Whose Paper Is It Anyway? Authorship Criteria According to Established Scholars in Health Professions Education

Demonstrating causality, bestowing honours, and contributing to the arms race: Threats to the sustainability of HPE research

As the field of health professions education (HPE) continues to evolve, it is necessary to occasionally pause and reflect on the potential effects and outcomes of our research practices. While future-casting does not guarantee that impending negative consequences will be evaded, the exercise can help us avoid pitfalls. In this paper, we reflect on two terms that have taken hold as powerful idols in HPE research that stand above questioning and apart from critique: patient outcomes and productivity. We argue that these terms, and the ways of thinking they uphold, threaten the sustainability of HPE research-one at the level of the community and one at the level of the scholar. First, we suggest that HPE research's history of endorsing a linear and causal association ethos has driven its quest to connect education to patient outcomes. To ensure the sustainability of HPE scholarship, we must deconstruct and disempower patient outcomes as one of HPE's god-terms, as the pinnacle goal of educational activities. To be sustained, HPE research needs to value all of its contributions equally. A second god-term is productivity; it impairs the sustainability of the careers of individual researchers. Problems of honorary authorship, research output expectations, and comparisons with other fields have constructed a space where only scholars with sufficient privilege can prevail. If productivity persists as a god-term, the field of HPE research could decay into a space where new scholars are silenced-not because they fail to make important contributions, but because access is restricted by existing research metrics. These are two of many god-terms threatening the sustainability of HPE research. By highlighting patient outcomes and productivity and by acknowledging our own participation in propagating them, we hope to encourage others to recognize how our collective choices threaten the sustainability of our field.

Faster, higher, stronger - together? A bibliometric analysis of author distribution in top medical education journals

INTRODUCTION

Medical education and medical education research are growing industries that have become increasingly globalised. Recognition of the colonial foundations of medical education has led to a growing focus on issues of equity, absence and marginalisation. One area of absence that has been underexplored is that of published voices from low-income and middle-income countries. We undertook a bibliometric analysis of five top medical education journals to determine which countries were absent and which countries were represented in prestigious first and last authorship positions.

METHODS

Web of Science was searched for all articles and reviews published between 2012 and 2021 within Academic Medicine, Medical Education, Advances in Health Sciences Education, Medical Teacher, and BMC Medical Education. Country of origin was identified for first and last author of each publication, and the number of publications originating from each country was counted.

RESULTS

Our analysis revealed a dominance of first and last authors from five countries: USA, Canada, UK, Netherlands and Australia. Authors from these five countries had first or last authored 70% of publications. Of the 195 countries in the world, 43% (approximately 83) were not represented by a single publication. There was an increase in the percentage of publications from outside of these five countries from 23% in 2012 to 40% in 2021.

CONCLUSION

The dominance of wealthy nations within spaces that claim to be international is a finding that requires attention. We draw on analogies from modern Olympic sport and our own collaborative research process to show how academic publishing continues to be a colonised space that advantages those from wealthy and English-speaking countries.

Misuse of co-authorship in Medical PhD Theses in Scandinavia: A Questionnaire Survey

Background

Several studies suggest that deviations from proper authorship practices are commonplace in medicine. The aim of this study was to explore experiences of and attitudes towards the handling of authorship in PhD theses at medical faculties in Denmark, Norway, and Sweden.

Methods

Those who defended their PhD thesis at a medical faculty in Scandinavia during the second half of 2020 were offered, by e-mail, to participate in an online survey. Survey questions dealt with experiences of violations of the first three of the ICMJE authorship criteria and misuse of authorship order in the thesis articles, as well as respondents’ attitudes to these matters. Both questions with fixed response alternatives and questions with free-text responses were used. Quantitative data were analysed statistically using the Table functions in SPSS 25 and Chi-2 tests. Free-text responses were analysed qualitatively using manifest content analysis.

