tables of findings, presentations of questions and statements used in self-reports and questionnaires, and examples of forms used (such as forms for behavioral assessments).

Modified from Net Lab

See also the Evaluating Sources Guide , especially the How to Read and Evaluate Articles page .

Peer Review

Databases with Peer-Reviewed Journals on Psychology

Databases with peer-reviewed psychology journal content . 

In most of these databases, you must check Scholarly (Peer Reviewed) Journals, usually before you click Search, or modify the search after you have received your results.  Check with the Reference Librarian to determine if a journal article is peer reviewed.

How to Find a Peer-Reviewed Psychology Article Using TMCC Resources

The following collections include only psychology-related journals. Gale OneFile Psychology has a few psychology magazines as well, but defaults to peer-reviewed results.

• APA PsycArticles (EBSCO)
• Gale OneFile Psychology
• Psychology and Behavioral Science Collection  (EBSCO)

Search the library catalog ( a "discovery service") to search these collections and many more resources in a single search, including open-access resources and eBooks.

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• Next: Web Sites >>
• Last Updated: Dec 6, 2022 10:25 AM
• URL: https://libguides.tmcc.edu/psychology

REVIEW article

Focus of attention in musical learning and music performance: a systematic review and discussion of focus instructions and outcome measures.

• Freiburg Institute for Musicians’ Medicine, University of Music Freiburg, Medical Center of Albert-Ludwigs-University Freiburg, Freiburg Center for Music Research and Teaching, Freiburg, Germany

The topic of attentional focus (focus of attention, FOA) in musical learning and performance has recently received increasing interest, as the growing number of empirical studies inspired by the established FOA paradigm in sports by Wulf and colleagues in 1998. The current systematical review aims at collecting, abstracting, and categorizing relevant data to show which kinds of FOA instructions were applied in experimental designs and what kinds of dependent variables were used to measure the effects of FOA instruction on musical performance. The three main inclusion criteria in the selection process were experimental design, detailed descriptions of FOA instructions, and outcome measures (OMs). A systematic search was conducted with a complex search term in four scientific databases in March 2023. For presenting and synthesizing results, we used data collection and an inductive-deductive data categorization. Fifteen studies with a total sample size of 401 participants were included out of 387 records initially identified. We collected 53 different FOA instruction citations from the 15 studies and classified them into 9 FOA subcategories, of which the most applied were bodily focus (21%), sound focus (15%), and visual focus (14%). Selected studies used 63 OMs that were abstracted to 10 different OM categories with expert ratings (27%) and acoustical analysis (22%) as the most applied dependent variables. Data categorization and abstraction of additional study information show multiple combinations of FOA instructions, OMs, participants’ instruments and expertise, and musical tasks. Finally, studies show no consistent results of superiority of either external or internal or otherwise different FOA considering positive effects on musical performance. Limitations of the review lie in the small study sample, possible criticism of applied eligibility criteria, and subjectivity of data categorization. We propose a research agenda with a more exploratory approach that comprehensively and qualitatively examines the dimensions of musical goals to create a database that could provide a foundation for developing a music-specific FOA model.

1 Introduction

The general questions of how we locate our attention while we perform and why we do so play a crucial role in physiological and psychological processes in performances of various everyday life areas as well as in many professional, high-performance domains (e.g., sports, music, dance, etc.). Considering these performance areas in which motor control and motor learning are highly important, we can add many questions that are of special interest to certain research fields, performers, trainers, and educators. Assuming there is a performance effect based on attentional mechanisms, questions arise as to how these processes manifest in different learning or performing situations. What degree of influence does the type of movement, movement task, expertise, pressure, anxiety, state of consciousness, and, finally, instructions have on performance quality and how can we measure it in a domain-specific way? The current systematic review aims to shed light upon some open challenges of focus of attention (FOA) research in general in the music domain by systematically collecting and abstracting data on the two much-discussed aspects of instruction and outcome measures (OMs).

The idea that attentional processes could affect motor performances is not new, nor is it the scientific discourse on it that began at the end of the 19th century and continues today. James (1890 , p. 520) describes in chapter XXVI of his book The Principles about the production of movement “[…] that we fail of accuracy and certainty in our attainment of the end whenever we are preoccupied with much ideal consciousness of the means.” Moreover, Bliss (1895 , p. 55) said in the last sentence of his report, Investigations in reaction-time and attention, that it is “[…] a well-known fact that we can perform numerous actions much better when only half attending to them.” From the 1960s, movement and sports research shaped the debate about positive or negative attentional effects on performance from the motor learning perspective. Many of the well-established motor learning theories and concepts refer to development from conscious and highly controlled movements or actions at the beginning of the acquisition of motor skill to a more unconscious and highly free, automatic performance of movements at an expert stage. Meinel (1960) defined this stage as Variable Verfügbarkeit (variable availability), in which a performer can detach from movement execution and focus on movement expression (for the role of variability in this regard, see also Bernstein, 1967 ). Other phase concepts described this as the autonomous phase ( Fitts and Posner, 1967 ) that contains automatic mechanisms and the ruggedness of movement execution against external resistances.

1.1 Attention under pressure: explicit monitoring and distraction theories

Following this tradition, experimental psychologists of the 1970s and 1980s started to ask and examine whether self-awareness, self-consciousness, and certain attentional processes could aid or detract from performance success ( Martens and Landers, 1972 ; Langer and Imber, 1979 ), especially in contexts, in which performers are under pressure ( Baumeister, 1984 ; see also Masters, 1992 ). Later, Beilock and Carr (2001) subsume the explanations for this phenomenon as explicit monitoring theory (EMT). The terms execution focus theory (see also Beilock and Carr, 2001 ) and conscious processing hypothesis (CPH; Mullen and Hardy, 2000 ; Wilson et al., 2007 ) are in line with EMT and highlight that a step-by-step focus on execution degrades performance and this control or self-control disrupts fluency as well as automaticity of movement on the expert level. Although Baumeister (1984) also emphasized the role of anxiety in his concept, other theories put the fear of failing in situations under pressure at the center of their arguments ( Wine, 1971 ; Eysenck, 1979 ). This distraction theory describes processes of involuntary shifts of attention to task-irrelevant information. Another attempt by Eysenck and Calvo (1992) claims that anxiety does not directly impair performance effectiveness but negatively impacts the efficiency of the on-task effort—and further leads to a reduction of processing capacity that results in performance degrading ( processing efficiency theory , see also Smith et al., 2001 ; Murray and Janelle, 2003 ). The first comparative experimental studies from the music and sports domains show that EMT or CPH seems to be a more useful explanation theory for choking under pressure processes than the distraction or processing efficiency attempts ( Wan and Huon, 2005 ; Wilson et al., 2007 ). However, more recent results tended to contradict those insights ( Lee and Grafton, 2015 ; Buchanan et al., 2018 ; Furuya et al., 2021 ), whereas other studies seemed to confirm it ( Reeves et al., 2007 ; Gray et al., 2013 ; Carson and Collins, 2016 )—the discussion and research on this topic is ongoing (see also Saikley and Haroush, 2021 ).

1.2 Attentional focus in motor learning and motor performance

In 1998, Gabriele Wulf and colleagues published the results of an experimental study that has received much attention in the last two decades up to the current discourse. Referring to the abovementioned concepts of Baumeister (1984) and Masters (1992) , explaining performance degrading under pressure, Wulf et al. (1998) developed an experimental paradigm to examine the effects of different attentional focus instructions on motor learning, independent from the existence of high-pressure situations or anxiety processes. In the first experiment, participants should perform a repetitive skiing-like movement task multiple times with a ski-simulator. The instruction was either “[…] to try to exert force on the outer foot (e. g., the right foot) as long as the platform moved in the respective direction (e. g., to the right side)” ( internal-focus group ) or “to try to exert force on the outer wheels as long as the platform moved in the respective direction” ( external-focus group ; Wulf et al., 1998 , p. 172). The results show significantly higher mean amplitude (derived from the platform position data) of movements of the external-focus group compared to the internal-focus group (and a control group that got no specific instruction) in both practice trials and retention tests. A second experiment containing a balance task somehow confirmed these results by showing fewer balance errors in the external-focus group than in the internal-focus group during a retention test after 2 days of practice, in which no further instructions were given. Although a concrete theoretical foundation of that outcome could not be found by the authors at that time, the common-coding theory ( Prinz, 1997 )—describing a common representation of perception and action in the brain—serves as a theoretical framework due to its link to distal events in the form of perception–action coupling mechanisms (an external FOA is a “distal event”). Wulf herself later interpreted that link as insufficient: “Yet, because the theory is rather abstract, it does not specifically predict the differential learning effects of external versus internal attentional foci. It also does not explain any underlying mechanisms of this effect” ( Wulf, 2013 , p. 91).

