Nationwide study of publication misrepresentation in applicants to residency

Characterization of Unpublished Manuscripts by Applicants to an Orthopedic Hand Surgery Fellowship

Purpose

Obtaining a hand surgery fellowship is becoming increasingly competitive, and research is an important factor when assessing applications. Given the competitive nature of the fellowship application process, applicants may feel the need to bolster their application by misrepresenting their research experience. One form of misrepresentation rarely discussed in prior studies is the listing of submitted works under a "Publications" heading in curricula vitae. This study examines the prevalence of misclassification of manuscripts by applicants to a hand surgery fellowship and identifies factors that might be associated with incorrect classification.

Methods

A retrospective review of 122 applicants to the 2020-2021 cycle for hand surgery fellowship was performed. Names and identifiable information were redacted prior to review. Demographic data collected included sex, United States Medical Licensing Examination Step 1 score, medical school rank, residency specialty, total publications, presence of submitted manuscripts in the "Publications" section, total number of submitted manuscripts, and total published abstracts and poster presentations.

Results

A total of 1,098 listed publications across the 122 applicants were reviewed with a median of five publications per applicant. Submitted manuscripts were listed as publications by 33 applicants (27%). No observable differences by age, United States Medical Licensing Examination Step 1 score, or total number of publications were seen. Misclassification rates were not associated with publication totals.

Conclusions

More than one-quarter of applicants incorrectly listed submitted or unaccepted manuscripts as publications. It is our hope that making fellowship applicants aware of this issue will decrease the rates of misrepresentation in future application cycles.

Clinical relevance

The competition for hand surgery fellowships has become more intense, and this may explain our finding that 27% of applicants misrepresent the status of research on hand surgery fellowship applications.

The race that never slows: Otolaryngology - Head and Neck Surgery residency applicant parameters over time

Background

There has been an increasing number of Canadian medical graduates who have gone unmatched in the residency selection process. Medical students have been engaging in extracurricular activities outside the formal curriculum which may help to distinguish themselves from their peers in the selection process. To understand how competitiveness in residency selection shapes applicant demographic characteristics and behaviours, this study set out to explore the demographic characteristics and prevalence of reported extra-curricular activities by applicants to Canadian Otolaryngology - Head & Neck Surgery (OTL-HNS) residency across time.

Methods

A retrospective, descriptive study reviewed specific sections of the curriculum vitae (CV) of applicants to OTL-HNS programs in Canada. These sections were self-reported, and included research productivity, involvement in volunteer and leadership activities, membership in associations, and honours or awards granted. Data was quantified and analyzed descriptively.

Results

Between 2013 to 2017, a total of 267 applicants reported a median of 12.6 research publications, 9.6 volunteer activities, six leadership activities, six association memberships and 9.8 honours/awards. Applicants were younger over time, with proportions of applicants over 30 years old decreasing from 56% in 2013 to 9% in 2017.

Conclusion

Applicants to Canadian OTL-HNS residency programs are reporting consistently high numbers of extracurricular activities and were of increasingly younger ages. Medical students are investing significant time and energy to pursue these activities which are above and beyond the formal curriculum, possibly contributing to decreased diversity in applicants for competitive residencies, increasing the likelihood of misrepresentation in residency applications, and likely contributing to medical student burnout.

Factors Associated with Early Career Research Productivity after Ophthalmology Residency

Background  Few studies have evaluated associations between ophthalmology trainee characteristics and performance with postgraduate research productivity. Purpose  This article evaluates factors associated with post-residency research productivity among U.S. ophthalmology graduates. Methods  Publicly available information of residents graduating between 2009 and 2014 from 30 randomly selected U.S. ophthalmology programs was collected from June to September 2020. Differences in publications between the 5 years post-residency and pre-residency/residency period were used as metrics of productivity. Residents with incomplete records were excluded. Results  A total of 758 of 768 residents, 306 females (40.4%) and 452 males (59.6%), met inclusion criteria. The mean (standard deviation [SD]) number of pre-residency publications was 1.7 (4.0), residency was 1.3 (2.2), and post-residency was 4.0 (7.3). Mean (SD) H-index was 4.2 (4.9). Top-ranked residency ( p  = 0.001), Alpha Omega Alpha (AOA) medical honor status ( p  = 0.002), U.S. medical school graduates ( p  < 0.001), and academic career ( p  < 0.001) were all associated with higher pre-/post-residency mean publication difference. Pursuing fellowship training also was associated with higher total publications ( p  < 0.001). Of all pre-residency degrees, PhD had the greatest odds of high postgraduate publications (defined as > 4). There was a positive correlation between both pre-residency/residency and post-residency publications (rho = 0.441; p  < 0.001) and between mean difference of pre-residency/post-residency publications for residents at a program and that program's Doximity rank (rho = 0.497; p  < 0.001). Multivariate logistic regression revealed, academic career choice (odds ratio [OR] = 3.38; p  < 0.001), Heed fellowship (OR = 3.12; p  = 0.031), > 2 residency publications (OR = 2.89; p  < 0.001), AOA status (OR = 2.0; p  = 0.004), and top-ranked residency programs (OR = 1.89; p  = 0.007), had greatest odds of > 4 postgraduation publications. Conclusion  Higher post-residency productivity was associated with multiple factors, with choice of an academic career, Heed fellowship, and residency productivity playing key roles.

