Plagiarism evidence found in residency applications

With tens of thousands of medical school graduates from around the globe competing for residency positions in the United States, not all applicants are honest in how they present themselves.

Some graduates have been found to plagiarize or falsify information on their applications to boost their competitive advantage. Researchers at Brigham and Women's Hospital say there needs to be a nationwide effort to prevent plagiarism among residency applicants.

Applications should be screened to catch potential plagiarism as they are submitted to the Electronic Residency Application Service, said Scott Segal, MD, associate professor at Harvard Medical School and vice chair for education in the Dept. of Anesthesiology, Perioperative and Pain Medicine at Brigham and Women's Hospital in Boston. ERAS is the application service operated by the Assn. of American Medical Colleges.

The study's conclusion came after an analysis of applications to Brigham's five largest residency programs found evidence of plagiarism in 5.2% of 4,975 personal statement essays submitted during a 19-month period. The results were in the July 20 issue of Annals of Internal Medicine.

Dr. Segal, co-lead study author, said he was surprised at the findings.

"This was supposed to be something that happened only rarely," he said. "We found that one in 20 applicants had plagiarized, and we think our estimate is conservative."

Many residency programs have processes to check for plagiarism, including staff or computer programs that search the Internet and past submissions for matches, said Renee Overton, who is director of ERAS.

ERAS has debated screening applications for plagiarism and is expected to discuss the issue at a meeting in September.

"The general feeling is that programs already have tools in place to look at this issue, and the question is whether it's really appropriate or needed for ERAS to get involved in it now," Overton said.

Unprofessional behavior

Professional lapses in medical school or the early part of residency training have been linked to future disciplinary actions by state medical boards, Dr. Segal said.

"Professionalism is very, very important for physicians, and plagiarism and anything like this where inaccurate or copied information on any application is of great concern," said Henry Sondheimer, MD, AAMC senior director for student affairs and student programs.

ERAS started its Integrity Promotion Program about six years ago to investigate complaints of fraud and educate applicants about ethical behavior. The program investigates about six cases each year; about four or five are found to be fraudulent.

That's a small percentage compared with the number of applications annually, Overton said. In 2009, ERAS had 30,470 applications from applicants from U.S medical schools and 53,712 applications from graduates of medical schools outside the U.S. The National Resident Matching Program reported 2,555 residency positions that year.

Maxine A. Papadakis, MD, professor and associate dean for student affairs at the University of California, San Francisco, School of Medicine, said it's important to remember that the vast majority of applicants submit original content.

However, "plagiarism is a cardinal sin of academic life, representing both theft and dishonesty," according to an editorial published with the study that Papadakis co-authored with David Wofsy, MD, professor and associate dean for admissions at the UCSF School of Medicine.

The editorial questions whether personal statements remain a useful tool, or if programs should consider alternatives such as multiple mini-interviews. "If the integrity of the personal statement is increasingly polluted by Internet samples or hired consultants, perhaps the personal statement is ill-suited to this era and best left to history."

But Dr. Segal said the essays provide valuable insight beyond an applicant's test scores. He recommends steps such as varying essay subjects each year to reduce chances of plagiarism.

For the Annals study, researchers examined applications submitted between Sept. 1, 2005, and March 22, 2007, using software called Turnitin for Admissions. The program uses an algorithm to identify exact or close matches within strings of 40 characters.

The analysis found higher rates of evidence of plagiarism among IMGs, people who were fluent in a foreign language and those with research experience.

Although the study was confined to Brigham and Women's Hospital, the applicants spanned a range of backgrounds, ethnicities and specialties. "Although more common in international applicants, evidence of plagiarism was found among applicants to all specialties, from all medical school types, and among those with significant academic honors," the study said. "We believe that a concerted, nationwide effort to detect and deter plagiarism is warranted."