March 25, 2018

Plagiarism: A Hidden Problem in Academic Medicine

Irène Mathieu. M.D. 

Dr. Mathieu is a resident in pediatrics and poet who lives in Philadelphia. For more of her work please visit her website:

The last time I heard anyone explicitly lecture about plagiarism was around the fourth grade. An aspiring writer, I remember thinking that it sounded like such a horrific breach of integrity that I couldn’t imagine anyone needing to reiterate such a thing. True to my instinct, no one ever did. Except for a brief discussion of my college’s honor code, I never again received any specific education around plagiarism and authorship – not as an undergraduate or medical student, and not in the nearly three years that I’ve been a pediatric resident. I never thought that it would happen to me.

However I am still in residency and have had more than one unfortunate experience around authorship. These experiences have been professionally distressing and disappointing, as the perpetrators are my peers – pediatricians close to my level of training who purport to be interested in social justice and equity. One specific instance was particularly egregious.

A mutual mentor introduced me to a colleague a few years ahead of me in training who had similar interests and perspectives. I was very excited to meet this person several years ago, and I began to think about possible collaboration almost immediately. When I approached her about writing a commentary on a topic of mutual interest she said yes without hesitation. She was just out of residency, and I was a fourth-year medical student with quite a bit of time flexibility, so I offered to do the background research and write the initial draft. We discussed authorship extensively over email during this phase of planning, and agreed that I would be the first author, she would be the second author, and that we would later invite a more senior pediatrician to provide further direction and to be the third author.

Over several months I completed background research for the commentary and wrote multiple drafts, to which my colleague provided feedback and direction. I created a framework, laying out the problem as we saw it and potential solutions. After several rounds of edits, I felt the piece was finally approaching readiness for publication in a major journal. Then things suddenly shifted.

My colleague told me that she didn’t like my writing style and that she wanted to make sure any piece with her name attached was consistent with her personal style. Therefore she proposed making herself first author after making more substantive edits, and sent me a modified version that was organized differently from what I had been working on for weeks. I was taken aback, as she had seen multiple drafts and had not brought up this concern previously, so we discussed it further over the phone. We came up with an alternative solution. We would write two papers – one in which she was the sole author and would lay out the scope of the problem, and one in which I was sole author, in which I would cite the papers I had researched and lay out the solutions that I had drafted. We would submit them as parallel papers, with the hope that they might be published in successive issues of a major journal. I agreed to the plan because I didn’t want to lose the work that I had already done, but the whole situation left me with a foreboding feeling.

At this point our communication dropped off. Months passed. One day I opened the latest issue of a major journal – the one in which we had been aiming to publish – and saw the article. There were the problem and the solutions, in a framework nearly identical to the one I had originally developed, complete with the data and citations that I had researched. My colleague was the first author, and two other people were second and third authors. My name did not appear anywhere in the piece, not even in the acknowledgments. Perhaps worst of all was how I discovered that the manuscript had made it to press.

I had no idea what to do, and I still don’t. No one taught me what steps you are supposed to take when you have been plagiarized. While I believe this piece was important and I’m glad that it found a home in a prominent place, my trust in my colleagues suffered from the betrayal. I flinch now when I come across her name, and even when I sat down to write this piece I had the same sick feeling in the pit of my stomach that rose up when I first saw the published paper.

I still want to be an academic pediatrician, and I trust that most of my present and future colleagues are people of integrity and good intentions. But I wish that at some point in the last ten years someone had crafted a lecture around authorship, how to reduce the chances of being plagiarized, and what to do if it happens. I know that many of us in academic medicine are bent on productivity and that we face intense pressure to publish. However this should not be at the expense of integrity and ethical teamwork. As a future mentor to medical students and residents, I will use my experiences as learning opportunities. Hopefully the day will come when plagiarism is omitted from medical education, not because it is uncomfortable to discuss, but because it no longer happens.