Lynn A. Crosby, M.D.; Department of Orthopaedic Surgery, Wright State University School of Medicine, 30 Apple Street, Suite L-200, Dayton, Ohio 45409-2939
Corresponding author: Wade P. McAlister, M.D., 397 State Street, Apartment 5B, Albany, New York 12210, E-mail address: email@example.com
To The Editor:
We read Misrepresentation of Research Criteria by Orthopaedic Residency Applicants (81-A: 1679-1681, Dec. 1999), by Dale et al., with great interest. Their findings were alarming. Therefore, we decided to evaluate the applications of the candidates who accepted an interview for our residency program for the current year. We were surprised to find results similar to those found by the authors.
Of the forty applicants who accepted an interview, thirteen (33 percent) listed citations in the Publications section of the Electronic Residency Application Service. The citations included book chapters and articles in peer-reviewed journals. These thirteen applicants listed a total of twenty-four published articles, four articles submitted for publication, and six published book chapters. We followed a verification process similar to that used by Dale et al. Book chapters and articles submitted for publication were omitted from review. A Medline search was undertaken for the remaining twenty-four citations, using the following keywords: name of first author, name of applicant, name of journal, and volume number. If no match was found, the journal was checked directly. If this last search was unsuccessful, we considered the citation to be misrepresented.
Five (21 percent) of the twenty-four journal article citations were considered misrepresentations, with three (8 percent) of the forty applicants responsible for all of the misrepresentations. In four cases, the article could not be located. In the fifth case, a poster abstract had been cited as an article. The three applicants have been contacted and asked to submit clarification of the misrepresentations. We await their responses.
Although we examined only a small number of applicants, the degree of misrepresentation was striking. We agree that an improved verification process for applicants needs to be instituted by residency and fellowship programs. To avoid confronting an applicant with a potential misrepresentation and to preserve the limited resources of the residency and fellowship programs, perhaps the burden of verification should rest with the applicant. We agree that such programs should require all cited publications to be included in an applicant's file.
If misrepresentations or inconsistencies are found, then whom should be notified? A consensus among residency and fellowship programs regarding this issue is necessary in order to convey the importance that we place on honesty and integrity in our profession.
Wade P. McAlister, M.D. John H. Velyvis, M.D. Richard L. Uhl, M.D.
Corresponding author: Wade P. McAlister, M.D. 397 State Street Apartment 5B Albany, New York 12210 E-mail address: firstname.lastname@example.org
L. A. Crosby replies:
I thank Drs. McAlister, Velyvis, and Uhl for their supportive letter regarding our findings. It is not surprising, however, that they came up with similar findings after evaluating the applicants to their program.
I fully agree with their comments regarding the need for an improved verification process for resident applications to orthopaedic training programs in this country. Requiring candidates to include copies of published articles with their applications should be an effective deterrent. It would be easy to dismiss this problem as one to be handled at the institutional level and to leave it up to individual programs to deal with applicants who are found to have misrepresented citations. However, I feel that this problem needs to be resolved at the leadership level of our specialty. I believe that the Academic Orthopaedic Society, the American Orthopaedic Association, the Residency Review Committee, the Board of Orthopaedic Surgery, and the Ethics Committee of the American Academy of Orthopaedic Surgeons all should be involved in this issue. Programs need guidance and a well thought-out solution that is uniformly followed in order to eliminate this fraudulent activity and to keep it from creeping into our specialty undetected.
Lynn A. Crosby, M.D.
Department of Orthopaedic Surgery Wright State University School of Medicine 30 Apple Street Suite L-200 Dayton, Ohio 45409-2939