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©2023 American Medical Writers Association. All rights reserved.  
ISSN 2163-5315

AMWAJournal.org     38

ABSTRACT 
Over the past 75 years, medical publications have included 
a growing number of authors. As a result, research teams 
face challenges in deciding who qualifies for authorship 
and in what order the authors should be listed. These chal-
lenges can lead to tension among research teams that is 
related to a large number of authors, a lack of knowledge 
about authorship guidelines, limited experience in research, 
power dynamics and work culture, and even unethical prac-
tices. To overcome these challenges, research teams may 
look to medical writers and editors for guidance. As a result, 
medical writers and editors need to be prepared to share best 
practices for deciding which authors qualify for authorship 
and which authors should be listed in the acknowledgments. 
Medical writers and editors also need to be aware of and 
advise against unethical authorship practices, including hon-
orary authorship and ghost authorship. Medical writers and 
editors can also guide research teams in best practices for 
ordering authors, including understanding the meaning of 
author positions, determining author contributions, planning 
authorship from the start, establishing authorship responsi-
bilities, agreeing on how to resolve disputes, keeping track of 
contributions, and documenting discussions about author-
ship. With this guidance, research teams can adopt best prac-
tices for ethically granting authorship and fairly ordering 
authors based on their contribution to the work.

Until the 1950s, publications were largely written by 1 author.1 
Since then, publications have included a growing number 
of authors, especially publications in medicine.1,2 Between 
1945 and 1988, medical publications gained 1.26 authors 
every 15 years (versus 0.41 authors in other branches of 
science).2 And across the sciences, the greater number of 
authors on publications has paralleled the rise in interna-
tional and interdisciplinary research collaborations.3

 This rise in the number of authors has created 2 import-
ant challenges. First, research teams must decide who qual-
ifies for authorship. And second, they must figure out the 
order in which to list the authors who contributed to the 

work. These challenges can occur in any research team,  
but they can be exacerbated among junior researchers 
who are not well versed in best practices for authorship or 
among teams that have unethical authorship practices.4,5 
To overcome these challenges, research teams may look 
to medical writers and editors—internal or external to the 
team—for guidance.
 To help medical writers and editors guide research 
teams, they need to fully understand the guidelines for 
authorship. They also need to be prepared to share best 
practices to help research teams determine who qualifies 
for authorship and strategies to help them determine in 
what order authors should be listed.

WHO QUALIFIES FOR AUTHORSHIP?
To determine who qualifies for authorship, many journals 
provide guidance on their website. Most often, these jour-
nals recommend that research teams use the guidelines 
created by the International Committee of Medical Journal 
Editors (ICMJE).6 According to the ICMJE, each author 
should fulfill all 4 of the following criteria.

1. The author made substantial contributions to conceiv-
ing or designing the work, or to acquiring, analyzing, 
or interpreting the data for the work; and

2. The author drafted the work or reviewing it critically 
for important intellectual content; and

3. The author reviewed and approved the final version of 
the manuscript to be published; and

4. The author agreed to be accountable for all aspects of 
the work, including being willing to answer questions 
about the accuracy or integrity of any part of the work.

 To ensure that listed authors meet all these criteria, many 
journals ask research teams to include a description of what 
each author contributed to the work in the manuscript, 
which the journal often publishes with the manuscript.
 But what if a contributor does not meet all 4 authorship  
criteria? These contributors should be acknowledged 

Crystal R. Herron, PhD, ELS / Redwood Ink, LLC, San Rafael, CA

Best Practices to Guide Decisions of Authorship and Author Order  
in a Research Manuscript

CONSCIOUS WRITING

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AMWAJournal.org     39Best Practices to Guide Decisions of Authorship and Author Order

instead.6-8 For example, contributors who supplied funding, 
research materials, lab management, administrative support, 
or writing and editing assistance may not meet all 4 criteria. 
These contributors should be thanked for their specific con-
tribution (eg, provided funding, critically reviewed the manu-
script, collected data) in the acknowledgments section.
 Some research teams disregard this guidance and  
grant honorary authorship.5,9 In other words, they give  
“gift authorship” out of respect or gratitude for someone 
(eg, supervisor, department head) or “guest authorship” to a 
well-known researcher to try to amplify the quality or pres-
tige of the paper. In some cases, honorary authorship may 
also be related to “pressured authorship,” in which a person 
of authority pressures more junior staff to include them as 
an author when they do not qualify.9 Because these prac-
tices are unethical and can be considered research miscon-
duct, medical writers and authors need to be prepared to 
advise against these practices.
 Another type of authorship is ghost authorship. With this 
form of authorship, a contributor is not listed as an author, 
even if they made contributions worthy of authorship.5,9 This 
practice occurs for a number of reasons, such as an author 
electing to exclude themselves or a research team hiring a 
professional writer. The ethical nature of ghost authorship 
is complex and should be discussed carefully among the 
research team and other contributors. For example, if a pro-
fessional writer qualifies for authorship based on the ICMJE 
criteria, they should be included in the author list.10

