Laird Harrison

April 11, 2014

SAN FRANCISCO — Nearly half of applicants to neurosurgery residencies at Vanderbilt University in Nashville, Tennessee, misrepresent their record of publications, a new study shows.

"The academic productivity of our neurosurgery residency applicants has certainly increased in recent years," said Vanderbilt neurosurgeon Heather Kistka, MD.

"However, along with that, the number of misrepresented works and applicants with misrepresentation has increased, and it's higher than previously reported. Also, applicants from top-tier medical schools and those with greater numbers of reported works are actually more likely to have inaccurate citations."

Dr. Kistka presented the study here at the American Association of Neurological Surgeons (AANS) 82nd Annual Meeting.

Claiming Authorship

Vanderbilt neurosurgeons became interested in the problem when they noticed that more applicants were claiming authorship of publications. Because it would be difficult for the school to check the accuracy of all the claims, the investigators wanted to get an idea of the frequency of misrepresentations.

So they analyzed all 148 applications for neurosurgery residencies at the school from 2006, the most recent year for which they had complete records, and all 191 applications from 2012.

They tallied 4 types of misrepresentation:

  • Claiming authorship to an article that did not exist

  • Inaccurately claiming to be the first author of a publication

  • Listing the presentation of an abstract at a meeting as a peer-reviewed publication

  • Inaccurately describing a publication as peer-reviewed

To verify these claims, they looked at only those the applicants said were published, accepted for publication, or in press, under the assumption that these would be easiest to verify.

They searched for the publications using Google Scholar and PubMed. When they suspected misrepresentation, they sought verification from the journals cited.

They found that the average Step 1 score on the US Medical Licensing Examination among applicants had increased, along with the number of applicants possessing advanced degrees, such as doctorates and masters.

They also found that the total percentage of applicants claiming authorship of publications increased from 47% to 97% from 2006 to 2012.

And they found almost a 4-fold increase in the number of peer-reviewed works reported.

But they also found that the proportion of applications with misrepresentations increased from 34% to 45%, a change that was statistically significant (P = .021).

In a quarter of the misrepresentations, the applicants claimed authorship of works that did not exist.

The researchers also found that applicants with the most impressive applications — including graduation from the "top medical schools" and those with over 10 reported works — were most likely to misrepresent their publications.

"This was alarming and somewhat surprising," said Dr. Kistka. "At the outset we thought that applicants with less attractive applications would have been more likely to have a misrepresentation in an attempt to improve their chances of obtaining a residency slot."

"Why are these highly competitive applicants believing that they have to misrepresent their works?" she said. "Do they think that everyone else is doing it, so they are at a disadvantage if they don't do it? Or do they simply think that it's not a very big deal? These questions all definitely need to be answered."

To address the problem, the neurosurgery department at Vanderbilt is training its medical students in correct reporting of publications.

And it is now seeking to verify the accuracy of publications reported by applicants it reviews for residencies.

In official commentary on the study during the session, Donald O. Quest, MD, a professor of neurosurgery at Columbia University, in New York, said, "Publication misrepresentation is definitely unprofessional behavior. And a number of studies have shown that unprofessional behavior in medical school is associated with disciplinary action from state medical boards later on in the person's career."

He observed that dishonesty on the part of applicants would make the difficult job of choosing residents even more difficult. Very little about an application reveals anything about the applicant's ethics, he said.

He noted that application forms typically ask residents to certify the accuracy of their statements, under pain of expulsion.

Dr. Kistka and Dr. Quest have disclosed no relevant financial relationships.

American Association of Neurological Surgeons (AANS) 82nd Annual Meeting. Abstract 701. Presented April 8, 2014.

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