Authorship in Oral and Maxillofacial Surgery

Background and Objective According to the International Committee of Medical Journal Editors (ICMJE), authorship should be offered based on fulfilling four criteria. Honorary authorship (HA) is a term used for authors enlisted who did not fulfill these criteria. The objective of this study was to determine the proportion of HA in the field of oral and maxillofacial surgery. Material and Methods In 2020, a twenty-two question survey was sent to corresponding authors of four high-impact journals in the field of oral and maxillofacial surgery. The survey covered (1) demographics, (2) awareness of authorship guidelines and decision-making of authorship, and (3) honorary authorship. Results The response rate was 24.8%. Of the respondents, 81.1% was aware of the issue of guidelines on authorship, while 56.3% was aware of the issue of HA. Yet, 15.5% of the respondents felt that one or more of their co-authors did not deserve authorship based on the ICMJE-guidelines. Conclusion Based on the estimated proportions of HA, attempts should be made by universities, medical journals and individual researchers to further reduce authorship misuse.


Introduction
Authoring scientific publications can provide clinicians opportunities to further their clinical or scientific career. According to the International Committee of Medical Journal Editors (ICMJE), authorship should be offered based on fulfilling four criteria [1]: 1. ''1. Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND 2. Drafting the work or revising it critically for important intellectual content; AND 3. Final approval of the version to be published; AND 4. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved [1].'' Mamta Jalimsing, Sandhia Jalimsing and Istifari Voigt have contributed equally to this work.
& Pravesh S. Gadjradj p.gadjradj@erasmusmc.nl Honorary authorship (HA) is a term used for authors enlisted who do not fulfill these criteria. As HA gives inappropriate credit to authors, it is classified as scientific misconduct in the medical literature [2]. It is unknown to what extent HA is an issue in the maxillofacial literature.
Therefore, the aim of the current study is to analyze the proportion of HA in different journals in various journals in the oral and maxillofacial surgery.

Material and Methods
In 2020, a twenty-two question survey was sent to corresponding authors of articles published in 2019 in four highimpact journals in the field of oral and maxillofacial surgery. Editorials, manuscript correspondence and articles with only one author were excluded. The survey covered (1) demographics, (2) awareness of authorship guidelines and decision-making of authorship, and (3) honorary authorship [3][4][5][6]. The survey contained a list of ''non-authorship'' tasks such as obtaining funding. Authors performing one or more of these tasks and not contributing to the manuscript otherwise, are defined as ''ICMJE-defined HA.'' Furthermore, respondents were asked if they felt that one or more of their co-authors did not deserve authorship. This was defined as ''self-perceived'' HA.

Demographics
In total, 227 out of the 914 sent surveys were answered, leading to a response rate of 24.8% (see Fig. 1). Most respondents were employed as oral and maxillofacial surgeon (65.2%), while they represent working locations from 40 different countries (see Table 1).

Awareness of Authorship Guidelines and Decision-Making of Authorship
Before the survey, 81.1% was aware of the ICMJEguidelines, while 56.3% was aware of the issue of HA. Regarding the publication surveyed, the order of authorship was mostly decided by authors as a group (40.1%), followed by the first author (29.1%) and senior author (22.5%) deciding. The order of authors was mostly determined by the amount each contributed (42.9%).

Honorary Authorship
Overall, the proportion of self-perceived HA was 15.5%, which ranges from 5.5 to 21.3% among the journals surveyed, while the proportion ICMJE-defined HA was 49.8% ranging from 41.0% to 57.6%. Continent of employment and the journal surveyed were not associated with HA. Figure 2 gives an overview of opinions on authorship issues. Most respondents (strongly) agreed (68.3%) that journals asking for ''a statement of contribution'' before submitting a work, does not prevent HA.

Discussion
The present study shows that the vast majority of the respondents are aware of the ICMJE-guidelines and agree with them. Despite this awareness of authorship guidelines, the proportion of self-perceived HA was 15.5%, while the proportion of ICMJE-defined HA was 49.8%.
Some limitations have to be acknowledged. First, the response rate is 24.8% which may introduce selection bias. Regarding your paper, who decided the order of authorship? 227 Second, we surveyed corresponding authors. Corresponding authors might consist of more senior authors which can give a lower estimate of HA. Finally, recall bias could be introduced due to the retrospective nature of the survey.
Previous published studies suggest some solutions to reduce the proportion of HA. For example, a solution might be the implementation of courses on publication ethics for researchers. Another solution might be the referral to and ''It means a lot, especially to be first author on a publication. This is, as specific criteria in terms of publications are requested by the university. It is also important in which journal the paper is published. Higher ranked journals bring more points with regards to the university criteria than lower ranked journals.'' ''I have previously felt pressure to put senior department members as authors on papers for which they did not contribute. This practice should and must change. Furthermore, implementing a support system to discuss and resolve authorship disputes may also help reduce the proportion of HA [7]. Based on the estimated proportions of HA, attempts should be made by universities, medical journals and individual researchers to further reduce authorship misuse. These attempts should not only focus on raising awareness of authorship guidelines but also on facilitating open discussions of authorship issues for both junior and senior researchers.

Conflict of interest
The authors have no conflicts of interest.
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Funding No funding was received for this work.