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ORIGINAL ARTICLE
Year : 2022 | Volume
: 17
| Issue : 6 | Page : 357-362
Understanding the awareness of publication ethics among medical postgraduate trainees in India: A web-based survey
Keerthi Talari1, Mohit Goyal2
1 Department of Rheumatology, Yashoda Hospitals, Secunderabad, Telangana, India
2 Department of Medicine and Rheumatology Clinic, Ananta Institute of Medical Sciences, Rajsamand; CARE Pain and Arthritis Centre, Udaipur, Rajasthan, India
Correspondence Address:
Dr. Keerthi Talari
Department of Rheumatology, Yashoda Hospitals, Alexander Road, Secunderabad - 500 026, Telangana
India
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/0973-3698.364680
Background: Postgraduate training is often the first stage where a medical trainee is required to research and publish. With no or scant prior training and the pressure to publish, it is potentially a stage where ethical lapses and publishing misconducts are likely to occur. We conducted a web-based survey among medical postgraduate trainees in India to assess their awareness about publication ethics and identify the specific areas where they lacked awareness.
Methods: This was a cross-sectional, web-based survey conducted among medical postgraduate trainees in India. A Google form with multiple choice type questionnaire comprising 10 items related to publication ethics was prepared and disseminated after checking its face and content validity. The questionnaire included items to assess awareness about informed consent, plagiarism, authorship issues, conflict of interest, data handling, and predatory publications.
Results: A total of 205 responses were analyzed. While the respondents had better awareness about the informed consent, sample size and consequences of data fabrication (correct responses by 55%, 66%, and 77% of respondents, respectively), the responses to other questions (direct plagiarism, duplicate submission, authorship issues, reviewer's conflict of interest, conflict of interest, salami publication, and predatory journals) were varied and demonstrated a greater degree of ignorance. Majority of the respondents were unaware that a manuscript cannot be submitted to multiple journals at the same time.
Conclusion: This survey shows that postgraduate medical trainees lacked adequate awareness of publication ethics. Structured approaches involving curricular exposure, focused workshops, and special courses covering these aspects may result in better awareness regarding these issues.
Keywords: Duplicate publication, informed consent, plagiarism, predatory journals, scientific misconduct
Publishing research is a way to further science. Previously published research is the bedrock on which the hypotheses for further research are laid. Scientific and ethical integrity, hence, is of utmost importance in the processes of conducting research and reporting it. The International Committee of Medical Journals Editors (ICMJE), World Association of Medical Editors, and Committee on Publication Ethics (COPE) have put forth guidelines on reporting research to avoid scientific misconduct.[1],[2],[3] For advancing medical research and acquainting students and faculty with the processes of research and publication, the National Medical Council (NMC) of India has recommended that the postgraduate students publish as part of their training. Furthermore, it is mandatory for faculty to publish for progression in the medical academia. While this intention is good in principle, it has led to rampant publication misconducts on the face of “publish” or else “perish” culture.
Scientific misconduct frequently arises as a result of a lack of awareness and it can range from authorship disputes, conflicts of interest, copyright violation, data fabrication, plagiarism, duplicate publication, informed consent, ethics approval, salami publication, editorial misconduct, and predatory publishing. With no or scant prior training and the pressure to publish, post graduate medical training is potentially a stage where ethical lapses and publishing misconducts are likely to occur. However, the extent of awareness regarding these aspects has not yet been systematically studied in our country. Therefore, the primary objective of the present web-based survey among medical postgraduate trainees in India was to assess their awareness regarding publication ethics.
MethodsThis was a cross-sectional survey-based study conducted between August 25, 2022, and October 05, 2022, among medical postgraduate trainees. The study has been granted exemption from review by the Institutional Ethics Committee, Goyal Hospital, Udaipur, vide letter no. IEC-GH/2022/004.
A Google-form-based questionnaire was prepared and was subjected to a face validity appraisal among a group of 4 consultant level doctors who checked the usability and the technical functionality of the questionnaire and survey was accordingly modified. A recheck was made by the same group to confirm its technical functionality. The survey was then subjected to a pilot testing for content validity among 10 medical postgraduate trainees and was also retested in the same group a week later. Test–retest reliability for the pilot study was conducted using kappa statistic. The final version of the survey included section 1 with general information about the participants and section 2 with 10 items to assess their awareness of publication ethics [Table 1] and [Table 2]. The survey was anonymous (no identifying details were collected), voluntary and took about 5 minutes to complete.
This survey was disseminated using e-mails, short messaging service, and WhatsApp among postgraduate medical trainees directly or via faculty at medical colleges. To be included, it was mandatory for participants to answer the general information and all the 10 items. No incentives were provided to the participants. The survey was open to medical postgraduate trainees of all broad and subspecialties.
Results were analyzed as the proportion of respondents with the correct response. Analyses were performed using Stata for Windows (version 14.2, StataCorp Texas, USA). Median with standard deviations were reported for continuous variables such as age, and percentages for the response rates of postgraduate trainees for individual questions.
ResultsIn the pilot phase of the study, 10 postgraduate medical trainees participated. The level of agreement for various questions ranged from 90%–100%. Corresponding values of kappa statistic ranged from 0.750 to 1.0.
