#KeyLIMEPodcast 237: Who Wrote This Stuff, Anyway? The Complex Construct of Authorship in Meded

Authorship. It is the basis of career advancement, global recognition, funding, wellness, professional identity, and even historical legacy.  But are the guidelines for authorship as they currently stand clear enough? The authors of Jason’s selected study argue that no, they are not … and with this qualitative study, they dig deeper to examine the confusion and manipulation of authorship. Listen to the co-hosts discuss here.


KeyLIME Session 237

Listen to the podcast.


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Maggio et. al., Exploring researchers’ perspectives on authorship decision making. Med Educ. 2019 Sep 1. doi: 10.1111/medu.13950. [Epub ahead of print]


Jason R. Frank (@drjfrank)


Tomfoolery. Apparently, that is what is going on when it comes to breaking the rules set out by the powerful and wise priests of journology at the ICMJE. Consider these authorship phenomena of our contemporary age:

  • honourary authorship
  • gift authorship
  • excluded authorship
  • demanded authorship
  • disputed authorship
  • inclusive authorship
  • plural authorship, and the dreaded
  • ghost authorship.

Apparently if you are a clinician educator listening to the Podcast, six out of ten of you have been an honourary author at some point (from Artino, Driessen & Maggio in Academic Medicine). So I ask you, dear listener, how many of these authorship phenomenon have you experienced so far in your career?

Authorship is a fundamental attribution for scholarly contribution, and is the basis of career advancement, global recognition, funding, wellness, professional identity, and even historical legacy. Unfortunately, it is mired in tomfoolery.

Today, Maggio, Artino, & Driessen are back with another authorship paper in #meded, and they brought two other heavyweights in the form of Chris Watling and Bridget O’Brien. This time, they are digging deeper to see why there is so much confusion and manipulation of authorship.


The authors proposed that the construct of authorship must be more complex than the guidelines set out by the ICMJE have published. They therefore set out to unpack the complexities in #meded researchers conceptualization of “authorship”.

Key Points on the Methods

This is a qualitative study using a constructivist approach. Interestingly, it was exempt from ethics the primary author’s home institution.

In a nutshell, the study has three phases:

  • The authors attempted to assemble a representative sample of North American (US & Canada) #meded researchers by searching for multi-authored research papers in Academic Medicine, Medical Education, and the 13 JAMA family of journals. This seemed like an odd bunch to me. They excluded all but one author from their own institutions. They found 119 first authors and invited them to participate. 31 said yes.
  • They interviewed 26 by phone using a semi-structured guide. Participants first reacted to two authorship scenarios (one of demanded authorship, one of authorship order change), then talked further about their experiences of authorship in their careers. Interviews were transcribed and deidentified.
  • Finally, the authors all coded the transcripts for themes in blocks of six interviews. They stopped when they achieved sufficiency.

Incidentally, there is a nice section of the paper where they also describe their own reflexivity.

Key Outcomes

The 26 participants were a mix of career stages, and half were women. There was a mix of MDs and PhDs from the US & Canada. Mean publications was 56, with a range of 1-301(!).

The authors identified some important themes related to conceptualizing authorship in #meded. Here are my highlights:

  • There fundamental finding was that authorship is complex, nuanced, involves numerous mental models and institutional norms. This is a threat to the utility of simplistic guidelines.
  • They identified numerous “grey areas” between black and white authorship status.
  • The authors also identified sources of vulnerability of scholars to authorship tomfoolery, including being early career, being beholden for funding or resources, being beholden for access to data, hierarchy, and gender.
  • Protection from authorship violations included: being senior in career or experienced in scholarship, institutional norms and protocols, protected salary, and researcher training.
  • Fascinatingly, authors also identified justifications for “breaking the rules”, including gratitude for funding or mentorship, “academic socialism” in which scholars give each other a hand up to advance careers, generosity, accommodation for those who speak other languages, and helping out busy clinicians.
  • Finally, the participants reported that some institutions create a culture prone to authorship deviations, with high-pressure, transactional funding, demanding leadership, poor role-modelling, and tacit institutional endorsement of breaking the rules.

Key Conclusions

The authors conclude that our community of scholars need more than guidelines on authorship. They need nuanced resources, faculty development, training, and mentorship.

Spare Keys – other take home points for clinician educators

  1. Another great study with simple and clear methods for telephone interviews.
  2. A nice example of a simple reflexivity section.
  3. All clinician-educators need training and mentoring when dealing with authorship. It is one of the first things I coach on when I work with an early career educator.

P.S. The #meded word of the day is “tomfoolery”.

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