Inaccuracies in Orthopaedic Research Fellowship Applications

Abstract

Background:

Academic integrity is a cornerstone of scientific research. However, increasing competition may cause applicants seeking competitive positions to report their research contributions inaccurately. An orthopaedic research fellowship offers substantial value for medical students and recent medical graduates to strengthen their applications for a residency position. Misrepresented authorship and publication history may distort applicant evaluations and compromise the credibility of the selection process.

Materials and Methods:

A retrospective cohort analysis was conducted on all applications received during the previous two consecutive application cycles (2024 and 2025) by our adult reconstruction research fellowship located in an academic medical center. Data were collected from all curriculum vitae received, which were cross-referenced with indexed databases to verify publication status and author order. Misrepresentations were categorized into (1) publication discrepancies (nonexistent or withdrawn papers) and (2) exaggerated authorship positions. Descriptive statistics and comparative analysis were performed.

Results:

A total of 87 applications were included in our analysis. Of the 87 applications, 15 (17.2%) were found to have either a publication discrepancy or an exaggerated authorship position. Publication discrepancies occurred in 8 applications (9.2%), while 9 applications (10.3%) demonstrated exaggerated authorship position(s). There were no significant differences between medical student versus medical graduate applicants nor among US medical applicants versus international medical graduate applicants, for number nor types of misrepresentations found.

Discussion:

The increasing competitiveness of orthopaedic surgery residency programs has led applicants to emphasize research productivity as a key component of their applications. However, discrepancies in self-reported research output highlight the potential for misrepresentation. These findings raise ethical concerns regarding honesty in academic reporting. Even minor misrepresentations can undermine the integrity of the application process, diminish trust among reviewers, and compromise the fairness of candidate evaluation. Implementing systems such as Open Researcher and Contributor ID could enhance transparency, ensure accurate attribution, and mitigate inconsistencies in research reporting, ultimately improving the research fellowship application process.

Introduction

Orthopaedic surgery residency has steadily become more competitive each year over the past two decades¹. Matching into an orthopaedic residency requires exceptional academic performance, outstanding United States Medical Licensing Examination (USMLE) scores, and involvement in quality research. The overall match rate for applicants has declined over recent years, demonstrating the increased competitiveness of the applicant pool. For example, in the 2021 to 2022 cycle, the match rate was 66.6%, down from 76% during 2016 to 2020². There was a 2.9% increase in USMLE Step 1 scores, a 4% increase in USMLE Step 2 scores, and a 400% increase in research output reported from 2007 to 2022¹. This culminated in the 2024 Match, the most recent match for which there are complete data available, being one of the most competitive orthopaedic match cycles in history, with matched applicants having mean USMLE Step 2 scores of 257, 8.1 research experiences, and 23.8 abstracts, presentations, and/or publications³.

As a result of the increased competition, dedicated orthopaedic research years have become increasingly common^4,5. Dedicated research years, often in the form of research fellowships, can be taken by students during “gap years” in medical school but are also pursued by recent medical graduates before enrolling in an orthopaedic surgery residency. These fellowships allow applicants to focus on research productivity, seek mentorship, network at orthopaedic conferences, and deepen their clinical knowledge⁵. While definitive evidence on their direct impact on match success is limited, research fellowships may offer particular value to international medical graduates (IMGs) and Doctor of Osteopathic Medicine (DO) candidates, who historically have lower rates of successfully matching into orthopaedic residencies when compared with their US Allopathic–trained counterparts^6,7. These graduates form a significant part of the medical workforce in the United States but often encounter many difficulties in securing training and employment in competitive specialties, such as orthopaedic surgery⁸. Given this intensifying pressure to stand out, applicants may feel compelled to overstate their involvement or misrepresent aspects of their research history, leading to potential discrepancies in reported experiences.

Currently, there is no validated system for reporting research contributions and publications when applying to residency or research fellowships. Orthopaedic residency and research fellowship applicants are asked to submit their curriculum vitae (CVs) listing their research contributions with the ethical promise that they accurately report them. Owing to the lack of a standardized research reporting system and the heightened expectation for research, applicants may report their research contributions inaccurately. These inaccuracies can be seen in reporting authorship on a publication that the applicant was not an author, claiming a higher authorship position than is true or even claiming authorship for a publication that does not exist. Publications are of value to residency selection committees, as publishing takes time, resilience, and collaboration, and successful publications demonstrate work ethic and the ability to follow through on complicated tasks. Authorship order is also of value to selection committees, as authorship is ascendingly assigned based on the overall contribution to study conceptualization and manuscript writing⁹.

