Resident First Author Publications

Resident physicians in the United States are expected to participate in scholarly activities. Such activities often prompt residency programs to offer “research blocks” for residents. The intent is for trainees to not only effectively interpret the existing literature but also to contribute to advancing knowledge in their respective specialties. Although a generalization, it is known throughout the medical community that the more publications a resident has, the more competitive he or she is in the fellowship selection process. While some may be concerned that too much focus on research detracts from residents' development of clinical skills, a study¹ has shown that increased publications during residency do not detract from clinical competency as measured by board scores and patient satisfaction surveys.

First authorship is highly sought after among residents and attending physicians. In a study by the department of medicine at the Mayo Clinic,¹ residents published an average of 2 articles during their 3-year training program; in only 59% of these publications they were the first author. Low publication numbers by residents may be a product of lack of time during rigorous training, lack of funding, or simply lack of interest.

First authorship continues to be held in high regard across all medical and surgical specialties. While first authorship guidelines vary across many different scientific fields, the lead author is generally assumed to be primarily responsible for the research. The subsequent authors are then listed in order of contribution. One could argue that the last author is equally as important as the first author, as he or she is often a senior individual supervising the research project, with likely considerable input into the research as well as the manuscript writing. Last authors often are attending physicians. At the same time, many attending physicians seek first authorships to advance their own careers. This potentially places residents at a disadvantage.

Although it will be challenging to assess the relationship between first authorships and further academic success given institutional and case-by-case variability, it would be interesting to see whether such a relationship exists. Even more intriguing is how authors would potentially alter the order of names on publications should future studies show that there is indeed an incentive for first authorship. If future studies clarified the importance of first authorship in achieving not only success in one's career but also success in academia through professorship promotions, then the dynamics outlined in this letter might shift drastically.