Canadian Family Physician policy on the use of artificial intelligence in manuscript writing, peer review, and editing
INTRODUCTION
Effective date
30-October-2025
Purpose
Following the rapidly evolving use of artificial intelligence (AI) tools such as large language models and generative chatbots, Canadian Family Physician (CFP) developed this policy to address the foreseeable harms of emerging AI-assisted technologies and provide transparency and guidance to authors, reviewers, editors, readers, and contributors. The policy is aligned with guidance for the use of AI tools provided by the International Committee of Medical Journal Editors (ICMJE) and the Committee on Publication Ethics. CFP will continue to monitor developments in this area and will adjust or refine this policy as appropriate.
Definition
CFP considers AI to include large language models, generative chatbots, and any other technologies that:
- use machine learning, deep learning, logical reasoning, knowledge representation, planning or navigation, natural-language processing, perception, emergent intelligence
- analyze text and produce new content in response to user prompts
- make automated decisions
- generate images or figures
- perform any other similar or equivalent functions
Application
This policy applies to journal editors, peer reviewers, and authors and contributors submitting content for publication in CFP. It applies to all types of content, including (but not limited to) commentaries, research, reviews, clinical articles, and infographics. The policy applies to all information formats, including, without limitation, all text, audio, video and audio-visual material, abstracts, databases, tables, data, diagrams, photographs, and other images or illustrative materials.
GUIDELINES FOR AUTHORS
Authorship
AI tools do not meet CFP’s definition for authorship because they are incapable of fulfilling several required ICMJE criteria for authorship, including being able to take responsibility for the published work, declare competing interests, and enter into copyright and licensing agreements. AI tools cannot be responsible for the accuracy, integrity, and originality of a manuscript, and therefore cannot be listed as an author or co-author on any content published by CFP.
Language and writing
CFP permits the use of basic AI tools in modern word-processing software applications solely to improve the spelling and grammar of a manuscript. This use of AI tools need not be disclosed. AI tools may not be used to translate manuscript text, generate ideas or research questions, reduce word counts, improve readability and manuscript structure, write all or portions of a manuscript, edit all or portions of a manuscript, generate or format references, or create manuscript outlines or summaries.
References
AI tools may not be cited as a reference or other primary source for any information provided in a manuscript, nor may AI tools be listed as an author or co-author of a reference.
Images, figures, and tables
AI tools may be used to assist in creating and designing explanatory diagrams, such as flowcharts or bar graphs, but ultimate responsibility for the quality, content, and accuracy of the figure remains with the author(s). CFP prohibits the use of AI tools to create or modify tables or other image types (e.g., illustrative content, clinical images, medical and diagnostic imaging), including (but not limited to) enhancing, obscuring, moving, flipping, cropping, removing, or introducing a specific feature within an image or figure. Adjusting the brightness, contrast, or color balance of an image or figure is permitted, provided it does not obscure or eliminate any information present in the original.
Exception: AI tools may be used to create or manipulate an image or figure if the use of AI tools is part of research design or methodology (e.g., AI-assisted imaging approaches to generate or interpret the underlying research data in the field of biomedical imaging). If this is done, such use must be described in a reproducible manner in the methods section of the manuscript and include:
- an explanation of how AI tools were used in the image creation or alteration process
- the name of the AI tool or model, version and extension numbers, and manufacturer
Authors must adhere to the AI tool’s specific usage policies and ensure correct content attribution. Where applicable, authors may be asked to provide pre-AI-adjusted versions of images and/or the composite raw images used to create the final submitted versions, for editorial assessment.
