All commissions and submissions are first considered by the Editor (or Handling Editor, if the Editor has a conflict of interest or if she has delegated editorial responsibility for certain special categories). If they pass this first scrutiny, each full article is subject to peer review by at least two assessors. Learning objectives and multiple choice questions are reviewed by a third assessor, with a special interest in education, to ensure that the answers are correct and that their style conforms to best educational practice. Shorter pieces (commentaries, editorials and those in special categories such as Mindreadings and Refreshments) may be peer reviewed by only one assessor. Appeals in relation to decisions are sent to a third independent reviewer for their opinion. If reviews are positive, the paper will be accepted for publication, often after several rounds of revision. Assessors must declare that they have no conflict of interest when accepting this role.