From the Editor
Academic Olympism and Authorship: Honoring
Contributions to Collaborative Scholarship
O n August 1, 2021, the world
witnessed an act of true collegiality as
2 athletes, Mutaz Essa Barshim and
Gianmarco Tamberi, shared the podium
for the gold medal in the high jump
at the 2020 summer Olympic games. 1
When the 2 longtime friends and rivals
Downloaded from http://journals.lww.com/academicmedicine by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdgGj2MwlZLeI= on 03/17/2022
reached the limit of their performance
at the same height, an official proposed a
jump-off to break the tie. Barshim asked
if 2 gold medals were an option and the
official promptly replied, “It’s possible,
yes.” Tamberi immediately agreed to a tie.
The act reflects the spirit of Olympism—
the “philosophy of life” that celebrates
“the joy of effort, the educational value
of good example, social responsibility,
and respect for fundamental ethical
principles.” 2 In keeping with this
philosophy, the Olympics can readily
accommodate athletes’ desires to share
recognition for their achievements. We
believe a similar philosophy can apply to
academia, in that guidelines for authors
can be designed to accommodate requests
to honor shared efforts and contributions
to scholarship.
The Olympic games may seem to be an
odd analogy for producing scholarship,
but the goals of Olympic endeavors are
surprisingly similar to those of team
science. 3,4 Ideally, Olympic athletes, much
like academic contributors, participate as
part of a team aiming to put forth the best
possible performance. Team members
contribute in different ways. In sports
like swimming relays or basketball, team
members may play less visible positions
or even compete with one another in
preliminary competitions. In the end,
each member of the winning team
receives a medal for their contribution,
even if they did not swim or play in
the final event. The same principle can
guide authorship in academia and team
science. Individuals who contribute to
and are accountable for the scholarly
product should be recognized for their
contributions through an appropriate
author designation.
Acad Med. 2022;97:315–318.
doi: 10.1097/ACM.0000000000004560
Academic Medicine, Vol. 97, No. 3 / March 2022
Copyright © by the Association of American Medical Colleges. Unauthorized reproduction of this article is prohibited.
The International Committee of Medical
Journal Editors 5 provides criteria for
determining which contributions merit
authorship. Honoring contributions
of scholars through authorship is
nevertheless complex, and authorship
alone does not carry the same weight
across all academic institutions and
academic roles. In some academic
environments, an author’s position in
the byline has become more important
than their presence in the byline because
their position indicates the value of
their contribution to the final scholarly
product.
In recent years, Academic Medicine, like
many journals, 6,7 has received a growing
number of requests for equal contribution
designations such as co-first, co-second,
and co-last author. Such requests are
consistent with findings from a survey 8
of the medical education community
that indicate a desire for greater use of
co-first author designations when authors
contribute equally to a manuscript.
We see this as an important signal of
the changes occurring in the norms
and culture of authorship and a clear
indication of progress in team science.
As members of the editorial team for
Academic Medicine, we have explored
some of the potential reasons for
the increase in requests for equal
contribution designations. We have also
researched and considered a variety of
different approaches for recognizing
author contributions. In this editorial,
we share our current approach to
authorship and, specifically, our approach
to equal contribution designations. We
refer our readers to past publications in
our journal 9,10 and elsewhere 5,8,11–15 for
additional considerations on the topic of
authorship.
What Are Equal Contribution
Designations and Why Might
They Be Requested?
Equal contribution designations can
be used to indicate that all authors
contributed equally or, alternatively,
that authors in certain positions on the
byline, typically first or last, contributed
equally. 6,16 Our review of the literature
and our personal experiences suggest
at least 4 possible reasons for the rise
in requests for equal contribution
designations at Academic Medicine.
Shifting expectations about authorship to
align with team science and supporting
diversity and inclusion in scholarship are,
in our view, 2 positive reasons for equal
contribution designations. Two other
reasons—(1) addressing the growing
pressure to have first- and last-author
publications for promotion, tenure,
and grants and (2) managing complex
relationships and resolving related author
disputes—are potentially more worrisome
and may adversely affect authorship
designations.
The rise of team science, with its
emphasis on interdisciplinary, multi-
institutional collaboration, and
coproduction of knowledge, encourages
larger and more diverse groups of
individuals to work together to advance
knowledge and find solutions to complex
social problems. 3 Individuals with
disciplinary expertise and individuals
with lived experience may work
together across multiple institutions and
communities. 17 These individuals may
have conceptualized the research project
together and may share responsibility for
conducting the research and writing-up
parts of the study. Multiple co-principal
investigators rather than a single
principal investigator may be listed on the
grant that funds the research. Or multiple
people may be volunteering their time—
without funding—as part of a learning
community seeking to solve a complex
problem. Team science encourages
these interwoven and collaborative
relationships.
