Transforming Toxic Research Cultures: Protecting the Future of Medical Students and Early Career Researchers – Part I

Have you ever felt your passion for research slowly erode under the weight of unfair practices and relentless pressure to publish? Or been denied authorship credit for work you tirelessly contributed to? If so, you are not alone. This is the harsh reality for many medical students and early career researchers trapped in a “toxic research culture.” This hidden crisis undermines the integrity of medical research and jeopardizes the well-being and career prospects of those eager to advance science. Despite its prevalence, this issue remains shrouded in silence, propagating cycles of harm and hampering scientific progress.
This editorial explores the evolution of medical research culture, defines the harmful practices that constitute a toxic environment, and highlights the vulnerability of junior researchers to such practices. Manifestations of toxicity, including bullying, harassment, and unethical authorship practices, are analyzed along with their detrimental impacts on mental health. Current policies and strategies for promoting a healthier research environment are discussed. We highlight the urgent need for reforms, including the promotion of whistleblowing without fear, diversifying leadership, revising evaluation criteria, and implementing educational interventions on research ethics as a preventive measure. Additionally, we explore the impact of fake mentors within academia, advising vigilance against individuals who exploit their roles for personal agendas rather than genuine mentorship.
Through a call to action, we urge stakeholders and institutions to safeguard junior researchers and uphold the integrity of scientific research. IJMS plays a crucial role in this transformation by promoting mentorship, ethical practices, and accessible research.


The Hidden Crisis in Academic Research
The Royal Society defines research culture as the behaviors, values, expectations, attitudes, and norms of our research communities.It influences researchers' career paths and determines the way that research is conducted and communicated. 1Medical research suffers from a hidden problem: a toxic culture that threatens the well-being and development of its participants.While it is known for contributing to scientific medical advances, the reality for many medical students and early career researchers is very different.
Have you ever worked tirelessly on research, only to have your supervisor demand being listed as the primary author, leaving you demoted to a secondary position or not acknowledged at all?Or perhaps you have faced a situation where permission to conduct research was denied because you did not include someone as a co-author, despite their lack of involvement in the actual work.Or have you experienced constant criticism and belittlement from your supervisor, causing you to doubt your abilities and reconsider your research career?If you have experienced any of these situations, you have been a victim of a toxic research culture.These are some examples but not all the potential situations that summarize this issue.
This culture undermines research integrity and threatens the health and career prospects of young researchers eager to advance medicine.It remains covered in a culture of silence and acceptance, despite its prevalence.Addressing this is essential to protecting researchers' interests, maintaining the integrity of medical research, and advancing scientific progress.

Historical Context: Evolution of Research Culture in Medicine
Medical research culture has evolved through various historical milestones being shaped by social norms, scientific advances, and economic pressures.From the systematic observations of Hippocrates 2 to the competitive grant-driven research environment post-World War II. 3 The emphasis on quantitative outputs over qualitative contributions, driven by technological innovations in the 20th century, has significantly shaped today's research culture leading to a publish-or-perish mentality 4 .

Defining Toxic Research Culture
The term "toxic research culture" refers to the spectrum of harmful practices in academic and research institutions that undermine the well-being and professional development of researchers.
Hugh P. McKenna defines it a range of harmful practices, 5 including: 1. Bullying and harassment 2. Poor employment terms and conditions 3. Inadequate practices in equality, diversity, inclusion, and belonging 4. Breaches of research integrity 5. Pathological pursuit of higher league table positions, Hindices, and impact factors 6. 'Ghost authoring' where senior researchers take undue credit for work primarily done by junior staff Factors cultivating this culture include short-term contracts, inadequate salaries (especially for early-career researchers), competitive work environments, and the relentless pressure to publish. 6ahnawaz MG and Siddiqi N. describe toxic research supervisors as individuals who tear apart your work without mercy, publicly humiliate you, offer no support whatsoever, abandon you to fend for yourself, and actively work to erode your confidence and progress. 7e pathognomonic feature of these toxic environments is a hierarchical structure that grants substantial power to a select group of senior researchers.This power mismatch creates a cycle in which junior researchers are compelled to tolerate harsh conditions to advance their careers. 8,9

