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Confirmation of research publications reported by neurological surgery residency applicants
Ethics
Confirmation of Research Publications Reported by Neurological Surgery Residency Applicants Aaron A. Cohen-Gadol, M.D.,* Cody A. Koch, B.S., M.P.A.,† Corey Raffel, M.D., Ph.D.,* and Robert J. Spinner, M.D.* *Department of Neurologic Surgery and †Mayo Medical School, Mayo Clinic and Mayo Foundation, Rochester, Minnesota
Cohen-Gadol AA, Koch CA, Raffel C, Spinner RJ. Confirmation of research publications reported by neurological surgery residency applicants. Surg Neurol 2003;60:280 – 4. OBJECTIVE
Previous studies have reported that as many as 30% of resident and fellow applicants misrepresent their publication record on their residency and fellowship applications. To determine if neurologic surgery residency applicants were guilty of similar rates of misrepresentation, we reviewed the applications submitted to our institution in the year 2001–2002. METHODS
There were 102 applications submitted to our neurologic surgery residency program for the 2001–2002 academic year. All publications listed by applicants on the Central Application Service for Neurologic Surgery were verified using various online bibliographic databases including MEDLINE and an interlibrary search. Manuscripts listed as being “in press” were authenticated by contacting the journals’ editorial office while those listed as either “in preparation” or “submitted for publication” were excluded. RESULTS
Seventy-three (71.6%) candidates reported 212 published citations, including 129 (61%) journal articles, 13 (6%) book chapters, and 70 (33%) printed abstracts. Twelve of these applicants also listed 13 papers as being “in press.” Overall, among the entire applicant pool, there were nine examples of possible misrepresentation in six applicants (6%). One applicant provided inadequate information to verify a book chapter. Another candidate cited four journal articles with the authors’ names, even though his name was not listed among them. Two applicants included one citation each without listing any of the authors’ names. Verification of these citations revealed that neither of them was a coauthor, although one was acknowledged. Among the articles listed as “in press,” one was still under consider-
Address reprint requests to: Aaron A. Cohen-Gadol, M.D., Department of Neurologic Surgery, Joseph 1–229, Saint Mary’s Hospital, 1216 Second Street SW, Rochester, MN 55905. Received October 29, 2002; accepted April 17, 2003. 0090-3019/03/$–see front matter doi:10.1016/S0090-3019(03)00429-4
ation for publication, and one could not be verified because of the journal’s discontinuation. CONCLUSIONS
We confirmed that applicants who reported their names along with their published citations did so honestly and accurately. In our study, misrepresentation of published manuscripts among neurologic surgery residency applicants was rare when compared to candidates in other specialties. © 2003 Elsevier Inc. All rights reserved. KEY WORDS
Research, residency, applicants, neurologic surgery.
revious studies have reported alarming rates of misrepresentation of research citations noted by applicants for residency and fellowship training in a number of specialties, including emergency medicine [5]; radiology [1,8]; orthopaedic surgery [4,7]; pediatrics [2]; and gastroenterology [9]. Sekas and Hutson investigated the incidence of misrepresentation by applicants for fellowships in the Division of Gastroenterology and Hepatology at the University of Pittsburgh Medical Center [9]. Of the 53 applicants who reported published articles, 16 applicants (30.2%) had misrepresented their bibliography. Subsequent studies of applications for postgraduate training in emergency medicine and orthopaedics found misrepresentation rates of 20.4% and 18%, respectively [4,5]. The high prevalence of misrepresentation among these applicants is both surprising and disturbing. In an era of fierce competition for medical and surgical postgraduate training positions, the incentive for an applicant to exaggerate his/her credentials is obvious but nevertheless unacceptable. The recent reduction in the number of neurologic surgery residency positions makes the admission
P
© 2003 Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010 –1710
Confirmation of Research Publications
process more competitive, increasing the potential for the applicants to “embellish” or even misrepresent their credentials. The goal of this study is to determine if such misrepresentation is widespread among the applicants for residency training in neurologic surgery.
