Academic integrity: "accepted," "in press," or unacceptable?

In this issue, Grimm and Maxfield report the results of an analysis of the outcomes of manuscripts listed as "provisionally accepted," "accepted," "in press," and "submitted" on applications to a university radiology residency program. Their surprising finding that one-third of manuscripts listed as "accepted" or "in press" were not published two years after being included on an application raises questions about the reasons for these discrepancies.The authors of this commentary argue that one explanation for these findings is that some applicants deliberately misrepresented facts in order to be seen as more attractive candidates. After examining the professionalism implications of the study by Grimm and Maxfield, the authors offer recommendations for addressing lapses in students' professionalism early on. They recommend that medical school admissions and teaching faculty establish clear and unshakable expectations that untruths will not be tolerated regardless of the difficult administrative challenges that may ensue. Further, medical school admissions committees should select entrance criteria that reward collaborative behaviors and honesty in addition to academic achievement. The authors encourage more longitudinal, systematic analyses of potential fabrications in residency applications, with the goal of fostering a culture of trust in medicine.