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Sound moral principles are essential in the development of all physicians. Given how heavily each clinical encounter is laden with ethical implications, this is taught early in medical school. The medical student and resident physician must be able to make ethical and moral decisions on a consistent basis.
Speaking as a psychiatrist in training, there is an intimate relationship between psychiatry and moral questions.1 Issues such as determining an individual’s ability to make decisions about their medical care, hospitalizing patients against their will, and involuntarily administering medication are an almost-daily occurrence.2 Physicians, especially those who practice psychiatric medicine, must be ethically grounded to properly make these difficult but common decisions. It is also imperative that residents are given proper guidance in ethical practice in structured didactics and hands-on training.
However, many residents may be unfamiliar with ethics in research, more specifically ethical authorship. While some trainees might have participated in scholarly activities before residency, residency is the time to discover one’s interests, and residents are encouraged to engage in research. Unfortunately, many of the considerations surrounding ethical authorship are not emphasized, and questionable practices are common.3 In this article, I summarize the different faces of unethical authorship, and call for a greater emphasis on ethical authorship in medical residency training programs.
What drives unethical authorship practices
One of the main drivers for the increase in unethical practices is the need to publish to advance one’s academic career. The academic principle of “publish or perish” pressures many faculty researchers.3 The impact of this expectation plays a significant role in potentially unethical authorship practices, and also has increased the number of publications of mediocre quality or fraudulent data.4 This mindset has also seeped into the clinical world because promotions and financial bonuses are incentives for attending physicians to perform scholarly work. Due to these incentives and pressures, a senior academician might compel a junior researcher to include them as a coauthor on the junior researcher’s paper, even when the senior’s contributions to the paper might be limited.5
Most journals have specific criteria for authorship. The International Committee of Medical Journal Editors (ICMJE) has 4 core criteria for authorship: 1) substantial contributions to the conception or design of the work, or the acquisition, analysis, or interpretation of data for the work; 2) drafting the work or revising it critically for important intellectual content; 3) providing final approval of the version to be published, and 4) agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.5,6 One survey found that in certain journals, approximately 15% of authors met full ICMJE authorship criteria, while one-half claimed there were substantial contributions but did not state anything more specific.7
There are several types of authorship abuse.5 Gift authorship is when authorship is awarded to a friend either out of respect or in hopes that friend will return the favor (quid pro quo). Ghost authorship occurs when a third party commissions an author to write or help write a paper (eg, when a pharmaceutical company hires writers to produce a paper about a medication they manufacture) or when legitimate authors are denied recognition on a paper. Honorary authorship occurs when authorship is granted with the hope that the reputation of the honorary author will increase the chances of the paper getting published and possibly boost citations.
While these forms of authorship abuse occur with unsettling frequency, they might not be common among physician trainees who do not engage in full-time research.5 Resident authors might be more likely to experience coercive authorship.
Continue to: Coercive authorship is when...
Coercive authorship is when an individual in a superior position (such as an attending physician) forces their name onto a paper of a junior individual (such as a resident). Kwok8 called this “The White Bull effect,” based on Greek mythology in which Zeus transformed himself into a white bull to seduce Europa. The White Bull represents the predatory nature of the senior individual who exploits ambiguous institutional research regulations to their benefit.8 They stretch out the ICMJE criteria, only superficially satisfying them to justify authorship. In this scenario, the attending physician with promotional incentives notices the work of a resident and demands authorship, given their role as the “supervising” physician (akin to general supervision of a research group). This is not justification for authorship per the ICMJE or any major medical journal criteria. However, a resident with limited research experience may agree to include the attending as a coauthor for a variety of reasons, including fear of a poor performance evaluation or professionalism complaints, or just to maintain a positive working relationship.
Serious implications
While there are countless reasons to be concerned about this behavior, the central issue is the attending physician’s role to train and/or mentor the resident. As previously stated, a physician—especially one practicing psychiatric medicine—must be of morally sound mind. A resident being taught unethical behaviors by their attending physician has dangerous implications. Academic dishonesty does not occur in vacuum. It is likely that dishonest and unethical behavior in research matters can cross over into the clinical arena. One study found that individuals who exhibit dishonest academic behavior are more likely to violate workplace policies.9 Also, these behaviors lead to increased moral disengagement in all areas.10,11 Imagining a morally disengaged attending psychiatrist practicing medicine and training the next generation of psychiatrists is unsettling.
