NEW YORK (Reuters Health) - Honesty and attention to detail are qualities expected of physicians, yet two studies looking at applications to training programs in obstetrics show that up to 30 out of every 100 applicants took credit for research publications that could not be found.
"Our hope is that these are honest mistakes and not willful attempts to mislead," said Dr. Michael Frumovitz, a professor at the University of Texas MD Anderson Cancer Center in Houston, and lead author of one of the studies.
In a field where precision is important, "even if it's an honest mistake it's very troubling," he said.
Earlier studies have found that other specialties within medicine suffer from the same problem.
Anywhere from one to 30 percent of applications to training programs in radiology, emergency medicine, orthopedics and others include references to published research that can't be located by reviewers.
Frumovitz and his colleagues and a separate group at the University of Washington, who published their reports in Obstetrics & Gynecology, wanted to find out if the same was true in their fields.
The team led by Frumovitz collected all 258 applications to a fellowship program at MD Anderson in gynecologic oncology from 2004 to 2008.
The applicants were doctors who had completed their medical school and residency training.
Of the 148 doctors who listed that they had published research findings, 44 included a reference to a publication that Frumovitz's group could not track down.
"We all believe that applicants have the best intention and are representing themselves truthfully. But (this result) falls right in line with others who have done similar work," said Frumovitz.
The University of Washington team, led by Dr. Anne-Marie Amies Oelschlager, looked through two years' worth of applications to a residency program in obstetrics and gynecology.
Residents are doctors who have finished medical school, and are continuing their required clinical training in a particular field.
Among the 937 applicants, 357 put down that they had at least one research study that was published or about to be published in a peer-reviewed outlet.
When Amies Oelschlager's group went to find those publications, 156 of the 1,000 publications listed turned up missing.
They looked online, in publication databases and even contacted the journal for verification.
Of the other publications that were confirmed, the researchers found inaccuracies there as well.
The biggest error was that 62 applicants had listed a publication as "peer-reviewed" when it wasn't.
Peer review involves submitting a study for scrutiny by other researchers before it gets published, and therefore implies a high degree of rigor.
Amies Oelschlager said her study could not tell whether these were honest mistakes or intentional misrepresentations.
"The best you can assume is that these applicants didn't look up what peer review meant or they don't understand it," she told Reuters Health. "None of that is flattering and you worry whether they really understand the tenets of authorship, research, what is peer review and what is not."
Residencies and fellowships are competitive, and research experience is looked upon favorably when applicants are being reviewed.
"Applicants might be deliberately padding their resumes to try and get a spot, and it's concerning. The whole thing about being a physician is that you are expected to be honest," Amies Oelschlager said.
Dr. Lee Learman, a professor of obstetrics and gynecology at Indiana University School of Medicine, said that it's not clear whether errors on applications relate to errors in medical practice, but it is of concern.
He said that medical students and residents should be aware that misrepresenting their work could have negative consequences on their careers.
"Even though we don't know how this predicts future infractions, most directors of residencies and fellowships don't want to take the risk," Learman told Reuters Health. "They might say, this person might misrepresent data about a patient or misrepresent a step they took during surgery."
Learman encouraged directors of residency and fellowship programs to check the accuracy of applications, and if they can't find the publications listed, to ask the person to produce a copy.
Frumovitz said one way to make sure publication lists are accurate is to require that applicants include a copy of the paper or an identification number that will make it easier to look up.
Amies Oelschlager and her colleagues suggested that medical schools should include training in authorship and peer review.
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