Research integrity and academic medicine: the pressure to publish and research misconduct.

CONTEXT: This narrative review article explores research integrity and the implications of scholarly work in medical education. The paper describes how the current landscape of medical education emphasizes research and scholarly activity for medical students, resident physicians, and faculty physician educators. There is a gap in the existing literature that fully explores research integrity, the challenges surrounding the significant pressure to perform scholarly activity, and the potential for ethical lapses by those involved in medical education. OBJECTIVES: The objectives of this review article are to provide a background on authorship and publication safeguards, outline common types of research misconduct, describe the implications of publication in medical education, discuss the consequences of ethical breaches, and outline possible solutions to promote research integrity in academic medicine. METHODS: To complete this narrative review, the authors explored the current literature utilizing multiple databases beginning in June of 2021, and they completed the literature review in January of 2023. To capture the wide scope of the review, numerous searches were performed. A number of Medical Subject Headings (MeSH) terms were utilized to identify relevant articles. The MeSH terms included "scientific misconduct," "research misconduct," "authorship," "plagiarism," "biomedical research/ethics," "faculty, medical," "fellowships and scholarships," and "internship and residency." Additional references were accessed to include medical school and residency accreditation standards, residency match statistics, regulatory guidelines, and standard definitions. RESULTS: Within the realm of academic medicine, research misconduct and misrepresentation continue to occur without clear solutions. There is a wide range of severity in breaches of research integrity, ranging from minor infractions to fraud. Throughout the medical education system in the United States, there is pressure to publish research and scholarly work. Higher rates of publications are associated with a successful residency match for students and academic promotion for faculty physicians. For those who participate in research misconduct, there is a multitude of potential adverse consequences. Potential solutions to ensure research integrity exist but are not without barriers to implementation. CONCLUSIONS: Pressure in the world of academic medicine to publish contributes to the potential for research misconduct and authorship misrepresentation. Lapses in research integrity can result in a wide range of potentially adverse consequences for the offender, their institution, the scientific community, and the public. If adopted, universal research integrity policies and procedures could make major strides in eliminating research misconduct in the realm of academic medicine.

Authentic Pathology Specimen Reception: A Valuable Resource for Developing Biomedical Science Student Competencies and Employability.

Background/Introduction: The pathology specimen reception is fundamental to the services provided by Biomedical Science laboratories worldwide. To ensure patient safety and that samples are of adequate quality to send for analysis, prospective Biomedical Scientists should have a robust knowledge of the processes involved and the acceptance criteria of the pathology specimen reception. This knowledge has been highlighted by employers as a current gap in Biomedical Science graduates and therefore needs to be addressed within higher education settings. To do this, this study aimed to 1) design a practical session to simulate the key processes of the pathology specimen reception and 2) to understand Biomedical Science students' opinions on these activities and the development of transferable skills required for post-graduate employment. Methods: The practical session was designed based on industrial requirements and academic knowledge of student skill sets to ensure suitability. Qualitative information regarding participant demographics and career interests was acquired through open-answer or multiple-choice questions. Quantitative student feedback was acquired via questionnaires utilising a 5-point Likert scale (n = 77). Results: The scenario-based practical session provided students with a positive learning experience with 98.7% of participants enjoying the session, with 87.0% stating they learned a lot by completing the session. It was also identified that participants preferred this style of learning to that of conventional higher education teaching modalities with 97.4% stating they would prefer simulated employment focussed scenarios embedded into the curriculum more often. The majority of participants also thought this session was helpful for the development of their key transferrable skills including teamworking, communication, and confidence. When stratified based on demographic data, there was minimal difference between cohorts and in the majority of cases, those participants from non-traditional university entry backgrounds had a more positive experience and better transferable skill development following the completion of this style of learning experience. Conclusion: This study highlights simulation-based learning as a tool to develop core Biomedical Science knowledge, build student graduate capital, and ensure the preparedness of students for post-graduation employment.

Determining intra-standard-setter inconsistency in the Angoff method using the three-parameter item response theory.