Results

287 valid questionnaires were returned (response rate: 34.1%). Almost half (46.0%) of the respondents reported that the ICMJE authorship criteria were not fully respected in at least one of the papers in their thesis, while a vast majority (96.7%) found it important that authorship is handled according to the ICMJE authorship criteria. 24.4% reported inadequate handling of authorship order in at least one paper. The qualitative results provide a wide spectrum of examples of how the ICMJE authorship criteria are circumvented.

Conclusion

Despite increasing educational efforts to reduce deviations from good research practice at Scandinavian universities, the handling of authorship in medical papers remains problematic.

I, we and they: A linguistic and narrative exploration of the authorship process

INTRODUCTION

While authorship plays a powerful role in the academy, research indicates many authors engage in questionable practices like honorary authorship. This suggests that authorship may be a contested space where individuals must exercise agency-a dynamic and emergent process, embedded in context-to negotiate potentially conflicting norms among published criteria, disciplines and informal practices. This study explores how authors narrate their own and others' agency in making authorship decisions.

METHOD

We conducted a mixed-methods analysis of 24 first authors' accounts of authorship decisions on a recent multi-author paper. Authors included 14 females and 10 males in health professions education (HPE) from U.S. and Canadian institutions (10 assistant, 6 associate and 8 full professors). Analysis took place in three phases: (1) linguistic analysis of grammatical structures shown to be associated with agency (coding for main clause subjects and verb types); (2) narrative analysis to create a 'moral' and 'title' for each account; and (3) dialectic integration of (1) and (2).

RESULTS

Descriptive statistics suggested that female participants used we subjects and material verbs (of doing) more than men and that full professors used relational verbs (of being and having) more than assistant and associate. Three broad types of agency were narrated: distributed (n = 15 participants), focusing on how resources and work were spread across team members; individual (n = 6), focusing on the first author's action; and collaborative (n = 3), focusing on group actions. These three types of agency contained four subtypes, e.g. supported, contested, task-based and negotiated.

DISCUSSION

This study highlights the complex and emergent nature of agency narrated by authors when making authorship decisions. Published criteria offer us starting point-the stated rules of the authorship game; this paper offers us a next step-the enacted and narrated approach to the game.

Using a Modified Delphi Method to Reach Consensus on Best Practices for Medical Education Abstract Submissions to Multiple Conferences

PURPOSE

Medical education researchers are often uncertain whether they should submit abstracts to certain conferences. Therefore, we aimed to elicit consensus among medical education conference organizers to answer the question: what are best practices for research abstract submissions to multiple conferences?

METHODS

Using a 44-question online survey, we conducted a modified Delphi process to identify best practices for abstract submissions to medical education conferences. Consistent with the Delphi process, we identified conference representatives from non-specialty medical education conferences and across four conference types (institutional, regional, national, and international) to serve as panelists.

RESULTS

Eleven expert panelists, representing all four conference types-two institutional conferences, five regional conferences, two national conferences, and two international conferences-completed three rounds of the survey. After three rounds, panelists reached consensus on 39/44 survey items-26 items in round 1, 10 items in round 2, and three items in round 3. Panelists' consensus and rationale indicated that it is most appropriate to resubmit abstracts to conferences with a larger or different audience, but not to more homogeneous audiences. Among the four conference types, abstract resubmission from institutional conferences to other conference types was the most widely accepted. Panelists agreed that abstracts using data and results submitted or accepted for publication could be submitted to any conference type.

CONCLUSION

The results of this study provide best practices for presenting scholarship to medical education conferences. We recommend that guidelines for medical education conference abstract submissions provide consistent, clear instructions regarding the appropriate life cycle of an abstract.