Manifestations of a Toxic Research Culture
Toxic research culture manifests in various detrimental ways, including: 1.Higher risk of depression and anxiety compared to the general population. 102. Bullying and harassment reported by 43% of researchers, with 61% witnessing such behavior (Wellcome, 2020). 113. Post-traumatic stress disorder, and suicide in severe cases. 12.The COVID-19 pandemic exacerbated these issues by shifting from traditional face-to-face bullying to new forms such as abusive emails. 13. Authorship abuses, such as coercion, guest authorship, gift authorship, mutual support authorship, duplication, ghost authorship, and denial of authorship, which are rampant in hierarchical research structures. 14,15er the last decade, researchers identified several significant issues in research settings such as poor management of personnel, work-life imbalance, bullying and harassment, a culture of publishing that suppresses creativity, high levels of stress, and a lack of diversity. 16

Breaches of Research Integrity
Researchers who felt underappreciated or denied proper credit are more likely to engage in misconduct and unethical behavior. 17ccording to Smith R, the primary reason researchers resort to research misconduct is pressure to publish. 18In toxic environments, the emphasis on productivity metrics often overshadows ethical research practices. 19For instance, a metaanalysis of survey data revealed that 1.97% of researchers admitted to manipulating data and 33.7% admitted to questionable research practices to meet publication pressures. 20his highlights the ethical compromises researchers might make under intense productivity pressures.Junior researchers are especially vulnerable to the negative impacts of such breaches, which can have long-lasting effects on their professional careers.Eric Poehlman, a University of Vermont researcher who spent 12 months in federal prison for falsifying data, attributed his actions partly to a toxic research culture "I was on a treadmill, and I could not get off". 21

The Vulnerability of Medical Students and Early Career Researchers
The inexperience of medical students and early career researchers navigating the complexities of research ethics and professional conduct makes them vulnerable.The intense competition for funding and positions in academic medicine may create a culture of secrecy and self-protection rather than openness and collaboration. 22This further isolates junior researchers who are still establishing their professional identities.
A study by Casadevall and Fang indicates that early career researchers are particularly vulnerable to ethical lapses due to the intense pressure to publish.This pressure is intense for medical students navigating their first research projects because of academic and professional stakes. 23This underscores the need for comprehensive support systems for junior researchers.
Junior researchers often face situations where supervisors or senior authors impose honorary authorship due to hierarchical power. 24The promised authorship or order can suddenly change without their consent.Furthermore, a junior researcher may become a ghost author if they leave their lab before the research is published as their contributions are not properly recognized as co-authorship.

Strategies for Change
1.In a survey of 13,000 researchers from over 160 countries, with strong representation from the top 10 researchproducing countries and diverse minority groups, 49% stated they were afraid of getting in trouble if they asked for assistance. 32It is therefore essential to create an environment where whistleblowing is not seen as a threat to one's own career.This is important for medical students and early career researchers who worry that senior researchers may affect their professional profiles and limit future opportunities.
2. The current system concentrates power in the hands of a few people.Principal investigators are usually given sole responsibility for grants instead of sharing them more evenly among team members.Because of this hierarchical structure, a single principal investigator oversees a large number of junior researchers.Similarly, heads of departments are led by a single person.A fairer environment can be achieved by encouraging leadership diversity and equitable responsibility distribution among team members. 5. Initiatives to reduce the over-dependence on quantitative metrics and research output in evaluating promotions and grant applications.A more holistic view of researchers' contributions could be achieved by Introducing narrative CVs and concordat for career development. 16e Swiss National Science Foundation successfully introduced the SciCV narrative CV format, which broadens evaluation criteria providing insights into academic backgrounds. 35 It focuses on improving the representation of ethnic staff within universities with the aim of equity and diversity in academic environments.

