Fraud and misconduct in medical research

Risk-based centralized data monitoring of clinical trials at the time of COVID-19 pandemic

OBJECTIVES

COVID-19 pandemic caused several alarming challenges for clinical trials. On-site source data verification (SDV) in the multicenter clinical trial became difficult due to travel ban and social distancing. For multicenter clinical trials, centralized data monitoring is an efficient and cost-effective method of data monitoring. Centralized data monitoring reduces the risk of COVID-19 infections and provides additional capabilities compared to on-site monitoring. The key steps for on-site monitoring include identifying key risk factors and thresholds for the risk factors, developing a monitoring plan, following up the risk factors, and providing a management plan to mitigate the risk.

METHODS

For analysis purposes, we simulated data similar to our clinical trial data. We classified the data monitoring process into two groups, such as the Supervised analysis process, to follow each patient remotely by creating a dashboard and an Unsupervised analysis process to identify data discrepancy, data error, or data fraud. We conducted several risk-based statistical analysis techniques to avoid on-site source data verification to reduce time and cost, followed up with each patient remotely to maintain social distancing, and created a centralized data monitoring dashboard to ensure patient safety and maintain the data quality.

CONCLUSION

Data monitoring in clinical trials is a mandatory process. A risk-based centralized data review process is cost-effective and helpful to ignore on-site data monitoring at the time of the pandemic. We summarized how different statistical methods could be implemented and explained in SAS to identify various data error or fabrication issues in multicenter clinical trials.

Research jobs: how good is the training?

OBJECTIVES

To determine if a period in a research job improves confidence in research skills and to assess the quality of research training.

DESIGN AND SETTING

A questionnaire was designed and piloted to assess the content, structure and process of research training.

POPULATION/SAMPLE

All individuals who had passed MRCOG in the five years prior to 1999 and were residents of England or Wales.

METHODS

Confidence scores were compared between those with and those without research experience. The availability and value of differing strategies for research training were compared.

MAIN OUTCOME MEASURES

Confidence in research skills and attitudes to training.

RESULTS

Of the 532 usable questionnaires returned, 226 respondents had done or were doing research and these individuals had higher confidence on a variety of research skills than those with no experience of a formal research job. Confidence was patchy with less than 50% feeling confident at assessing bias in a case-controlled study, understanding the statistics used in a paper or assessing the power of a study. Of those who had done research, 50% or less felt their training had been good or excellent in any area. Self-directed learning and discussion with peers were felt to be the most useful strategies for research training. Short intensive courses were not available for many respondents, but were felt to be useful.

CONCLUSION

The high levels of dissatisfaction with the training in key skills required for research suggests that there is a need for a system for recognition of research posts. Reform of training in the research job should build on the current strength of encouraging self-directed learning.

Students' perceptions of whistle blowing: implications for self-regulation. A questionnaire and focus group survey

AIM

The aims of this study are to gauge and use the views of medical students to elaborate on the concept of whistle blowing and to give an indication of its role in self-regulation.

METHODS

An anonymous questionnaire survey was conducted among medical students from a Scottish medical school. Students were asked (i) whether they should, and (ii) whether they would report to faculty academic misconduct by other students. Comparisons were made between all five year groups. Subsequently students in focus groups were asked to give their reasons for whistle-blowing or not doing so.

RESULTS

Of the students, 40% felt they should whistle-blow, with 13% saying they would actually do so. The numbers of students who felt they should or would whistle blow were smaller in the later year groups. Focus groups identified positive and negative reasons for whistle blowing or not, and reasons connected to the process itself. Reasons given for not whistle blowing included camaraderie, retaliation by peers, self-preservation and a belief that it is not a student's responsibility to report the misconduct of others.

CONCLUSIONS

The results have two important implications. First, medical schools have to decide whether students have a duty to whistle blow and/or whether there is a need to devise clear procedures. Any procedures should take into account the reasons given for not whistle blowing, but should concentrate on positive motivating factors. Secondly the medical profession needs to consider the role of whistle blowing, as the results suggest that whistle blowing should not be the only method of detection of misconduct in an undergraduate setting.