Research
CFP prohibits the use of AI tools to produce scientific insights, collect, analyze, or interpret data, draw scientific conclusions, make recommendations, or establish research hypotheses. Research designed to study the nature and effect of AI is permitted. When AI is used as part of a scientific study, authors must:
- Follow the relevant reporting guideline for the study design and report each recommended guideline element with sufficient detail to enable reproducibility
- Adhere to all copyright and intellectual property requirements
- Describe how AI was used for relevant aspects of the study
- Provide the name of the AI tool or model, version and extension numbers, and manufacturer, dates and prompt(s) used, their sequence, and any revisions to prompts in response to initial outputs
- For studies reporting machine learning and algorithm development:
- include details about data sets used for development, training, and validation
- clearly state if algorithms were trained and tested on previously collected or existing data sets (or if the study includes prospective deployment)
- include the machine learning model and describe the variables and outcome(s) and selection of parameters
- describe assumptions involved (e.g., log linearity, proportionality) and how these assumptions were tested
- Indicate the metric used to evaluate the performance of algorithms, including bias, discrimination, calibration, reclassification, etc.
- Indicate institutional review board/ethics review, approval, waiver, or exemption
- Describe and report results of methods or analyses included to address missing data and manage AI-related methodologic bias and inaccuracy of AI-generated content
- Indicate if sensitivity analyses were performed to explore the performance of the AI model in vulnerable or underrepresented subgroups
- Provide a statement on data and code sharing
- Discuss the way in which AI-related bias was identified and mitigated
- Discuss generalizability of findings across populations
Responsibility
Authors are fully responsible for the content of manuscripts submitted to CFP, including those parts produced by an AI tool, and must ensure all manuscript content is accurate, and free from error, fabrication, and plagiarism; contains appropriate attribution of all quoted material, including full citations; that the manuscript has been thoroughly reviewed and validated by the authors. Authors of manuscripts submitted to CFP are solely liable for any breach of publication ethics.
Disclosure
At article submission, CFP requires authors to disclose and describe use of AI tools in any content submitted to the journal, as well as in any other work by the authors that underpins or is otherwise connected to the content submitted to CFP. Disclosure must occur in 1) the manuscript itself, 2) the cover letter or title page that accompanies manuscript submission, and 3) in the question about the use of AI tools on the online manuscript submission form. Authors should also be prepared to provide detailed information regarding the nature of AI use upon request from the CFP editorial team.
GUIDELINES FOR PEER REVIEWERS
CFP abides by the highest standards of integrity in the peer review process. Evaluating a scientific manuscript requires critical thinking, original assessment, and implies accountability and responsibilities that can only be attributed to humans. As such, AI tools may not be used by peer reviewers to evaluate CFP manuscripts because these attributes are outside of the scope of this technology and there is a risk AI tools will generate incorrect, incomplete, or biased conclusions.
Further, manuscripts submitted to CFP are privileged communications and peer reviewers are required to maintain the confidentiality of manuscripts, as authors may be harmed by premature disclosure of manuscript details. Uploading all or part of an unpublished manuscript to software or other AI technologies where confidentiality cannot be assured constitutes a violation of this requirement.
COMMITMENT OF EDITORS
CFP editors will:
- endeavour to understand the use and limitations of AI and be aware of the potential of AI to generate incorrect, incomplete, or biased output
- continue to provide authors and peer reviewers with clear guidelines on accountable and transparent use of AI tools
- establish an editorial judgement system to pre-emptively mitigate the risks posed by AI to research integrity, including data fabrication, copyright infringement, and ethical violations
- use AI tools responsibly, where appropriate, to check for duplicate, highly similar, plagiarized, or fake manuscripts; recommend peer reviewers based on keywords or other metadata; and verify image integrity, ensuring human review and oversight remain paramount
- disclose the use of AI tools used to generate any cover artwork and ensure correct content attribution
- on a systematic or case-by-case basis, use screening tools, image forensic tools, or specialized software pre- or post-publication to identify article or peer review content generated (in whole or in part) by AI technologies and take action to address any violations of this policy
- review this policy as necessary, or every 18 months, and adjust or refine the content as required to ensure the policy remains aligned with industry best practices
CFP editors will not:
- use AI tools to process manuscripts in a manner that may violate author or manuscript confidentiality, proprietary rights, or where the paper contains personally identifiable information, or may breach data privacy rights
- use AI tools to make editorial decisions on manuscripts