Sekas and Hutson (Reference 1) convincingly show that fabrication of academic accomplishments is more common among trainee applicants than one may like to believe.

When applicants for gastroenterology programs were compared with applicants for infectious disease programs, no statistically significant difference was found. The most important inference—that such fabrication is likely to be widespread—was drawn. The comparison had little statistical power, however, so the findings should not be interpreted as evidence against a difference.

Importantly, some innocent errors may have been interpreted as misrepresentative by the authors, given that some types of genuine publications might not have been confirmed. I doubt whether these were common enough to have had any effect on the authors' conclusions; however, they could be extraordinarily important in judging an individual trainee applicant.

First, students and trainees commonly do not understand the distinction between "submitted" and "in press" in a bibliographic entry, innocently using the latter term when the former is more precise. This practice may make a 1.5-year MEDLINE follow-up too brief to detect a genuine contribution.

Second, persons may list genuine contributions to publications that are not listed in MEDLINE or in any of the usual compendia. These include intramural publications, publications of local (or very new) societies, publications in journals that are themselves very new, proceedings of meetings that are not published more broadly, and publications in newer formats that are not indexed by the traditional services (for example, software).

A MEDLINE follow-up of 1.5 years will detect most (but not all) articles legitimately listed as "in press" at the beginning of the interval. Some journals have delays exceeding 6 months from acceptance to print, and some journals have a lag time of a year or more from cover date to appearance in MEDLINE. In a recent investigation of fraud (Reference 2), one of the suspect articles was in a foreign (although English-language) journal that had a low citation impact score; it appeared on line 13 months after its publication date.

Sekas and Hutson have done a real service in calling our attention to a problem that has probably been systematically underestimated. Their methods were appropriate to the survey task they undertook, but one should recognize their limitations in the examination of individual trainee applications. I therefore strongly endorse the authors' closing recommendations: Trainee applicants should be expected to document and explain their claimed accomplishments, and we as mentors should do a better job of teaching academic ethics.