Due to the promising results, and despite missing adequate theoretical constructs, Wulf and other researchers applied the paradigm to other movement tasks and could confirm the claimed benefit of an external FOA for motor learning (e.g., Shea and Wulf, 1999 ; McNevin et al., 2000 ; Wulf et al., 2000 ) before formulating the constrained action hypothesis (CAH; Wulf et al., 2001a , b ). The CAH describes a negative effect chain from (1) focusing consciously on body movement execution or trying to control it, (2) interfering with automatic control motor processes, to (3) a performance degrading or action constraining effect. In addition, or as an expansion, a less beneficial focus on the self through an over-evaluation of one’s own actions could enhance the interference effect ( self-invoking trigger hypothesis , Wulf and Lewthwaite, 2010 ; McKay et al., 2015 ). Turning the CAH—which focuses on disadvantageous processes—into an assumption, what kind of FOA could be beneficial for supporting the motor system to be automatic and self-organized, Wulf and colleagues formulate the general instruction advice to focus “[…] on the intended movement effect or task goal” ( Wulf and Lewthwaite, 2016 , p. 1402). Another hypothesis describes the importance of distance in this regard. The further away a goal appears that refers to external FOA instructions, the greater the effect on motor learning and performance ( distal foci effect hypothesis ; Bell and Hardy, 2009 ; Duke et al., 2011 ; McKay and Wulf, 2012 ; Stambaugh, 2017 ). Current results from a meta-analysis confirmed the hypothesis that distal-external foci instructions have a more positive impact on motor learning than proximal-external foci instructions ( Chua et al., 2021 ).

An impressive number of experimental studies demonstrate the superiority of the effects of external FOA instructions on motor learning and motor performance. However, there are critical discussions on some aspects of the big picture, e.g., regarding various theoretical issues ( Ehrlenspiel and Maurer, 2007 ; Oudejans et al., 2007 ; Poolton et al., 2007 ; Raab, 2007 ; Peh et al., 2011 ), methodical questions ( Mullen, 2007 ), and the missing of a theoretical construct that could explain learning benefits of an external FOA ( Maurer and Zentgraf, 2007 ; for an overview, collection of critical commentaries, and responses by Wulf, see the special issue of Bewegung und Training [Movement and Training], 2007).

1.3 Focus of attention in music

Madsen and Geringer (1990) , Geringer and Madsen (1996) , Madsen (1997) started a series of studies investigating the focus of attention on different musical elements of musicians and non-musicians while listening to music. Whereas this research is not in line with the attentional effects of focus instructions on motor learning, the results show how different the attentional focus on diverse musical parameters can be in relation to musical expertise or musical stimuli. Wulf and Mornell (2008 , see also Mornell, 2007) were the first to investigate the transfer and adaptation of FOA findings from sports to music and dance (see also Guss-West and Wulf, 2016 ; Mornell and Wulf, 2019 ). This was followed by an experimental study by Duke et al. (2011) on the effects of attentional instructions on various aspects of solving a short piano task. In their study, participants focused on the fingers, the keys, the hammers, and the sound of the music while playing as part of a repeated measures design. The authors investigated the effect of different FOAs on the evenness of playing movements and showed that non-experts play significantly more consistently in the transfer test when focusing on the hammers and the sound of the music.

Following these results, the FOA paradigm of Wulf et al. (1998) , and different explanatory hypotheses (e.g., CAH), some music-related experimental and exploratory studies have been conducted, e.g., in singing ( Atkins and Duke, 2013 ; Atkins, 2017 , 2018 ; Treinkman, 2022a ), on the effect in piano playing ( Cheng et al., 2011 ; Lipke-Perry et al., 2022 ; Jentzsch and Braun, 2023 ), violin playing ( Allingham et al., 2021 ; Allingham and Wöllner, 2022 ), wind instrument playing ( Stambaugh, 2017 , 2019 ; Williams et al., 2023 ), or in music education settings ( Silvey and Montemayor, 2014 ; Montemayor et al., 2016 ; Parsons and Simmons, 2021 ). The results of these studies vary widely, with some evidence of a positive effect of an external FOA on certain aspects of musical learning and musical performances and some results showing no significant differences between different FOA instructions.

Most of the studies investigating FOA in music predominantly used motor learning and performance under pressure models as theoretical underpinnings and transferred those to create an experimental paradigm with a musical task (e.g., Duke et al., 2011 ; Atkins and Duke, 2013 ; Atkins, 2017 ; Stambaugh, 2017 ; Mornell and Wulf, 2019 ). Allingham et al. (2021) used an additional music-specific theoretical framework by Jensenius (2007) that presents an action-sound chain describing the process from neurological activity in the brain at the start to the production of sound at the end. In more detail, he outlined a paired connection mechanism between the involved performance part and its location area (Brain–Neurological, Muscle–Physiological, Limb–Physical, Instrument–Mechanical, Sound–Acoustical; see Jensenius, 2007 , p. 24). In all these parts of the process, a multimodal feedback-loop takes place. This model could be used as an explanation for sound as an external FOA because, at least in the dimension of time, it is the furthest point. Williams et al. (2023 , p. 3) provided an attentional focus continuum model for musicians, classifying focus instructions into four main categories from proximal to distal, namely internal focus , external focus , distal external focus, and very distal external focus . It is a movement-oriented approach that subsumes insights from the motor learning and music research field but lacks precise sources and theoretical underpinnings regarding what dimension the continuum is grounded on—it could be time, room, and mental capacity. There are only very few approaches to investigating the attention processes of musicians in an explorative and qualitative manner to discover which music-specific aspects condition the direction of an attentional focus. Buma et al. (2015) used a collection of statements from experienced professional musicians to examine different thoughts before and during a performance situation under pressure. The various statements were categorized using cluster analysis and inductively assigned to six focus categories. The individual statements were then evaluated by musicians for their importance and frequency of occurrence during stage performances. The results show that a musical focus is mentioned most frequently, but the relevance and application of a musical focus are not considered as important as that of a focus on physical aspects. A study by Oudejans et al. (2017) , which builds on this, deals with the focus shortly before and after moments of choking under pressure and assigns an important significance to a focus on musical aspects here. Another qualitative approach was made by Treinkman (2022a) , who examines attentional focus processes in singing by asking more than 200 singers about their foci while practicing and performing. The deductive assignment of the singer’s open statements, where they direct their attention to Wulf’s paradigm of internal vs. external FOA, showed no convincing results regarding which kind of foci were preferred, used, or useful in singing. A qualitative thematic analysis of open-format questionnaires with string players conducted by Lubert et al. (2023) shows four main themes of reported attentional foci during music performance under pressure, that is, navigation of music-related aspects, physical and emotional performance experience, critical thoughts and attempts and control, and quality and dynamic of focus. These explorative studies and inductively performed qualitative analyses are very important for the field due to the differentiated perspective on attentional foci in various musical situations.

1.4 Challenges of attentional focus instruction and outcome measures in music

A critical aspect in assessing the effect of attentional instructions in music is the heterogeneity in terms of participants (amateur and professional musicians), instruments (vocals, strings, winds, etc.), and musical tasks or tests (high internal validity and low ecological validity or very application-oriented tasks or music practice interventions). However, the variety of reported verbal attentional instructions and their mainly deductive classification to the internal vs. external FOA categorization by Wulf et al. (1998) lead to difficulties in the interpretation of effects as well as study results. There are some limitations of a dichotomous assignment of instructions for executing a musical task into categories of internal and external FOA (or complementarily possibly far-external and proximal-external FOA). Instructions used in the experiments do not exclusively refer to one movement execution (internal FOA) or one (near or far) movement target (external FOA) as Wulf and colleagues’ paradigm purports ( Wulf et al., 1998 ; see also Wulf, 2013 ; Wulf and Lewthwaite, 2016 ). They refer to many different aspects that play a role in making music—namely, body movements, breathing, sound, visual orientation, consistency, communication, visual and auditory imagination, metaphors, musical instruments, physical resistance, creativity, expressivity, musical articulation, etc.—and a music-specific theoretical FOA model that could explain, connect, or differentiate these aspects from another is missing. Recently, Herrebrøden (2023) argued in his critical review that the superiority of external FOA instructions in motor learning experiments in the sports and music domains could alternatively be explained with the direction of instructions on task-relevant information—whereas internal foci instruction often refers to task-irrelevant information.

