A submitted paper detailing the negative experiences of overseas doctors applying for a training post in a district general hospital was poorly presented and scientifically weak, but on a topic of great interest and importance. The study consisted of an analysis of the CVs of the applicants and an analysis of responses to questionnaires sent to them with their rejection letters. Over a third of the questionnaires were returned. The editors were concerned that the authors had used the applicants’ CVs without their permission, and that the applicants were unaware that they would be used for reasons other than a job application. The CVs were not anonymised before the authors analysed them. And the study did not seem to have been submitted for ethical review. The thinking was that the overseas doctors might have been subtly pressurised to complete the questionnaire. In response to these concerns, the authors said that the study had been approved by the human resources department, who "own" the CVs, and the postgraduate tutor, who is responsible for pre-registration house officers. The study had also been informally submitted to the local research ethics committee whose view was that as it was an audit formal ethical approval was not warranted. The authors added that they did not ask for "permission" from the doctors as they felt implicit in the questionnaire was the fact that their answers would be used as part of the audit. The questionnaire was completely anonymous, they said, so to have asked the doctors “to sign a statement would have destroyed feelings of confidentiality which we felt were so important to the study.” The authors also enclosed a copy of a letter from their director of personnel and development in support of the above. The editors also wrote to the postgraduate dean and the chairman of the research ethics committee. The postgraduate dean replied that he was not aware of any formal approach for approval of the study, although he acknowledged that the postgraduate clinical tutors operate with a high degree of autonomy. The dean also stated that, in his opinion, the work was research and not audit. The chairman of the local research ethics committee wrote: “The part of the study involving sending questionnaires to the unsuccessful applicants was essentially research. …If consulted, we would probably have suggested that this part of the study required ethical approval. Individual consent would not have been required. However, the collection of individual comments may well have met with a different response. It is likely that we would have requested that further information outlining the purpose of the study and details of potential dissemination would have been required. We are not in a position to give retrospective ethical approval for research. We felt it was important that this information, having been obtained in good faith, should not be wasted. There was, however, concern that such a retrospective study, without adequate scientific scrutiny, may have introduced biases.”
- One way to rectify the use of the applicants’ data without permission would be to write to them and ask for retrospective permission. - The attitude of local research ethics committees varies and the authors might have found it difficult to obtain a review because the research did not concern patients. Nevertheless, the authors should have attempted it. - An ethics committee could have helped them draft a statement to potential applicants. - The human resources department does not “own” the CVs. - The likely harm from sending out the questionnaire was minimal in this instance, but the seemingly casual approach to the maintenance of confidential personal information at the trust was a cause for concern. - The editor should write to the authors to inform them of COPE’s views. - The editor should also ask the trust’s chief executive to look into the use of confidential personal information in the trust.