Materials and Methods The publications listed by the applicants to the Mayo Clinic on the Central Application Service for Neurologic Surgery for the 2001–2002 academic year were reviewed. The listed citations were verified using MEDLINE by checking the name of the first author, applicant, or coauthors in conjunction with the title of the article, journal, and volume number. If MEDLINE did not list the journal, multiple other databases, including BIOSIS (Biologic Abstracts, Inc.) and Science Citation Index, were consulted. Different spellings of the foreign names were attempted. Abstracts published electronically were verified using society and association Web sites. If the citation could not be found, the printed journal or meeting program was reviewed. Book chapter citations were confirmed by locating the book in the library. Articles listed “in press” were verified by directly contacting the journals’ editorial offices. Articles that were listed “in preparation” (52) and “submitted for publication” (35) were excluded from this study. Finally, both MEDLINE and BIOSIS were checked for potential publications of those candidates not listing citations on their application.
Results There were 102 completed applications submitted to our residency program, including those of 13 foreign medical graduates. Seventy-three (71.6%) applicants reported publications on their applications. There were 212 published citations as well as 13 listed as being “in press.” The number of published citations averaged 2.9 per applicant (range, 1–15). There were 129 (61%) journal articles, 13 (6%) book chapters, and 70 (33%) published abstracts. We were able to verify 211 of the 212 published citations and 12 of 13 “in press” manuscripts. Sixtynine of 73 (94.5%) applicants with published citations reported their citations accurately. Ten of the 12 applicants reported their “in press” citations correctly and truthfully. Overall, there were 9 examples of possible misrepresentation in 6 individuals (6%). These involved four applicants with 7 published citations and 2 applicants with 1 “in press” article each. One applicant cited 4 publica-
Surg Neurol 281 2003;60:280 – 4
tions with the authors’ names, even though he was not listed among them. Two other applicants each reported one citation without listing the authors’ names. Neither applicant was verified to be a coauthor, but one was listed in the acknowledgment section. One candidate provided inadequate information to verify the existence of a book chapter. Among the “in press” citations, one could not be corroborated as being submitted due to the discontinuation of the journal. Another citation was still in the process of review. These 6 applicants who possibly misrepresented their published citations listed on average 8 articles on their applications (range, 1–15). Four of the 6 applicants who inaccurately reported their manuscripts in this series matched in neurologic surgery residency in the United States. Of the 96 remaining candidates to our program, 77 successfully matched in neurologic surgery. Interestingly, our review found one applicant who did not report 2 of his published abstracts in his bibliography.
Discussion Research experience and authorship have been regarded as factors that improve an applicant’s candidacy. Fierce competition for the limited number of available residency positions encourages applicants to look for ways to distinguish themselves. Previous studies have reported that misrepresentation of publications among the candidates for postgraduate training has been used to embellish the candidates’ application. The hypothesized motivations for applicants to falsify their credentials included competitive advantage, minimal chance of being caught, the universal acceptance of this misconduct, or “innocent error” [9]. In some instances, applicants had misrepresented their entire bibliography [9]. In one study, the applicants with more reported citations also had an increased prevalence of misrepresented citations [5]. These reports have raised disturbing concerns about the reliability of applicants in reporting their credentials. In our study, we found nine examples of possible misrepresentation in 6 individuals. We defined a definite case of misrepresentation as a report of a nonexisting publication or false inclusion of one’s name as a coauthor in a verifiable journal citation. A citation was considered possibly misrepresented if the candidate reported an article in which he or she was not listed as an author, provided inadequate information to verify a manuscript, or inaccurately listed a manuscript as “in press.” Although
282 Surg Neurol 2003;60:280 – 4