Finally, the measurement methods used in the experiments are as heterogenic as the various aspects mentioned before. Measuring musical performance is a fundamental problem that plays a major role in a transfer or commonality of sports and musical performance models (“First, we have the problem of measurement,” Schmidt and Lee, 2012 , p. 17). In sports and movement research, there is no discussion of the outcomes of gross movement tasks or specific types of sports scoring systems. We can easily measure how high we jump, and we can count baskets, holes, bull’s eyes, or detect errors while trying to reach a task goal (for an overview of outcome measures in the FOA motor learning field, see Chua et al., 2021 , p. 622, footnote 2 and Appendix). One of the few exceptions in the FOA research field is expert ratings in gymnastics ( Lawrence et al., 2011 ). In music performance research, the discussion of how to assess musical performances validly and reliably has a long tradition ( Saunders, 1993 ; McPherson and Thompson, 1998 ; Thompson and Williamon, 2003 ) and is still up to date ( Wesolowski and Wind, 2019a , b ; for an overview of different perspectives on the issue from education and research see Brophy, 2019 ).

1.5 Review aims and research questions

Although there was no empirical research on the effects of FOA in music at the time of Wulf and Mornell’s (2008) contribution, the authors formulated implications for music education based on the findings from the field of motor learning: “Teachers will ideally look for verbal instructions that direct attention away from small muscle movements or body, so that automatic motor programs are not disrupted by cognitive interference” (p. 14). Similar deductions are also made based on other results, although the study situation and less evidence do not (yet) provide clear pedagogical or didactical implications for musicians and singers while they practice or perform on stage.

Thus, this review first aims to contribute to a broader discourse in the FOA field by systematically displaying the genesis and actual research situation, mainly in the sports and music domains. Second, we intend to highlight theoretical and methodical challenges and examine to what extent a movement-based model can be transferred to the specifics of musical skill acquisition and music performance. Two of the main questions in this context serve as a framework for the current review and future directions of examining FOA effects in music: What should we focus on and how can we measure it? In more detail and in the context of the present review, we have the following three research questions:

1. How many experimental studies investigate the effects of different attentional focus instructions on learning and performance in the music domain?

2. What kind of FOA instructions, outcome measures, and classifications do they use?

3. Which concrete aspects of FOA research in music should be discussed in the field in the future, and what directions of an application-oriented agenda could there be in music performance research?

The present systematical analysis and its methods are strongly oriented to the PRISMA statement ( Moher et al., 2009 ) and the updated guidelines for reporting a systematic review ( Page et al., 2021 ). The abstract was written in line with the PRISMA 2020 for Abstracts checklist ( Page et al., 2021 , p. 185). The application of the PRISMA guidelines in this systematic review lies in both the methodological process and the structure of illustration by continuously following the PRISMA 2020 item checklist (see Page et al., 2021 , pp. 183–184). Due to the research topic and main research aims of reviewing FOA instructions and outcome measures, and not effects, the current study did not consider items from the checklist related to meta-analysis recommendations ( 11. Study risk of biases ; 12. Effect measures ; 13. Synthesis methods ; 14. Reporting risk of bias ; 15. Certainty assessment ; 18. Risk of bias in studies ; 20. Results of syntheses ; 21. Reporting biases ; 22. Certainty of evidence , see Page et al., 2021 ).

A detailed and comprehensive review protocol , which can be found in the Supplementary material (Review protocol), contains different tables of datasets to understand the review process better. However, important outcomes referring to the research questions of the current study and additional findings are implemented in the text.

2.1 General eligibility criteria

Regarding the whole study selection process recommended by Moher et al. (2009) , the eligibility check of reports contains three main levels, i.e., identification of records, screening of records, and a final, full-text eligibility check that includes data collection as well as data abstraction. Beyond singular methodical steps, we defined eight eligibility criteria, which have been reviewed throughout different stages of the selection process. Included studies should meet the following criteria:

a. Be published in the English language.

b. Be published between February 1998 and March 2023 (due to the first publication of Wulf et al. (1998) presenting the FOA paradigm in movement science).

c. Be published in a peer-reviewed journal.

d. Refer to the research topic focus of attention on music in a broad sense.

e. Apply an experimental paradigm referring to Wulf et al. (1998) .

f. Address the processes of learning or performing a musical skill.

g. Contain a precise description of FOA instructions.

h. Contain a precise description of outcome measures.

Considering the study selection flow, the first four criteria (a–d) were reviewed in the screening phase, whereas the latter four (e–h) were examined during the full-text eligibility check.

2.2 Information sources and search strategy

To find appropriate reports referring to FOA in music as much as possible and guarantee a high degree of transparency, we defined a search term suitable for various scientific search engines and databases. It contains keywords, Boolean operators, truncations, quotation marks, and parentheses. The search with the term (“focus of attention” OR “attentional focus” OR “external focus” OR “internal focus”) AND (music* OR music OR singer OR singing OR voice) was performed using a title/abstract filter in PubMed , SAGE journals , Taylor & Francis Online, and Web of Science . In addition, we conducted an open search with the term “focus of attention” music in Google Scholar and examined the first 300 records (as recommended by Haddaway et al., 2015 , who analyzed the procedure, usefulness, and weaknesses of Google Scholar for systematic scientific literature searches in detail). Finally, we scanned the reference lists of representative articles in the field. All actions regarding the systematic search of records were performed by the first author (JH). The search was conducted on 30 March 2023.

2.3 Study selection process

After the identification of records and exclusion of duplicates, two reviewers (JH and AI) independently scanned the publishing date, publication type, journal name, record title, and abstract under consideration of the first four eligibility criteria (a–d). If the record did not meet one of the four criteria, it was rated with [EC] for exclusion; otherwise, we assigned the code [TM] for transmission to the next level. In the case of a mismatch rating (a record was rated with [TM] by the first reviewer, but the second reviewer assigned [EC] or vice versa), the records in question were looked at together again and discussed before a decision was made (see the Review protocol for review methods, code explanation, and contents of the screening categories, Supplementary material ).

Records that met the criteria were transmitted to the final eligibility check, performed by two reviewers (JH and AI) together. At the beginning of this stage, we collected additional basic information about the reports (e.g., Authors , APA citation , and DOI ). One report could contain two or more studies (experiments); in such cases, both studies were reviewed. There were no studies published twice, so we did not exclude double-published contributions. Subsequently, we performed a first collection of relevant data in line with the research aim of this review to check the studies under consideration of the latter four eligibility criteria (e–h) and finally, to decide on inclusion or exclusion. Therefore, we created six main data abstraction variables, which are important for the eligibility check, i.e., type of report , research approach , research design (each of these was filled with data by JH and AI, who followed a variable-specific categorization system; see Supplementary material ), FOA instruction description , musical task description , outcome measure description (each of these was filled by JH and AI with either [YS] for reported or [NO] for not reported ). In the next step, we checked the four criteria (e–h) for eligibility and finally decided on the inclusion [IC] or exclusion [EC] of the study. In two cases, the decision for selection was made after intensive discussion. Furthermore, the decision about the criteria being fulfilled or missing was distinct.

