Rationale and Objectives
The aim of the present study was to assess the potential usefulness of written instructional vignettes relating to publication and journalism ethics in radiology via a survey of radiology trainees.
Materials and Methods
A literature review was conducted to guide the development of vignettes, each describing a scenario relating to an ethical issue in research and publication, with subsequent commentary on the underlying ethical issue and potential approaches to its handling. Radiology trainees at a single institution were surveyed regarding the vignettes’ perceived usefulness.
Results
A total of 21 vignettes were prepared, addressing institutional review board and human subjects protection, authorship issues, usage of previous work, manuscript review, and other miscellaneous topics. Of the solicited trainees, 24.7% (16/65) completed the survey. On average among the vignettes, 94.0% of the participants found the vignette helpful; 19.9 received prior formal instruction on the issue during medical training; 40.0% received prior informal guidance from a research mentor; and 42.0% indicated that the issue had arisen in their own or a peer’s prior research experience. The most common previously experienced specific issue was authorship order (93.8%). Free-text responses were largely favorable regarding the value of the vignettes, although also indicated numerous challenges in properly handling the ethical issues: impact of hierarchy, pressure to publish, internal politics, reluctance to conduct sensitive conversations with colleagues, and variability in journal and professional society policies.
Conclusion
Radiology trainees overall found the vignettes helpful, addressing commonly encountered topics for which formal and informal guidance were otherwise lacking. The vignettes are publicly available through the Association of University Radiologists (AUR) website and may foster greater insights by investigators into ethical aspects of the publication and journalism process, thus contributing to higher quality radiology research.
Introduction
Ensuring the highest quality of science in radiology demands observing the highest of ethical standards throughout the research and publication process. A uniform code of conduct for authors, reviewers, editors, and publishers fosters a consistent and fair process for manuscript selection. In addition, professional journalism standards help to avoid sources of bias in publication and thus improve the rigor and clinical importance of the work. On the other hand, publication misconduct risks far more than just the authors’ reputation, but also dissemination of incorrect or misleading results, thereby leading to inappropriate clinical management and potential patient harm.
Although promoting high ethical and professional standards in radiology journalism is clearly an important objective, numerous challenges toward this aim exist. Although numerous journal and editorial bodies have released professional standards for academic publishing , no single uniform code of publication ethics exists. This absence can create uncertainty regarding the optimal course of action in an ambiguous circumstance. In addition, insufficient training regarding publication ethics for medical students, residents, and junior faculty may contribute to an overall lack of awareness of such issues . Moreover, academic pressure to successfully publish the output of one’s research efforts can be intense, with such productivity having implications for promotions, bonuses, and other end points . This pressure furthers the need to continually highlight the critical nature of publication ethics.
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Methods
Construction of Vignettes
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Survey of Radiology Trainees
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Results
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Table 1
Topics of the 21 Vignettes in Publication and Journalism Ethics in Radiology Research
IRB and human subjects protection (1.1) Patient consent for case reports (1.2) Criteria for human subjects research (1.3) Determination of IRB exemption status (1.4) IRB oversight of quality improvement initiatives Author issues (2.1) Determination of author order (2.2) Honorary authorship (2.3) Author approval of final submission (2.4) Author verification forms (2.5) Addition of author to manuscript Usage of previous work (3.1) Self-plagiarism (3.2) Redundant publication (3.3) Manuscript based on earlier conference abstract (3.4) Alteration of medical images (3.5) Use of previously published image Manuscript review process (4.1) Confidentiality of manuscript under review (4.2) Conflict of interest related to manuscript authors (4.3) Conflict of interest related to manuscript content (4.4) Blinding of manuscript during review process Miscellaneous (5.1) Disclosures by study investigators (5.2) Representation of manuscript review status (5.3) Permission for acknowledgments
IRB, institutional review board.
