First, second, and last (FSL): a novel metric for assessing author contributions to surgical research based on a 20-year analysis of a surgical journal

The topic of authorship in medical journals is nuanced, with inconsistent attribution of work. Furthermore, the trend toward increasing numbers of authors complicates the comparison of academic productivity. In this work, we demonstrate the utility of a novel ‘First, Second, Last’ metric to evaluate the degree of an author’s contribution to their body of published works.

The Journal of the American College of Surgeons has required explicit author contributions for over twenty years. We reviewed all articles from 2003 to 2022 and created a database to investigate the number of authorship roles performed by author position, as well as determining which roles were commonly performed by different authorship positions. Additionally, the total number of authors and institutions per article published were collected.

The overall number of authors, institutions, and groups per article has increased with time (p < 0.001). The first, second, and last authors have significantly more authorship roles compared to the remaining authors (p < 0.001). Furthermore, the first, second, and last authors are more likely to contribute to study conception & design, analysis & interpretation of data, and drafting of the manuscript, while the remaining authors are more likely to contribute to critical revision of the manuscript (p < 0.001).

In academic medicine, evaluating a candidate’s curriculum vitae or body of publications is a constant process throughout medical school, residency, and professorship. We therefore propose the FSL metric, verified by 20 years of surgical data, which identifies an individual’s ability to drive projects. The metric is simply calculated by counting one point for every publication in which an author is the first, second, or last author. This information will supplement the existing use of total productivity (n) and academic impact (h-index) as a means of assessing an individual’s academic contributions.