these circumstances could be construed as misrepresentation, we believe that these applicants in our series improperly “overstated” their credentials. For example, one was acknowledged for work that he performed in a laboratory study. Another applicant listed 8 published articles from the same group of coauthors in his application even though he was only included in four. These applicants may have attempted to reflect their laboratory research experience, not realizing that this does not equal authorship. We believe these examples more likely show the inexperience of the applicants in the preparation of their bibliography rather than attempts at overt misrepresentation. Our misrepresentation rate was considerably lower than that of the other specialties [1,2,4,5,8,9] despite our nearly 100% retrieval rate. We acknowledge that the actual misrepresentation rate may be underestimated by excluding the 87 citations reported as “in preparation” or “submitted for publication.” Boyd reported that only 27% of the manuscripts in the category of “submitted for publication” and only 30% of the “in press” articles were eventually published in the 18 to 24 months after submission of the candidates’ applications [3]. Our successful retrieval rate was because of several factors. Even though MEDLINE listed most of the published articles, the majority of the abstracts could not be confirmed. We found consultation of additional databases including BIOSIS especially helpful. Association and society meetings’ programs including their web sites were carefully reviewed, accounting for our higher retrieval rate for the abstracts. Unlike other reports [1,2,4,5,9], we believe inability to locate a reference may reflect an inadequate search rather than definite misrepresentation of the citation. Therefore, when a citation could not be found, an experienced librarian was consulted to conduct a second comprehensive investigation. This revealed 2 cases where slightly different spellings of foreign applicants’ names revealed the actual publications. Our analysis of the other reports raised a number of questions about their methods used to authenticate the citations listed by applicants. In some studies, research citations were confirmed by mention of research in a letter of recommendation from mentors and collaborators or limiting the search to the Ulrich’s International Periodicals Directory [4,9]. These verification methods can be subjective and limited database searches estimate the rate of misrepresentation at the high end of probability [6]. Therefore, a judicial and thorough search to allow for an accurate verification of the publications
Cohen-Gadol et al
listed by applicants is necessary to avoid exaggeration of the rate of misrepresentation. The application process is difficult for both candidates and residency programs. Postgraduate training programs should use other credentials besides publications to evaluate applicants. We concur with other reports recommending that all applicants provide some proof of their credentials including a copy of their published articles, submission letter for manuscripts under consideration, or an acceptance letter for the “in press” citations. Misrepresentation may also be prevalent in letters of reference and academic awards. Their verification may be more difficult. The significance of professionalism must be emphasized in medical schools and postgraduate training programs. Residency programs should develop policies to deal with candidates who misrepresent their credentials. We are pleased to report that neurologic surgery continues to attract the most competitive candidates among medical school graduates who have interest in academic medicine. A higher percentage of applicants in neurologic surgery reported citations (71.6%) compared to other candidates in orthopedics (30%) [4], gastroenterology (58.5%) [9], dermatology (64%) [3], pediatrics (36.4%) [2], radiology (19.3%) [1], and emergency medicine (32.3%) [5]. Likewise, our series confirms the sincerity of our neurologic residency applicants in reporting their published research citations. While encouraging, it should be noted that our study only reviewed applications for the 2001–2002 academic year. Our results should not be generalized but confirmed by other residency programs through a similar review process. More extensive investigations, including reviewing applications over longer time spans, are needed to assess this growing problem in the medical community. The honesty demonstrated by neurologic surgery residency applicants in this study is a reflection of their collective integrity in representing their skills and competency to the public in their future profession.
Conclusion In our study, we found that the vast majority of applicants to neurologic surgery residency programs report their publications accurately. In fact, when an applicant provided a published citation with his name as an author, in all cases the citation could be verified. The rate of misrepresentation among the applicants to neurologic surgery residency was significantly lower than that of other specialties. Misrepresentation can constitute a se-
Confirmation of Research Publications
rious threat to the integrity of the residency selection process of which program directors should be aware. Guidelines regarding report of publications by residency applicants need to be developed to prevent this problem. The authors acknowledge the expert secretarial assistance of Mary Soper in preparation of this manuscript.
