Residency applications can place an immense amount of pressure on medical students in the United States. Preparing a competitive application that emphasizes academic excellence while highlighting extracurricular achievement can result in unethical methods of bolstering applications. In addition, the transition of the United States Medical Licensing (USMLE) Step 1 to the Pass/Fail format has also required students to search for alternative methods of standing out amongst peers.
A key component of Electronic Residency Application Service (ERAS) applications is an applicant’s research experiences, with categories including peer-reviewed publications, posters, abstracts, oral presentations and non-peer reviewed publications. Studies have shown that osteopathic and allopathic students who matched into residency programs have higher numbers of research experiences compared to those who went unmatched, and there was a strong correlation between research experiences and match success rate.
My initial encounter with the pressures of research began after completing my first year of medical school. While I was anticipating spending the summer in a respiratory research program to determine my interest in the field, I observed many peers fretting over their lack of research experiences planned for the summer. The stress of juggling multiple projects, some of which held little interest, seemed to overshadow their summer which should have been devoted to personal and professional development. In addition, I began to question if some of them would attempt to take shortcuts in their research.
To pursue increased success with the Match, medical students may practice many methods of misrepresentation, including misrepresenting both research success and data. This article focuses on this “gaming” of the system and searches for solutions to hold medical students accountable.
Misrepresentation of Research
Misrepresentation of research success can be defined in many ways. Misrepresentation can include incorrectly taking credit for papers, falsifying project responsibilities and overstating involvement in current/future research projects.
In a study done on the Canadian Resident Matching Service (CaRMS) for otolaryngology residency programs, research misrepresentation was found in 47 of the 385 verifiable publications (12% of publications). In this manuscript misrepresentation was defined as falsely claiming authorship, claiming authorship of a non-existent article and misrepresenting the order of authorship.
This trend was similar in the United States, with misrepresentation found in residency applications as well. In a review of applications to orthopedic residency programs from 1998 to 2017, 20% of applications had one misrepresentation of research (defined similarly as the study above), with trends showing lower rates of misrepresentation in recent years.
Students should be focused on engaging in high-quality research to better the field they are studying, rather than fixating on how their research will be represented in their residency application. One way this can be done is by having a relationship with physician mentors in their research fields. Mentors can help show students how their research is applied to their daily practice and the benefit provided to patients. In addition, research should be a tool to understand various medical specialties. Research can provide students the opportunity to explore fields of interest, understand novel pathologies or procedures and understand deficiencies in areas that they can advance in their future careers.
Medical students may be inclined to fabricate data or results to produce research that can be published or presented. Students have a limited timeline in their graduate education, and with other responsibilities such as academics, shadowing and community service, they may be more likely to take shortcuts in their research process. With medical students spearheading their own projects, they may have most, if not all, control over the project, granting them the opportunity to manipulate methods and results to fit their intentions. In addition, medical students may not be trained adequately in proper data acquiring techniques, and their inexperience can lead to inaccurate data production.
Medical students should not be the only ones to blame for unethical research practices. It is imperative that both medical schools and research institutions emphasize research ethics early in graduate education. Medical students should be required to attend in-person educational sessions on research ethics. In-person training courses have demonstrated attendee satisfaction in comprehending research ethics and can play a pivotal role in researcher development. While most institutions utilize online modules as a prerequisite for research participation, in-person seminars offer valuable opportunities for discussion, questions and meaningful engagement with attendees. In my personal experience, online modules have proven to be more burdensome than enriching learning opportunities, and are not an effective method of distributing information.
An additional measure would be to conduct a thorough review of data and methodologies of medical student driven projects and ensure that mentors uphold the integrity of their mentees’ work. Mentors and senior lab members should take the initiative to review student data, as they have the best understanding of the methodology of the study. This would require mentors to adopt a more active mentorship role, which can result in the unintended, positive outcome of medical student growth. In addition, editorial boards of journals can take a further step in the peer-review process by reviewing research methods and data to ensure validity.
Furthermore, reforming the residency match process can cultivate an ethical research culture in the medical student community. Programs should prioritize the quality of research experiences over the quantity of research accolades. Greater opportunities for explanation of the research experiences can display passion for students’ medical advancements. This approach can also be extended to the interview process, where interviewers can assess research success based on the enthusiasm with which applicants articulate their experiences and demonstrate how it shaped their medical experience and future aspirations as physicians.
The mounting pressure of residency applications on medical students has led to a concerning trend of unethical research practices. Recognizing that this is a critical issue is the first stride towards resolution. Institutions and medical schools should concentrate on fostering an ethical research culture to instill integrity in future physicians who will continue to propel the field of medicine.
Education on research integrity, transparency in the research process and robust mentorship can produce medical students who are passionate about their research without exclusively focusing on career advancement. It is the responsibility of educational institutions to hold medical students accountable and supply them with necessary resources to foster research integrity.