How honest are aspiring ophthalmologists?
It’s not a question many people would think to ask. But that didn’t stop Dr. Michael Wiggins, of the Jones Eye Institute at the University of Arkansas for Medical Sciences. He was curious about the veracity of applications sent to his institute by medical students who were interested in completing their ophthalmology residencies in Little Rock.
Amazingly, Wiggins isn’t the first person to wonder about this type of thing. The first published report on the credibility of physician applications was published in 1995. That landmark paper — in the Annals of Internal Medicine — focused on doctors applying to the University of Pittsburgh’s gastroenterology fellowship program, a highly competitive medical specialty. It revealed that 30.2% of doctors who said they had authored or co-authored studies in medical journals were involved in “misrepresentation” of some kind. Some of the applicants had listed “nonexistent articles in actual journals,” while others cited “articles in nonexistent journals,” among other offenses.
In the 15 years since, the study has been repeated at least 17 times for fields including radiation oncology, orthopedics, emergency medicine, pediatrics, radiology, psychiatry and neurosurgery. In one study, the misrepresentation rate was only 1.8%; in another it was 100%.
No one knows exactly why young doctors and med students would falsify their applications, but it’s easy to speculate. Wiggins offers several possible reasons, including “the desire to appear more competitive, the low likelihood of detection, the justification that everyone likely enhances his or her curriculum vitae, the competitiveness of the field, psychiatric problems and mistakes owing to carelessness or misunderstandings.”
Ophthalmology is a competitive field. In 2008, more than 230 people applied for just three residency spots at the University of Arkansas for Medical Sciences. Would those long odds give some applicants an incentive to lie?
Wiggins reviewed 821 applications sent to UAMS from 2000 to 2004. Of those, 201 included publications in peer-reviewed medical or scientific journals. Altogether, 15 applicants engaged in 16 instances of misrepresentation, which worked out to a misrepresentation rate of 8.1%. Eight of the cases involved students listing themselves too high on an article’s list of co-authors, and four involved omitting the names of other authors altogether. Among the remaining cases, two involved applicants who listed real articles that were written by others, and two involved articles that were simply made up.
Some of these misrepresentations could have been innocent mistakes, but Wiggins doesn’t think that’s likely. If applicants were just being lazy in typing up their CVs, then students would be just as likely to bump themselves down on the author list as to bump themselves up. But in each case in which an applicant’s name was listed out of order, he wrote, “every case was a promotion.” Alternatively, some applicants may have been listed as co-authors at some point but had their names removed later in the process. However, Wiggins wrote, “It is difficult to imagine that a first author could have unknowingly been eliminated and then looked up the citation to record it on the residency application without noticing the absence of his or her name.”
Among the 15 transgressors, five were graduates of U.S. medical schools and 10 had studied abroad. Foreign medical grads are typically at a competitive disadvantage, and this may explain why they were more than twice as likely to be caught with an error on their applications, Wiggins said.
At 8.1%, Wiggins concluded that the misrepresentation rate he found was fairly low. “Although no level of publication misrepresentation is desirable,” he wrote, the rate for aspiring ophthalmologists is “the lowest reported among all previous studies except for internal medicine and dermatology.”
The results are published in Tuesday’s edition of Archives of Ophthalmology.