My hope is that residency programs discourage this detrimental conduct in their departments and support those trying to uphold integrity.
1. Scher S, Kozlowska K. Teaching ethics in psychiatry: time to reset. Harv Rev Psychiatry. 2020;28(5):328-333. doi:10.1097/HRP.0000000000000258
2. Allen NG, Khan JS, Alzahri MS, et al. Ethical issues in emergency psychiatry. Emerg Med Clin North Am. 2015;33(4):863-874. doi:10.1016/j.emc.2015.07.012
3. Pfleegor AG, Katz M, Bowers MT. Publish, perish, or salami slice? Authorship ethics in an emerging field. Journal of Business Ethics. 2019;156(1):189-208.
4. Rivera H. Fake peer review and inappropriate authorship are real evils. J Korean Med Sci. 2018;34(2):e6. doi:10.3346/jkms.2019.34.e6
5. Strange K. Authorship: why not just toss a coin? Am J Physiol Cell Physiol. 2008;295(3):C567-C575. doi:10.1152/ajpcell.00208.2008
6. Ali MJ. ICMJE criteria for authorship: why the criticisms are not justified? Graefes Arch Clin Exp Ophthalmol. 2021;259(2):289-290. doi:10.1007/s00417-020-04825-2
7. Malički M, Jerončić A, Marušić M, et al. Why do you think you should be the author on this manuscript? Analysis of open-ended responses of authors in a general medical journal. BMC Med Res Methodol. 2012;12:189. doi:10.1186/1471-2288-12-189
8. Kwok LS. The White Bull effect: abusive coauthorship and publication parasitism. J Med Ethics. 2005;31(9):554-556. doi:10.1136/jme.2004.010553
9. Harding TS, Carpenter DD, Finelli CJ, et al. Does academic dishonesty relate to unethical behavior in professional practice? An exploratory study. Sci Eng Ethics. 2004;10(2):311-324. doi:10.1007/s11948-004-0027-3
10. Shu LL, Gino F. Sweeping dishonesty under the rug: how unethical actions lead to forgetting of moral rules. J Pers Soc Psychol. 2012;102(6):1164-1177. doi:10.1037/a0028381
11. Shu LL, Gino F, Bazerman MH. Dishonest deed, clear conscience: when cheating leads to moral disengagement and motivated forgetting. Pers Soc Psychol Bull. 2011;37(3):330-349. doi:10.1177/0146167211398138
Sound moral principles are essential in the development of all physicians. Given how heavily each clinical encounter is laden with ethical implications, this is taught early in medical school. The medical student and resident physician must be able to make ethical and moral decisions on a consistent basis.
Speaking as a psychiatrist in training, there is an intimate relationship between psychiatry and moral questions.1 Issues such as determining an individual’s ability to make decisions about their medical care, hospitalizing patients against their will, and involuntarily administering medication are an almost-daily occurrence.2 Physicians, especially those who practice psychiatric medicine, must be ethically grounded to properly make these difficult but common decisions. It is also imperative that residents are given proper guidance in ethical practice in structured didactics and hands-on training.
However, many residents may be unfamiliar with ethics in research, more specifically ethical authorship. While some trainees might have participated in scholarly activities before residency, residency is the time to discover one’s interests, and residents are encouraged to engage in research. Unfortunately, many of the considerations surrounding ethical authorship are not emphasized, and questionable practices are common.3 In this article, I summarize the different faces of unethical authorship, and call for a greater emphasis on ethical authorship in medical residency training programs.
