Lying on applications to fellowship and residency is increasingly common and can involve publication history, membership in Alpha Omega Alpha (AOA), or gaps in education and employment.
Lies told early during medical education and training can set the stage for a lifelong pattern.
Although it may be difficult to detect lies on CVs, it’s imperative that medical students, residents, and physicians remain honest and exhibit high moral character when tendering their CVs.
Incoming member of the US House of Representatives, George Santos, gained notoriety for lying about nearly every facet of his life: his Jewish roots, his education, his employment history, and more. It may be surprising that a person elected to such high office would lie so blatantly and extensively. The truth is, however, that many people lie on their CVs and applications, including physicians.
By the numbers
Physicians’ lying may begin early in their medical career, starting with applications for training positions.
A study published in the Journal of Empirical Research on Human Research Ethics reported that an average of 22% of applicants to residency and fellowship programs have included falsified research citations on their CVs.
The range for this was 2% among internal medicine applicants, up to 50% among applicants for positions in pediatric pulmonology applicants.
Obstetrics & Gynecology published a 2012 study that examined 243 applications to a single gynecologic oncology fellowship program at MD Anderson Cancer Center. Among the applicants, 11% who claimed to be members of Alpha Omega Alpha were not listed as official members. Only 83% of articles listed as “in press” could be verified, and for the applicants reporting at least one published or “in press” article, 30% had at least one that was unverifiable. The only factor that predicted the likelihood of reporting unverifiable publications was male gender.
A similar study, also published in Obstetrics & Gynecology, was conducted at the University of Washington, and led by Anne-Marie E Amies Oelschlager, MD. It reported similar findings with regard to publication errors.
"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."
— Anne-Marie E Amies Oelschlager, MD, Reuters interview
It’s unclear whether lying on one’s CV for post-graduate training is related to lying in medical practice, although experts commenting on the studies to Reuters Health are concerned about this possibility.
A slippery slope
The highly competitive environment in medicine, from securing an elite Match in residency or fellowship, to the accomplishments needed to excel in the field, can create pressures that lead to a decision to deceive.
That's according to a commentary written by Edward Feller, MD, of Brown University, published in the Rhode Island Medical Journal. Such pressures can “overwhelm ethical behavior,” he says, to the point where the individual ignores or rationalizes their misconduct. And one incident can lead to another.
"Misconduct may deteriorate gradually, perhaps starting with falsely filling in a missing data point on a manuscript or granting oneself an unearned leadership position in an organization. Some students progress to blatant fabrication, falsification or plagiarism. Some misconduct is tempting because it is unlikely to be detected and so easily accessible."
— Edward Feller, MD, Rhode Island Medical Journal
Nature of lies told
The author of a blog posting published on Bioethics Today stated that lies told on CVs run the gamut. They can include adjusting job titles (eg, research associate vs intern), covering up gaps in work or education history, or fabricating previous employment positions. Lying about awards and grants also occurs.
It’s likely that not all lies carry the same weight. For instance, stating that a commentary in a journal was “peer reviewed” could be considered a “little lie,” says the blog’s author, if the editorial was merely editorially reviewed. Other examples of little lies include misrepresenting stages of publication, which could be due to a lack of understanding about the editorial process. On the other hand, “big lies” include lying about research and employment positions, including dates.
Dr. Feller cited a more extreme example: In one study, 11.8% of faculty letters of recommendations in ERAS applications were plagiarized, as determined by plagiarism software.
Dr. Feller sounded the alarm on the different forms of lying. “Academic dishonesty contaminates the residency Match, threatening its integrity,” he wrote. “Instruction about plagiarism is vital. Although deliberate intent is difficult to assess, conscious misrepresentation of academic credentials, research productivity and non-academic accomplishments is probable in as many as 5 to 10% of submitted applications.”
Currently, ERAS applications include a space for unique PubMed identifiers for publications. Applicants are also asked—but not obligated—to confirm publications. Some residency programs ask for a hard copy of all articles listed in the ERAS application. There is a paucity of identifiers, however, for submitted, in press, or accepted articles, as well as for conference presentations.
Although formal ethics training has been suggested to keep applicants honest, Dr. Feller noted that there is little evidence supporting the efficacy of such interventions.
What this means for you
Although lies told on ERAS applications and CVs range from small to big, it’s best to make a conscious effort to tell the truth with every accomplishment, publication, or research and employment experience listed. Medicine is a profession of honesty and character, thus the CV should be a completely truthful document.