Case Report Is Peer Reviewed on Eras ?

Misrepresentation of professional person achievements is a well-recognized miracle across a variety of professions. Scholarly works in medicine are especially vulnerable to this type of embellishment.^6,9,13 The prevalence of scholarly misrepresentation has been studied in applicants for residency and fellowship in several medical and surgical subspecialties,^{one–5,7,x–12,fourteen,15,eighteen–23} and published rates vary widely from 1.8% to xxx.ii%.^11,21 The most recent report in neurosurgery, by Cohen-Gadol et al.,⁴ demonstrated beneath-average rates of misrepresentation for neurosurgery applicants from 2001–2002 compared with other fields, leading to the conclusion that the bulk of applicants to residency programs in neurological surgery are honest in their reporting.

In recent years, we take noticed a dramatic increment in the number of publications reported by applicants to the neurosurgery residency program at our institution. Our initial assumption was that this was due to increasing competitiveness in the applicant pool leading to increased pressure level on applicants to have substantial publications before applying to a neurosurgery residency plan. Even so, we also thought information technology prudent to determine whether this same force per unit area led to quack embellishments of academic achievements as well. Furthermore, in an effort to streamline the application surveillance process, we sought to identify other awarding variables that may serve as "red flags" for further scrutiny of citations.

Methods

After obtaining exemption from our institutional review board, we retrospectively reviewed all 2006 SF Match (San Francisco Match) applications (n = 148) and 2012 ERAS (Electronic Residency Awarding Service) applications (n = 194) submitted by candidates for our neurosurgical residency program. Information nerveless included sex, scholarly piece of work, medical school, advanced degrees (MBA, MPH, JD, PhD, etc.), Alpha Omega Alpha (AOA) membership, and United States Medical Licensing Test (USMLE) Step 1 score. Usa News & Earth Report inquiry ranking for the year of awarding was recorded for US medical schools. Ninety-i schools were ranked in 2007 and 89 in 2013. Cited works were included if they were reported as published, accustomed, in press, or without a specific designation and listed in the "Peer Reviewed Journal Article/Abstracts," "Peer Reviewed Journal Article/Abstracts (other than published)," and "Peer Reviewed Online Publication" sections of the ERAS application.

Oral presentations, posters, chapters, and manufactures listed as submitted, provisionally accepted, non-peer reviewed, or other were excluded from analysis. The accuracy of all reported published piece of work was verified via online search of Google Scholar (scholar.google.com), PubMed (http://world wide web.ncbi.nlm.nih.gov/pubmed), and periodical websites. If a piece of work could not be verified via online search, the periodical was contacted directly via telephone and/or e-mail. Publications that were erroneously reported or were unverifiable through direct contact with the publication offices were considered misrepresentations. The definition of erroneous reporting included reporting work that did not exist, incorrectly list the applicant every bit first author, incorrectly list a work as peer reviewed, or listing an online-only publication in the "Peer Reviewed Periodical Article/Abstracts" section of the application rather than the "Peer Reviewed Online Publication" department. If a periodical could non be reached for verification, the work was excluded from the analysis. Retrieval rate was calculated every bit the total number of papers and abstracts in journals that could be reached for comment divided by the total number of reported publications. Pocket-sized inaccuracies in citations, such every bit incorrect page numbers, were non considered misrepresentation. De-identified information was entered into a Microsoft Excel spreadsheet.

The primary endpoints included misrepresentation of abstracts, misrepresentation of papers, and misrepresentation of the full number of published works (abstracts and papers combined). The covariates included in multivariate models were: sex, AOA member, avant-garde degree, USMLE Stride ane score, The states News & World Study research ranking, foreign medical schoolhouse graduate, and the total number of reported works (abstracts, papers, posters, books, etc.). Descriptive statistics for continuous and categorical variables were presented as median (with interquartile range [IQR]) and frequency (pct), respectively. Comparison of continuous baseline demographics between the ii awarding years was conducted using the Wilcoxon rank-sum test, and the Pearson chisquare examination was used to compare categorical variables between groups. Zero-inflated negative binomial regression was used to evaluate misrepresentation among applicants who reported published piece of work. All model assumptions were evaluated. All tests were two-tailed, and statistical significance was gear up a priori at 5%. Statistical analyses were performed using open source R statistical software (version 3.0.2).