REFERENCES 1. Baker D, Jackson V. Misrepresentation of publications by radiology residency applicants. Acad Radiol 2000; 7:727–9. 2. Bilge A, Shugerman R, Robertson W. Misrepresentation of authorship by applicants to pediatrics training programs. Acad Med 1998;73:532–3. 3. Boyd A, Hook M, King L Jr. An evaluation of the accuracy of residency applicants’ curricula vitae: are the claims of publications erroneous? J Am Acad Dermatol 1996;35:606 –8. 4. Dale J, Schmitt C, Crosby L. Misrepresentation of research criteria by orthopaedic residency applicants. J Bone Joint Surg Am 1999;81:1679 –81. 5. Gurudevan S, Mower W. Misrepresentation of research publications among emergency medicine residency applicants. Ann Emerg Med 1996;27:327–30. 6. Kimball H. Credentials misrepresentation: another challenge to professionalism. Ann Intern Med 1995; 123:58 –9. 7. McAlister W, Velyvis J, Uhl R. Misrepresentation of research criteria by orthopaedic residency applicants. [letter]. J Bone Joint Surg Am 2000;82-A:1512–3. 8. Panicek D, Schwartz L, Dershaw D, Ercolani M, Castellino R. Misrepresentation of publications by applicants for radiology fellowships: is it a problem. AJR 1998;170:577–81. 9. Sekas G, Hutson W. Misrepresentation of acadmeic accomplishments by applicants for gastroenterology fellowships. Ann Intern Med 1995;123:38 –41.
COMMENTARY
It is interesting that out of 102 applicants to the Mayo Neurosurgical residency program, 71.6% cited 225 publications with just 9 cases of possible misrepresentation by 6 of the applicants. Compared to applicants to emergency medicine, radiology, orthopedic surgery, pediatrics, and gastroenterology, applicants for a neurosurgical residency are commendably honest in listing publications despite the fierce competition. As the authors point out, the apparent flattering profile for neurosurgical applicants may in part be a result of the diligence with which the authors tracked down references. If the reference was not in MEDLINE, other data bases such as BIOSIS were consulted, and in the case of “in press,” the journals were called. Of course, there is no tracking down
Surg Neurol 283 2003;60:280 – 4
articles listed as “submitted” or “in preparation,” many of which never see daylight. Russel H. Patterson, Jr., MD New York, New York This report is indeed timely given the current international scandal related to corporate malfeasance. I am sure that many of these multinational corporations had ethics initiatives and teaching programs as part of their corporate structure. I believe that fact underscores the inability to “teach” ethics. It further underscores the need to select for that trait. It is relatively easy to identify people who are intellectually capable of performing well in a neurosurgical residency. It is more difficult to select for those who will function honestly. I hope the authors’ conclusions relative to the high percentage of honesty among our candidates is true. It is quite possible that the authors’ compulsiveness in identifying all possible resources in corroborating citations may have realized a more reliable statistic in comparison to other reports in the literature. Steven L. Giannotta, M.D. Los Angeles, California
The embellishment of a curriculum vitae is more common than most of us would like to admit. Unfortunately, success in academics is often measured by publications. Hence, the temptation to embellish documentation that reflects career accomplishments comes as no surprise. The problem is not unique to medicine. Recently the discovery of a falsified curriculum vitae resulted in withdrawal of an offer to a football coach at the University of Notre Dame. “Publish or perish” is a common stimulus for faculty in most academic institutions. Most academicians recognize that expectation and the demands that go with it. Falsification of documents reflects dishonesty, a trait that is clearly undesirable in our profession. This article highlights the problem and will make our readers more alert to it. That neurosurgeons have fewer dishonest applicants than other specialties is a dubious distinction. Neurosurgery should have none! Julian T. Hoff, M.D. Ann Arbor, Michigan
We should not be surprised at the favorable showing of neurosurgical resident applicants. We should
