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Academia and the Profession |

Plagiarism in Residency Application Essays

Scott Segal, MD, MHCM; Brian J. Gelfand, MD; Shelley Hurwitz, PhD; Lori Berkowitz, MD; Stanley W. Ashley, MD; Eric S. Nadel, MD; and Joel T. Katz, MD
[+] Article and Author Information

From Brigham and Women's Hospital, Harvard Medical School, and Massachusetts General Hospital, Boston, Massachusetts.


Note: Drs. Segal and Gelfand contributed equally to this study.

Potential Conflicts of Interest: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M09-2460.

Reproducible Research Statement:Study protocol and statistical code: Available from Dr. Segal (e-mail, bssegal@zeus.bwh.harvard.edu). Data set: Not available.

Requests for Single Reprints: Scott Segal, MD, MHCM, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115; e-mail, bsegal@partners.org.

Current Author Addresses: Drs. Segal, Gelfand, Hurwitz, Berkowitz, Ashley, Nadel, and Katz: Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.

Author Contributions: Conception and design: S. Segal, B.J. Gelfand, J.T. Katz.

Analysis and interpretation of the data: S. Segal, B.J. Gelfand, S. Hurwitz, L. Berkowitz, E.S. Nadel, J.T. Katz.

Drafting of the article: S. Segal, B.J. Gelfand, S. Hurwitz.

Critical revision of the article for important intellectual content: S. Segal, B.J. Gelfand, S. Hurwitz, L. Berkowitz, S.W. Ashley, E.S. Nadel, J.T. Katz.

Final approval of the article: S. Segal, B.J. Gelfand, S. Hurwitz, L. Berkowitz, S.W. Ashley, E.S. Nadel, J.T. Katz.

Provision of study materials or patients: S. Segal, L. Berkowitz, E.S. Nadel, S.W. Ashley, J.T. Katz.

Statistical expertise: S. Segal, S. Hurwitz.

Obtaining of funding: S. Segal.

Administrative, technical, or logistic support: B.J. Gelfand.

Collection and assembly of data: S. Segal, B.J. Gelfand.


Ann Intern Med. 2010;153(2):112-120. doi:10.7326/0003-4819-153-2-201007200-00007
Text Size: A A A

Background: Anecdotal reports suggest that some residency application essays contain plagiarized content.

Objective: To determine the prevalence of plagiarism in a large cohort of residency application essays.

Design: Retrospective cohort study.

Setting: 4975 application essays submitted to residency programs at a single large academic medical center between 1 September 2005 and 22 March 2007.

Measurements: Specialized software was used to compare residency application essays with a database of Internet pages, published works, and previously submitted essays and the percentage of the submission matching another source was calculated. A match of more than 10% to an existing work was defined as evidence of plagiarism.

Results: Evidence of plagiarism was found in 5.2% (95% CI, 4.6% to 5.9%) of essays. The essays of non–U.S. citizens were more likely to demonstrate evidence of plagiarism. Other characteristics associated with the prevalence of plagiarism included medical school location outside the United States and Canada; previous residency or fellowship; lack of research experience, volunteer experience, or publications; a low United States Medical Licensing Examination Step 1 score; and nonmembership in the Alpha Omega Alpha Honor Medical Society.

Limitations: The software database is probably incomplete, the 10%-match threshold for defining plagiarism has not been statistically validated, and the study was confined to applicants to 1 institution. Evidence of matching content in an essay cannot be used to infer the applicant's intent and is not sensitive to variations in the cultural context of copying in some societies.

Conclusion: Evidence of plagiarism in residency application essays is more common in international applicants but was found in those by applicants to all specialty programs, from all medical school types, and even among applicants with significant academic honors.

Primary Funding Source: No external funding.

Figures

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Figure.
Excerpts of representative similarity reports from personal statements.
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Figure.
Continued.

Submitted essays are on the left, and the sources matched to these essays are on the right. Green text indicates matching material. A. An essay scoring 9%. B. An essay scoring 30%. C. An essay scoring 66%.