What drives unethical authorship practices
One of the main drivers for the increase in unethical practices is the need to publish to advance one’s academic career. The academic principle of “publish or perish” pressures many faculty researchers.3 The impact of this expectation plays a significant role in potentially unethical authorship practices, and also has increased the number of publications of mediocre quality or fraudulent data.4 This mindset has also seeped into the clinical world because promotions and financial bonuses are incentives for attending physicians to perform scholarly work. Due to these incentives and pressures, a senior academician might compel a junior researcher to include them as a coauthor on the junior researcher’s paper, even when the senior’s contributions to the paper might be limited.5
Most journals have specific criteria for authorship. The International Committee of Medical Journal Editors (ICMJE) has 4 core criteria for authorship: 1) substantial contributions to the conception or design of the work, or the acquisition, analysis, or interpretation of data for the work; 2) drafting the work or revising it critically for important intellectual content; 3) providing final approval of the version to be published, and 4) agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.5,6 One survey found that in certain journals, approximately 15% of authors met full ICMJE authorship criteria, while one-half claimed there were substantial contributions but did not state anything more specific.7
There are several types of authorship abuse.5 Gift authorship is when authorship is awarded to a friend either out of respect or in hopes that friend will return the favor (quid pro quo). Ghost authorship occurs when a third party commissions an author to write or help write a paper (eg, when a pharmaceutical company hires writers to produce a paper about a medication they manufacture) or when legitimate authors are denied recognition on a paper. Honorary authorship occurs when authorship is granted with the hope that the reputation of the honorary author will increase the chances of the paper getting published and possibly boost citations.
While these forms of authorship abuse occur with unsettling frequency, they might not be common among physician trainees who do not engage in full-time research.5 Resident authors might be more likely to experience coercive authorship.
Continue to: Coercive authorship is when...
Coercive authorship is when an individual in a superior position (such as an attending physician) forces their name onto a paper of a junior individual (such as a resident). Kwok8 called this “The White Bull effect,” based on Greek mythology in which Zeus transformed himself into a white bull to seduce Europa. The White Bull represents the predatory nature of the senior individual who exploits ambiguous institutional research regulations to their benefit.8 They stretch out the ICMJE criteria, only superficially satisfying them to justify authorship. In this scenario, the attending physician with promotional incentives notices the work of a resident and demands authorship, given their role as the “supervising” physician (akin to general supervision of a research group). This is not justification for authorship per the ICMJE or any major medical journal criteria. However, a resident with limited research experience may agree to include the attending as a coauthor for a variety of reasons, including fear of a poor performance evaluation or professionalism complaints, or just to maintain a positive working relationship.
Serious implications
While there are countless reasons to be concerned about this behavior, the central issue is the attending physician’s role to train and/or mentor the resident. As previously stated, a physician—especially one practicing psychiatric medicine—must be of morally sound mind. A resident being taught unethical behaviors by their attending physician has dangerous implications. Academic dishonesty does not occur in vacuum. It is likely that dishonest and unethical behavior in research matters can cross over into the clinical arena. One study found that individuals who exhibit dishonest academic behavior are more likely to violate workplace policies.9 Also, these behaviors lead to increased moral disengagement in all areas.10,11 Imagining a morally disengaged attending psychiatrist practicing medicine and training the next generation of psychiatrists is unsettling.
My hope is that residency programs discourage this detrimental conduct in their departments and support those trying to uphold integrity.
Sound moral principles are essential in the development of all physicians. Given how heavily each clinical encounter is laden with ethical implications, this is taught early in medical school. The medical student and resident physician must be able to make ethical and moral decisions on a consistent basis.
Speaking as a psychiatrist in training, there is an intimate relationship between psychiatry and moral questions.1 Issues such as determining an individual’s ability to make decisions about their medical care, hospitalizing patients against their will, and involuntarily administering medication are an almost-daily occurrence.2 Physicians, especially those who practice psychiatric medicine, must be ethically grounded to properly make these difficult but common decisions. It is also imperative that residents are given proper guidance in ethical practice in structured didactics and hands-on training.
However, many residents may be unfamiliar with ethics in research, more specifically ethical authorship. While some trainees might have participated in scholarly activities before residency, residency is the time to discover one’s interests, and residents are encouraged to engage in research. Unfortunately, many of the considerations surrounding ethical authorship are not emphasized, and questionable practices are common.3 In this article, I summarize the different faces of unethical authorship, and call for a greater emphasis on ethical authorship in medical residency training programs.