Confirmation of Research Publications Reported by Neurological Surgery Residency Applicants Aaron A. Cohen-Gadol, M.D.,* Cody A. Koch, B.S., M.P.A.,† Corey Raffel, M.D., Ph.D.,* and Robert J. Spinner, M.D.* *Department of Neurologic Surgery and †Mayo Medical School, Mayo Clinic and Mayo Foundation, Rochester, Minnesota
Cohen-Gadol AA, Koch CA, Raffel C, Spinner RJ. Confirmation of research publications reported by neurological surgery residency applicants. Surg Neurol 2003;60:280 – 4. OBJECTIVE
Previous studies have reported that as many as 30% of resident and fellow applicants misrepresent their publication record on their residency and fellowship applications. To determine if neurologic surgery residency applicants were guilty of similar rates of misrepresentation, we reviewed the applications submitted to our institution in the year 2001–2002. METHODS
There were 102 applications submitted to our neurologic surgery residency program for the 2001–2002 academic year. All publications listed by applicants on the Central Application Service for Neurologic Surgery were verified using various online bibliographic databases including MEDLINE and an interlibrary search. Manuscripts listed as being “in press” were authenticated by contacting the journals’ editorial office while those listed as either “in preparation” or “submitted for publication” were excluded. RESULTS
Seventy-three (71.6%) candidates reported 212 published citations, including 129 (61%) journal articles, 13 (6%) book chapters, and 70 (33%) printed abstracts. Twelve of these applicants also listed 13 papers as being “in press.” Overall, among the entire applicant pool, there were nine examples of possible misrepresentation in six applicants (6%). One applicant provided inadequate information to verify a book chapter. Another candidate cited four journal articles with the authors’ names, even though his name was not listed among them. Two applicants included one citation each without listing any of the authors’ names. Verification of these citations revealed that neither of them was a coauthor, although one was acknowledged. Among the articles listed as “in press,” one was still under consider-
Address reprint requests to: Aaron A. Cohen-Gadol, M.D., Department of Neurologic Surgery, Joseph 1–229, Saint Mary’s Hospital, 1216 Second Street SW, Rochester, MN 55905. Received October 29, 2002; accepted April 17, 2003. 0090-3019/03/$–see front matter doi:10.1016/S0090-3019(03)00429-4
ation for publication, and one could not be verified because of the journal’s discontinuation. CONCLUSIONS
We confirmed that applicants who reported their names along with their published citations did so honestly and accurately. In our study, misrepresentation of published manuscripts among neurologic surgery residency applicants was rare when compared to candidates in other specialties. © 2003 Elsevier Inc. All rights reserved. KEY WORDS
Research, residency, applicants, neurologic surgery.
revious studies have reported alarming rates of misrepresentation of research citations noted by applicants for residency and fellowship training in a number of specialties, including emergency medicine [5]; radiology [1,8]; orthopaedic surgery [4,7]; pediatrics [2]; and gastroenterology [9]. Sekas and Hutson investigated the incidence of misrepresentation by applicants for fellowships in the Division of Gastroenterology and Hepatology at the University of Pittsburgh Medical Center [9]. Of the 53 applicants who reported published articles, 16 applicants (30.2%) had misrepresented their bibliography. Subsequent studies of applications for postgraduate training in emergency medicine and orthopaedics found misrepresentation rates of 20.4% and 18%, respectively [4,5]. The high prevalence of misrepresentation among these applicants is both surprising and disturbing. In an era of fierce competition for medical and surgical postgraduate training positions, the incentive for an applicant to exaggerate his/her credentials is obvious but nevertheless unacceptable. The recent reduction in the number of neurologic surgery residency positions makes the admission
P
© 2003 Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010 –1710
Confirmation of Research Publications
process more competitive, increasing the potential for the applicants to “embellish” or even misrepresent their credentials. The goal of this study is to determine if such misrepresentation is widespread among the applicants for residency training in neurologic surgery.