Conclusion: A Call to Action
In conclusion, addressing toxic research cultures is imperative for the future of medical research.By prioritizing mentorship, mental health, ethical behavior, collaboration, and inclusivity, we can create a supportive environment for medical students and early career researchers.Institutions must take decisive action to safeguard the welfare of junior researchers and uphold the integrity of scientific research.
Another important action is to avoid fake mentors.A mentor should be transparent, serve as a role model, and provide experience, support, and knowledge. 368] Tackling toxic research culture includes steering clear of individuals with a poor record of successful mentees, those who are unavailable, unwilling to invest time in your growth, and those with a poor reputation.Genuine mentors will foster a positive and constructive learning environment, unlike fake mentors who may exploit their position for personal gain or fail to provide meaningful support.
Moving forward, abolishing toxic research culture requires implementing policies such as the Wellcome Trust's Bullying and Harassment Policy and advocating for reforms like those in DORA and CoARA.This includes revising evaluation criteria to prioritize quality over quantity, promoting diversity and equitable distribution of responsibilities, and enhancing educational interventions in research ethics.

Role of the International Journal of Medical Students
The International Journal of Medical Students (IJMS) can play a pivotal role in addressing and mitigating the toxic research culture by promoting ethical research practices and supporting early career researchers.IJMS is dedicated to fostering positive change by prioritizing publications that involve mentorship, emphasizing articles that highlight successful mentorship models and strategies for creating inclusive and supportive research environments.By partnering with organizations that advocate for research quality, IJMS ensures that its standards align with the best practices in the field.The journal is committed to accessible research, offering free open access to its publications to ensure widespread dissemination of knowledge.Additionally, IJMS promotes ethical and sustainable research practices, providing a platform for early career researchers to share their experiences and challenges.Through webinars, workshops, and discussion forums on topics like research ethics, mental health, and professional development, IJMS can and will offer valuable resources and support.By advocating for fairer and more holistic evaluation criteria within academic institutions and funding bodies, IJMS aims to transform the research culture into one that is nurturing, ethical, and conducive to scientific advancement.

In this Issue
In the upcoming issue of the International Journal of Medical Students, we feature a diverse array of articles addressing crucial health issues and educational insights.One highlight includes a study on antibiotic use awareness among the Indian community during the later stages of the COVID-19 pandemic, revealing significant gaps in knowledge and proper usage. 39Another study explores the disparities in blindness prevalence among different racial and ethnic groups in Texas, uncovering higher rates among Black individuals, which underscores ongoing healthcare inequalities. 40ditionally, we present an evaluation of tuberculosis-related information on Instagram, noting that posts by medical professionals tend to be more accurate. 41Further, we describe menopausal symptoms in post-menopausal women in Eluru, Andhra Pradesh, 42 and examine the quality of intimate area examination training among Pakistani medical students. 43The issue also delves into innovative educational methods, such as leveraging podcasts for nutrition education and the impact of skipping breakfast on sleep duration among medical students. 44,45reover, the impact of COVID-19 on the U.S. healthcare system and children's physical activity is analyzed, 46,47 alongside a systematic review of stress factors affecting medical students' academic outcomes. 48Other notable articles include an exploration of intrinsic factors causing tendinopathy, 49 and three case reports, one about Bardet Biedl syndrome, 50 another about disseminated tuberculosis and how challenging this diagnostic can be, 51 and a discussion on the potential for continuous rifampicin therapy to induce acute kidney injury in tuberculosis patients. 52Personal reflections from medical students on their experiences with research and patient loss, 53,54 and an acting internship in colorectal surgery, 55 round out this comprehensive issue.These articles aim to enrich the ongoing dialogue on improving healthcare education and addressing health disparities.

3 .
According to Rice et al.'s33 review of 92 faculties worldwide, 95% of promotion and tenure guidelines are influenced by peer-reviewed publications, authorship order, journal impact factors, grant funding, and reputation.It is necessary to update these traditional criteria to reflect modern research practices that encourage diverse contributions.4.Structured educational interventions could be used toimmunize academic environments against toxicity.34A Course on Research Ethics and Integrity could function as a metaphorical vaccination.These would provide researchers with ethical frameworks and resilience against unethical practices and hostile work environments.
Wellcome Trust's Bullying and Harassment Policy (2021) and BEIS's People and Culture Strategy (2021), aim to foster positive research environments by addressing workplace conduct and promoting diversity and ethical practices.Initiatives like DORA (2023) advocate for reforming research assessment to prioritize quality over quantity, while CoARA (2022) works to standardize evaluation practices within the EU.The Research Development Concordat (2023) supports researchers' career development and well-being, and the Race Equality Charter (2023) focuses on improving ethnic representation in academia.