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Table 2
Participants’ Responses to Survey
Question Overall ( n = 16) PGYs 2–4 ( n = 9) PGYs 5–6 ( n = 7) Was the vignette helpful? 94.0% 95.8% 91.8% Prior formal instruction on issue in medical school or other classroom setting 19.9% 18.0% 22.4% Prior informal guidance on issue from past research mentor or advisor 40.2% 41.8% 38.1% Issue arising in own or peers’ previous research experiences 42.0% 45.5% 37.4%
PGY, post-graduate year.
Table 3
Vignettes Receiving Highest Scores for Survey Questions
Case Helpful Prior Formal Training Prior Informal Guidance Issue Previously Arising Topic %Topic__% Topic % Topic % 1 \* Tie 100.0% (1.2) Human subjects 56.3% (2.1) Author order 75.0% (2.1) Author order 93.8% 2 NA (5.1) Disclosures 56.3% (1.2) Human subjects 75.0% (1.2) Human subjects 68.8% 3 NA (1.3) IRB exemption 43.8% (3.1) Self-plagiarism 68.8% (3.3) Prior abstract 68.8% 4 NA (3.1) Self-plagiarism 37.5% (3.2) Redundant publication 56.3% (3.4) Image alteration 62.5% 5 NA (1.4) QI oversight 31.3% \\ Tie 56.3% \\\* Tie 56.3%
IRB, institutional review board; NA, not applicable; QI, quality improvement.
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Table 4
Vignettes Receiving Lowest Scores for Survey Questions
Case Helpful Prior Formal Training Prior Informal Training Issue previously Arising Topic % Topic % Topic % Topic % 21 (5.2) Review status 75.0% (2.5) Adding author 0.0% (4.2) Reviewer conflict—authors 12.5% (4.2) Reviewer conflict—authors 12.5% 20 (2.3) Manuscript approval 81.3% (4.3) Reviewer conflict—content 6.3% (5.3) Acknowledgment 12.5% (5.3) Acknowledgment 12.5% 19 (5.3) Acknowledgment 87.5% (5.3) Acknowledgment 6.3% (4.3) Reviewer conflict—content 18.8% (4.3) Reviewer conflict—content 18.8% 18 (3.4) Image alteration 87.5% (3.5) Reuse of image 6.3% (4.4) Manuscript blinding 25.0% (4.4) Manuscript blinding 18.8% 17 (2.4) Author form 87.5% (3.3) Prior abstract 6.3% (2.4) Author form 25.0% (4.1) Reviewer confidentiality 18.8%
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Table 5
Representative Free-text Comments Indicating Usefulness of Case
Case Comment 3 “Important topic, as mentioned there is an epidemic of inappropriate authorship as a young researcher learning what constitutes authorship has never been explained to me” 5 “Comes up a lot with medical students and residents who collaborate on a project with multiple departments” 9 “Very happy to see this specific aspect of plagiarism addressed because it came up so frequently during my time in medical school performing research and is not often discussed in the ethics of research” 17 “This case sheds light on something that may seem trivial, but may have unforeseen consequences and potentially delay the publication of a study if an issue like this is not dealt with upfront” 21 “Very little teaching is generally given about the review process” 17 “Did not realize this could happen and found the discussion interesting” 1 “Great scenario, often overlooked. Will change the way I approach writing a case report in the future” 1 “Important topic as stated these are usually easy early publications that most don’t know about rules about publishing” 1 “This case brought up issues I have never really thought about before, but it makes sense that in a very rare condition, patient anonymity could be a real concern” 2 “Helpful and important scenario. While professional and delicate discussions are warranted, I believe the lead author/investigator is ultimately in the best position to evaluate the relative contributions of the authorship team” 2 “Realistic true-life scenario that undoubtedly occurs more often than we’d like to think, especially when there are a lot of collaborators involved” 2 “Need of the hour that journals should start elaborate the roles of individual author” 2 “I think it’s a great vignette that explores the nuances and delicacies regarding authorship order that frequently comes up in the academic environment but is rarely addressed prior to the issues arising” 4 “Learned something new: iThenticate” 5 “Very helpful and involving a topic which I was confused about beforehand” 5 “Good case- I honestly didn’t even think this was an ethical issue prior to reading this!” 6 “Did not realize the possibility of overlap before reading this case. Much appreciated” 6 “I had no idea that these designations existed; therefore, I found this to be a very useful, informative case” 8 “Great detailed explanation regarding a scenario in which people often turn a blind eye” 9 “Good to be aware ofnever really thought of this” 9 “Great case and very informative! As