Trends in Academic Misrepresentation in Neurological Surgery Residency Applicants: A 2-Year Analysis

OBJECTIVE

Academic misrepresentation is not an unknown phenomenon, with recent reports in neurosurgery detecting a 45% misrepresentation rate in prospective neurosurgical residents. The purpose of this study was to determine current rates of academic misrepresentation by prospective neurosurgical residents at a single institution across 2 distinct application cycles.

METHODS

We retrospectively reviewed all Electronic Residency Application Service applications to 1 institution's neurosurgical residency program in the 2015 (n = 320) and 2020 (n = 355) application cycles. Reported academic works were verified through an extensive Web search of PubMed, Google Scholar, and the individual journal Web sites. Misrepresentation was defined in our study as listing work that does not exist, self-promotion to primary authorship, self-promotion (excluding primary authorship), incorrectly listing online-only publications, and listing non-peer-reviewed work as peer-reviewed.

RESULTS

In 2015, 253 (79.1%) applicants reported a total of 2097 citations and 305 (85.9%) applicants reported a total of 3018 citations in 2020 (P < 0.05). Median peer-reviewed articles per applicant rose significantly in 2020 (3.0 vs. 4.0, P < 0.001). Misrepresentation rates decreased dramatically in 2020 to 18.4% from a previously reported misrepresentation rate of 45% in 2012 (P < 0.0001). Increased United States Medical Licensing Exam Step 2 scores were associated with a decreased likelihood of misrepresentation (odds ratio = 0.97, P < 0.001).

CONCLUSIONS

Misrepresentation rates within neurosurgical residency candidates have significantly decreased despite an increase in reported citations. A variety of steps including education, modifying reporting methods, and increased screening may help even further decrease misrepresentation.

Increasing the Number of Black Otolaryngologists

Otolaryngology continues to have one of the lowest percentages of black physicians of any surgical specialty, a number than has not improved in recent years. The history of exclusion of black students in medical education as well as ongoing bias affecting examination scores, clerkship grades and evaluations, and honors society acceptance of black students may factor into the disproportionately low number of black otolaryngology residents. In order to increase the number of black physicians in otolaryngology, intentional steps must be taken to actively recruit, mentor, and train black physicians specializing in otolaryngology.

Analysis of factors affecting Canadian medical students' success in the residency match

BACKGROUND

In North America, there is limited data to support deliberate application strategies for post-graduate residency training. There is significant interest in determining what factors play a role in Canadian medical graduate (CMG) matching to their first choice discipline and heightened concern about the number of students going unmatched altogether.

METHODS

We analyzed matching outcomes of CMGs based on seven years (2013-2019) of residency application data (n= 13,499) from the Canadian Residency Matching Service (CaRMS) database using descriptive and binary logistic regression modeling techniques.

RESULTS

The sample was 54% female, with 60% between the ages of 26 and 29, and 60% attended medical schools in Ontario. Applicants who received more rankings from residency programs were more likely (OR = 1.185, p < 0.001) to match. Higher research activities (OR = 0.985, p < 0.001) and number of applications submitted (OR = 0.920, p < 0.001) were associated with a reduced likelihood of matching. Number of volunteer activities and self-report publications did not significantly affect matching. Being male (OR = 0.799, p < 0.05) aged <25 (OR = 0.756, p < 0.05), and from Eastern (OR = 0.497, p < 0.01), or Western (OR = 0.450, p < 0.001) Canadian medical schools were predictors of remaining unmatched.

CONCLUSIONS

This study identified several significant associations of demographic and application factors that affected matching outcomes. The results will help to better inform medical student application strategies and highlight possible biases in the selection process.