Results

Demographic Characteristics

Vanderbilt University Medical Center received 148 applications for neurosurgical residency in 2006 and 194 in 2012. The overall demographic characteristics of the applicants were similar betwixt application years. Males accounted for 72% of candidates in 2006 and 66% in 2012 (p = 0.27). Similar percentages of applicants were members of AOA (13% vs 19%, p = 0.xv) and graduates of strange medical schools (20% vs 19%, p = 0.81) in the 2 application years. The median USMLE Step 1 score (230 vs 243, p < 0.001) and the percentage of applicants who had advanced degrees (19% vs 34%, p = 0.002) were significantly higher in 2012 (Tabular array 1).

Tabular array 1.

Demographic characteristics and publication record of applicants in 2006 and 2012

Variable	2006 (n = 148)	2012 (n = 194)	p Value
Sex, n (%)
Male	106 (72%)	128 (66%)	0.27^*
Female	42 (28%)	66 (34%)
USMLE Step 1 score, median (IQR)	230 (214–244)	243 (228–253)	<0.001^†
AOA membership, n (%)	xix (13%)	36 (xix%)	0.15^*
Other avant-garde degree, northward (%)	28 (19%)	66 (34%)	0.002^*
Foreign medical school graduate, northward (%)	29 (20%)	36 (19%)	0.81^*
Ranked U.s.a. medical school, due north (%)	90 (61%)	126 (65%)	0.43^*
Total no. of reported works^‡ per applicant, median (IQR)	2.5 (0.0–6.00)	9.00 (6.00–17.00)	<0.001^†
No. of applicants due west/ peer-reviewed publications (%)	69 (47%)	188 (97%)	<0.001^*
Abstracts	42 (28%)	97 (fifty%)	<0.001^*
Articles	61 (41%)	177 (91%)	<0.001^*
No. of peer-reviewed publications per applicant, median (IQR)	0.00 (0.00–2.00)	3.00 (one.00–6.00)	<0.001^†
Abstracts	0.00 (0.00–1.00)	0.50 (0.00–one.00)	<0.001^†
Articles	0.00 (0.00–one.20)	2.00 (1.00–5.00)	<0.001^†
Abstract & paper retrieval rate	231/242 (96%)	877/898 (98%)	0.104^*

Verified Publications

A total of 73 abstracts and 169 articles met inclusion criteria for 2006; these figures increased to 211 abstracts and 687 articles for 2012. In 2012, significantly more applicants reported published works (97% vs 47%, p < 0.001), and there was a statistically significant increase in the median number of published works per applicant (3 vs 0, p < 0. 001) (Table 1). The overall retrieval rate was like for the 2 years studied (96% in 2006 and 98% in 2012, p = 0.104).

Misrepresentation

In 2006, 23 (33%) of the 69 applicants who reported a published abstract or paper had at least 1 erroneous citation. This rate increased to 84 (45%) of 188 in 2012. In addition, more applicants had multiple inaccuracies in 2012 (Fig. i). The most common form of misrepresentation in 2012 was improperly list an online only publication in the section for peer-reviewed, published journals (n = 125) rather than the section for online publications. This was followed by articles and abstracts that did not be (n = 15 in 2006, northward = 57 in 2012) and abstracts that were presented at meetings only simply were erroneously listed as peer-reviewed publications (n = eighteen in 2006, north = 42 in 2012) (Fig. 2).

FIG. i.

Histogram illustrating the number of misrepresentations per applicant in 2006 and 2012.

FIG. 2.

Pie charts illustrating the relative prevalence of each type of misrepresentation in 2006 and 2012. DNE = does not exist (reporting work that does not exist); FAO = false writer social club (incorrectly listing the bidder equally first author); MAO = meeting abstract simply (abstract presented at meeting); NPR = not peer reviewed (incorrectly listing a work equally peer reviewed); OPO = online publication only (listing an online-only publication in the "Peer Reviewed Journal Article/Abstracts" section of the application rather than the "Peer Reviewed Online Publication" section). Effigy is bachelor in color online simply.

Multivariate, zilch-inflated negative binomial regression analysis of misrepresentation in 2012 revealed that for every unit increase in total reported works, the expected number of misrepresentations increased by 4% if all other variables in the model were held constant (p < 0.001). Additionally, a graduate of an unranked US medical school is expected to have 84% more misrepresentations compared with other applicants with otherwise similar credentials (p = 0.038). There was besides a trend for applicants who were AOA members (p = 0.079) to have fewer inaccuracies. There is no evidence that sex activity, advanced degrees, or USMLE Step 1 score were associated with the accuracy of citations (Table ii, Fig. 3).

FIG. 3.

Graphical depiction of the prevalence of misrepresentation according to number of total works and medical schoolhouse ranking. Adjusted to male applicant with avant-garde degree and 2 publications, USMLE Pace 1 score of 238, and AOA member. Unranked US grads = graduates of unranked US medical schools (non ranked past US News & World Written report). Figure is bachelor in color online merely.