Reducing tensions and expediting manuscript submission via an authorship agreement for early-career researchers: A pilot study

Authorship can be a source of tension on research teams, in academic/industry collaborations, and between mentors/mentees. Authorship misconduct is prevalent among biomedical researchers, and disputes about authorship can generate tensions that have the potential to disrupt professional relationships and damage careers. Early-career researchers may experience particular challenges navigating authorship both because of inexperience and power differentials; in effect, they lack the language and confidence to have these conversations and may feel unwilling to challenge the status quo. The authors implemented an Authorship Agreement for use when collaborating on a manuscript and hypothesized that using this agreement would reduce authorship tensions and speed time to manuscript submission by helping early-career investigators manage authorship conversations more effectively. The authors surveyed trainees (n = 65) on the prevalence of authorship-related tensions and compared the results from the first survey in 2017 to the final survey in 2020. The decrease in tensions around meeting deadlines was significant (z = 2.59, p = 0.010). The authors believe the effect of an Authorship Agreement on authorship-related tensions has not previously been investigated. This work extends what is known about the prevalence of commonly cited authorship tensions, and provides evidence of the effectiveness of steps that can be taken to alleviate them.

A Survey-Weighted Analytic Hierarchy Process to Quantify Authorship

BACKGROUND

Authorship is a pinnacle activity in academic medicine that often involves collaboration and a mentor-mentee relationship. The International Committee of Medical Journal Editors criteria for authorship (ICMJEc) are intended to prevent abuses of authorship and are used by more than 5500 medical journals. However, the binary ICMJEc have not yet been quantified.

AIM

To develop a numeric scoring rubric for the ICMJEc to corroborate the authenticity of authorship claims.

METHODS

The four ICMJEc were separated into the nine authorship components of conception, design, data acquisition, data analysis, interpretation of data, draft, revision, final approval and accountability. In spring 2021, members of an international association of medical editors rated the importance of each authorship component using an 11-point Likert scale ranging from 0 (no importance) to 10 (most important). The median component scores were used to calibrate the pairwise comparisons in an analytic hierarchy process (AHP). The AHP priority weights were multiplied against a four-level perceived effort/capability grade to calculate an authorship score.

RESULTS

Sixty-six decision-making medical editors completed the survey. The components had the median scores/AHP weights: conception 7.5/5.3%; design 8/8.9%; data acquisition 7/3.6%; data analysis 7/3.6%; interpretation of data 8/8.9%; draft 8/8.9%; revision 8/8.9%; final approval 9/20.1%; and accountability 10/31.8%, with Kruskal-Wallis Chi² = 65.11, p < 0.001.

CONCLUSION

The editors rated accountability as the most important component of authorship, followed by the final approval of the manuscript; data acquisition had the lowest median importance score for authorship. The scoring rubric (https://tinyurl.com/eyu86y96) transforms the binary tetrad ICMJEc into 9 quantifiable components of authorship, providing a transparent method to objectively assess authorship contributions, determine authorship order and potentially decrease the abuse of authorship. If desired, individual journals can survey their editorial boards and use the AHP method to derive customized weightings for an ICMJEc-based authorship index.

Factors influencing pharmacy faculty behavior, perceptions, and challenges with determining authorship credit

INTRODUCTION

This study aimed to identify challenges in determining authorship and author order, factors and criteria that influence behavior in determining authorship and author order, and beliefs about authorship and familiarity with guidelines among pharmacy faculty.

METHODS

An online survey was emailed to faculty from three groups of schools categorized by degree of external research funding. Academic discipline and rank, tenure status, years in rank, and gender were queried. Questions were created to determine frequency of authorship justification and author order by specific factors. Power pressures experienced when determining authorship were queried. Three case studies were also included to determine behavior for authorship and authorship order.

RESULTS

A total of 295 usable responses were received (30.2% response rate). A majority of faculty experienced power pressures when determining authorship. Justifying authorship for supervision of student projects and statistical analysis was common. Quantity and quality of contributions were the most common reason for justifying order. Writing substantial sections of an article was ranked the most important component in determining author order. Differences in justifying authorship based on promotion and tenure pressures were noted by academic rank, tenure status, and academic discipline. Familiarity with International Committee for Medical Journal Editors guidelines did not appear to influence behaviors.

CONCLUSIONS

There is a plurality of perceptions and attitudes among faculty in relation to authorship. A model for recognition of contributions is needed. More structured guidance in concert with moral and ethical principles would help to clarify how to best establish authorship and author order.