A total of 207 members responded to the survey. Two responses were excluded as they were not postgraduate medical trainees, leaving 205 respondents for analysis. The mean age of the participants was 28.13 ± 3.18 years with 107 (52.2%) males. There were 156 broad-specialty and 49 subspecialty trainees. Of these, 39 were from corporate hospitals, 39 were from government hospitals, 105 were from medical colleges, and 22 were from other private hospitals. Eighty-three (40.5%) were pursuing their course in Telangana, 55 (26.8%) in Rajasthan and the rest (32.7%) were from other states (Andhra Pradesh, Kerala, Madhya Pradesh, Maharashtra, Tamil Nadu, and Uttar Pradesh). Sixty-three out of 205 respondents had published articles in indexed, peer-reviewed journals (47 had published one article, 13 had published 2–5 articles, 2 had published 6 to 10 articles, and 1 had published more than 10 articles). The responses of the participants to individual questions are presented in [Table 2].
DiscussionOur survey has underscored a lack of awareness about ethical aspects and publication misconducts among medical postgraduate trainees. A lack of exposure to publication ethics in medical curriculum is a potential reason why most postgraduates are not aware of the “code of conduct” in research and publication process, and addressing these lacunae may help improve the situation. In a study conducted at four health profession colleges; an orientation program on publication ethics has shown significant post training improvement in postgraduates about their knowledge and attitude regarding publication ethics. The percentage of participants providing correct responses for different statements regarding publication ethics increased from 17.47% to 82.51% before attending the orientation session to 49.64%–93% after attending the session.[4]
The responses regarding different aspects of publication ethics were varied. Regarding informed consent process, while a majority of the trainees were aware that a written, informed consent is necessary for drug trials, many were unsure when audio and video consent is additionally required. The latter is required for vulnerable subjects participating in a study and for new molecular entity as per the Central Drugs Standard Control Organisation guidelines.[5] Majority of respondents understood that if the desired sample size is not achieved, it can be mentioned as a limitation rather than trying to fabricate or falsify data. Changing the thesis topic and then trying to complete it in a short-stipulated period is both unnecessary and difficult for postgraduate trainees. On the other hand, delaying the thesis submission for the same may make a postgraduate trainee ineligible for giving his/her final examination.[6] However, it was concerning to note that 8% of respondents believed that fabricating missing data is fine. The consequences of data fabrication as per COPE are outlined in question 7 of the survey.[7]
The question 3 of the survey is an example of verbatim plagiarism and would mean cancellation of a trainee's registration as per the University Grants Commission (UGC) guidelines.[8] It was surprising to note that less than half of the respondents in our survey knew the consequences of verbatim plagiarism and majority believed that they could get away with such a thesis by just acknowledging the senior's work or by changing a few phrases. Redundant or duplicate submission is a publication misconduct where simultaneous submission to two journals are done (either the same manuscript or by merely changing the author order or grammar of the manuscript). Most postgraduates thought that by seeking permission from one journal, submission can be made to another journal. During the submission of a manuscript, most journals would ask the author to verify that no simultaneous submissions have been made. However, presenting a paper at a conference does not preclude the option of submitting it to a journal.[9] Salami publication is unnecessarily making many “slices” of a single research and publishing it as multiple papers. When editors suspect a salami publication, the authors are asked for an explanation and if the authors' explanation is satisfactory, the editorial board may consider the manuscript for publication.[10] Less than half the respondents knew about the ethical issues of salami publications.
Authorship disputes are common especially when multiple members are involved in the care of the patient(s). Clinical care must not be confused with research and COPE lays clear-cut guidelines regarding authorship. In the present survey, in the scenario outlined in question 5, as the senior had neither contributed to the conceptualization nor to the writing or reviewing of the manuscript, he/she does not qualify for the authorship.[11] About a fifth of the respondents erroneously thought that such “gift authorship” is acceptable.
In the situation outlined in question 6 of the present survey, there is a conflict of interest with the reviewer and hence a bias is raised by the author. The author can only notify to the editor and the editor would consider the options and take action as appropriate. If a bias is proven, the reviewer is usually notified by the editor and appropriate action taken; if not found correct, the author is given a sufficient explanation. A legal action or reporting it as a misconduct will not be considered without editor's assessment, however, the author may request that the same reviewer may not be asked to review authors' submissions in the future.[12]
Question 10 of the present survey pertains to how would a predatory journal approach potential authors and the best solution to this would be to avoid getting into such a trap. COPE document on predatory publishing helps authors suspect and identify predatory journals.[13] Withdrawing the manuscript before publication was the best course of action in scenario presented to protect one's academic reputation. However, many predatory journals may not cooperate with the authors when such requests for withdrawal are made. Thus, being aware about such journals and avoiding submitting to them remains the best thing to do.
Our survey assessed awareness regarding publication ethics among medical postgraduate trainees. There are very few studies assessing the knowledge and awareness in this area and to the best of our knowledge, this is perhaps the first such nationwide survey in India. However, the present survey has certain limitations. One is that the respondents were not uniformly distributed across the different geographic regions of India. However, we believe that the results of the survey are fairly representative. Second, the survey does not account for and differentiate between respondents who might have or not attended any workshops or courses on ethical aspects of research.
ConclusionThe present survey has confirmed the notion that there is a lack of awareness about ethical aspects and misconducts related to academic publishing among postgraduate medical trainees. Inclusion in medical curriculum, adequate guidance from faculty during research writing and publication, regular (and mandatory) workshops for postgraduate trainees are some potential ways to address these lacunae. Training in conducting research, writing manuscripts and publication process through workshops may also result in better knowledge[14] and may transform into good research and credible manuscripts.
Author contributions
Both the authors were involved in the conceptualization of the study, conduct of the survey, analyzing the results, writing the manuscript, revising it and approved the final version.
Acknowledgments
The authors would like to acknowledge Dr. Vinod Ravindran, Dr. Sham Santhanam, and Dr. Durga Prasanna Misra for their inputs in planning this survey. They also thank the respondents and their colleagues who have helped us in disseminating the link to the survey.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
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