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Comments

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Personal Statements: Best When Fresh?
Posted on July 25, 2010
Jason P. Lott
Department of Dermatology, Yale University School of Medicine
Conflict of Interest: None Declared

To the Editor:

Segal and colleagues (1) offer compelling evidence demonstrating a significant incidence of plagiarism among applicants' essays to select residency programs and conclude that "a concerted, nationwide effort to detect and deter plagiarism is warranted." In an accompanying editorial (2), Papadakis and Wofsy call attention to numerous online essay revision services which aid and abet in "misrepresentation of the applicant's independent capability" and question whether the personal statement is "best left to history."

As a former member of various medical admissions committees, my reviews of personal statements were often wrought with skepticism precisely because of such provenancial concerns. I ultimately attempted to ascertain only whether applicants could marshal sentences together in a logically and grammatically coherent manner (I rarely cared about the content of their writing, since most clustered about the usual bromidic themes--sick relatives, parental influences, exotic escapades to faraway lands, and so forth), and reluctantly looked elsewhere (i.e. test scores and publications) for more "objective" measures of intellectual prowess.

Still, I believe it would be premature to abandon the personal statement altogether. Perhaps these sorts of essays are better consumed fresh, before spoilage and contamination accrues from repeated handling. Incorporating fifteen or twenty minutes for formal essay writing into the interview process, while likely burdensome for both interviewer and interviewee, could potentially provide a more revealing, unobstructed glimpse of the candidate's mental architecture. Though not a perfect solution, this modest proposal might go far toward minimizing the confounding effects of academic thievery.

Naturally, impassioned protest will invariably ring throughout the medical school hallways--"That isn't enough time to write an outstanding essay!" and "I won't be able to edit my work!"--which is, of course, exactly the point.

References:

1. Segal S, Gelfand BJ, Hurwitz S, et al. Plagiarism in residency application essays. Ann Intern Med. 2010;153:112-20.

2. Papadakis MA, Wofsy D. Plagiarism on personal statements: a disturbing symptom of a broader trend. Ann Intern Med. 2010;153:128-9.

Conflict of Interest:

None declared

Plagiarism in Residency Application Essays
Posted on August 5, 2010
Rahul Koushik
International Kidney Care Foundation, San Antonio, TX
Conflict of Interest: None Declared

Sir,

Segal et al. present a methodical study noting the prevalence of plagiarism in residency application essays submitted to the Harvard Medical School (1). In their thoughtful yet cautious editorial, Papadakis and Wofsky correctly question the usefulness of these essays in judging residency applications and hope to avoid stigmatization of foreign medical graduates (FMGs) (2).

In an equally recent study, patients treated by FMGs fared as well, and even had significantly lower mortality in some areas, when compared with US-educated medical graduates (3). Segal et al. sadly reveal their own ivory tower bias with their condescending and factually incorrect statement that "international applicants (come from) cultures (that) do not perceive copying the work of others as negatively as Western academics do."

While dishonesty in any form is deplorable, the personal statement is clearly an outdated relic of a bygone era. It compels the applicant to sell himself/herself above the competition, which itself is considered by traditional ethicists as a questionable attribute for a physician (4). Plagiarism in residency application essays, although wrong, could be an attempt by competent physicians to fit in to an ill-conceived mold of a salesperson, which may be a desirable "culture" for the likes of Segal et al.

References:

1. Segal S, Gelfand BJ, Hurwitz S, Berkowitz L, Ashley SW, Nadel ES, Katz JT. Plagiarism in residency application essays. Ann Intern Med. 2010 Jul 20;153(2):112-20.

2. Papadakis MA, Wofsy D. Plagiarism on personal statements: a disturbing symptom of a broader trend. Ann Intern Med. 2010 Jul 20;153(2):128-9

3. Norcini JJ, Boulet JR, Dauphinee WD, Opalek A, Krantz ID, Anderson ST. Evaluating the quality of care provided by graduates of international medical schools. Health Aff (Millwood). 2010 Aug;29(8):1461-8.

4. Pandya SK. Advertizing remains unethical even in the digital age. Issues Med Ethics. 2001 Jan-Mar;9(1):15

Conflict of Interest:

None declared

Plagued with plagiarism : Other burning questions
Posted on August 6, 2010
Matiram Pun
University of Calgary
Conflict of Interest: None Declared

Dear Editor,

The findings from Segal and colleagues (1) are appalling about plagiarism. I agree with editorial (2) that it is less likely someone will come up in defense of it but we all will be exploring why this is happening. I'm not surprised with the findings but I'm surprised with the setting where it has been found, "Brigham and Women's Hospital in Boston, Massachusetts" which is one of the best medical centers in the world and only extremely competitive graduates apply there. The research has raised some of the issues that need to be included in the discussion of this article.