Requiring team members to determine
author order may at times conflict with
the collaborative nature of team science.
The first author is often considered the
person who contributed most to the
work or the person most responsible
for the work. The last author position is
315
From the Editor
often given to the senior author or the
person who held the role of primary
mentor. Multiple individuals, however,
may have contributed to these roles
in different but equally valuable ways.
For example, multiple members of the
research team may have served in a
mentoring or guiding role for different
parts of the manuscript (e.g., design
of the intervention, analysis of data,
write-up of the manuscript). Additionally,
some members of the team may have
contributed in the context of a role that
has not historically merited authorship.
For example, community members or
patients may have contributed in ways
that profoundly influenced the final
product, librarians may have crafted a
novel and highly effective search strategy,
and informatics specialists may have
designed methods to extract the data that
other team members needed to conduct
the research. The contributions of these
individuals may warrant authorship or
formal acknowledgment in the context of
team science. 16
Ideally, the designation of authorship will
entail dynamic, rigorous, and equitable
decision making throughout the process
of co-creation of scholarship. 10 Such
decision making may be hard to attain
or sustain as research teams are reshaped
or reconfigured, as analytic and writing
processes evolve, and as projects change
over time. Mapping out a plan in advance
for rotating authorship positions related
to publications for a particular study
may seem attractive for some established
teams. Yet this approach may also carry
inequalities, given that articles are likely
to be published in a variety of journals
with variable visibility and prestige, and
given that certain articles are likely to
have more impact than others. Equal
contribution designations may be more
appealing in this situation, reflecting
collaborative effort and allowing
multiple individuals to receive credit for
contributions typically associated only
with first- or last-author positions.
Scholarship benefits from diverse
expertise, experiences, and perspectives.
Therefore, a clear need exists to encourage
and support early career authors, as
well as authors with nonmajority,
nontraditional, underresourced, or
disadvantaged backgrounds. Partnership,
inclusion, and mentorship ensure that the
full range of experiences, interpretations,
outcomes, and implications are included
316
Copyright © by the Association of American Medical Colleges. Unauthorized reproduction of this article is prohibited.
and formally recognized in published
scholarship. 18 Participatory research
and the coproduction of scholarship
are 2 means of increasing inclusion,
allowing scholars with diverse expertise
and experience to contribute to research
and allowing those contributions to be
appropriately honored.
Growing pressure to produce first- and
last-author publications for the sake of
promotion, tenure, and grants may be
another factor leading to requests for
equal contribution designations. 9,19 Many
promotion, tenure, and grant systems still
evaluate the contributions of individuals
by their position in the author byline. 20,21
These systems may introduce pressures
that distort authentic collaborative
approaches to research and the creation
of written scholarship. 9,19 These systems,
furthermore, may discourage people
who are early- and midcareer from
contributing to work that may not yield
a first-author position. The promise of
equal contribution designations might be
offered in advance to foster participation
in larger projects, such as multi-
institution, interdisciplinary studies. In
such cases, clear roles and expectations
ought to be established and agreed to
up front and evaluated throughout
the planning, research, writing, and
publication process. The promise of
equal contribution designations becomes
ethically problematic if team members do
not fulfill their responsibilities as equal
and accountable contributors, especially
if other team members feel obligated to
maintain the original agreement out of
goodwill or to avoid conflict.
Interest in equal contribution designations
may also be driven by a desire to manage
complex relationships and resolve related
author disputes. 15,22 In these instances,
equal contribution designation may
be a diplomatic or convenient way to
resolve issues related to authorship. 22 If
author roles and responsibilities were not
discussed up front and team members
disagree on the amount or value of their
contributions and, correspondingly, their
positions in the author byline, equal
contribution designations may seem
particularly attractive. Such designations
may also be appealing if authors hold
different opinions, based on cultural,
disciplinary, or institutional norms, about
whether team members contributed at the
level commensurate with their position in
the author byline.
Academic Medicine, Vol. 97, No. 3 / March 2022
Some requests for equal contribution
may be analogous to gift or honorary
authorship. 22 A senior or more influential
team member might be offered an equal
contribution designation to increase the
credibility and visibility of an article or to
make a favorable impression. Much like
honorary authorship, 22 team members
with more seniority who have made
minor contributions to an article might
request or demand an equal contribution
designation as last author, despite having
contributed far less than their co-last
author.
A team of authors might agree to
use equal contribution designations
for a number of reasons, some more
worrisome than others. Ideally, these
decisions should be the product of
ongoing conversations among team
members and should be guided by the
tangible contributions of each author.
