All elements of the research protocol were approved by the University of Washington Human Subjects Review Committee, including the study's opt-out design for reviewer recruitment, since it was considered important that reviewers not know that the paper they evaluated was part of a study. To minimize the potential for harm, the authors chose as the topic of the fabricated test manuscript an intervention that could not be immediately put into practice at reviewers' own centers (a particular team-training process in the operating room). In addition, participating reviewers were informed which paper was the test manuscript at the completion of data collection, so that they did not pursue this sort of team training based on the results of the fabricated study.