Competing interests and medical education

Dear Sir

For many years, medical journals have asked authors to declare their competing interests, and have published these interests. Medical education journals are no different – they also publish competing interests. Competing interests “may exist when an author (or the author’s institution or employer) has financial or personal relationships or affiliations that could influence (or bias) the author’s decisions, work, or manuscript.” (Thompson 1993) Competing interests may be financial or non-financial. Financial competing interests are easiest to understand – however non-financial competing interests are no less real. Non-financial competing interests take many forms but most commonly occur when an author has “the need for published research to support applications for academic tenure or promotion, or to support pre-existing academic beliefs” (Walsh & Sandars 2008). Even though most medical education journals now request authors to declare competing interests, our hypothesis has been that competing interests are actually rarely declared and published (Walsh & Sandars 2008).

To investigate this we looked at articles published in three of the main medical education journals in 2012. These journals were Medical Teacher, Medical Education and Biomed Central Medical Education. All of these instruct authors to declare competing interests and publish these competing interests on the articles in question.

We found the following results. We found 361 articles published in Medical Teacher. Fifty-seven articles reported a funding source. In three articles, a competing interest was declared. We found 244 articles published in Medical Education. Forty-three articles reported a funding source. In seven articles a competing interest was declared. We found 127 articles published in Biomed Central Medical Education. Fifty-four articles reported a funding source. In 10 articles a competing interest was declared. In total, 732 articles were published. In 20 articles, a competing interest was declared – representing 2.7% of all articles. Eight of these were financial and 12 were non-financial – these were related to authors’ interests or activities in medical education. We included all articles published in the analysis (including editorials and letters), and not just original research and systematic reviews. We did this because competing interests can affect the content within all types of articles.

In only 2.7% of all articles was a competing interest declared. This seems low for a number of reasons. Nearly all authors are employees of one institution or another and 21% of articles reported a source of funding for their work. Most authors have non-financial interests in medical education of one sort or another. There are over 176 sources of bias from actor observer bias to the Zeigamik effect (List of cognitive biases 2014). In this context 20 declared competing interests seems low and seems to warrant further investigation. Thought needs to be given to the form that further investigation might take. It might be further research but might equally be theoretical work to work out what forms of interests might be most relevant to medical education.

Declaration of interest: The authors report no conflict of interest.