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: wadeprince@aol.com
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