2.4 Data collection, data abstraction, data categorization, and frequency analysis

The included studies were reviewed in more detail with the help of a complex dataset that was divided into five major sections, namely design , participants , focus of attention , outcome measures, and results . In each of the sections, we created different variables and deductively developed various information categories and an associated code system. The dataset contains four types of variables, namely dichotomous variables (with the codes [YS] for reported or [NO] for not reported ), categorization variables (either with a category system created by us or by the authors of the reviewed studies), and citation variables (with relevant original content from the reviewed studies) or quantitative variables (e.g., sample size). First, this structure provides the basis for an overview of the objective, methods, and outcomes, and second, it lets us focus on the important data to answer the research questions, i.e., (1) the precise wording of FOA instructions and (2) the type of outcome measures trying to assess the effect of those instructions. We either collected FOA instruction classifications (as assigned by the authors of the reviewed studies) or categorized instructions inductive-deductively to give an overview of the field in this regard. Furthermore, we conducted an inductive-deductive categorization of outcome measures, aiming to overview which dependent variables were used in the studies. To display the actual research situation as comprehensively as possible, we finally ran frequency analyses of the most relevant variables in relation to the research questions of this review and displayed percentage distributions accordingly.

The systematic search identified 387 records, of which 163 were duplicates and thus sorted out. The publishing date , title of the journal , record title, and abstract of the remaining 224 records were screened by the two reviewers independently. The decision for exclusion [EC] or transmission [TM] was made with a total agreement rate of 91% (see review protocol, Tab. III, Supplementary material ). After discussing critical records and a final agreement about the decision, 185 records (79%) were not transmitted to the final eligibility check. Most records (75%, n = 139) were excluded since the contribution did not refer to the research topic FOA in music at all (criteria d), and 4% ( n = 7) were sorted out because the report was not published in a peer-reviewed journal (c). Five records (3%) were not published between February 1998 and March 2023 (b). The remaining 18% of records ( n = 34) were not transmitted due to a failure of more than one eligibility criteria (see Figure 1 and Tab. III, Review protocol, Supplementary material). Finally, 39 records passed the screening criteria and were reviewed in detail in the next step.

Figure 1 . Flow diagram of the study selection process.

Within the final full-text eligibility check, we reviewed 39 reports on 41 studies by proofing relevant data in the manuscripts, and we discussed important criteria to decide on study inclusion or exclusion. Finally, 14 reports (36%) with 15 studies were included in the review. One report ( Mornell and Wulf, 2019 ) contains two experiments that should be interpreted as two studies following the Glossary of terms of the PRISMA 2020 statement (see Page et al., 2021 , p. 181). Almost all reports ( n  = 25, 96%) were excluded due to the failing of more than one of the four eligibility criteria (e–h). For an overview of the study selection flow, see Figure 1 .

After collecting and abstracting relevant data from the studies for the eligibility check, we did another data collection, abstraction, and categorization step for the 15 studies included in the review (see Review protocol, Tab. V, Supplementary material ). Many variables containing citations of aims and hypotheses, participant information (e.g., sample size, participants’ instrument, and participants’ expertise), descriptions of musical tasks and material, and detailed information about the results (e.g., post-hoc results) were added to the protocol. Finally, we collected and categorized the important data to answer the review research questions, that is, the correct citations of FOA instructions within the 15 studies and all outcome measures used to measure the effects of experimentally manipulated attentional focus instructions in different experiments. Furthermore, we collected the classifications of FOA instructions by the authors of the original studies and inductive-deductively developed a code system that helps to categorize all focus instructions and assign these categories to the two main FOA classifications by Wulf et al. (1998) , that is, internal and external . The coding and categorization process of dependent variables was conducted with an inductive-deductive attempt to cluster outcome measures into 10 categories (e.g., expert rating, acoustical analysis, and self-evaluation rating).

3.1 Attentional focus instruction in music

In total, we collected 53 different experimental FOA instructions. On the first abstraction level, we assigned these instructions to 9 different FOA subcategories inductive-deductively, i.e., either the category is strongly oriented to the original instruction citation or it was assigned by the authors of this review by abstracting on a broader aspect of the FOA field. Fourteen out of 15 included studies designed an experimental paradigm that contains—albeit in different ways—a comparison of different movement (or playing or teaching) instructions made by the experimenter, which refer at least to one external and one internal aspect of the required task. This fact can be seen as a minimal match across all studies. The study by Williams et al. (2023) serves as an exception due to comparing a practice program that contains external foci with a control group without any FOA instruction. However, the collection, abstraction, and categorization of instruction data show a wide variety of attentional focus instructions with reference to many different goals (see Tables 1 , 2 ).

Table 1 . Participant information and attentional focus (FOA) instructions of included studies.

Table 2 . Frequencies of FOA instruction categories, experimental groups, or conditions used in included studies.

The most frequently used instructions refer to an attentional focus on the body ( n  = 12, 21%), a FOA on sound ( n  = 9, 16%), and a control condition or control group, in which generally no specific focus instructions were given ( n  = 9, 16%). Instructions referring to a visual focus were solely used in studies with singers and investigating FOA instructions on different singing tasks ( Atkins and Duke, 2013 ; Atkins, 2017 , 2018 ). The reason for this specificity lies in the behavior that singers do not have naturally to visually focus their instruments, as they are hidden inside the body, so they can adopt an attentional focus while visualizing different focal points in their environment. An instrumental focus was instructed in 4 of the 15 studies reviewed. Furthermore, there are a few experimental FOA instructions that we could not assign reasonably to one of the other 9 subcategories because they were part of a whole practice ( Williams et al., 2023 ) or education program ( Silvey and Montemayor, 2014 ; Montemayor et al., 2016 ) and their content between and within the program was very different. That is why they were subsumed in the category Other focus (see Table 2 ).

Those 10 subcategories were assigned to three main categories of a category system that is oriented on the original experimental paradigm of Wulf et al. (1998) ; see also ( Wulf, 2013 ) consisting of FOA instructions either as internal, external, neutral, or with no specific focus. In the current review, we abstracted each of the FOA instructions used and 10 subcategories to one of these three main categories based on either a note for a link in the original manuscript of the study or due to an interpretation of the original group/condition classification in terms of Wulf’s definitions of an external focus (to focus “[…] on the intended movement effect or task goal,” Wulf and Lewthwaite, 2016 , p. 1,402) and an internal focus (“[…] concentration on body movements,” Chua et al., 2021 , p. 619). Within the 15 studies reviewed, 27 (51%) external foci have been used, 32% of all FOA instructions refer to internal attentional processes ( n  = 17), and 9 instructions had no special focus and served as control or baseline conditions (17%, see Table 3 ).

Table 3 . Frequencies of FOA instruction categories referring to the paradigm by Wulf (2013) .

For internal focus instructions used by experimenters and authors of the studies, the wording appears often sharp, precise, and goal-oriented with a clear link to body parts or body motions, e.g., “focus on your fingers” ( Duke et al., 2011 ), “focus on your right arm” ( Allingham et al., 2021 ), “focus on the precision of their finger movements” ( Mornell and Wulf, 2019 ), or “focus on your soft-palate” ( Atkins, 2017 ). In the included studies, 21% of all instructions refer to the body ( n  = 12, see Table 2 ). On the other hand, there are internal FOA instructions relating to different dimensions, such as a type of auditory imagery (“[…] and development of an aural image of the music,” Silvey and Montemayor, 2014 ) or reference to notes or the score (“[…] and correct notes,” Mornell and Wulf, 2019 ). Some authors classify a focus on technical performance aspects as an internal FOA, e.g., “[…] keeping their vibrato steady and consistent” ( Atkins, 2017 ) or “[…] and creating staccato articulation” ( Lipke-Perry et al., 2022 ), even if the words refer to outcomes that could be interpreted by definition (see Wulf, 2013 ) as movement goals – that is, in reference to the abovementioned instructions, move in a certain manner to sing consistently or to create staccato.

Within the package of instruction wordings of the 15 included studies referring to external attentional foci in music ( n  = 27), the interpretation, abstraction, or classification is challenging, at least due to the variety of musical tasks, materials, participants’ experiences, and participants’ instruments. However, one crucial aspect is the interpretation of sound as the central goal of musical movements or musical tasks in equivalence or as a modification of the definition of external FOA in motor learning, focusing on the movement effect (see Wulf, 2013 ). This is supported by the percentage of instructions categorized as sound focus ( n  = 9, 33% of all external FOA instructions). A further subcategory of special relevance for research in singing is classified as visual focus ( n  = 8, 30% of external FOA instructions). An important difference compared to sound as a movement effect is the action dimension of visualizing a certain point (either near or far away) in the room (see Atkins and Duke, 2013 ; Atkins, 2017 , 2018 ). Adopting a visual focus while making music is not a focus on a movement effect or movement goal; it can be seen as a supporting moderator between movement execution and sound to optimize sound. Obviously, concentrating on a visual task during a music performance is easier when musicians are not physiologically and perceptually tied because hand–eye coordination is not essential, as for singers.

