Medical students applying for anesthesiology residency positions through the Electronic Residency Application Service (ERAS) must include a short personal statement. These statements are generally 1-page essays in which applicants describe themselves and why they are applying. Plagiarism, the use of the work of another author without attribution, was detected in 5% of resident application personal statements submitted between 2005 and 2007.1 The authors of this study encouraged action to detect and discourage future plagiarism.
Plagiarism occurred occasionally in anesthesia journal articles until 2011, when editors began to use plagiarism detection software and reject submissions with uncredited unoriginal content. Authors were advised that plagiarism is misconduct that could and would be detected.2 Plagiarism detection freeware was listed in the same journal, in hopes that authors would screen submissions for plagiarism before submission.3
In a study of anesthesiology applicant personal statements, also published in 2011, we cautioned applicants that personal statements were likely to be screened in the future by plagiarism-detecting software.4 We advised applicants “to be original, avoid plagiarism, and never buy an essay.”4 This observation and advice article has been viewed and downloaded hundreds of times.
We performed the current study to detect the rate of plagiarism in personal statements by anesthesiology resident applicants for the 2014 match and to compare it with the pre-2011 rate.
The entire planned project was submitted to the IRB and deemed to be exempt from full review before the commencement of the study.
After the 2014 National Residency Match Program had concluded, all ERAS applicant files received by the Anesthesiology Residency Program at West Virginia University were opened and their personal statements extracted. Identifying information was removed from the statements, except for whether they came from students or graduates of US or non-US (“international”) medical schools. Both allopathic and osteopathic applicants were included without distinction in the US group. Personal statements were converted into a usable format for software scanning.
We used the Viper Plagiarism Scanner (http://www.scanmyessay.com) to detect unoriginal content in the personal statements. Viper Plagiarism Scanner software contains a database of >10 billion resources. Each personal statement was scanned by the software and the results captured and saved. Any quoted material in a personal statement was omitted before the scan to improve detection relevance. The scan results included word count, unique wording, unoriginal wording, and sources of the unoriginal content. Viper Plagiarism Scanner detects and reports as possible plagiarism strings of ≥8 consecutive words that exactly duplicate the words in an existing document. The software displayed a side-by-side comparison between the original document (personal statement) and the duplicated source text, with a hyperlink to the source. Each completed and displayed scan was viewed by a study author to exclude coincidental overlap in content with other documents. Coincidental overlap in content is commonly used wording and phrases (examples in Results).
Each of the 3 authors independently reviewed and judged for plagiarism the personal statements, based on the analysis provided by the software. Sections of duplicated text were judged as plagiarized, not plagiarized, or uncertain. Any paper judged as plagiarized by ≥2 of the authors was scored as containing plagiarized text. Percentage of unoriginal content was also calculated for the plagiarized essays, defined as the number of software-detected unoriginal words divided by the total number of words in the personal statement. This calculation was done after removal of quoted text.
We report the rates for personal statements with unoriginal content and those judged to be plagiarized. We tested the difference between plagiarism rates in the United States and international groups by calculating a 2-sample Z-score and using a P value <0.05 as a significant difference.
Of the 472 applicants to the program, 228 were US and 244 international applicants. Four applicants were omitted from the US section because of clerical error and 1 was omitted from the international section because of incomplete application and lack of a personal statement.
On initial screening, after quotes had been removed, 82 of 467 applicant personal statements (17.6%) contained software-detected unoriginal content. Thirty-eight of these came from the US group and 44 from the international group. Upon detailed review by the authors, 9 essays (4.0%) from the US group were judged to include plagiarized content. Thirty-three essays (13.6%) from the international group were judged to include plagiarized content. The international plagiarism percentage differed from the US percentage by 9.6%, a P value of 0.0003, with a 95% confidence interval of 4.37% to 14.75%.
In judging plagiarism, the 3 authors agreed unanimously on 33 of the 38 (87%) US essays and 36 of the 44 (82%) international essays. In the 5 disagreements reviewing US essays, 2 authors rated the essays plagiarized and 1 uncertain. In the 8 disagreements reviewing international essays, 4 were rated 2-1 plagiarized uncertain, 2 were rated 2-1 not plagiarized uncertain, 1 was rated 2-1 uncertain not plagiarized, and 1 was rated 1-1-1 plagiarized uncertain not plagiarized. This last 3-way split-judgment wording is shown in Table 1.
Two of the US statements (0.9%) and 17 of the international statements (7.0%) contained >10% plagiarized content. Unoriginal content ranged up to 58% of an applicant’s personal statement.
Examples of coincidental content removed include “… the patient had undergone a CT scan of the …,” “… to achieve the goals I have set for myself,” “… from the University of *location omitted* at *city omitted*….”
The most common source of plagiarized content was www.medfools.com/personal statements.