Firstly, the cutoff score for plagiarism could be as low as below 10 but it is really important to look into the extent of copying material. It could be low score but the author may be copying whole paragraph word by word. It has been reported that there was no false positive but individual essay analysis is warranted.

Secondly, the nature of personal statement could potentially lead to same structure and composition. The stories of personal statement are often similar and the best sellable stories/statements are taken by the applicants. Hence, there could be both plagiarized and personalized (which will be very similar). That might be the reason on why even the good merit students had been copying. So, it is the matter of system which needs personal statement and the evaluation system which buys exciting personal statements. Therefore, there is a narrow grey area between red of plagiarism and green of originality.

Thirdly, the data is from single center where usually less international medical graduates (IMGs) apply for residency. Considering plagiarism is more common among IMGs, the extent could be way worse in community hospitals where IMGS are enrolled in higher numbers.

Fourth, it is extremely important to analyze the curriculum vitae (CV) of these applicants as well. The CV of many of the applicants in medical school or residency program could be overstated and might be false as well. Hence, it will be interesting to look CV vs Personal statement (plagiarized). This could give a better picture of that person and plagiarism.

Finally, were all these applicants for residency only or some of them were in the program of physician scientists like MD/PhD? If they were pursuing medicine and research both; the immediate intervention in the system is needed.

Personal statement is again a subjective assessment. This could be easily explored during interview. Therefore, I think it is appropriate to remove it from application process of residency.

References:

1. Segal S, Gelfand BJ, Hurwitz S, et al. Plagiarism in residency application essays. Ann Intern Med. 2010;153:112-20.

2. Papadakis MA, Wofsy D. Plagiarism on personal statements: a disturbing symptom of a broader trend. Ann Intern Med. 2010;153:128-9.

Conflict of Interest:

I am an international medical graduate (from Nepal). I am currently a graduate student in Mountain Medicine and High Altitude Physiology at University of Calgary, Canada. I hold the position of Senior Research Editor of a premier and peer-reviewed undergraduate journal "The Journal of Young Investigators."

Re:Plagiarism in Residency Application Essays - oversimplified conclusions for a complex issue?
Posted on August 9, 2010
Sameer Siddique
Albert Einstein Medical Center
Conflict of Interest: None Declared

While Segal et al must be congratulated for their study in converting long held suspicions to hard research evidence, we feel that their conclusions are simplistic and do not address multiple issues. Firstly while the majority of IMGs come from places where English is not their first language and are culturally and socially different from US or Canadian graduates, this does not in any way imply that plagiarism there is more socially acceptable or less of an ethical crime than in the Western world contrary to the authors conclusion.

Secondly, it is almost inevitable that in a competitive field of professionals each displaying similar traits to a large extent, unique selling points become less unique and narrower with passage of time and repetition. Unlike original academic work, personal statements will reflect what most program directors are anticipating to see in a potential future resident and to expect the majority to conform to the norm, exceed expectations and still be unique in their statements is like asking McDonalds to make every burger distinct yet taste the same. Thirdly literature review has shown that a substantial proportion of biomedical publications had evidence of honorary as well as ghost authorships (2) suggesting either that such traits as plagiarism may persist as residents advance to consultants or that such traits are prevalent independent of career stage. Perhaps the time has come when quaint personal statements, either concocted or plagiarized, maybe true or possibly false, are rightly confined to history and more objective assessments inducted into the resident selection process.