Another important type of external FOA can be described as an instrumental focus in general ( n  = 5, 19% of external FOA instructions). Looking back at the original experimental design and experimentally manipulated instruction in the ski-simulator study by Wulf et al. (1998) , an attentional instruction focusing on the musical instrument (or maybe certain aspects of voice as the pendant for singers) has the biggest theoretical overlap to the original external instructions in motor learning, focusing on not the feet but the wheels of the ski-simulator platform. Allingham et al. (2021) ; see also ( Allingham and Wöllner, 2022 ) used the term somatic focus to depict the importance of physical resistance and the tactile sensory feedback while focusing on the instrument. Duke et al. (2011) and Stambaugh (2017) also used the instrumental focus on keys to find differences between concentrating on essential parts of the piano or the wind instrument and concentrating on the sounds that arise through actuating these essential parts.

3.2 Outcomes measures in FOA studies in the music domain

Across all included studies, we collected 63 descriptions of dependent variables to measure the outcomes and, thus, the effects of experimentally manipulated attentional focus instructions on the performance of a musical task. Thereby, the distribution of used outcome measures per study is very heterogeneous and reaches from 1 ( Stambaugh, 2019 ; Temporal evenness ) to 14 ( Allingham et al., 2021 ; 3 different OM categories). A detailed collection of OM and other relevant information can be overviewed in Table 4 . An inductive-deductive data categorization of all OM descriptions of the original manuscripts resulted in 9 different OM categories (see Table 5 ), of which expert ratings (EXR) were used most to measure FOA effects ( n  = 17; 27%). In total, 7 out of 15 studies used EXR. Furthermore, another 4 studies used different kinds of 14 acoustical analyses of recorded performances as dependent measures (ACU; 22%), e.g., roughness, spectral centroid, formant frequencies, or harmonic-to-noise ratio (see Table 5 ). Electromyography analysis (EMG) for measuring the effects of FOA on muscle activity or muscle energy—and therefore on movement efficiency—was solely conducted by two studies of the same research group ( Allingham et al., 2021 ; Allingham and Wöllner, 2022 ). However, six different EMG measures were applied (10%), the same amount as for self-evaluation ratings (SER; 10%) and error detection (ERD; 10%). One study used another’s evaluation ratings (OER; 3%; Silvey and Montemayor, 2014 ), that is, an evaluation rating of performance conducted neither by an expert nor by oneself. Furthermore, one study measured FOA effects with the help of movement analysis (MVA) and used five different movement parameters (8% of all OM).

Table 4 . Musical tasks, outcome measures (OMs), and results of included studies.

Table 5 . Frequencies of outcome measures (OMs) categories used in included studies.

In general, the total frequency of different OM used in FOA studies in the music domain is very high considering the small number of experimental studies in the field (on average, 4.2 OM per study, sd  = 3.2). One explanation of this result could lie in the explorative character of the included studies, although all studies applied an experimental design with a relatively fixed paradigm. Due to the tenuous research situation in this regard and the lack of clear results yet, a one-sided focus on one OM may not be adequate for the explorative aim of most of the research groups.

3.3 Further outcomes

In addition to the main research aim, to depict the actual research work in terms of FOA instructions and OM, a few other important outcomes emerged based on the full-text analysis and the data abstraction process. In line with the argument of the explorative character of the studies, frequency analysis showed that just 4 studies out of 15, to the best of our knowledge, formulated a clearly directed hypothesis ( Mornell and Wulf, 2019 , Exp1&2; Allingham et al., 2021 ; Allingham and Wöllner, 2022 ), in which the type of FOA was assumed to be superior regarding the music performance or music learning effect.

In addition to the illustration of FOA instructions, FOA sub, and main categories, Table 1 depicts the sample size, participants’ expertise (experts, novices, and both), and participants’ instrument category. Across all included studies, the sample size ranges from 7 to 52, with a total sample size of 401 and an average of 27.7 participants per study ( sd  = 13.8). In terms of participants’ expertise, the frequency distribution is homogenous, with six studies investigating experts, five studies that defined either two groups of experts and novices or no distinction at all (both), and four studies solely with participants and authors defined as novices or amateurs. As expertise plays a big role in the discussion of FOA effects in sports or motor learning (see Introduction and Singh and Wulf, 2020 ), this differentiation was discussed in many of the included studies (e.g., Stambaugh, 2019 ; Allingham and Wöllner, 2022 ; Jentzsch and Braun, 2023 ). Regarding the participants’ instruments category, which is strongly correlated with the type of musical task within the experimental design (see Table 4 ), all classical instrumental groups (wind, string, piano, and voice) are present in the included studies except for percussion instruments. However, there are two additional studies that examined music educational skills in ensemble teaching ( Silvey and Montemayor, 2014 ; Montemayor et al., 2016 ) and two studies that apply the same task to various instrumental groups ( Mornell and Wulf, 2019 , Exp1 & 2).

Table 4 shows the research design (within-subject, between-subject, and mixed), musical tasks, the task paradigm (performance or learning paradigm) of each study, and a summarized display of post-hoc results for each OM. There are two included studies investigating FOA effects without a within-subject factor and, hence, a between-subject design containing one internal FOA group and one external FOA group ( Silvey and Montemayor, 2014 ; Montemayor et al., 2016 ). In addition to that, we found three studies with a mixed design, all of them with the experimental and control conditions as within-subject factor and expertise as between-subject factor ( Allingham et al., 2021 ; Allingham and Wöllner, 2022 ; Jentzsch and Braun, 2023 ). Musical tasks are very particular, each of them specially adjusted for the participants’ instrument, research design, and performance paradigm. The two studies that applied a traditional learning paradigm ( Duke et al., 2011 ; Stambaugh, 2017 )—i.e., acquisition/training block, retention test, and transfer test—used more controlled and internally valid experimental tasks. On the other hand, investigations of more authentic music performances designed more externally valid musical tasks (for an overview, see Table 4 ). Finally, a summary of post-hoc results, as described by the authors of the original manuscripts of the studies, is depicted in Table 4 , if available. This style of illustration is oriented to Wulf’s (2013) review of FOA effects on motor learning, although the current review does not explicitly focus on FOA effects for the aforementioned reasons. Nevertheless, the results of the small number of included studies convey an impression of how heterogeneous the interplay of participant information, musical tasks, FOA instructions, and OM is (see Tables 1 , 4 ). This fact confirmed the complexity and difficulty of outcome interpretation.

4 Discussion

This review aims to overview the current research situation of investigating attentional focus mechanisms in the music performance field by systematically collecting, abstracting, and categorizing relevant data referring to FOA instructions and outcome measures used in studies with experimental paradigms, in accordance with Wulf et al. (1998) . In this context, we specifically asked (1) what is the current state of research, (2) what type of FOA instructions and dependent variables are used, and (3) to what extent can a future research agenda be derived from the findings. Out of 387 records initially identified, 15 studies could be included in a more in-depth investigation through several selection steps oriented on the PRISMA statement ( Moher et al., 2009 ) and the PRISMA 2020 item checklist ( Page et al., 2021 ). Thereby, different types of interesting additional information were collected, that is, aspects of research design, participant information, experimental tasks, and finally, attentional focus effects. Although that data collection was not the main goal of the review, it provides useful information as a basis for the following discussion and supports taking a comprehensive view of the research field and the actual discourse.