Objectives: To measure intra-standard-setter variability and assess the variations between the pass marks obtained from Angoff ratings, guided by the latent trait theory as the theoretical model. Methods: A non-experimental cross-sectional study was conducted to achieve the purpose of the study. Two knowledge-based tests were administered to 358 final-year medical students (223 females and 135 males) as part of their normal summative programme of assessments. The results of judgmental standard-setting using the Angoff method, which is widely used in medical schools, were used to determine intra-standard-setter inconsistency using the three-parameter item response theory (IRT). Permission for this study was granted by the local Research Ethics Committee of the University of Nottingham. To ensure anonymity and confidentiality, all identifiers at the student level were removed before the data were analysed. Results: The results of this study confirm that the three-parameter IRT can be used to analyse the results of individual judgmental standard setters. Overall, standard-setters behaved fairly consistently in both tests. The mean Angoff ratings and conditional probability were strongly positively correlated, which is a matter of inter-standard-setter validity. Conclusions: We recommend that assessment providers adopt the methodology used in this study to help determine inter and intra-judgmental inconsistencies across standard setters to minimise the number of false positive and false negative decisions.

Social justice in medical education: a student-led approach to addressing COVID-19 vaccine equity in the Hispanic/Latinx community.

The current healthcare system disproportionately affects vulnerable populations, leading to disparities in health outcomes. As a result, medical schools need to equip future physicians with the tools to identify and address healthcare disparities. The University of Nevada, Reno School of Medicine implemented a Scholarly Concentration in Medical Social Justice (SCiMSJ) program to address this issue. Three medical students joined the program and pioneered a project to address the equitable vaccine distribution within the local Hispanic/Latinx community. After identifying the disparity in vaccine uptake and high levels of vaccine hesitancy, they collaborated with local organizations to address vaccine misinformation and accessibility. They organized outreach events, provided vaccine education, and hosted a vaccine clinic at a Catholic church with a high Hispanic/Latinx congregation. Through their efforts, they administered 1,456 vaccines. The estimated economic and societal impacts of their work was 879 COVID-19 cases avoided, 5 deaths avoided, 45 life years saved, and $29,286 in economic value. The project's success highlights the effectiveness of a student-led approach to promote skill development in social justice training. Leadership skills and coalition building were crucial in overcoming resource limitations and connecting organizations with the necessary volunteer force. Building trust with the Hispanic/Latinx community through outreach efforts and addressing vaccine hesitancy contributed to the well-attended vaccine clinic. The project's framework and approach can be adopted by other medical students and organizations to address health disparities and improve health outcomes in their communities.

Implications of the Dobbs Decision for Medical Education: Inadequate Training and Moral Distress.

This Viewpoint discusses how states' restrictions on abortion will affect medical students' training in providing reproductive health care and also create moral distress by being forced to provide care that may harm patients.

The impact of medical students' attitudes towards group ethical norms on their academic achievement and classroom deviant behaviour: An empirical study from China / El impacto de las actitudes de los estudiantes de medicina hacia las normas éticas de grupo en su rendimiento académico y el comportamiento desviado en el aula: un estudio empírico de China / O impacto de atitudes de estudantes de medicine em relação a normas éticas grupais em suas conquistas acadêmicas e comportamentos desviantes em sala de aula: um estudo empírico da China

Abstract: In recent years, medical students' absenteeism has been investigated in depth. Classroom deviant behavior is a richer concept than truancy behavior, but there are few researchers on this aspect in China. There are still many issues worth discussing about deviant classroom behavior. In this paper, questionnaires were given to 977 medical students to collect relevant data. After classifying the data, correlation analysis and multilevel linear regression analysis were used to conclude that academic performance and group ethical norms have a negative impact on medical students' deviant behaviors in class. Group ethical norms have a significant positive influence on academic performance, and descriptive ethical norms and imperative ethical norms of group ethical norms have a significant influence on academic performance. The four dimensions of academic performance: academic performance, task performance, interpersonal promotion, and social comparison have a negative influence on medical students' deviant behaviors in class. Descriptive ethical norms have an inverse effect on medical students' deviant behaviors, while imperative ethical norms have no significant effect on deviant behaviors in class. Group ethical norms as a category of ethical norms clearly have significant implications for improving academic performance and reducing their transgressions in class. Reinforcing group ethics in medical students will not only contribute to their professional ethics upon graduation, but also to their academic performance.