The recent transition of the USMLE Step 1 examination to a Pass/Fail scoring system in January 2022 has forced orthopaedic program directors to rely more heavily on additional application components beyond standardized examination scores to evaluate residency candidates¹⁰. Although USMLE Step 2 still provides residency applicants with an objective score, it is not required to be taken before submitting a residency application. Furthermore, evaluating applicants based on a single test score goes against the holistic principles of the residency application³. More than ever, residency program directors are now giving higher preference to less-objective metrics in applications, such as away rotations, letters of recommendation, and research¹⁰. The increased emphasis on these experiences has forced orthopaedic applicants to increase productivity outside of the traditional avenues^11,12.

We aim to assess inaccuracies in authorship claims in the CVs submitted as part of applications to our orthopaedic adult reconstruction research fellowship to identify potential discrepancies that may misrepresent applicants’ research experiences. This study highlights the need for ethical research training and standardized verification processes to ensure integrity in academic contributions by evaluating the prevalence and nature of these inaccuracies.

Materials and Methods

Research fellowship applications from the 2024 and 2025 application cycles at a single academic institution were retrospectively reviewed. Applicants applied for a 2-year, funded research fellowship position within the adult reconstruction division. The position was intended for senior medical students and recent medical graduates. Data were collected from submitted CVs and application materials provided by each applicant. All manuscript publications listed on the CVs were manually cross-referenced with indexed databases such as PubMed and Google Scholar to verify the authenticity of the publications and their journals, as well as to confirm author order. Publications marked on the applicant’s CV as “accepted” but not yet published were excluded from the study's analysis. Inaccuracies were classified into two categories: (1) false publications, defined as nonexistent or withdrawn manuscripts, and (2) exaggerated authorship positions, defined as inaccurate authorship order compared with what was listed on an actual, existent publication. This study was deemed institutional review board exempt, as no patient data were involved.

To compare and identify false publications, each claimed publication on each CV was individually searched on PubMed and Google Scholar to identify if the manuscript was indeed published in the stated journal. As there is no reliable method to cross-reference abstracts or submitted publications currently under review, these were excluded from the study. A false publication was determined when a publication did not appear on search or was verified as published but without the applicant listed as an author. Exaggerated authorship was determined if the publication was confirmed to be published in the stated journal and the applicant was confirmed to be a listed author on the publication, but the reported author order differed in the applicant's CV compared to what was listed in the published journal (i.e., the applicant's CV reported their name as a first author when their name was published in the journal as a fourth author). There was no distinction made for whether authorship involved first-named or last-named authorship position. The number of false publications and exaggerated authorship was recorded for each applicant. Statistical analysis included chi-squared tests to determine correlations between inaccurate reporting and applicant demographics. This included comparing the inaccuracies between medical degree types (Doctor of Medicine, MD versus DO), medical students versus graduates, and US graduates versus IMGs. Statistical analyses were performed using SPSS Statistics v. 29.0 (IBM).

Results

A total of 87 CVs from 87 applicants were included in our analysis. Most applicants were medical students (56.3%). Most applicants were non-US IMGs (35.6%), followed by MDs or current US MD candidates (34.5%). US-IMGs, or medical students who are US citizens who went to medical school outside of the US, made up 18.4% of the study population. The remaining 11.5% of applicants were DO candidates or recently graduated DOs (Table I). There was a 63.6% increase in applicants from 2024 to 2025, rising from 33 to 54. Furthermore, there was an 84.23% increase in the average number of publications reported by applicants, from 3.93 to 7.24 year-over-year (Table II).

TABLE I.

Distribution of Applicants By Type of Medical Training

Applicant Type	Distribution, n (%)
MD	30 (34.5)
DO	10 (11.5)
US IMG	16 (18.4)
Non-US IMG	31 (35.6)

DO = Doctor of Osteopathic Medicine; MD = Doctor of Medicine; Non-US IMG = Non-US Citizen International Medical Graduate; US IMG = US Citizen International Medical Graduate.