4.1 What is the goal of movement in a musical performance?

The original FOA paradigm of comparing internal and external foci using their effects on motor learning and performance is well-established in the sports domain and movement science research. Significant results of a superior external FOA can be found in studies examining various types of sports and different kinds of gross motor skills (for reviews and meta-analysis, see Wulf, 2007a ; Wulf, 2013 ; Wulf and Lewthwaite, 2016 ; Chua et al., 2021 ). Explanations of these effects, even the specification of distinguishing between proximal and distal external foci, are mainly based on the theory that a shift of attention onto the movement effect or a task goal prevents the constrained action effect and, thus, leads to improved motor performance. With small exceptions, included studies of the current review refer to its research questions, aims (and hypotheses), research designs, experimental paradigms, as well as outcome interpretations to Wulf’s motor theory, and music-specific theoretical constructs, play a marginal role, even during outcome discussions. Overviewing the variety of external FOA instructions in the reviewed studies, the question arises, how a movement goal or movement effect is manifested in music. Many of the authors decided to operationalize the external FOA instructions with wording that targets the sound (see Table 1 ). The challenge with this implementation in the music domain lies in its self-evidence because no musician aims to execute musical movements or sound-producing gestures ( Dahl et al., 2010 ; Jensenius et al., 2010 ) without aiming to produce sound. Transferring that problem back to the sports domain, we could compare this operationalization with the external FOA instruction to focus on playing basketball or darts (not to shoot baskets, e.g., see Zachry et al., 2005 , p. 306; or not to throw bull’s eyes, e.g., see Lohse et al., 2014 , p. 124). A few of the included studies from the music domain therefore added some instructions referring to sound quality (“thinking about filling the room with their sound,” Atkins, 2017 , p. 425; “focus on playing for the audience and the expressive sound of the music,” Mornell and Wulf, 2019 , p. 379; “focusing on creating the style of the dance,” Lipke-Perry et al., 2022 , p. 425)—as it is a quality to shoot baskets in basketball.

4.2 Dimensions of musical goals and musical technique

However, these focus-instruction extensions in external FOA music instructions refer to a variety of musical performance dimensions, namely, music communication aspects (“filling the room” or “playing for the audience”), musical expression (“expressive sound”), or musical auditory/visual imagery or musical metaphors (“style of a dance”). These elements of musical performances and musical learning processes could be seen as musical goals, as it is not the sound production itself that lies in the musician’s focus of attention, but how the sound is produced, whom the sound is addressed to, and what it should express. Another methodical issue appears when combining different FOA directions in one instruction. As Wulf herself stated, “[…], we have always attempted to make external and internal focus instructions so similar that they differed in only one or two words to avoid confounds with other variables” ( Wulf, 2013 , p. 92). Subsequently, she mentioned that “contradictory results” (p. 92)—that is, study outcomes that showed no difference between internal and external FOA or a superiority of internal FOA—could be explained by this aspect. This suggestion of a highly controlled experimental manipulation of FOA instructions was made to optimally trace back FOA effects on motor learning effects to the fact that one word makes the difference. Across all included FOA studies of this systematic review, only two studies are close to transposing this advice ( Duke et al., 2011 ; Stambaugh, 2019 ). The others more or less failed to control FOA instruction in this regard (see Table 1 ), at least when paying attention to the number of differently used words.

In addition, there is a big difference between changing words in FOA instructions or consciously referring the instruction to a different musical performance dimension, which took place as well while operationalizing internal FOA instructions. A few of the collected internal FOA instructions relate to technical aspects of musical learning or music performance processes (“focus on the precision of their finger movements (or lip movements for singers) and correct notes,” Mornell and Wulf, 2019 , p. 379; “focusing on the fingertips and creating staccato articulation,” Lipke-Perry et al., 2022 , p. 4; “focusing their attention on keeping their vibrato steady and consistent,” Atkins, 2017 , p. 425). Two points should be discussed concerning aspects of musical technique. On the one hand, the first listed FOA instruction citation refers to the precision of playing (see Mornell and Wulf, 2019 ). When looking at the control/baseline condition of Stambaugh (2019) , she used the wording to play “[…] as accurately as possible” (p. 239), which refers to the same kind of technical dimension. This wording is also used as the basic instruction for all experimental conditions in another study (see Stambaugh, 2017 , p. 48). To summarize, we have the same reference of instruction used in three different studies with different functions within the experimental FOA paradigm, i.e., as a control condition, internal FOA, and general instruction underlying all conditions. Reflecting the methodical advice by Wulf (2013) in this context, contradictory results may not be surprising. On the other hand, a technical FOA instruction (“staccato articulation” or “consistent and steady vibrato”) conceptually lacks a precise assignment to one of the two traditional FOAs due to the point that it could be referred to a style of playing or a specific type of sound-production as defined as an external FOA in many studies of this review. Still, all included studies classified technical foci as internal FOA.

4.3 FOA in music and multimodal action–perception coupling processes

From a sensory perception perspective, performing music and learning to perform music are processes with many related action–perception coupling mechanisms ( Jensenius, 2007 ; Leman and Naveda, 2010 ), which are linked with sensory feedback processes as auditory (e.g., Bangert and Altenmüller, 2003 ; Pfordresher and Chow, 2019 ), visual (e.g., Wöllner and Williamon, 2007 ; Bishop and Goebl, 2015 ), somatosensory (tactile or kinesthetic; e.g., Goebl and Palmer, 2008 ; Kuchenbuch et al., 2014 ), or multisensory feedback (for a recent review see Nunes-Silva et al., 2021 ). In general, musicians spend their whole lives practicing, concentrating consciously or unconsciously on body movements and sound, as the two are inextricably linked. Therefore, it is difficult to argue that a specific focus on one of the two aspects can succeed while not focusing on the other. Furthermore, when it comes to perception, multimodal perception processes, mainly audiovisual integration, are present in making music (see, e.g., Schutz and Lipscomb, 2007 ). Wulf (2007b) answered a proposal of Hegele and Erlacher (2007) to consider the perceptual dimension of FOA in motor learning, or more concretely, dimensions of the movement effect, with the following statement: The “[…] suggestion that ‘temporal’ and ‘perceptional’ dimensions of movement effects should be considered, […], is interesting. Examining those factors independently would appear to be challenging, however” ( Wulf, 2007b , p. 62). She added later: “Nevertheless, examining different dimensions of movement effects would seem like a worthwhile endeavor, as it may provide more insight into the effects of attentional focus on motor control” (p. 62). In the visual perception domain, a few studies ( Moore et al., 2012 ; Klostermann et al., 2014 ; Rienhoff et al., 2015 ) investigated the relationship between FOA effects and effects of a visual fixation duration, such as the quiet eye phenomenon (for an overview, see Vickers, 2007 ; Lebeau et al., 2016 ). Neugebauer et al. (2020) recently found a significant effect of perceptional-directed attentional foci by implementing a 2 × 2 experimental design using a dart-throwing task (visual–internal vs. visual–external vs. kinesthetic–internal vs. kinesthetic–external), that is, quiet-eye duration was increased in the visual instruction groups. On the other hand, kinesthetic instruction leads to a decrease in visual fixation duration, indicating that the perceptual dimension is highly relevant within FOA research. This outcome is also worthy of discussion because Duke et al. (2011) mentioned this topic from a methodical perspective: “It is important to note that the term focus in this research does not refer to visual focus but to focus of attention (i.e., what one is thinking about). In fact, in much of the laboratory research in this domain, participants look at a visual fixation point throughout all the experimental conditions” (p. 46). To the best of our knowledge, there is just one FOA research attempt to study the auditory perceptual dimension of movement goals in music by Cheng et al. (2011) . The group experimentally manipulated the auditory feedback (normal, mute, and delayed)—that was seen by the authors as the external FOA—of a piano task performed by professional pianists. Interestingly, although Cheng et al. (2011) did not use the FOA paradigm by Wulf et al. (1998) , they had no verbal FOA instructions. Instead, they apparently pre-supposed that the sound of the piano is the movement goal of the pianists, and the absence or manipulation of fingering while playing was associated with the presence or the absence of an internal focus. Nevertheless, the results show that even when the fingering was manipulated on instruction, the most important performance factor was auditory feedback. Based on this outcome, it is worthwhile to examine the relationships between auditory or audiovisual sensory feedback and FOA effects in music.