TABLE 2.

Upshot of applicant characteristics on 2012 rates of misrepresentation

Variable	Exp (coefficient)^*	95% CI	p Value
USMLE Step 1 score	1.00	0.99–i.02	0.656
Total no. of reported works	1.04	one.03–1.06	<0.0001
AOA member	0.56	0.29–1.07	0.079
Advanced degree	0.99	0.60–1.61	0.953
Male person sexual activity	i.27	0.79–2.05	0.321
Unranked U.s.a. medical school	1.84	1.03–3.26	0.038

Discussion

Reports of publication misrepresentation among applicants for residency positions in surgical subspecialties, including neurosurgery, have traditionally reported a depression charge per unit of errors compared with other fields.^{ane,4,five,x,11,14,19,21–23} Disparate results abound in the literature on this topiclikely due to the thoroughness of search criteria, definition of misrepresentation, and variability between applicant populations.^xi,22 However, one must also consider that the landscape of the application process and puddle of applicants evolves over time. Our results indicate that the proportion of erroneous reporting has increased in the past 6 years. These changes could reflect a difficulty with the application or, more disturbingly, a decline in academic integrity. Regardless of the crusade, the issue of inaccurate citations needs to be addressed to ensure a fair and equal application process for all residency candidates. The information highlight ways in which the awarding process and ERAS may be improved to avoid unintentional errors also as provide insight into particular situations in which programs may consider performing boosted surveillance.

The major force of this study is the examination of multiple time points. Studies in various subspecialties have reported their current rates of misrepresentation. Even so, those are static analyses, and comparisons with historical data are hard due to the aforementioned variability in written report design. This written report evaluated the data from 2 time points, using identical search criteria and statistical analysis, assuasive for more accurate comparisons between recent data and historical norms. Although changes in the awarding process make straight statistical comparison difficult, this method provides balls that the differences seen are due to changes in the bidder pool or application procedure rather than beingness due to a change in methodology.

Some other two-time-point assay was performed by Konstantakos et al. in 1999 and 2005 and 2006.^v,14 These authors reported a 2% increase in erroneous reporting in applicants in orthopedic surgery from 18% to 20.6%. The pocket-size size of this increase compared with our finding could exist due to a number of factors. Start, information technology is possible that the substantial increase in erroneous reporting is a new phenomenon over the past vi years studied in our sample rather than the prior 8 years studied by Konstantakos et al. 2nd, our results are each from 2 single years at a single establishment, whereas the previous report compared data from 2 years at one institution to data from 1 yr at a different establishment.

An boosted distinction of our written report is that we separate published manufactures from abstracts. These are significantly different types of publications which require vastly dissimilar fourth dimension commitments, feel, and scientific rigor. They should be weighted accordingly when reviewing an application. Yet, the electric current organization of the ERAS awarding includes peer-reviewed articles and abstracts under the aforementioned heading with no fashion to quickly distinguish between the ii, which can be misleading to faculty members reviewing the awarding and disruptive to applicants seeking to accurately cite their piece of work.

Given the adequately high rate of misrepresentation demonstrated by our study and the contempo dramatic increase in erroneous reporting, we are anxious to decipher the motivation underlying this behavior. Previous authors^14,21 have described potential reasons for erroneous reporting. First there is a widespread belief that a greater number of academic works gives applicants an advantage in the awarding process.^sixteen Indeed, a contempo survey of Canadian neurosurgeons reported that 78% felt pressure level to publish and that the desire to obtain a proficient job was a significant research motive.⁸ Furthermore, all medical students at our institution who are interested in neurosurgery are urged to get involved in research projects both for their pedagogy and to increment their chances of matching at the programme of their choice. Since there keep to be more than applicants than residency positions in neurosurgery (314 applicants for 204 positions in the 2013 Match),¹⁷ the desire to artificially broaden publication records in order to exist viewed more favorably past potential programs may be a gene.

Furthermore, in that location may exist a perception amongst applicants that embellishing a curriculum vitae is common do, and they may therefore believe that they are at a distinct disadvantage if they do not do and so themselves. Additionally, some applicants may simply believe that the benefit of matching at the program of their choice outweighs the risk of a falsification being discovered. It has been suggested that relatively lucrative procedural subspecialties, such as neurosurgery, are more vulnerable to a subpopulation willing to take increased risk to achieve increased financial rewards.²¹ Finally, the misrepresentation of work might merely be a mistake.

