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In Reply to Abu-Zaid and Alamri

Uijtdehaage, Sebastian, PhD; Mavis, Brian, PhD; Durning, Steven J., MD, PhD

doi: 10.1097/ACM.0000000000002530
Letters to the Editor
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Professor of medicine and associate director, Graduate Programs in Health Professions Education, Uniformed Services University, Bethesda, Maryland; Sebastian.uijtdehaage@usuhs.edu.

Professor, Office of Medical Education Research and Development, College of Human Medicine, Michigan State University, East Lansing, Michigan.

Professor of medicine and pathology and director, Graduate Programs in Health Professions Education, Uniformed Services University, Bethesda, Maryland.

Disclosures: None reported. The views expressed in this letter are those of the authors and do not necessarily reflect the official policy or position of the Uniformed Services University of the Health Sciences, the Department of Defense, or the U.S. Government.

We thank the authors for their comments on our article and for their appeal to promote authorship integrity. They suggest, among other things, that “strict … authorship criteria” be codified through institutional review board (IRB) applications. This would mean expanding the purview of IRBs to include authorship decisions, while they already struggle to fulfill their traditional roles.1 We encourage early, and perhaps uncomfortable, discussions among prospective authors that clarify expectations, commitments, and roles in the research endeavor, including roles associated with the dissemination of scholarship. However, determining authorship a priori (let alone the order of authors) may prove to be challenging. After all, most research projects span many months, if not years. When it is time to write a manuscript, the composition of a research team may have changed; some may have moved on and others may have joined during the analytic phase of the research. Hence, for better or worse, ethical authorship decisions boil down to the correct interpretation and a posteriori application of International Committee of Medical Journal Editors (ICMJE) criteria.

Despite the growing interest in research ethics, questionable authorship practices remain rampant. A recent study by our colleagues Artino, Driessen, and Maggio2 found that 61% of a large group of health professions researchers reported to have added someone as an author who did not qualify. Thus, we understand Abu-Zaid and Alamri’s appeal for strict enforcement of ICMJE criteria. We as a field, however, need to have a conversation about how we can operationalize those criteria in a manner that allows fair and appropriate attribution to those who contributed to the work. “Final approval of the draft” is a criterion that should be crystal clear. But how much “important intellectual content” needs to be contributed in order to qualify for authorship, and what exactly does “accountable for all aspects of the work” entail? Until we remove these “ethical shades of gray,”2 lead authors are likely to err on the side of being overinclusive, and consequently—and perhaps unintentionally—may perpetuate questionable authorship practices.

Sebastian Uijtdehaage, PhD

Professor of medicine and associate director, Graduate Programs in Health Professions Education, Uniformed Services University, Bethesda, Maryland; Sebastian.uijtdehaage@usuhs.edu.

Brian Mavis, PhD

Professor, Office of Medical Education Research and Development, College of Human Medicine, Michigan State University, East Lansing, Michigan.

Steven J. Durning, MD, PhD

Professor of medicine and pathology and director, Graduate Programs in Health Professions Education, Uniformed Services University, Bethesda, Maryland.

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References

1. Dyrbye LN, Thomas MR, Mechaber AJ, et al. Medical education research and IRB review: An analysis and comparison of the IRB review process at six institutions. Acad Med. 2007;82:654–660.
2. Artino AR, Driessen EW, Maggio LA. Ethical shades of gray: International frequency of scientific misconduct and questionable research practices in health professions education [published online ahead of print August 14, 2018]. Acad Med. doi:10.1097/ACM.0000000000002412
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