Dr. Haich, Chairman of the Surgery Department at Best University asks chief resident Dr. Jay to write a review article for the Journal of Biomedical Results (JBR). Jay-whom Haich considers the most brilliant surgeon Haich has ever trained and the best tennis doubles partner he's ever played with-writes the article and gives the draft to Haich at the end of training. Shortly afterward, Jay departs for his new, accelerated position as Chief of Surgery at the world-famous trauma center at Ultimate University Medical School, which is located across town. Dr. Haich asks the new chief resident, Dr. Kai, to finish the manuscript up and get it prepared for publication.

Kai notes right off that the article has an evident lack of organization and that some of the reasoning appears illogical. Before tackling a revision, Kai looks over the bibliography and finds that not all of the references listed are cited in the text. As JBR requires that every reference be cited, Kai reviews the references closely. One of the references is in Japanese-a language that Kai is fluent in and a language she knows Jay cannot speak or read.

Kai tracks down every article listed and reads each article herself-obtaining a translation of those in languages foreign to her. Five of the articles in English sound very familiar. On comparing the papers with Jay's draft, Kai finds that individual paragraphs have been lifted, word for word, from each author. Those paragraphs are pieced together under arbitrary subheadings. Kai does not add articles to the references cited in Jay's draft but she completely rewrites the review from scratch, comparing findings of studies, critically assessing prior reviews, and synthesizing ideas where possible.

When Kai attempts to tell Haich that she has had to completely revise the paper and incorporate many references that had not been cited, Haich laughs saying that he doesn't doubt that Jay might have been preoccupied during the last month of his residency, when Jay was making plans to take on his new job and move to his new house at the shore. "Everybody forgets to cite a reference here and there, Haich says, patting Kai on the shoulder, "but come now-Jay is such a brilliant guy, there couldn't possibly have been all that much additional work to do." Haich tells Kai to list herself as second author-it will help her career and Haich doesn't mind taking "the back seat."

QUESTIONS:

1. Given the various individuals and institutions that might have an interest in this incident, is there any person, or institution, to whom Kai has an obligation to report this finding?
   
   
2. Assume Dr. Kai relays her concerns to Dr. Haich. What responsibilities does Dr. Haich have as coauthor on the paper and as Dr. Jay's former boss, once he becomes aware of Dr. Kai's concerns?
   
   
3. Assume Dr. Haich is unresponsive. What should Dr. Kai do next?
   
   
4. What role, if any, should be given to the cultural element possibly at work in that Kai is unwilling to confront her superior with criticism of a person he respects.