What drives unethical authorship practices
One of the main drivers for the increase in unethical practices is the need to publish to advance one’s academic career. The academic principle of “publish or perish” pressures many faculty researchers.3 The impact of this expectation plays a significant role in potentially unethical authorship practices, and also has increased the number of publications of mediocre quality or fraudulent data.4 This mindset has also seeped into the clinical world because promotions and financial bonuses are incentives for attending physicians to perform scholarly work. Due to these incentives and pressures, a senior academician might compel a junior researcher to include them as a coauthor on the junior researcher’s paper, even when the senior’s contributions to the paper might be limited.5
Most journals have specific criteria for authorship. The International Committee of Medical Journal Editors (ICMJE) has 4 core criteria for authorship: 1) substantial contributions to the conception or design of the work, or the acquisition, analysis, or interpretation of data for the work; 2) drafting the work or revising it critically for important intellectual content; 3) providing final approval of the version to be published, and 4) agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.5,6 One survey found that in certain journals, approximately 15% of authors met full ICMJE authorship criteria, while one-half claimed there were substantial contributions but did not state anything more specific.7
There are several types of authorship abuse.5 Gift authorship is when authorship is awarded to a friend either out of respect or in hopes that friend will return the favor (quid pro quo). Ghost authorship occurs when a third party commissions an author to write or help write a paper (eg, when a pharmaceutical company hires writers to produce a paper about a medication they manufacture) or when legitimate authors are denied recognition on a paper. Honorary authorship occurs when authorship is granted with the hope that the reputation of the honorary author will increase the chances of the paper getting published and possibly boost citations.
While these forms of authorship abuse occur with unsettling frequency, they might not be common among physician trainees who do not engage in full-time research.5 Resident authors might be more likely to experience coercive authorship.
Continue to: Coercive authorship is when...
Coercive authorship is when an individual in a superior position (such as an attending physician) forces their name onto a paper of a junior individual (such as a resident). Kwok8 called this “The White Bull effect,” based on Greek mythology in which Zeus transformed himself into a white bull to seduce Europa. The White Bull represents the predatory nature of the senior individual who exploits ambiguous institutional research regulations to their benefit.8 They stretch out the ICMJE criteria, only superficially satisfying them to justify authorship. In this scenario, the attending physician with promotional incentives notices the work of a resident and demands authorship, given their role as the “supervising” physician (akin to general supervision of a research group). This is not justification for authorship per the ICMJE or any major medical journal criteria. However, a resident with limited research experience may agree to include the attending as a coauthor for a variety of reasons, including fear of a poor performance evaluation or professionalism complaints, or just to maintain a positive working relationship.
Serious implications
While there are countless reasons to be concerned about this behavior, the central issue is the attending physician’s role to train and/or mentor the resident. As previously stated, a physician—especially one practicing psychiatric medicine—must be of morally sound mind. A resident being taught unethical behaviors by their attending physician has dangerous implications. Academic dishonesty does not occur in vacuum. It is likely that dishonest and unethical behavior in research matters can cross over into the clinical arena. One study found that individuals who exhibit dishonest academic behavior are more likely to violate workplace policies.9 Also, these behaviors lead to increased moral disengagement in all areas.10,11 Imagining a morally disengaged attending psychiatrist practicing medicine and training the next generation of psychiatrists is unsettling.
My hope is that residency programs discourage this detrimental conduct in their departments and support those trying to uphold integrity.
1. Scher S, Kozlowska K. Teaching ethics in psychiatry: time to reset. Harv Rev Psychiatry. 2020;28(5):328-333. doi:10.1097/HRP.0000000000000258
2. Allen NG, Khan JS, Alzahri MS, et al. Ethical issues in emergency psychiatry. Emerg Med Clin North Am. 2015;33(4):863-874. doi:10.1016/j.emc.2015.07.012
3. Pfleegor AG, Katz M, Bowers MT. Publish, perish, or salami slice? Authorship ethics in an emerging field. Journal of Business Ethics. 2019;156(1):189-208.