Materials and Methods The publications listed by the applicants to the Mayo Clinic on the Central Application Service for Neurologic Surgery for the 2001–2002 academic year were reviewed. The listed citations were verified using MEDLINE by checking the name of the first author, applicant, or coauthors in conjunction with the title of the article, journal, and volume number. If MEDLINE did not list the journal, multiple other databases, including BIOSIS (Biologic Abstracts, Inc.) and Science Citation Index, were consulted. Different spellings of the foreign names were attempted. Abstracts published electronically were verified using society and association Web sites. If the citation could not be found, the printed journal or meeting program was reviewed. Book chapter citations were confirmed by locating the book in the library. Articles listed “in press” were verified by directly contacting the journals’ editorial offices. Articles that were listed “in preparation” (52) and “submitted for publication” (35) were excluded from this study. Finally, both MEDLINE and BIOSIS were checked for potential publications of those candidates not listing citations on their application.
Results There were 102 completed applications submitted to our residency program, including those of 13 foreign medical graduates. Seventy-three (71.6%) applicants reported publications on their applications. There were 212 published citations as well as 13 listed as being “in press.” The number of published citations averaged 2.9 per applicant (range, 1–15). There were 129 (61%) journal articles, 13 (6%) book chapters, and 70 (33%) published abstracts. We were able to verify 211 of the 212 published citations and 12 of 13 “in press” manuscripts. Sixtynine of 73 (94.5%) applicants with published citations reported their citations accurately. Ten of the 12 applicants reported their “in press” citations correctly and truthfully. Overall, there were 9 examples of possible misrepresentation in 6 individuals (6%). These involved four applicants with 7 published citations and 2 applicants with 1 “in press” article each. One applicant cited 4 publica-
Surg Neurol 281 2003;60:280 – 4
tions with the authors’ names, even though he was not listed among them. Two other applicants each reported one citation without listing the authors’ names. Neither applicant was verified to be a coauthor, but one was listed in the acknowledgment section. One candidate provided inadequate information to verify the existence of a book chapter. Among the “in press” citations, one could not be corroborated as being submitted due to the discontinuation of the journal. Another citation was still in the process of review. These 6 applicants who possibly misrepresented their published citations listed on average 8 articles on their applications (range, 1–15). Four of the 6 applicants who inaccurately reported their manuscripts in this series matched in neurologic surgery residency in the United States. Of the 96 remaining candidates to our program, 77 successfully matched in neurologic surgery. Interestingly, our review found one applicant who did not report 2 of his published abstracts in his bibliography.
Discussion Research experience and authorship have been regarded as factors that improve an applicant’s candidacy. Fierce competition for the limited number of available residency positions encourages applicants to look for ways to distinguish themselves. Previous studies have reported that misrepresentation of publications among the candidates for postgraduate training has been used to embellish the candidates’ application. The hypothesized motivations for applicants to falsify their credentials included competitive advantage, minimal chance of being caught, the universal acceptance of this misconduct, or “innocent error” [9]. In some instances, applicants had misrepresented their entire bibliography [9]. In one study, the applicants with more reported citations also had an increased prevalence of misrepresented citations [5]. These reports have raised disturbing concerns about the reliability of applicants in reporting their credentials. In our study, we found nine examples of possible misrepresentation in 6 individuals. We defined a definite case of misrepresentation as a report of a nonexisting publication or false inclusion of one’s name as a coauthor in a verifiable journal citation. A citation was considered possibly misrepresented if the candidate reported an article in which he or she was not listed as an author, provided inadequate information to verify a manuscript, or inaccurately listed a manuscript as “in press.” Although
282 Surg Neurol 2003;60:280 – 4