Is authorship sufficient for today's collaborative research? A call for contributor roles

Assigning authorship and recognizing contributions to scholarly works is challenging on many levels. Here we discuss ethical, social, and technical challenges to the concept of authorship that may impede the recognition of contributions to a scholarly work. Recent work in the field of authorship shows that shifting to a more inclusive contributorship approach may address these challenges. Recent efforts to enable better recognition of contributions to scholarship include the development of the Contributor Role Ontology (CRO), which extends the CRediT taxonomy and can be used in information systems for structuring contributions. We also introduce the Contributor Attribution Model (CAM), which provides a simple data model that relates the contributor to research objects via the role that they played, as well as the provenance of the information. Finally, requirements for the adoption of a contributorship-based approach are discussed.

Authorship stories panel discussion: Fostering ethical authorship by cultivating a growth mindset

Because peer review publication is essential for academic advancement across scientific fields, when authorship is wrongly attributed the consequences can be profound, particularly for junior researchers who are still establishing their professional norms and scientific reputations. Professional societies have published guidelines for authorship, yet authorship dilemmas frequently arise and have harmful consequences for scientific careers. Researchers have noted the complexities of authorship and called for new mechanisms to foster more ethical research cultures within institutions. To address this call, we organized a panel discussion at the Institute for Clinical Research Education at the University of Pittsburgh in which senior faculty members from diverse backgrounds and professional disciplines discussed their own authorship challenges (e.g., renegotiating author order, reconciling inter-professional authorship norms, managing coauthor power differentials) and offered strategies to avoid and/or resolve them. Informed by growth mind-set theory, our storytelling format facilitated an open exchange between senior and junior researchers, situated authorship dilemmas in specific contexts and career stages, and taught researchers how to address authorship challenges not adequately informed by guideline recommendations. Though not empirically assessed, we believe this approach represents a simple, low-cost, and replicable way to cultivate ethical and transparent authorship practices among researchers across scientific fields.

A review of the literature on ethical issues related to scientific authorship

The article at hand presents the results of a literature review on the ethical issues related to scientific authorship. These issues are understood as questions and/or concerns about obligations, values or virtues in relation to reporting, authorship and publication of research results. For this purpose, the Web of Science core collection was searched for English resources published between 1945 and 2018, and a total of 324 items were analyzed. Based on the review of the documents, ten ethical themes have been identified, some of which entail several ethical issues. Ranked on the basis of their frequency of occurrence these themes are: 1) attribution, 2) violations of the norms of authorship, 3) bias, 4) responsibility and accountability, 5) authorship order, 6) citations and referencing, 7) definition of authorship, 8) publication strategy, 9) originality, and 10) sanctions. In mapping these themes, the current article explores major ethical issue and provides a critical discussion about the application of codes of conduct, various understandings of culture, and contributing factors to unethical behavior.

Exploring researchers' perspectives on authorship decision making

CONTEXT

Authorship has major implications for researchers' careers. Hence, journals require researchers to meet formal authorship criteria. However, researchers frequently admit to violating these criteria, which suggests that authorship is a complex issue. This study aims to unpack the complexities inherent in researchers' conceptualisations of questionable authorship practices and to identify factors that make researchers vulnerable to engaging in such practices.

METHODS

A total of 26 North American medical education researchers at a range of career stages were interviewed. Participants were asked to respond to two vignettes, of which one portrayed honorary authorship and the other described an author order scenario, and then to describe related authorship experiences. Data were analysed using thematic analysis.

RESULTS

Participants conceptualised questionable authorship practices in various ways and articulated several ethically grey areas. Personal and situational factors were identified, including hierarchy, resource dependence, institutional culture and gender; these contributed to participants' vulnerability to and involvement in questionable authorship practices. Participants described negative instances of questionable authorship practices as well as situations in which these practices were used for virtuous purposes. Participants rationalised engagement in questionable authorship practices by suggesting that, although technically violating authorship criteria, such practices could be reasonable when they seemed to benefit science.