References:

1. Segal S, Gelfand BJ, Hurwitz S, et al. Plagiarism in residency application essays. Ann Intern Med. 2010;153:112-20

2. Mowatt G, Shirran L, Grimshaw JM; et al. Prevalence of Honorary and Ghost Authorship in Cochrane reviews. JAMA. 2002;287(21):2769-2771

Conflict of Interest:

None declared

Plagiarism in Residency Application Essays
Posted on August 18, 2010
Moxie Stratton-Loeffler
Resident in Internal Medicine and Public Health, Oakland, CA
Conflict of Interest: None Declared

Dear Editor,

I am writing in response to the article by Segal et. al in the July 20, 2010 issue of Annals, which discussed plagiarism among residency applicants. As a literature and ethics major in college, this topic appealed to me because I think it would be a loss to exclude the personal statement, and so to include it at all it must be made valid. There are some factors which may contribute to student's motives to plagiarize, in addition to the obvious factor of competition -- lack of confidence in writing and communication skills, true lack of skill, exhaustion and lack of inspiration from fatigue during medical school, stymied creative expression due to long hours and overwork, and a widely held belief that no one actually reads the personal statements. There is also doubt amongst students that a program will decide anything on the basis of the essay.

One issue that is not often considered dishonorable, though it often occurs, is seeking help from family members or friends in medicine to help write essays. People with opportunities to network with other people in medicine may have quite a lot more privilege in terms of socioeconomic status. This access to insider advice can augment their advantage compared with people who get little or no help with applications.

A possible solution to the loss of sincerity in the writing process and ethical lack would be to have applicants complete essays at testing centers with no books or internet access and no ability to seek outside help. This would be the same environment that we provide for fair testing for medical board exams. It would also signal to future doctors that this part of the application is as important as the others. Knowing why people want to be doctors, why they would want to make such a sacrifice and take on such a weighty responsibility, is as important as their ability to memorize.

I would propose that the application include two or three short essays. There could be many topics to allow people to show their communication and decision-making ability or to recount stories of their work with patients, or to show their awareness of the complexity of managing patients. If one purpose of this process would be to avoid plagiarism, the topics ought to change frequently so as to prohibit writing, memorizing and reproducing the work of another writer. As for time limit, it could be quite generous, perhaps 30-60 minutes each, with breaks in between. Though there would be some expense to administer the essay writing in a test center, it would be minuscule in comparison to the overall cost of medical education.

Conflict of Interest:

None declared

Plagiarism in Medicine: A Different View
Posted on August 24, 2010
Michael Kirsch
No Affiliation
Conflict of Interest: None Declared

A recent editorial (1) in the Annals commented on an article (2) that reported on plagiarism in residency application essays. The researchers reported that at least 5% of personal statements included copied material. One could argue that plagiarism should bar entry into a profession that properly regards high ethical standards and behavior as core professional values.

Applicants to medical residency programs, who become practicing physicians, will face a barrage of conflicts of interest and must have a sturdy ethical rudder to navigate around them. Applicants, who become scientific investigators, will be charged to serve as guardians of the truth, not of their careers or incomes. Because integrity is so fundamental to the medical profession, we must insist on the highest standards of those who seek to enter it, and its members.

Is a plagiarist, who has sacrificed his personal integrity for personal gain, disqualified from the medical profession?

In my view, a single episode of plagiarism on an application or a journal article should not automatically end a career. But, it should generate a response and emphasis different from that expressed by the Annals' editorial writers. The editorialists comment:

"If the integrity of the personal statement is increasingly polluted by Internet samples of hired consultants, perhaps the personal statement is ill-suited to this era and best left to history."

This is the wrong reaction. If applicants are missing the ethical target, then we do not remedy this lapse by moving the target closer or simply abandoning the target from the field. The proper response is to teach the applicants to shoot straight and true. We should not lower or eliminate standards to capture of pool of applicants who cannot meet established quality thresholds. Ironically, such a practice is itself unethical and communicates to the profession and beyond that our ethical standards are flexible. Extrapolating this approach, we could quickly achieve a more law abiding society by simply declaring that many crimes and offenses were now legal and acceptable.

I was dismayed that the authors, who are physicians and high officials in the admissions process at University of California, did not focus more on improving ethical training and behavior of applicants, than they did on questioning the need for an essay requirement. They admit in their concluding sentence that integrity "deserves the continued attention of those in our profession," but this seeming afterthought should have been the main event of the editorial.

References

1.Segal S, Gelfand BJ, Hurwitz S, Berkowitz L, Ashley SW, Nadel ES, et al. Plagiarism in medical residency application essays. Ann Intern Med. 2010:153:112-20.