these circumstances could be construed as misrepresentation, we believe that these applicants in our series improperly “overstated” their credentials. For example, one was acknowledged for work that he performed in a laboratory study. Another applicant listed 8 published articles from the same group of coauthors in his application even though he was only included in four. These applicants may have attempted to reflect their laboratory research experience, not realizing that this does not equal authorship. We believe these examples more likely show the inexperience of the applicants in the preparation of their bibliography rather than attempts at overt misrepresentation. Our misrepresentation rate was considerably lower than that of the other specialties [1,2,4,5,8,9] despite our nearly 100% retrieval rate. We acknowledge that the actual misrepresentation rate may be underestimated by excluding the 87 citations reported as “in preparation” or “submitted for publication.” Boyd reported that only 27% of the manuscripts in the category of “submitted for publication” and only 30% of the “in press” articles were eventually published in the 18 to 24 months after submission of the candidates’ applications [3]. Our successful retrieval rate was because of several factors. Even though MEDLINE listed most of the published articles, the majority of the abstracts could not be confirmed. We found consultation of additional databases including BIOSIS especially helpful. Association and society meetings’ programs including their web sites were carefully reviewed, accounting for our higher retrieval rate for the abstracts. Unlike other reports [1,2,4,5,9], we believe inability to locate a reference may reflect an inadequate search rather than definite misrepresentation of the citation. Therefore, when a citation could not be found, an experienced librarian was consulted to conduct a second comprehensive investigation. This revealed 2 cases where slightly different spellings of foreign applicants’ names revealed the actual publications. Our analysis of the other reports raised a number of questions about their methods used to authenticate the citations listed by applicants. In some studies, research citations were confirmed by mention of research in a letter of recommendation from mentors and collaborators or limiting the search to the Ulrich’s International Periodicals Directory [4,9]. These verification methods can be subjective and limited database searches estimate the rate of misrepresentation at the high end of probability [6]. Therefore, a judicial and thorough search to allow for an accurate verification of the publications
Cohen-Gadol et al
listed by applicants is necessary to avoid exaggeration of the rate of misrepresentation. The application process is difficult for both candidates and residency programs. Postgraduate training programs should use other credentials besides publications to evaluate applicants. We concur with other reports recommending that all applicants provide some proof of their credentials including a copy of their published articles, submission letter for manuscripts under consideration, or an acceptance letter for the “in press” citations. Misrepresentation may also be prevalent in letters of reference and academic awards. Their verification may be more difficult. The significance of professionalism must be emphasized in medical schools and postgraduate training programs. Residency programs should develop policies to deal with candidates who misrepresent their credentials. We are pleased to report that neurologic surgery continues to attract the most competitive candidates among medical school graduates who have interest in academic medicine. A higher percentage of applicants in neurologic surgery reported citations (71.6%) compared to other candidates in orthopedics (30%) [4], gastroenterology (58.5%) [9], dermatology (64%) [3], pediatrics (36.4%) [2], radiology (19.3%) [1], and emergency medicine (32.3%) [5]. Likewise, our series confirms the sincerity of our neurologic residency applicants in reporting their published research citations. While encouraging, it should be noted that our study only reviewed applications for the 2001–2002 academic year. Our results should not be generalized but confirmed by other residency programs through a similar review process. More extensive investigations, including reviewing applications over longer time spans, are needed to assess this growing problem in the medical community. The honesty demonstrated by neurologic surgery residency applicants in this study is a reflection of their collective integrity in representing their skills and competency to the public in their future profession.
Conclusion In our study, we found that the vast majority of applicants to neurologic surgery residency programs report their publications accurately. In fact, when an applicant provided a published citation with his name as an author, in all cases the citation could be verified. The rate of misrepresentation among the applicants to neurologic surgery residency was significantly lower than that of other specialties. Misrepresentation can constitute a se-
Confirmation of Research Publications
rious threat to the integrity of the residency selection process of which program directors should be aware. Guidelines regarding report of publications by residency applicants need to be developed to prevent this problem. The authors acknowledge the expert secretarial assistance of Mary Soper in preparation of this manuscript.