CONCLUSIONS

Authorship guidelines portray authorship decisions as being black and white, effectively sidestepping key dimensions that create ethical shades of grey. These findings show that researchers generally recognise these shades of grey and in some cases acknowledge having bent the rules themselves. Sometimes their flexibility is driven by benevolent aims aligned with their own values or prevailing norms such as inclusivity. At other times participation in these practices is framed not as a choice, but rather as a consequence of researchers' vulnerability to individual or system factors beyond their control. Taken together, these findings provide insights to help researchers and institutions move beyond recognition of the challenges of authorship and contribute to the development of informed, evidence-based solutions.

Authorship Considerations for Publishing in Pharmacy Education Journals

The distinction of authorship and its associated credit has important implications for academia. Pharmacy education encompasses faculty members from a wide and diverse range of disciplines, including the clinical, basic, and social sciences. These disciplines embody varying traditions and perspectives concerning who qualifies for authorship. As an academy, pharmacy education must do more to equip education researchers with the tools needed to navigate authorship decisions. The following commentary provides examples and recommendations concerning the issue of authorship within pharmacy education. We define authorship, examine authorship guidelines from health professions and education disciplines, and discuss authorship order. We then provide authorship recommendations for pharmacy education with the goal of supporting authorship decisions and further promoting discourse about authorship.

Authorship Order in Medical Education Publications: In Search of Practical Guidance for the Community

Phenomenon: With scholarly collaborations come questions about the order of authorship. Authorship order is an important consideration because it often used as an indicator of seniority, expertise, leadership, and scholarly productivity. As a result, authorship order factors into decisions about hiring, salary, resource allocation, and professional advancement. This study describes principles commonly applied to authorship order decisions within the medical education community and educators' opinions about the significance of authorship order. Approach: A questionnaire was developed to ascertain current practices related to authorship decisions. Sixteen items were rated in terms of frequency of actual use and the desirability of the practice using a 4-point rating scale: 1 (never), 2 (sometimes), 3 (often), and 4 (always). Additional questions addressed the perceived significance of authorship order. The last set of questions provided information about respondents' personal and career characteristics. The survey was delivered via e-mail to a random sample of 391 subscribers from the DR-ED listserv. Findings: Fifty-four e-mail addresses were returned as undeliverable; of the remaining 337 mailed surveys, 109 responses (32.3%) were received. Five of the current practices for determining authorship order were rated as both frequent and desirable; 4 items had low ratings suggesting that these practices were both infrequent and undesirable. For 7 items, there was a significant gap between the ratings of practice frequency and desirability. When asked about preferred authorship order strategies, most respondents (94%) endorsed listing authors by descending order based on contribution but were split in identifying the last author (47%) or second author (46%) as the next best placement after first author. Respondents supported the practice of many journals requiring authors to disclose their contributions, agreeing (69%) that it provides useful information for promotion and tenure committees; however, 43% were uncertain about how disclosed contributions were reflected in authorship order. Insights: Respondents strongly endorsed the importance of listing authors in order of decreasing contribution, although the meaning of second versus last author lacks consensus. This finding, together the other strategies that received strong endorsement and those that were not strongly endorsed, provides a starting point to develop guidance for medical educators about how to determine authorship order. Clear guidance for authors would promote fairness and accountability within the medical education community as well as provide more consistent interpretation for those who consider authorship order for career- and resource-related decisions.

Factors associated with scientific misconduct and questionable research practices in health professions education

INTRODUCTION

Engaging in scientific misconduct and questionable research practices (QRPs) is a noted problem across fields, including health professions education (HPE). To mitigate these practices, other disciplines have enacted strategies based on researcher characteristics and practice factors. Thus, to inform HPE, this study seeks to determine which researcher characteristics and practice factors, if any, might explain the frequency of irresponsible research practices.