residents, we are always trying to go to meetings but often do not think of the next step (ie, manuscript submission). Again, learned a few things from this case” 10 “Good case- sometimes take this for granted with the multiple rounds of edits but very important to keep in mind” 12 “The ICMJE authorship criteria are important, and I was not aware of them prior to reading these cases, meaning they are not well covered in medical school curricula” 12 “I feel like this issue comes up quite a bit and I was never quite sure as to what actually qualifies as a contributing author. Helpful case” 12 “I think this issue comes up frequently, especially for medical students who are approached by more senior residents, etc. to do “grunt work” with the expectation of authorship, so it’s a nice case to address that issue” 13 “This case made me more cognizant of the implications of potentially “altering” images to make one’s work look good. It seems benign enough with no real intent to deceive the readers, but there are far more important factors, such as professional integrity, to consider as this case nicely illustrates” 13 “I find it a useful topic. It certainly wasn’t discussed in my medical school. However, the ease with which we can now manipulate images makes this a pertinent discussion point” 14 “Pretty straightforward, although important to clarify that once published, images are no longer your own ” 16 “Useful case, especially the part about how to list projects on one’s CV that have not been accepted/published” 16 “I’m glad there was a mention of honesty regarding one’s CV. I’ve seen former classmates “upgrade” the status of their papers during the residency trail” 17 “Acknowledgements can be murky (a gray area). Helpful case” 19 “Good to know all the techniques to de-identify one’s own work, and that sometimes it might just be impossible (eg Single center methodology)”
CV, curriculum vitae; ICMJE, International Committee of Medical Journal Editors.
Table 6
Representative Free-text Comments Indicating Challenges Relating to Presented Issue
Case Comment Comments indicating challenges regarding presented issue 2 “Possibly someone will not agree in the end, someone will always not get what they want, what then?” 3 “What if pressure from other faculty to include her? Risk of losing funding from other sources?” 3 “How should a medical student or resident deal with this? It happens all the time. Suggesting inclusion as an acknowledgement is unlikely to be received well” 4 “This case doesn’t address the major issue that comes up with papers focusing on a single technique—it is almost impossible to find a novel way of describing it in the methods across multiple papers” 5 “I think it addresses an issue we often don’t think enough about and something we are often tempted to do in an environment that prizes frequency of publication” 9 “Perhaps a blurb could be added about poster presentations to the same effect: that copyright is contingent upon the society at which the poster is being presented” 16 “I would like more attention drawn to use/abuse of “in press” in CVs as this is probably where it happens more at the resident level” 18 “What if you see someone else doing this?” 20 “What if you suspect your reviewer rejected based on bias?” 2 “Helpful discussion of common scenario. The conversation is often easier conceptually than in reality, however, due to reasons related to hierarchy” 2 “Nice bread and butter case for an issue that commonly arises, but perhaps people are reluctant to speak about” 3 “Intra-departmental and intra-divisional politics too often seem to cloud judgment in such cases, as those lower on the “totem pole” feel pressure to include individuals with more seniority due to tradition and appeasement. This case is valuable in showing that there are ethical considerations and very real repercussions for such acts” 5 “Journals seem to have different criteria for what constitutes redundant publications” 5 “I think researchers sometimes purposely do this in order to increase publication numbers knowing the ethical issues involved. I had a research mentor who did something similar, but had the intention of publishing multiple papers from the same data set from the outset, which put me in an ethically challenging situation when the time came to write all the manuscripts and submit them” 9 “Had to deal with a similar scenario recently and many societies do not publish clear guidelines”
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Discussion
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Appendix
Supplementary material
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