Resumen: En los últimos años, se ha investigado en profundidad el absentismo de los estudiantes de medicina. El comportamiento desviado en el aula es un concepto más rico que el comportamiento de absentismo escolar, pero hay pocos investigadores sobre este aspecto en China. Todavía hay muchas cuestiones que vale la pena discutir sobre el comportamiento desviado en el aula. En este trabajo, se entregaron cuestionarios a 977 estudiantes de medicina para recoger los datos pertinentes. Tras clasificar los datos, se utilizó el análisis de correlación y de regresión lineal multinivel para llegar a la conclusión de que el rendimiento académico y las normas éticas de grupo tienen un impacto negativo en los comportamientos desviados de los estudiantes de medicina en clase. Las normas éticas de grupo tienen una influencia positiva significativa en el rendimiento académico, y las normas éticas descriptivas y las normas éticas imperativas de las normas éticas de grupo tienen una influencia significativa en el rendimiento académico. Las cuatro dimensiones del rendimiento académico: rendimiento académico, rendimiento de la tarea, promoción interpersonal y comparación social tienen una influencia negativa en los comportamientos desviados de los estudiantes de medicina en clase. Las normas éticas descriptivas tienen un efecto inverso en las conductas desviadas de los estudiantes de medicina, mientras que las normas éticas imperativas no tienen un efecto significativo en las conductas desviadas en clase. Las normas éticas de grupo como categoría de normas éticas tienen claramente implicaciones significativas para mejorar el rendimiento académico y reducir sus transgresiones en clase. Reforzar la ética de grupo en los estudiantes de medicina no sólo contribuirá a su ética profesional al graduarse, sino también a su rendimiento académico.

Resumo: Nos últimos anos, o absenteísmo dos estudantes de medicina tem sido pesquisado em profundidade. O comportamento desviante na sala de aula é um conceito mais rico do que o comportamento de evasão escolar, mas há poucos pesquisadores sobre este aspecto na China. Ainda há muitas questões que vale a pena discutir sobre o comportamento desviante em sala de aula. Neste documento, foram entregues questionários a 977 estudantes de medicina para coletar dados relevantes. Após a classificação dos dados, análise de correlação e análise de regressão linear multinível foram utilizadas para concluir que o desempenho acadêmico e as normas éticas de grupo têm um impacto negativo sobre o comportamento desviante dos estudantes de medicina em sala de aula. Normas éticas de grupo têm uma influência positiva significativa no desempenho acadêmico, e normas éticas descritivas e normas éticas imperativas de normas éticas de grupo têm uma influência significativa no desempenho acadêmico. As quatro dimensões do desempenho acadêmico: desempenho acadêmico, desempenho de tarefas, promoção interpessoal e comparação social têm uma influência negativa sobre os comportamentos desviantes dos estudantes de medicina nas aulas. As normas éticas descritivas têm um efeito inverso sobre os comportamentos desviantes dos estudantes de medicina, enquanto as normas éticas imperativas não têm efeito significativo sobre os comportamentos desviantes nas aulas. Normas éticas de grupo como uma categoria de normas éticas têm claramente implicações significativas para melhorar o desempenho acadêmico e reduzir suas transgressões na classe. O reforço da ética de grupo em estudantes de medicina não só contribuirá para sua ética profissional ao se formarem, mas também para seu desempenho acadêmico.

The Pandemic and Beyond: Innovation in Cardiovascular Training to Improve Quality of Education and Trainees' Well-being.

During the first 2 years of the coronavirus-19 pandemic, many changes and innovations occurred to overcome the challenges associated with the pandemic and improve cardiovascular training. This review highlights the literature on the pandemic response regarding cardiovascular fellowship education and identifies areas of need to ensure future opportunities for fellows to achieve competency and career advancement. Specifically, we describe the recent changes to the four cornerstones of cardiovascular training: core content education, procedural training, career development, and the well-being of trainees.

Assessment and Evaluation in Social Determinants of Health Education: a National Survey of US Medical Schools and Physician Assistant Programs.

BACKGROUND: Social determinants of health (SDOH) curricular content in medical schools and physician assistant programs are increasing. However, there is little understanding of current practice in SDOH learner assessment and program evaluation, or what the best practices are. OBJECTIVE: Our study aim was to describe the current landscape of assessment and evaluation at US medical schools and physician assistant programs as a first step in developing best practices in SDOH education. DESIGN: We conducted a national survey of SDOH educators from July to December 2020. The 55-item online survey covered learner assessment methods, program evaluation, faculty training, and barriers to effective assessment and evaluation. Results were analyzed using descriptive statistics. PARTICIPANTS: One hundred six SDOH educators representing 26% of medical schools and 23% of PA programs in the USA completed the survey. KEY RESULTS: Most programs reported using a variety of SDOH learner assessment methods. Faculty and self were the most common assessors of learners' SDOH knowledge, attitudes, and skills. Common barriers to effective learner assessment were lack of agreement on "SDOH competency" and lack of faculty training in assessment. Programs reported using evaluation results to refine curricular content, identify the need for new content, and improve assessment strategies. CONCLUSIONS: We identified a heterogeneity of SDOH assessment and evaluation practices among programs, as well as gaps and barriers in their educational practices. Specific guidance from accrediting bodies and professional organizations and agreement on SDOH competency as well as providing faculty with time, resources, and training will improve assessment and evaluation practice and ensure SDOH education is effective for students, patients, and communities.