Dishonesty and research misconduct within the medical profession

While there has been much discussion of how the scientific establishment’s culture can engender research misconduct and scientific irreproducibility, this has been discussed much less frequently with respect to the medical profession. Here the authors posit that a lack of self-criticism, an encouragement of novel scientific research generated by the recruitment policies of the UK Royal Training Colleges along with insufficient training in the sciences are core reasons as to why research misconduct and dishonesty prevail within the medical community. Furthermore, the UK General Medical Council’s own data demonstrates a historic inattentiveness to the ease with which doctors can engage in research misconduct. Suggestions are made as to how these issues can be investigated and alternative incentives for career advancement are adumbrated.

Low Misrepresentation Rates of Scholarly Work in Otolaryngology-Head and Neck Surgery Residency Applications

Objectives

To evaluate research trends, including rates of misrepresentation of scholarly work, in otolaryngology residency applications received by a single institution during the 2018-2019 residency application cycle.

Methods

After obtaining Institutional Review Board approval, all residency applications to the Department of Otolaryngology-Head and Neck Surgery at Indiana University School of Medicine, Indianapolis, IN for the 2018-2019 cycle were de-identified and analyzed. Demographic and research information including the number of listed peer-reviewed articles/abstracts, types of research projects, and misrepresentations were retrospectively evaluated.

Results

Our institution received 321 applications, which represented 69.5% of the entire 2018-2019 otolaryngology applicant pool. The average United States Medical Licensing Examination (USMLE) Step 1 score was 246 ±12.4. There were 203 (62.2%) applicants who reported 591 published citations with 20 (6.2%) applicants misrepresenting 26 items (4.4%). Applicants who misrepresented research output had lower average Step 1 scores (237.4 vs 246.4, p: <0.05). Self-promotion to higher authorship status was the most common form of misrepresentation (61.5%).

Conclusions

The role of scholarly work in stratifying applicants continues to expand. Although a competitive application climate motivates a minority of applicants to misrepresent scholarly work, rates of misrepresentation in otolaryngology applications are low and continue to decline. The level of evidence assigned to this study is III.

Update on Misrepresentation of Research Publications Among Orthopaedic Surgery Residency Applicants

BACKGROUND

Our 2 previous studies (1999, 2007) examining misrepresentation of research publications among orthopaedic residency applicants revealed rates of misrepresentation of 18.0% and 20.6%, respectively. As the residency selection process has become more competitive, the number of applicants who list publications has increased. The purpose of this study was to determine current rates of research misrepresentation by orthopaedic surgery applicants.

METHODS

We reviewed the publication listings and research section of the Common Application Form from the Electronic Residency Application Service (ERAS) for all applicants applying to 1 orthopaedic residency program. The PubMed-MEDLINE database was principally used to search for citations. The PubMed Identifier (PMID) number was used; if no PMID number was listed, a combination of authors or the title of the work was used. If the citations were not found through PubMed, a previously developed algorithm was followed to determine misrepresentation. Misrepresentation was defined as (1) nonauthorship of a published article in which authorship was claimed, (2) claimed authorship of a nonexistent article, or (3) self-promotion to a higher authorship status within a published article.

RESULTS

Five hundred and seventy-three applicants applied to our institution for residency in 2016 to 2017: 250 (43.6%) of 573 applicants did not list a publication, whereas 323 (56.4%) of 573 applicants listed ≥1 publication. We found 13 cases of misrepresentation among a total of 1,100 citations (1.18% in 2017 versus 18.0% in 1999 and 20.6% in 2007, p < 0.001). Ten cases of misrepresentation were self-promotion to a higher authorship status. There were 2 cases of claimed authorship of an article that could not be found. Only 1 applicant misrepresented more than once.

CONCLUSIONS

Based on our findings, orthopaedic surgery residency applicants are accurately representing their publication information. The incorporation of the PMID number on the ERAS application has streamlined the process for finding publications, and has possibly encouraged veracity on residency applications. Faculty involved in the resident selection process should be aware of the significant decline in the rate of misrepresentation by medical students applying for orthopaedic surgery residency versus the rate in our prior studies.

Pre-residency publication and its association with paediatric residency match outcome-a retrospective analysis of a national database

INTRODUCTION

Scholarly activity is considered valuable in the resident selection process by candidates and program directors alike, despite existing literature suggesting applicants with scholarly work do not perform better in the match. These studies, however, are limited in that they have only measured whether candidates have successfully matched or not. To try and reconcile the existing disconnect in the value of pre-residency scholarly activity, we sought to deepen the understanding by investigating whether pre-residency publication is associated with a higher rank-order list match achievement.

