Authorship and Author Order: What Is Ethical

Authorship is credit and responsibility. Under the ICMJE recommendations that most medical journals follow, you are an author only if you meet four criteria, and everyone who meets them should be listed. Buying, selling or gifting authorship is research misconduct. Because programs can ask about every item on your application and ECFMG treats misrepresentation seriously, honest authorship matters more for an IMG than it might seem. This guide explains the rules, the usual conventions for order and how to handle problems. For finding a project, see finding a research position.

The four ICMJE criteria #

ICMJE recommends that authorship be based on all four of the following:

1. Substantial contributions to the conception or design of the work, or to the acquisition, analysis or interpretation of data.
2. Drafting the work or reviewing it critically for important intellectual content.
3. Final approval of the version to be published.
4. Agreement to be accountable for all aspects of the work, ensuring that questions about accuracy or integrity are appropriately investigated and resolved.

Everyone listed as an author must meet all four, and everyone who meets all four should be listed. ICMJE also says authors should be able to identify which co-authors are responsible for which parts, and have confidence in the integrity of their co-authors' contributions.

Contributors who are not authors #

People who do not meet all four criteria are not authors. They are listed in the acknowledgments with their contributions specified. ICMJE says editors should require written permission to be acknowledged. Typical examples:

• Providing funding or general supervision.
• Providing access to patients, equipment or a department.
• Language editing or technical help.
• Collecting data without involvement in the other criteria.

ICMJE also says that AI-assisted technologies should not be listed as authors, that use of AI should be disclosed and that humans remain responsible for the work.

How author order is decided #

ICMJE does not set an order. Conventions differ by field, journal and team, so ask rather than assume. Common practice in biomedical papers (not an official rule):

Practical steps:

1. Discuss authorship at the start, not at submission.
2. Write down who will be first, corresponding and last, and what would change the plan, for example someone leaving the project or doing far more or less than expected.
3. Revisit the plan when roles change, and record the update.
4. Make sure each author approves the final manuscript.

Buying, selling and gifting authorship is misconduct #

Be direct about this, because IMGs are targeted by it.

• Buying or selling authorship, including paying a "research company" to be added to a paper or to a promised publication, is research and publication misconduct. COPE, the Committee on Publication Ethics, describes paper mills as organizations that sell manufactured manuscripts or authorship, and describes them as a serious threat to the scholarly record.
• Gift or guest authorship, which means adding someone who did not meet the criteria as a favor or to add prestige, is an authorship problem under COPE's guidance.
• Ghost authorship means omitting someone who did meet the criteria, for example a paid writer or a junior contributor.
• Late requests to add or remove authors are a recognized warning sign. ICMJE says editors should seek an explanation and a signed statement of agreement from all authors, and from the person being added or removed.

Consequences can include rejection, retraction, notification of your institution and a permanent record. ICMJE says that when misconduct is proven the editor should publish a retraction, and retracted articles remain public and labeled as retracted. For IMGs, ECFMG's irregular behavior policy covers misrepresentation in applications, so a fabricated or purchased item on your CV can have consequences beyond one journal. Confirm the details on ECFMG's current page.

If someone offers you a place on a paper for money, or sells a "guaranteed publication," decline and leave. Do not treat it as a shortcut. See research fellowships for other warning signs, and predatory journals for related schemes.

Special situations #

• Students and volunteers. Being present at a project is not authorship. Contribute meaningfully, then ask.
• Case reports. The treating clinicians often author; others who only observed the case should be acknowledged. See case reports.
• Large groups. Some consortium papers list a group name. ICMJE expects the individuals who meet the criteria to be identified.
• Low-resource settings. ICMJE notes that excluding local researchers from low- and middle-income countries should prompt questions, so local contributors who qualify should be included.
• Data from someone else. Using another group's data does not make you an author of their work, and their involvement should be handled according to their policy.

If you disagree about authorship #

1. Re-read the criteria and compare them with what you did.
2. Talk to the senior author privately and politely, with specific contributions in writing.
3. If unresolved, contact the department chair, research integrity officer or ombudsperson.
4. Journal editors generally do not decide authorship disputes. ICMJE says the institution where the work was done should be asked to investigate.
5. Keep records of emails, drafts and the contributions you made.

Listing authorship honestly on your application #

Be able to say what you did on every item. List authors in the order they appear on the paper. Do not list yourself on work you cannot discuss, and do not list work as published when it is not. See how programs actually view research and how to publish a paper.