TABLE II.

The Average Number Of Publications Stratified By Applicant Type and Application Cycle

	Applicant Type	No. of Applicants, n	Average No. of Publications, n (SD)
2024 application cycle
	All applicant types	33	3.93 (4.14)
	US MD	18	4.44 (4.23)
	DO	4	3.25 (4.72)
	US IMG	4	3.00 (2.94)
	Non-US IMG	7	3.57 (4.86)
2025 application cycle
	All applicant types	54	7.24 (12.45)
	US MD	12	5.00 (9.54)
	DO	6	5.33 (4.80)
	US IMG	12	9.00 (20.33)
	Non-US IMG	24	7.95 (10.24)

DO = Doctor of Osteopathic Medicine; MD = Doctor of Medicine; Non-US IMG = Non-US Citizen International Medical Graduate; US IMG = US Citizen International Medical Graduate.

There were 15 applicants (17.2%) with either a false publication or an exaggerated authorship, including two applicants (2.3%) with at least 1 false publication and 1 exaggerated authorship. The most common inaccuracy amongst applicants was exaggerated authorship, with 9 applicants (10.3%) listing exaggerated authorship in their CVs. There were no significant differences between applicant types in the amount of exaggerated authorship inaccuracies (P = 0.513; Table III). There were 8 applicants (9.2%) who falsely reported nonexistent publications. There were no significant differences in falsely reported publications between the 4 applicant types (P = 0.520; Table III). Furthermore, there were no significant differences in the number of false publications (P = 0.143) or exaggerated authorship (P = 0.576) inaccuracies between medical graduates and students (Table IV).

TABLE III.

The Number of False Publications and Exaggerated Authorships Among Applicants Stratified By Applicant Type

Inaccuracy Type	MD (n = 30)	DO (n = 10)	US IMG (n=16)	Non-US IMG (n = 31)	p
False Publications, n					0.520
No inaccuracies	27	9	14	29
At least 1 inaccuracy	3	1	2	2
Exaggerated Authorship, n					0.513
No inaccuracies	27	9	15	27
At least 1 inaccuracy	3	1	1	4

DO = Doctor of Osteopathic Medicine; Non-US IMG = Non-US Citizen International Medical Graduate; MD = Doctor of Medicine; US IMG = US Citizen International Medical Graduate.

TABLE IV.

The number of false publications and exaggerated authorships among applicants stratified by education level.

Inaccuracy Type	Education Level
	Medical Graduate (n = 38)	Medical Student (n = 49)	p
False publications, n			0.143
No inaccuracies	34	45
At least 1 inaccuracy	4	4
Exaggerated authorship, n			0.576
No inaccuracies	33	45
At least 1 inaccuracy	5	4

Discussion

The CVs submitted to our institution's orthopaedic research fellowship and included in our analysis show a high prevalence of false publications and exaggerated authorship. These data indicate that inaccuracies are enabled without a validated system for reporting research. In addition, the competitiveness of matching into an orthopaedic residency program and the emphasis on research output may sway applicants into purposefully misrepresenting their research experiences to appear more desirable to selection committees. However, it certainly remains a possibility that some applicants may have inaccuracies unknowingly and without malintent.

Inaccuracies in research involvement are not limited to adult reconstruction research fellowship applicants. Compared with residency and fellowship applications, this rate is higher than the pooled mean of 4.9% reported in a meta-analysis of residency and fellowship applicants across specialties¹³. Still, it falls within the upper range of competitive specialty-specific reports (4%-23%)^13,14. Satar found that 12% of reported publications were misrepresented, affecting 23% of applicants who claimed at least 1 publication in Canadian otolaryngology residency applications¹⁵. Similarly, El Beaino found that 20.5% of orthopaedic residency applicants who reported accepted, in-press, or published scholarly activity had at least one instance of publication misrepresentation¹⁶. Like our findings, previous literature has not found misrepresentation to be associated with specific applicant characteristics, suggesting that all applicants may be susceptible.

A key distinction of our study is that it focuses on applicants to research fellowships, specifically adult reconstruction research fellowships, as opposed to clinical residency or fellowship programs. Although any amount of misrepresentation is disturbing, the high rate seen in our study is especially concerning. These findings demonstrate that questionable or dishonest practices are not rare and may be influenced by factors such as publication pressure, lack of detection, and cultural or institutional norms. This persistent issue underscores the need for ongoing vigilance and verification in the application process across all levels of medical education, as well as the importance of fostering a culture of academic integrity within the field.