METHODS

Anonymized data were collected from the Canadian Residency Matching Service for individuals matched to paediatric programs from 2007-2012. The primary analysis was to identify whether documentation of ≥1 pre-residency publication was associated with achieving a first-choice match. Secondary analyses included evaluating for an association between multiple pre-residency publications, academic presentations or a graduate degree and match outcome.

RESULTS

Of a total of 843 matched individuals, 406 (48.2%) listed ≥1 pre-residency publication and 494 (58.6%) matched to their first-choice program. The possession of ≥1 pre-residency publications was not associated with matching to a candidate's first-choice program (odds ratio = 0.94 [95% confidence interval = 0.71-1.24], p = 0.66). Similarly, listing ≥2 publications, ≥3 publications, a graduate degree, or an academic presentation was not associated with achieving a first-choice match.

CONCLUSIONS

The results provide increased support for the notion that in aggregate, candidate scholarly activity does not influence match outcome. Accordingly, it is recommended that medical student research activities are fostered with the goal to improve their skills as scientists, and not simply to achieve a better residency match outcome.

The State of the Otolaryngology Match: A Review of Applicant Trends, "Impossible" Qualifications, and Implications

Objective This State of the Art Review aims (1) to define recent qualifications of otolaryngology resident applicants by focusing on United States Medical Licensing Examination (USMLE) scores, Alpha Omega Alpha (AOA) status, and research/publications and (2) to summarize the current literature regarding the relationship between these measures and performance in residency. Data Sources Electronic Residency Application Service, National Residency Matching Program, PubMed, Ovid, and GoogleScholar. Review Methods Electronic Residency Application Service and National Residency Matching Program data were analyzed to evaluate trends in applicant numbers and qualifications. Additionally, a literature search was performed with the aforementioned databases to identify relevant articles published in the past 5 years that examined USMLE Step 1 scores, AOA status, and research/publications. Conclusions Compared with other highly competitive fields over the past 3 years, the only specialty with decreasing applicant numbers is otolaryngology, with the rest remaining relatively stable or slightly increased. Additionally, USMLE Step 1 scores, AOA status, and research/publications do not reliably correlate with performance in residency. Implications for Practice The consistent decline in applications for otolaryngology residency is concerning and reflects a need for change in the current stereotype of the "ideal" otolaryngology applicant. This includes consideration of additional selection measures focusing on noncognitive and holistic qualities. Furthermore, otolaryngology faculty should counsel medical students that applying in otolaryngology is not "impossible" but rather a feasible and worthwhile endeavor.

Prevalence of Research Publication Misrepresentation Among Urology Residency Applicants and Its Effect on Match Success

OBJECTIVE

To report the prevalence of research misrepresentation among urology residency applicants and assess its effect on match success.

MATERIALS AND METHODS

All applications to the Columbia University urology residency program for the 2014-2015 match cycle were reviewed. "In-press," "accepted," and "submitted" manuscripts were verified using PubMed, Google Scholar, and journal websites. Misrepresentation for "in-press" and "accepted" manuscripts was defined as: (1) nonexistent manuscript, (2) nonauthorship of existent manuscript, (3) self-promotion to a higher author rank, and/or (4) existent manuscript in a nonpeer-reviewed publication. Logistic regression was performed to identify associated factors of misrepresentation and of match success.

RESULTS

Of 257 applicants, 204 (79.4%) reported 1098 total manuscripts and 142 (55.3%) reported 371 unpublished manuscripts. About 5% (13 of 257) of applicants misrepresented 1 or more publications: 10 listed nonexistent manuscripts, 1 listed a publication for which he/she was listed a lower author rank than reported, 1 listed an accepted manuscript in a nonpeer-reviewed publication and for which he/she was not listed as an author, and 1 listed 4 in-press manuscripts in a nonpeer-reviewed publication. Only 55.8% (139 of 249) of "submitted" manuscripts were published within 12 months, with 41% (51 of 139) published in a journal of a lower impact factor than the reported journal of submission. Higher number of unpublished manuscripts was associated with misrepresentation. Higher Step 1 score, number of away sub-internships, and publication ratio were associated with match success.

CONCLUSION

Research misrepresentation is a persistent issue in urology residency applications. However, misrepresentation in this cohort did not confer a significant advantage in match success.