4.4 Musical performance outcomes: measuring more or less?

One of the core aims of the current review was to shed light on the type of application of outcome measures possible within FOA research in the music performance domain. We, therefore, collected and categorized all data of dependent variables used to measure FOA effects on the accomplishment of the different musical tasks. As already mentioned, the number of different kinds of outcome measures was surprisingly high in relation to the small number of studies that met the eligibility criteria of inclusion and compared to the amount of applied OM in many motor learning studies from the sports domain (see Wulf, 2013 ; Chua et al., 2021 ). It almost seems as if many studies reviewed in this article used several dependent measures to find the effects of experimentally manipulated FOA instructions. One of the reasons for that high amount of OM could lie in the dimension of the movement goal in music, the sound . Identifying sound as the external FOA means finding a solution to measure the performance effect, and this challenge was solved partially by conducting an acoustical analysis ( Atkins and Duke, 2013 ; Atkins, 2018 ; Allingham et al., 2021 ; Allingham and Wöllner, 2022 ; see Table 4 ). Considering the amount of existing information of (post-hoc) results within the original manuscripts (see Table 4 ) of the studies, the question arises, how exploratory in its origin research designs of FOA studies in music are. Directed hypotheses are rare and, if available, a theoretically and/or empirically derived answer to why the experimental manipulation should affect this certain outcome measure, if at all, is slightly posed. Vice versa, the methodical sharpness of the FOA paradigm in its original implementation in motor learning research—and the pervasive number of significant results supporting the superiority of adopting an external FOA—provides a solid base for a precisely formulated, directed hypothesis. We argue that one of the key aspects of this methodical issue or challenge of analysis selection is a missing theoretical underpinning of FOA effects in music in general. If we do not know how it works, we know even less how to measure it. Another issue lies in the general challenge of measuring musical performance (see Schmidt and Lee, 2012 ). Expert ratings have been established through their extensive use within different music educational settings, grading in the music study context, performance evaluations in music competitions, and judgments with scores for various musical performance characteristics in auditions for positions as professional musicians. However, the high amount of different OMs used in the growing FOA music field somehow prevents comparable results. Thus, the interpretation of outcomes is challenging. Moreover, this problem is grounded on the inconsistency of applied musical tasks and the musical instruments used in the studies (see Table 4 ). Singers, wind instrument players, and pianists have different motor skills, different sensory awareness, gestural flexibility, and finally, a different perceptual-directed focus of attention during musical performance. There is a lack of replication studies and a lack of studies with different subjective performance ratings, such as ratings of competitors or the audience, which play a big part in the discourse of musical goals.

4.5 Limitations of the review study

The limitations of the review study are mainly due to the small number of experimental studies. In addition, the inconsistent application of analysis between those studies leads to problems in classifying the results and reported effects. Challenges to the interpretation of study results from the FOA in the music field impede formulations of credible insights. Furthermore, it is not possible to estimate the effects of internal, external, or otherwise different attentional focus instructions on musical learning, music performance, or motor learning in music based on this investigation. Another limitation lies in various steps of the PRISMA guidelines to conduct and display systematic reviews, which are in their implementation—even if the claim is to be as transparent and objective as possible—inherently still subjective. We tried to strictly follow the checklist and explain why we deviated from it in some places. Moreover, data abstraction, data categorization, and the design of the categorization systems in terms of FOA instructions and outcome measures are explorative in nature. However, the specific goal of this review lies in focusing on the methodical aspects in detail and not evaluating the results and effects of the reviewed studies. Transparent elucidations of conducting this inductive-deductive style of analysis were given so they can be discussed or criticized in the field and may serve as an impulse for further investigations in this regard. Finally, the definition of eligibility criteria in systematic reviews is often challenging as it determines the study selection process. Formulations of the eight criteria are somehow worthy of discussion, e.g., the requirement that studies must apply an experimental FOA paradigm in reference to the Wulf et al. (1998) attempt (criteria e) and contain a precise description of FOA instruction (criteria g). There are a few theoretical contributions overviewing the situation of FOA research in singing (e.g., Helding, 2015 , 2016 ; Brand, 2021 ; Treinkman, 2021 , 2022b ), but they failed these criteria. Other studies used qualitative methods to provide important ideas on studying FOA in music (e.g., Buma et al., 2015 ; Guss-West and Wulf, 2016 ; Oudejans et al., 2017 ; Parsons and Simmons, 2021 ; Treinkman, 2022a ; Lubert et al., 2023 ); however, they were not included due to missing criteria (e) and (g). The study by Cheng et al. (2011) ; published in conference proceedings and a few unpublished dissertations (e.g., Atkins, 2013 ; Mentzel, 2016 ; Williams, 2019 ; Allingham, 2022 ) approaching aspects of FOA in music were excluded—besides other reasons—because they failed criteria (c), i.e., reports were not published in a peer-reviewed journal or we could not finally be sure of it. With the exception of the study by Mentzel (2016) , the mentioned unpublished dissertations described the same studies that were included in the review. Our decision to apply somehow strict criteria in this regard is grounded on the aim of deepening face up to two of the relevant aspects of the discussion, namely FOA instructions and outcome measures.

4.6 Implications and future studies

Almost every discussion or conclusion section of the study reports included in this review contains ideas of music pedagogical implications from their study results. In other cases, the authors have concrete suggestions of didactical implications for practicing music in general or, in more detail, for singing and playing an instrument. Considering the inconclusive results and effects of FOA instructions on music performance, we would not make concrete music pedagogical suggestions for using shifts of FOA while practicing music at this point. One of the main reasons for that is the absence of FOA studies in music with a learning paradigm in an application-oriented educational setting. Concerning on-stage musical performances in performance under pressure contexts, the research situation manifests as tighter due to a long tradition of multidisciplinary investigations in relation to anxiety and stress in high-pressure performing settings from psychology, sports, and music, e.g., the growing field of music performance anxiety research (for current reviews, see Fernholz et al., 2019 ; Osbourne and Kirsner, 2022 ; Kenny, 2023 ). However, studies showed that dealing with music-specific high-pressure challenges is highly individual and diverse, and depends on multiple factors (see, e.g., Buma et al., 2015 ; Oudejans et al., 2017 ). When dealing with the wide range of practice routines at different practice stages (see Antonini Philippe et al., 2020 ) and the very different pedagogical approaches of instrumental and vocal teachers, it is very difficult to assess the impact of conscious changes in attentional focus on musical learning. This is also supported by anecdotic evidence from discussions with many music students in different lectures, where practice and teaching routines, the practice stage, and the musical literature play a major role.

In relation to the last-mentioned issue and as a preliminary conclusion, future studies of FOA effects in the music domain should first go a step back. For the construction of a music-specific theoretical model, it is necessary to take the musical goals of musicians seriously. Undoubtedly, basic principles of motor learning and motor control have an important influence on how successful musicians learn and perform, but when supposing an integral understanding of musical goals, mental and physiological health and wellbeing should be noted as well. We would argue that it is necessary to conduct big qualitative and quantitative questionnaire surveys to collect as much as possible of existing FOA routines and pedagogical instructions in various music-relevant learning and performance situations of musicians with different goals. Subsequently, it could be interesting to do some in-depth investigations of singular practicing and on-stage performances, e.g., by applying video-stimulated-recall settings (see, e.g., Després, 2022 ), in which the relation between conscious or involuntary shifts of attentional foci, musical material, and sound characteristics could be analyzed solidly. Maybe a strict inductive strategy of data analysis will generate clusters, categories, or structures that somehow confirm the reasonableness of a transfer of the original binary FOA paradigm by Wulf et al. (1998) from sports to music—maybe not, however, because dimensions of musical performances could be more complex.

5 Conclusion

To conclude the current review, we start with a reference to the three main research questions. Out of 387 records, a small number, 15 studies, were included in the study, which, by definition of certain eligibility criteria, applied a FOA instruction paradigm in an experimental design. FOA instructions could be abstracted into 10 different subcategories, e.g., sound focus , visual focus , bodily focus, or instrumental focus , which again could be assigned to the two classifications of internal and external FOAs. We classified 63 outcome measures into 9 outcome measure categories, e.g., acoustical analysis and expert rating . Future scientific discourse in the field should focus on exploring musical goals as one of the critical aspects when comparing FOA effects in sports with those that could be expected in music. We could show that the current research situation is lacking in various points that must be considered before generalizing insights and offering music pedagogical implications. Finally, it seems to be promising to pursue a new application-oriented attempt at exploratory research on attentional focus routines and FOA shifts of musicians in different practice stages to get a solid database of music-specific attentional foci.