METHOD

In 2017, a cross-sectional survey of HPE researchers was conducted. The survey included 66 items adapted from three published surveys: two published QRP surveys and a publication pressure scale. The outcome variable was a self-reported misconduct score, which is a weighted mean score for each respondent on all misconduct and QRP items. Statistical analysis included descriptive statistics, reliability and correlation analysis, and multiple linear regression modelling.

RESULTS AND DISCUSSION

In total, 590 researchers completed the survey. Results from the final regression model indicated that researcher age had a negative association with the misconduct score (b = -0.01, β = -0.22, t = -2.91, p <0.05), suggesting that older researchers tended to report less misconduct. On the other hand, those with more publications had higher misconduct scores (b = 0.001, β = 0.17, t = 3.27, p < 0.05) and, compared with researchers in the region of North America, researchers in Asia tended to have higher misconduct scores (b = 0.21, β = 0.12, t = 2.84, p < 0.01). In addition, compared with those who defined their work role as clinician, those who defined their role as researcher tended to have higher misconduct scores (b = 0.12, β = 0.13, t = 2.15, p < 0.05). Finally, publication pressure emerged as the strongest individual predictor of misconduct (b = 0.20, β = 0.34, t = 7.82, p < 0.01); the greater the publication pressure, the greater the reported misconduct. Overall, the explanatory variables accounted for 21% of the variance in the misconduct score, with publication pressure accounting for 10% of the variance in the outcome, above and beyond the other explanatory variables. Although correlational, these findings suggest several researcher characteristics and practice factors that could be targeted to address scientific misconduct and QRPs in HPE.

Progressive research collaborations and the limits of soft power

Collaboration in diverse teams is a central topic area in medical education, health research, and healthcare. As medical education researchers we implemented an internal grant policy to develop a progressive research partnership based on widely accepted guidelines for responsible conduct of research. Our intention was to proactively manage and guide group expectations around issues such as access to data and authorship. Our policy was based on 'soft power' principles, using the persuasiveness of ideas, relationships and inducements to encourage people to 'want what you want.' This article shares how we developed and implemented the policy, experienced first-hand the limits of soft power, and it explicates some of the lessons learned.

Assessment of Women Physicians Among Authors of Perspective-Type Articles Published in High-Impact Pediatric Journals

IMPORTANCE

Most pediatricians are women; however, women pediatricians are underrepresented in academic leadership positions such as department chairs and journal editors and among first authors of original research articles published in pediatric journals. Publication of all types of articles, particularly in high-impact specialty journals, is crucial to career building and academic success.

OBJECTIVE

To examine the gender-related profile associated with authors of perspective-type articles in the 4 highest-impact general pediatric journals to determine whether women physicians were similarly underrepresented.

DESIGN AND SETTING

Cross-sectional study of perspective-type articles published between 2013 and 2017 in the 4 highest-impact general pediatric journals: Academic Pediatrics, JAMA Pediatrics, The Journal of Pediatrics, and Pediatrics.

MAIN OUTCOMES AND MEASURES

The primary outcome measure was the number and percentage of first-author women physicians as compared with men physicians. Secondary outcome measures included number and percentage of all men and all women among last authors and coauthors associated with physician first authors.

RESULTS

A total of 425 perspective-type articles were identified, with physicians listed as the first author on 338 (79.5%). Women were underrepresented among physician first authors of known gender (140 of 336 [41.7%]), particularly among physician first authors of article categories described as scholarly (range, 15.4%-44.1%) vs categories described as narrative (range, 52.9%-65.6%) in nature. Women were also underrepresented among last authors and coauthors of articles attributed to both men and women physician first authors, although the underrepresentation of women among last authors and coauthors was more pronounced if a man physician was the first author.

CONCLUSIONS AND RELEVANCE

Because perspective-type articles provide an opportunity for authors to express their opinions, provide insights that may influence their field, and enhance their academic resumes, there is a need for pediatric journal editors and leaders of medical societies who are associated with these journals to ensure the equitable inclusion of women in medicine. A hallmark of best practices for diversity and inclusion in academic medicine is transparency with regard to reporting of gender disparities in all areas of scholarship attribution and credit.