Unfortunately, there is no way to discern which contributing factors are the most salient. Although we believe in giving applicants the do good of the doubt, 1 would not wait the frequency of unintentional oversights to increase substantially over time. Furthermore, it is difficult to imagine that well-educated applicants would make a large number of errors on a document critical to their future success; nor is the tendency to make mistakes on vital documents a trait of an ideal neurosurgery residency candidate. Therefore, we experience it is doubtful that clerical errors made a substantial contribution to these results.

The increase in misrepresentations could partially be explained past the modify in application format from SF Match to ERAS that occurred between 2007 and 2008. Whereas the SF Match applications required the applicants to independently ascertain their work, the 2012 ERAS application (like the current version available at https://www.aamc.org/students/download/424186/information/worksheet2016.pdf) provided 9 categories (peer reviewed journal manufactures/abstracts, peer reviewed articles/abstracts other than published, peer reviewed book chapter, scientific monograph, other articles, affiche presentation, oral presentation, peer reviewed online publication, and non-peer-reviewed online publication). The presumed intent of categories is to remove any ambiguity that may result from freehand cocky-report, a concern raised by previous authors on this subject.¹⁴ Notwithstanding, our review found far fewer cases of misleading reporting in the freehand applications.

It is believable that the existence of well-defined categories opens the door for unintended misclassification of works by applicants who may non be familiar with the terminology. Investigators who have questioned applicants regarding misrepresentations have found that some did not understand that their works were non peer reviewed.^one,15 Although this may exist truthful in select situations, the finding of more misrepresentations from applicants with large numbers of publications contradicts this theory. An applicant with a prolific publication record is presumably immersed in an academic environment and should accept an acceptable noesis of the terminology and access to mentors to avert such errors. An culling possibility is that multiple categories create ways for data to be misrepresented in a way that may not seem like a flagrant law-breaking. Listing a non-peer-reviewed article or online-simply publication under the peer-reviewed heading, although dishonest, may seem like a "white lie" that is unlikely to be caught.

There are several limitations to our report. It is retrospective and is therefore susceptible to bias. We narrowly defined misrepresentation to include confirmation through direct journal contact then as not to overestimate the results. Our exhaustive search deemed for misspellings and clerical errors. Even so, at that place is a possibility that a legitimate piece of work with a grossly inaccurate commendation was labeled a misrepresentation. Too, the pool of applicants and the awarding used differed between time points. While none of these factors are avoidable, they introduce boosted variability into our sample and foreclose an authentic directly statistical comparison between years. Finally, the results from a single institution may not exist generalizable; however, our sample included 61% of all neurological surgery applicants in 2012.¹⁷

To certify their awarding, all applicants must admit an honor statement which states: "I understand that any false or missing information may disqualify me from consideration for a position; may result in an investigation by the AAMC [Clan of American Medical Colleges] …. or if employed, may constitute cause for termination." Unfortunately, we take learned that the award organization previously applied in this realm is not sufficient. These results bespeak that the applicants with greater numbers of total reported works on their CV and those from unranked US medical schools were more probable to accept erroneous citations. Nevertheless, given the lack of specificity of these findings, it is advisable that programs employ increased vigilance when reviewing all applications.

This study highlights an alarming trend among young recruits to neurosurgery and leads to concerns that this may likewise exist a problem in their mentors at higher levels of the field. These results are an important reminder that maintaining impeccable research ethics is the responsibility of all medical leaders, and inquiry advisors must atomic number 82 by instance. We advocate improved education and supervision of medical students and so that they are not misinformed regarding the critical nature of accurate reporting or its consequences.

Conclusions

Misrepresentation of scholarly achievements is an increasing problem among neurosurgery residency applicants. We believe immediate widespread attending to this issue is necessary to prevent perpetuation of a belief that such behavior is adequate.

Author Contributions

Conception and blueprint: Kistka, Nayeri, Dow, Chambless. Acquisition of data: Nayeri, Dow. Assay and estimation of information: Kistka, Nayeri, Wang, Chandrasekhar, Chambless. Drafting the article: Kistka. Critically revising the article: Kistka, Nayeri, Dow, Chandrasekhar, Chambless. Reviewed submitted version of manuscript: all authors. Canonical the final version of the manuscript on behalf of all authors: Kistka. Statistical assay: Kistka, Nayeri, Wang, Chandrasekhar. Administrative/technical/material support: Dow, Chambless. Written report supervision: Chambless.

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Source: https://thejns.org/view/journals/j-neurosurg/124/1/article-p193.xml

Case Report Is Peer Reviewed on Eras ?

Methods

Results

Demographic Characteristics

Verified Publications

Misrepresentation

Discussion

Conclusions

Author Contributions

References

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