Data availability statement

The datasets for this study can be found in the Supplementary material (see Review protocol).

Author contributions

JH: Conceptualization, Investigation, Methodology, Visualization, Writing – original draft, Writing – review & editing. AI: Conceptualization, Investigation, Methodology, Visualization, Writing – review & editing.

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.

Acknowledgments

The authors would like to thank Charlotte Eckler for proofreading the manuscript.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary material

The Supplementary material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyg.2024.1290596/full#supplementary-material

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* References of reports included in the review are marked with an asterisk.

Keywords: attentional focus, motor learning, musical performance, focus instruction, outcome measures, systematic review

Citation: Hohagen J and Immerz A (2024) Focus of attention in musical learning and music performance: a systematic review and discussion of focus instructions and outcome measures. Front. Psychol . 15:1290596. doi: 10.3389/fpsyg.2024.1290596

Received: 07 September 2023; Accepted: 26 February 2024; Published: 08 April 2024.

Reviewed by:

Copyright © 2024 Hohagen and Immerz. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Jesper Hohagen, [email protected]

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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Gender medicine for children and young people is built on shaky foundations. Here is how we strengthen services

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Guidelines on gender related treatment flouted standards and overlooked poor evidence, finds Cass review

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“Medication is binary, but gender expressions are often not”—the Hilary Cass interview

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• Independent Review into Gender Identity Services for Children and Young People

Improving the evidence base for young people is an essential next step, writes Hilary Cass, as her independent review into gender identity services for children and young people is published

Medicine is a science of uncertainty and an art of probability

–William Osler

William Osler’s much quoted aphorism is well known to every medical student. Living with medicine’s many uncertainties would be intolerable for doctors and for patients without some coping mechanisms. In Osler’s time, doctors relied on a mix of knowledge, custom, and paternalism to hide uncertainties from patients, and provide treatments they had learnt from their mentors. Nowadays we have the three pillars of evidence based medicine to lean on: the integration of best available research evidence with clinical expertise, and patient values and preferences.

My independent review into gender identity services for children and young people is published today. 1 When conducting the review, I found that in gender medicine those pillars are built on shaky foundations.

I took on this review in full knowledge of the controversial nature of the subject, the polarisation and toxicity of the debate, and the weakness of the evidence base. Gender care for children and young people had moved from a “watchful waiting” approach to treatment with puberty blockers from Tanner stage 2 for those with early onset gender incongruence, followed by masculinising or feminising hormones from age 16. My review launched while the Divisional Court was considering the case of Bell v Tavistock, which focused on whether young people under 18 have the competence or capacity to give consent to endocrine treatments. 2 Competence or capacity is only one part of the process of informed consent. My review also had to consider the other components: the evidence underpinning the treatments, and the clinical judgements which might lead to recommending an endocrine pathway.

Since my interim report was published in March 2022, the review has commissioned the University of York to conduct a series of systematic reviews appraising the evidence on the characteristics of the population of children and young people presenting to gender services, and the outcomes of social transition, psychosocial interventions, and endocrine treatments. 3 4 5 The review also commissioned an appraisal of international guidelines and a survey of international practice.

The findings of the series of systematic reviews are disappointing. They suggest that the majority of clinical guidelines have not followed the international standards for guideline development. 6 The World Professional Association of Transgender Healthcare (WPATH) has been highly influential in directing international practice, although its guidelines were found by the University of York’s appraisal to lack developmental rigour and transparency. 6 Early versions of two international guidelines—the Endocrine Society 2009 and WPATH 7—influenced nearly all other guidelines, with the exception of recent Finnish and Swedish guidelines; the latter were the only guidelines to publish details of how developers reviewed and utilised the evidence base, and the decision making process behind their recommendations. 6 7 8

The rationale for early puberty suppression remains unclear, with weak evidence regarding the impact on gender dysphoria and mental or psychosocial health. 9 The effect on cognitive and psychosexual development remains unknown. 9 The clearest indication is in helping a small number of birth registered males, whose gender incongruence started in early childhood, to pass in adult life by preventing the irreversible changes of male puberty.

The use of masculinising/feminising hormones in those under the age of 18 also presents many unknowns, despite their longstanding use in the adult transgender population. However, the lack of long term follow-up data on those commencing treatment at an earlier age means we have inadequate information about the range of outcomes for this group. 10 11 In particular, we lack follow up data on the more recent cohort of predominantly birth-registered females who frequently have a range of co-occurring conditions including adverse childhood experiences, autism, and a range of mental health challenges. Filling this knowledge gap would be of great help to the young people wanting to make informed choices about their treatment.

A key message from my review is that gender questioning children and young people seeking help from the NHS must be able to access a broad-based holistic assessment delivered by a multi-professional team. Notwithstanding the pressures on CAMHS and paediatric services, these young people should not receive a lower standard of care than other similarly distressed adolescents. This means access to a wide range of services, including autism diagnostic services, psychosocial support, and evidence based interventions for commonly co-occurring conditions such as depression, anxiety, and eating disorders. Regardless of whether or not they chose a social or medical transition in the longer term, they need support to help them thrive and fulfil their life goals.

The challenge of the assessment process is that while it may direct a broader care plan, it does not give certainty about which young people will ultimately develop a long term trans identity and which will resolve their gender-related distress in other ways. Young people are in a state of neurocognitive and psychosexual development into their mid-20s. Some mature faster than others, and we have no way of knowing when the majority will be in a settled identity. The review has spoken to young adults who are happy and empowered by their decision to medically transition and to others who have regrets.

The ethical challenges are great. Some young adults have told us that they wish they had known when they were younger that there are many more ways of being trans than following a binary medical transgender pathway. The fastest growing identity under the trans umbrella is non-binary. There is almost no research on this group, many of whom want a spectrum of treatments falling short of full medical transition. This raises questions about what medicine can do, what medicine should do, and more specifically what the NHS should do.

Improving the evidence base for this population of young people is an essential next step. Fortunately, because this review has been an iterative process with interim recommendations, the new regional services which are being established to expand provision for the population will have a research structure embedded from the outset, data collection will be integral to the service model, and a prospective puberty blocker study is already in development.

I very much hope that this strong multi disciplinary team model, with networked service delivery and embedded research, will encourage more clinicians with experience in child and adolescent health to work in this evolving area of clinical practice.

Competing interests: none declared.

Provenance and peer review: not commissioned, not peer reviewed.

• ↵ The Cass Review. Independent review of gender identity services for children and young people. April 2024 https://cass.independent-review.uk/?page_id=936
• ↵ v Tavistock B. (Divisional Court) [2020] EWHC 3274 (Admin) https://www.judiciary.uk/wp-content/uploads/2020/12/Bell-v-Tavistock-Judgment.pdf
• ↵ Archives of Disease in Childhood. Gender identity service series. https://adc.bmj.com/pages/gender-identity-service-series
• Taylor J. ,
• ↵ Council for Choices in Healthcare in Finland 2020. Medical treatment methods for dysphoria associated with variations in gender identity in minors – recommendation. https://palveluvalikoima.fi/en/recommendations#genderidentity : Council for Choices in Healthcare in Finland 2020
• ↵ The Swedish National Board of Health and Welfare 2022. https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/kunskapsstod/2023-1-8330.pdf
• ↵ Taylor, J., Mitchell, A., Hall, R., et al (2024). Interventions to suppress puberty in adolescents experiencing gender dysphoria or incongruence: a systematic review. Archives of Disease in Childhood, Published Online First: April 2024. doi: https://doi.org/10.1136/archdischild-2023-326669
• ↵ Taylor, J., Mitchell, A., Hall, R., et al (2024). Masculinising and feminising hormone interventions for adolescents with gender dysphoria or incongruence: a systematic review. Archives of Disease in Childhood, Published Online First: April 2024. doi: https://doi.org/10.1136/archdischild-2023-326670
• ↵ Taylor, J., Hall, R., Langton, T., et al (2024). Care pathways of children and adolescents referred to specialist gender services: a systematic review. Archives of Disease in Childhood, Published Online First: April 2024. doi: https://doi.org/10.1136/archdischild-2023-326760