Our Approach to Equal
Contribution Designations
Equal contribution designations, at face
value, are an appealing means of shifting
from a culture of authorship that has
long emphasized the individual to one
that embraces team-based, collaborative
contributions. Yet, such a shift requires
careful consideration of risks as well
as benefits. Ambiguity around what
constitutes equal contribution for a
given authorship position carries risks
similar to those involved in making
general co-authorship decisions,
including dishonesty surrounding
inflated contributions or honorary or
gift authorship. 9,23–26 Additionally, the
criteria for designating equal contributor
roles vary by journal and can easily be
missed. 27 As authorship culture is in a
state of transition, there are no guarantees
that readers, grant reviewers, promotion
committees, and other stakeholders will
interpret equal contribution designations
as intended, which may disadvantage some
members of the team. These designations
can also be prone to the same inequalities
and biases present in conventional author
bylines. For example, studies found that
in co-first authored articles published in
high-impact clinical journals, the name of
a male co-first author was more likely to be
listed first than was the name of a female
co-first author. 28–30
Ultimately, authorship designations
are the professional responsibility of

the author team. Sound and rigorously
derived authorship designations should,
as in the past, align with International
Committee of Medical Journal Editor
guidelines and should fulfill the ethical
criteria of scholarly contribution and
professional accountability. 5,10 Verification
of author contributions is generally
beyond the scope of journal editors and
publishers. Authors are trusted to make
informed, ethical decisions. At Academic
Medicine, we make this trust clear by
stating in the published article that the
authors “informed the journal that they
agree that [author names] completed the
intellectual and other work typical of the
[first or last] author.”
Academic medicine is entrusted with
advancing the health and well-being of
people, communities, and populations
through the 5 missions of research,
education, clinical care, community
collaboration, and professionalism. As
editors of the journal Academic Medicine,
we are firmly committed to upholding
the ethical standards of authorship 5,12
while embracing innovations and
changes in the culture and norms
surrounding authorship and collaborative
scholarship, including equal contribution
designations.
The full authorship guidelines for
our journal, Academic Medicine,
can be found at https://journals.
lww.com/academicmedicine/Pages/
InstructionsforAuthors.aspx#authorship.
The journal allows equal contribution
designations for first- and last-author
positions. The editors may request
more information about the roles and
contributions of authors, particularly if
more than 2 authors are designated for a
given position. Additional designations
are considered on a case-by-case basis. The
editors do not adjudicate author disputes.
We encourage our readers, reviewers,
and authors to be knowledgeable about
ethical standards for authorship. 5,12
Some journals require authors to use
the Contributor Roles Taxonomy
(CRediT), 13,31,32 which describes 14 roles
associated with scholarly contributions
to research outputs, to increase
transparency. 29,30 Including CRediT or
similar role information in the published
article can make clear the reasons for
equal contribution designations and the
overall author order. This method does
Academic Medicine, Vol. 97, No. 3 / March 2022
Copyright © by the Association of American Medical Colleges. Unauthorized reproduction of this article is prohibited.
not necessarily elucidate the weight of
contributions to each component of the
work (e.g., how much each contributed
to writing the original draft or to formal
analysis). Nor are the 14 CRediT roles
necessarily equal in weight. While we
currently do not require authors to
provide CRediT information for each
author, we encourage authors to use
the CRediT taxonomy and to discuss
equal contribution designations in their
authorship planning conversations.
We also encourage authors to set
specific criteria for what warrants
equal contribution designation and to
periodically revisit these criteria to ensure
they are met and to adjust designations as
needed. 9–11,33
In Olympic team sports, the International
Olympic Committee could choose to
award 1 medal to the most valuable
player on the medaling team. The
committee could also choose to give
athletes medals of different weights to
signify their contributions to the team.
Instead, the committee has chosen to
give identical medals to each member
of the team, an approach consistent
with the value Olympism places on
excellence, friendship, and respect in
support of peace and the betterment of
humankind. 34 When used appropriately,
equal contribution designations can
similarly reflect the value academic
medicine places on generative
collaborations advancing its 5 missions.
Equal contribution designations are
an emerging approach to authorship,
reflecting changes in the expectations
and culture of academic medicine.
At Academic Medicine, we value
collaborative team science, inclusion, and
ethical rigor in authorship. As editors, we
encourage those who submit scholarship
to our journal to be knowledgeable about
authorship guidelines and to engage in
careful and transparent decision making
around authorship.
Bridget C. O’Brien, PhD
Deputy editor, Academic Medicine
Monica L. Lypson, MD, MHPE
Associate editor, Academic Medicine
Teresa M. Chan, MD, MHPE
Associate editor, Academic Medicine
John Coverdale, MD, MEd
Associate editor, Academic Medicine
From the Editor
Mary Beth DeVilbiss
Managing editor, Academic Medicine
Colin P. West, MD, PhD
Deputy editor, Academic Medicine
Laura Weiss Roberts, MD, MA
Editor-in-chief, Academic Medicine
Editor’s Note: The opinions expressed in this
editorial do not necessarily reflect the opinions of
the AAMC or its members.
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