2. Papadakis MA, Wofsy, D. Plagiarism on personal statements: a disturbing symptom of a broader trend. Ann Intern Med. 2010:153:128-9.

Conflict of Interest:

None declared

Conflicting Obligations in the Management of Plagiarism
Posted on October 4, 2010
Andrew Fisher
UPMC Montefiore/Presbyterian Internal Medicine Program
Conflict of Interest: None Declared

TO THE EDITOR: My appreciation of Segal and colleagues expose (1) on the prevalence of plagiarism in residency applications was moderated by disappointment at the author's decision to protect the anonymity of the plagiarizers. Does the obligation to maintain the privacy of applicants outweigh the obligation to protect the future patients of omissive liars? Or is this a false choice, and in fact, the architects of the study considered other factors when they decided to protect the identities of the applicants? I am very interested in the thoughts of the authors on the balance of these competing obligations.

Very Sincerely, Andrew Fisher, PGY3

References

1. Segal S, Gelfand BJ, Hurwitz S, Berkowitz L, Ashley SW, Nadel ES, Katz JT. Plagiarism in Residency Application Essays. Ann Intern Med. 2010; 153:112-20.

Conflict of Interest:

None declared

Response to Comments on Plagiarism in Residency Application Essays
Posted on November 24, 2010
Scott Segal
No Affiliation
Conflict of Interest: None Declared

We appreciate the comments (1-5) on our research on the prevalence of plagiarism in residency application essays and the accompanying editorial by Papadakis and Wofsy (6). We agree with Dr. Siddique and colleagues (1) that an applicant's national origin should not excuse plagiarism, and we did not mean to imply otherwise. However, we caution that there is evidence of varying mores regarding copying of previously authored material in some cultures and that any response to our findings should be sensitive to such diversity (7). Drs. Siddique colleagues (1) and Dr. Green (2) note that evidence of academic dishonesty also affects publication citations and authorship of biomedical publications both during residency and in later career stages. We agree, and we suggest that a firm policy on plagiarism in the application, early in a physician's career, would be an appropriate part of an overall strategy to address dishonesty within the profession. Dr. Green (2) also suggests that persons who offer assistance to applicants with their personal statements should limit their contributions to stylistic rather than conceptual suggestions. This is wise counsel, although we suspect this guideline would be difficult to enforce. Dr. Stratton-Loeffler (3), Dr. Kirsch (4), and Dr. Lott (5) express concern that the editorial authors go too far in their suggestion that the personal statement be abandoned altogether. As residency program directors and educators, we agree that the essay often offers insight into the applicant that extends beyond the objective data provided by test scores and grades. We further agree that this should make the quest for authenticity and originality more earnest, and that simply eliminating the personal statement might "depersonalize" the recruitment process, to the detriment of programs and applicants alike. Indeed, as educators, we seek not only well-qualified applicants, but those with unique and exceptional characteristics who will contribute to and develop our training programs. To this end, Dr. Stratton-Loeffler (3) and Dr. Lott (5) suggest moving the venue for authoring the personal statement either to supervised testing centers or to the interview day itself. These intriguing possibilities are certainly worthy of further discussion and experimentation.

Brigham and Women's Hospital; Boston, MA 02115

References

1. Siddique S, Naina HV, Harris S. Plagiarism in residency application essays [Letter]. Ann Intern Med. 2010;153:765-6.

2. Green JB. Plagiarism in residency application essays [Letter]. Ann Intern Med. 2010;153:764-5.

3. Stratton-Loeffler M. Plagiarism in residency application essays [Letter]. Ann Intern Med. 2010;153:766.

4. Kirsch M. Plagiarism in residency application essays [Letter]. Ann Intern Med. 2010;153:765.

5. Lott JP. Plagiarism in residency application essays [Letter]. Ann Intern Med. 2010;153:765.

6. Papadakis MA, Wofsy D. Plagiarism on personal statements: a disturbing symptom of a broader trend [Editorial]. Ann Intern Med. 2010;153:128-9. [PMID: 20643994]

7. Park C. In other (people's) words: plagiarism by university students--literature and lessons. Assessment & Evaluation in Higher Education. 2003;28:471-88.

Conflict of Interest:

None declared

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