Implementing and optimizing a communication curriculum in medical teaching: Stakeholders' perspectives.

OBJECTIVE: The relevance of communication in medical education is continuously increasing. At the Medical Faculty of Hamburg, the communication curriculum was further developed and optimized during this project. This article aims to describe the stakeholders' perceived challenges and supporting factors in the implementation and optimization processes. METHODS: The initial communication curriculum and its development after a one-year optimization process were assessed with a curricular mapping. A SWOT analysis and group discussions were carried out to provide information on the need for optimization and on challenges the different stakeholders faced. RESULTS: The curricular mapping showed that the communication curriculum is comprehensive, coherent, integrated and longitudinal. In both the implementation and the project-related optimization processes, support from the dean, cooperation among all stakeholders and structural prerequisites were deemed the most critical factors for successfully integrating communication content into the curriculum. CONCLUSION: The initiative and support of all stakeholders, including the dean, teachers and students, were crucial for the project's success. PRACTICE IMPLICATIONS: Although the implementation of a communication curriculum is recommended for all medical faculties, their actual implementation processes may differ. In a "top-down" and "bottom-up" approach, all stakeholders should be continuously involved in the process to ensure successful integration.

Impact of the COVID-19 pandemic on surgical trainee education and well-being spring 2020-winter 2020: A path forward.

BACKGROUND: The time course and longitudinal impact of the COVID -19 pandemic on surgical education(SE) and learner well-being (LWB)is unknown. MATERIAL AND METHODS: Check-in surveys were distributed to Surgery Program Directors and Department Chairs, including general surgery and surgical specialties, in the summer and winter of 2020 and compared to a survey from spring 2020. Statistical associations for items with self-reported ACGME Stage and the survey period were assessed using categorical analysis. RESULTS: Stage 3 institutions were reported in spring (30%), summer (4%) [p < 0.0001] and increased in the winter (18%). Severe disruption (SD) was stage dependent (Stage 3; 45% (83/184) vs. Stages 1 and 2; 26% (206/801)[p < 0.0001]). This lessened in the winter (23%) vs. spring (32%) p = 0.02. LWB severe disruption was similar in spring 27%, summer 22%, winter 25% and was associated with Stage 3. CONCLUSIONS: Steps taken during the pandemic reduced SD but did not improve LWB. Systemic efforts are needed to protect learners and combat isolation pervasive in a pandemic.

Medical Education and the Ethics of Self-Care: A Survey of Medical Students Regarding Professional Challenges and Expectations for Living Healthy Lifestyles.

OBJECTIVES: Little is known about medical students' attitudes regarding the healthy lifestyle habits they are taught to recommend to patients and whether they believe they have a professional responsibility to live a healthy lifestyle. Understanding students' attitudes and practices regarding healthy lifestyles may provide insights into the personal and professional challenges that students face as they navigate the ethical tension between obligations to care for others (altruism) and for themselves (self-care). METHODS: The authors conducted a cross-sectional, anonymous, online survey of all medical students at the University of Iowa Carver College of Medicine in fall 2019, using descriptive statistics for analysis. RESULTS: A total of 351 students participated (response rate, 52.0%). Most agreed that physicians (85.5%) and medical students (77.8%) have a responsibility to try to live a healthy lifestyle; that physicians who practice healthy behaviors are more confident in counseling patients (94.0%), more likely to counsel patients (88.3%), and more likely to have their advice followed (86.9%); that as students they are more likely to counsel patients if they practice the healthy behavior (90.0%); and that their medical school workload resulted in exercise (69.7%), sleeping (69.4%), and eating (60.2%) practices that were less healthy than they should be. CONCLUSIONS: Most medical students support the professional responsibility to live a healthy lifestyle and believe doing so increases their effectiveness in counseling patients about healthy lifestyle habits. The medical school workload may limit some students' ability to live healthy lifestyles, however. Medical students need educational opportunities in ethics and professionalism to discuss challenges and expectations for living healthy lifestyles, with an eye toward practical approaches to living the life of a medical student that are professionally responsible and personally realistic.