To the author’s knowledge, no studies directly evaluate the competitiveness of research fellowships following the change of the USMLE Step 1 to a pass/fail scoring metric. However, it is plausible that competition may be increasing. In our institution, there was a 63.6% increase in applicants from 2024 to 2025, rising from 33 to 54. Furthermore, there was an 84.23% increase in the average number of publications reported by applicants, from 3.93 to 7.24, during this same timeframe (Table II). Although this 2-year comparison is limited and insufficient to draw conclusions, the observation aligns with previous studies that demonstrate an increased demand for research experiences among applicants to orthopaedic residency programs^5,17. Residency applicants are applying to more residency programs than ever, and the rise in research expectations for residency may sway more students to apply for research fellowships^18,19. Although our study found no statistically significant correlations between applicant types and discrepancies, there were more inaccuracies among medical graduates and non-US international medical graduates (IMGs). Although historically non-US IMGs and reapplicants have shown lower match rates in orthopaedic surgery residency programs, all applicant types may feel the added pressure to appear more desirable to selection committees, potentially leading to intentional inaccuracies in research involvement^8,20.

The presence of inaccuracies in reporting research contributions among adult reconstruction fellowship applicants, such as fabricated publications, honorary authorship, or exaggerated roles in scholarly work, raises serious ethical concerns. Orthopaedic residency is among the most competitive specialties, and research productivity is often a key differentiator in the selection process^6,12. Misrepresentation in this context not only undermines the integrity of applicant evaluations but also creates an uneven playing field, disadvantaging individuals who report their achievements honestly²¹. These ethical breaches may allow unqualified candidates to advance inappropriately, potentially affecting future clinical competency and patient care. Moreover, the normalization of such practices risks eroding the core values of professionalism and accountability that are essential to medical training. Addressing these issues through improved verification processes, more straightforward authorship guidelines, and a culture that values integrity over inflation is critical for preserving fairness and trust in the orthopaedic match process.

This study is not without its limitations. Our study had a limited sample size and focused on a single subspecialty at a single institution, limiting generalizability across different institutions and specialties. Future multicenter consortia are needed to better understand the extent of this misrepresentation across academic settings. This study was not powered to detect statistically significant differences between groups; therefore, observations should be interpreted as hypothesis-generating rather than conclusive. Our methodology included manual searches through indexed databases such as PubMed and Google Scholar, but there was limited access to international journals, which could have led to some miscategorizations of publication discrepancies in our analyses. In addition, this retrospective study has inherent limitations, as applications were submitted over a year before being analyzed. Applicants' CVs are constantly changing, and claimed publications at the time of submission may not be representative of what was found to be published at the time of analysis.

Research contribution inaccuracies may not always be intentional, as some applicants may have been left off publications without knowing or mistakenly assigned themselves higher authorship. Regardless, discrepancies seen at our institution highlight the need for validated research processes to ensure research integrity and accurate authorship representation. Thurston highlighted using the Contributor Roles Taxonomy (CRediT), which defines 14 essential roles of manuscript authors, to characterize individual author contributions²². They also emphasized the need for early and frequent communication in the research process to prevent conflicts and ensure proper credit. Similarly, McNutt proposed changes to journal authorship policies to enhance transparency in authors' contributions and responsibilities²³. They recommended adopting the CRediT methodology and requiring the use of the Open Researcher and Contributor ID identifier, an individualized identifier that ensures accurate author identification, facilitates research tracking, and streamlines submission²⁴. These approaches ensure clear attribution of contributions and reduce inconsistencies in reported research output, allowing for the complete and fair evaluation of applicants.

Conclusion

We found that 17.2% of applicants to our single academic center orthopaedic adult reconstruction research fellowship during the 2024 and 2025 application cycles had publication inaccuracies listed on their CVs. The presence of inaccuracies in reporting research contributions among research fellowship applicants raises serious ethical concerns. Further studies are needed to investigate the underlying causes of authorship misrepresentations and to develop strategies for enhancing research integrity and validated publication reporting processes.