REFERENCES 1. Baker D, Jackson V. Misrepresentation of publications by radiology residency applicants. Acad Radiol 2000; 7:727–9. 2. Bilge A, Shugerman R, Robertson W. Misrepresentation of authorship by applicants to pediatrics training programs. Acad Med 1998;73:532–3. 3. Boyd A, Hook M, King L Jr. An evaluation of the accuracy of residency applicants’ curricula vitae: are the claims of publications erroneous? J Am Acad Dermatol 1996;35:606 –8. 4. Dale J, Schmitt C, Crosby L. Misrepresentation of research criteria by orthopaedic residency applicants. J Bone Joint Surg Am 1999;81:1679 –81. 5. Gurudevan S, Mower W. Misrepresentation of research publications among emergency medicine residency applicants. Ann Emerg Med 1996;27:327–30. 6. Kimball H. Credentials misrepresentation: another challenge to professionalism. Ann Intern Med 1995; 123:58 –9. 7. McAlister W, Velyvis J, Uhl R. Misrepresentation of research criteria by orthopaedic residency applicants. [letter]. J Bone Joint Surg Am 2000;82-A:1512–3. 8. Panicek D, Schwartz L, Dershaw D, Ercolani M, Castellino R. Misrepresentation of publications by applicants for radiology fellowships: is it a problem. AJR 1998;170:577–81. 9. Sekas G, Hutson W. Misrepresentation of acadmeic accomplishments by applicants for gastroenterology fellowships. Ann Intern Med 1995;123:38 –41.
COMMENTARY
It is interesting that out of 102 applicants to the Mayo Neurosurgical residency program, 71.6% cited 225 publications with just 9 cases of possible misrepresentation by 6 of the applicants. Compared to applicants to emergency medicine, radiology, orthopedic surgery, pediatrics, and gastroenterology, applicants for a neurosurgical residency are commendably honest in listing publications despite the fierce competition. As the authors point out, the apparent flattering profile for neurosurgical applicants may in part be a result of the diligence with which the authors tracked down references. If the reference was not in MEDLINE, other data bases such as BIOSIS were consulted, and in the case of “in press,” the journals were called. Of course, there is no tracking down
Surg Neurol 283 2003;60:280 – 4
articles listed as “submitted” or “in preparation,” many of which never see daylight. Russel H. Patterson, Jr., MD New York, New York This report is indeed timely given the current international scandal related to corporate malfeasance. I am sure that many of these multinational corporations had ethics initiatives and teaching programs as part of their corporate structure. I believe that fact underscores the inability to “teach” ethics. It further underscores the need to select for that trait. It is relatively easy to identify people who are intellectually capable of performing well in a neurosurgical residency. It is more difficult to select for those who will function honestly. I hope the authors’ conclusions relative to the high percentage of honesty among our candidates is true. It is quite possible that the authors’ compulsiveness in identifying all possible resources in corroborating citations may have realized a more reliable statistic in comparison to other reports in the literature. Steven L. Giannotta, M.D. Los Angeles, California
The embellishment of a curriculum vitae is more common than most of us would like to admit. Unfortunately, success in academics is often measured by publications. Hence, the temptation to embellish documentation that reflects career accomplishments comes as no surprise. The problem is not unique to medicine. Recently the discovery of a falsified curriculum vitae resulted in withdrawal of an offer to a football coach at the University of Notre Dame. “Publish or perish” is a common stimulus for faculty in most academic institutions. Most academicians recognize that expectation and the demands that go with it. Falsification of documents reflects dishonesty, a trait that is clearly undesirable in our profession. This article highlights the problem and will make our readers more alert to it. That neurosurgeons have fewer dishonest applicants than other specialties is a dubious distinction. Neurosurgery should have none! Julian T. Hoff, M.D. Ann Arbor, Michigan
We should not be surprised at the favorable showing of neurosurgical resident applicants. We should