4. Rivera H. Fake peer review and inappropriate authorship are real evils. J Korean Med Sci. 2018;34(2):e6. doi:10.3346/jkms.2019.34.e6
5. Strange K. Authorship: why not just toss a coin? Am J Physiol Cell Physiol. 2008;295(3):C567-C575. doi:10.1152/ajpcell.00208.2008
6. Ali MJ. ICMJE criteria for authorship: why the criticisms are not justified? Graefes Arch Clin Exp Ophthalmol. 2021;259(2):289-290. doi:10.1007/s00417-020-04825-2
7. Malički M, Jerončić A, Marušić M, et al. Why do you think you should be the author on this manuscript? Analysis of open-ended responses of authors in a general medical journal. BMC Med Res Methodol. 2012;12:189. doi:10.1186/1471-2288-12-189
8. Kwok LS. The White Bull effect: abusive coauthorship and publication parasitism. J Med Ethics. 2005;31(9):554-556. doi:10.1136/jme.2004.010553
9. Harding TS, Carpenter DD, Finelli CJ, et al. Does academic dishonesty relate to unethical behavior in professional practice? An exploratory study. Sci Eng Ethics. 2004;10(2):311-324. doi:10.1007/s11948-004-0027-3
10. Shu LL, Gino F. Sweeping dishonesty under the rug: how unethical actions lead to forgetting of moral rules. J Pers Soc Psychol. 2012;102(6):1164-1177. doi:10.1037/a0028381
11. Shu LL, Gino F, Bazerman MH. Dishonest deed, clear conscience: when cheating leads to moral disengagement and motivated forgetting. Pers Soc Psychol Bull. 2011;37(3):330-349. doi:10.1177/0146167211398138
1. Scher S, Kozlowska K. Teaching ethics in psychiatry: time to reset. Harv Rev Psychiatry. 2020;28(5):328-333. doi:10.1097/HRP.0000000000000258
2. Allen NG, Khan JS, Alzahri MS, et al. Ethical issues in emergency psychiatry. Emerg Med Clin North Am. 2015;33(4):863-874. doi:10.1016/j.emc.2015.07.012
3. Pfleegor AG, Katz M, Bowers MT. Publish, perish, or salami slice? Authorship ethics in an emerging field. Journal of Business Ethics. 2019;156(1):189-208.
4. Rivera H. Fake peer review and inappropriate authorship are real evils. J Korean Med Sci. 2018;34(2):e6. doi:10.3346/jkms.2019.34.e6
5. Strange K. Authorship: why not just toss a coin? Am J Physiol Cell Physiol. 2008;295(3):C567-C575. doi:10.1152/ajpcell.00208.2008
6. Ali MJ. ICMJE criteria for authorship: why the criticisms are not justified? Graefes Arch Clin Exp Ophthalmol. 2021;259(2):289-290. doi:10.1007/s00417-020-04825-2
7. Malički M, Jerončić A, Marušić M, et al. Why do you think you should be the author on this manuscript? Analysis of open-ended responses of authors in a general medical journal. BMC Med Res Methodol. 2012;12:189. doi:10.1186/1471-2288-12-189
8. Kwok LS. The White Bull effect: abusive coauthorship and publication parasitism. J Med Ethics. 2005;31(9):554-556. doi:10.1136/jme.2004.010553
9. Harding TS, Carpenter DD, Finelli CJ, et al. Does academic dishonesty relate to unethical behavior in professional practice? An exploratory study. Sci Eng Ethics. 2004;10(2):311-324. doi:10.1007/s11948-004-0027-3
10. Shu LL, Gino F. Sweeping dishonesty under the rug: how unethical actions lead to forgetting of moral rules. J Pers Soc Psychol. 2012;102(6):1164-1177. doi:10.1037/a0028381
11. Shu LL, Gino F, Bazerman MH. Dishonest deed, clear conscience: when cheating leads to moral disengagement and motivated forgetting. Pers Soc Psychol Bull. 2011;37(3):330-349. doi:10.1177/0146167211398138