Plagiarism is the representation of another author’s work as one’s own. Plagiarism violates the common ethical principle of dealing honestly with others. Plagiarism is generally disliked, even abhorred, by the public. Journal editors consider plagiarism a form of academic misconduct, ranging from intellectual sloth to theft of scholarship, and unacceptable for publication.2 Unfortunately, plagiarism is rife today, with many examples from well-known authors, political leaders, and scientists, including anesthesiologists.5,6
The development of software to detect plagiarism, tied with large databases of published and unpublished works, led in 2011 to notices that plagiarism in anesthesiology journal submissions and residency personal statements would likely be detected. Noting that plagiarism continues to arise in multiple venues,a and that commercial sites continue to advertise their services of providing personal statements to applicants,b a new measurement of the extent of plagiarism in applicant personal statements was warranted.
We detected plagiarized content in 4% of the statements from graduates of US medical schools and 14% of the statements from graduates of international medical schools. The overall rate of 9% is on the same order of magnitude as that detected by Segal et al.1 in a study of personal statements submitted between 2005 and 2007 to 5 residency programs at Brigham and Women’s Hospital. Similar to the study by Segal et al.1, we relied on the personal review of software-identified non-original material to determine plagiarism.
There is no clear definition of how much copying of previously used wording constitutes plagiarism, making percentage overlap with existing sources difficult to use as a final determination. We relied on the individual review and majority judgment of the authors, all experienced in reading applicant personal statements. Sometimes the overlap of just a few words with source documents was judged plagiarism, whereas an overlap of 1 or 2 sentences was not. Overlaps of unusual words, unique experiences, misspellings, and mispunctuations from Internet-available personal statements were all judged plagiarism. As shown by the example in Table 1, experienced judges may sometimes view unoriginal wording differently.
Although the plagiarism rates we report are high, we may be underreporting its true incidence because the scanning software we used only identifies exact matches of ≥8 consecutive words. The software may miss plagiarism if the author uses synonyms or paraphrases the original content. In addition, paraphrasing may be a perfectly reasonable way of expressing common thoughts in one’s own words.
The software-detected unoriginal word strings in 18% of personal statements, even after quotes were removed from scanning. Table 2 presents 2 examples of plagiarism that were detected because just enough words were copied. In 1 an incorrect word, not highlighted by the plagiarism detection software, was copied, compliment instead of complement, making plagiarism more likely. This illustrates some of the difficulties in detecting plagiarism.
The most common source for plagiarized material that we detected was sample personal statements at www.MedFools.com. The site contains the warning, “Please do not copy or plagiarize residency personal statements in the Medfools Personal Statement Library …. If you get caught it’s game over for you.” The site advertises that it will review applicant essays for $50 to $85, paid in advance, and offers testimonials on its effectiveness. The name “Medfools” speaks for itself. Other Internet sites advertise personal statement services without warnings and will provide personal statements after the client answers some questions and pays a fee.
Information on the American Medical Association Web site advises applicants that the personal statement is important and allows applicants to make a personal case for their admission. Forty-one percent of program directors have found personal statements very or somewhat important in selecting candidates for interviews.7 Ninety percent of program directors rate proper use of English in personal statements a very or somewhat important feature of the essay.7 A review of personal statements by dermatology residency applicants showed that certain themes occur more commonly in those accepted.8 This information may motivate applicants to plagiarize statements of previous applicants who were accepted or to buy them from sites advertising high acceptance rates.
Neuman et al.9 found publication misrepresentation among anesthesiology residency applicants for 2010 fairly common, with 2.4% of the applications containing fraudulent publications, and another 0.9% other errors that could favorably affect the competitiveness of an applicant for a residency position. ERAS subsequently modified their process to allow easier confirmation of publications.
We separated all personal statements into 2 categories: those from graduates of US medical schools and those from graduates of international medical schools. The significantly higher rate of plagiarism among graduates of international medical schools deserves further study, for instance whether plagiarism is tied to ≥1 particular schools or countries. This analysis was not possible in our study.
The role of personal statements in residency applications in general deserves further review. The high plagiarism rates we detected raise many concerns. Previous commentaries on personal statement plagiarism have characterized it as disturbing, pollution, a failure of personal integrity, and a lack of professionalism.10,11 Several widely reported cases of extensive fraud and misconduct by anesthesiologists have tarnished the specialty in recent years. These include faked data in 21 studies by Scott Reuben,12 the withdrawal of 88 studies published by Joachim Boldt,13 and the withdrawal of 172 papers with fabricated results published over 19 years by Yoshitaka Fujii.14 These embarrassing incidences of academic misconduct require extra vigilance in excluding residency applicants who demonstrate a willingness to bend the rules of proper conduct.
We recommend clear instructions to applicants to avoid plagiarism. This obviously includes buying essays. We also recommend the screening by ERAS of all personal statements for unoriginal content. If plagiarism is detected, then the candidate’s institution should be notified. Our institution plans to screen the personal statements of applicants otherwise selected for an interview and void the application of anyone judged to have plagiarized. If neither ERAS nor residency programs take action to detect and thwart plagiarism, its rate will likely remain high.
a Wikipedia.org/wiki/List_of_plagiarism_incidents. Accessed February 25, 2015.
b See, for example, http://www.atriumlearning.com/residency-school-personal-statement.html. Accessed February 25, 2015.
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