IN WHAT ORDER SHOULD AUTHORS BE LISTED?
Once a research team determines who qualifies for author-
ship, they must figure out in what order to list the authors. 
This process can be challenging, partly because ordering 
conventions vary between fields, guidelines, and journals. 
And the ICMJE guidelines do not provide any guidance on 
how to determine author order.6 Some journals offer guid-
ance that can help research teams determine author order. 
But with professional guidance from medical writers and 
editors, and some easy strategies, research teams can agree 
on a fair order to list the authors.

The Emphasis on First and Last Authors
The 2 most coveted (ie, most valuable) positions in a publi-
cation are the first and last author positions. The first author 
is most often the person who has contributed the most to the 
work.7,8,11 This contribution can involve designing the study, 
performing experiments, collecting data, analyzing data, 
writing the manuscript, or other tasks related to the project.
 The last author is usually—but not always—the super-
visor or principal investigator who oversaw the project.12 
In some fields, the person who oversaw the project may be 

listed as the first author. The person who oversaw the proj-
ect often receives much of the credit when the project is 
successful, or the criticism when something goes wrong.

The Importance of Corresponding Author
The corresponding author is the person who takes primary 
responsibility for communicating with the journal. They 
ensure that all required information is submitted to the 
journal, and they receive all updates related to the submis-
sion, such as the status, reviewers’ comments, and final 
decision.6 The corresponding author is often the person 
who oversaw the project, so most research teams will desig-
nate the last or first author as the corresponding author.13

The Relative Contribution of In-Between Authors
Between the first and last author positions, authors are  
usually listed according to their relative contribution to the 
work, from the most to the least.7,8 To determine this order, 
many research teams use a mathematical approach. They 
will choose which items will appear in the manuscript, 
determine how much each author contributed to those 
items, and then rank the items based on their importance to 
the manuscript. Then, they will calculate each author’s total 
contribution to the manuscript and order the authors from 
the most to least contribution.

The Challenges of Equal Contribution
In some cases, research teams believe (or calculate) that 
more than 1 author contributed an equal amount to the 
work. And this equal contribution can apply to any position 
in the author order, including the first and last positions. 
Some journals will let research teams indicate whether 
authors contributed equally to the work. But even then, the 
team has the (sometimes daunting) task of choosing the 
order of the authors who contributed equally.
 This task can be even more challenging when the equal 
contribution applies to the coveted positions of first or last 
author.14 For example, the first “first” author will get more 
visibility than the other “first” author because the first “first” 
author is the first—and sometimes only—name a reader 
will see. This same challenge can occur with the last author 
position, because the last “last” author often gets the most 
credit for the work.
 What can you do to settle a debate about equal contribu-
tion? A simple approach is to just list them alphabetically, 
although the use of this approach has declined over time.15 
Some research teams will order authors who contributed 
equally by their seniority in the group, the degree of diffi-
culty needed to carry out a specific part of a project, or a 
combination of these approaches. And other teams get  
creative. For example, a researcher at Stanford University 

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AMWAJournal.org     40Best Practices to Guide Decisions of Authorship and Author Order  

had 2 researchers in his laboratory play 3 games, and the 
winner was given the first slot.16 This approach is certainly 
not conventional, but it added a fun spin to an otherwise 
daunting task.

HOW CAN TEAMS PREVENT AUTHORSHIP 
CONFLICT?
Discussions of authorship and author order can lead to con-
flict among research teams. And this conflict is influenced by 
a variety of factors, including power dynamics, experience in 
research, and the culture in the institution, department, or 
laboratory.4,5 To navigate these conflicts, medical writers can 
guide research teams to use the following best practices.

Plan Authorship from the Start
The best way to mitigate any issues in granting authorship 
and ordering authors is to plan authorship from the begin-
ning of the project, before the writing or even the research 
project starts.7,8 During an initial meeting with the research 
team (or an established committee for larger studies),17 dis-
cuss the ICMJE guidelines and define what is considered a 
contribution that qualifies for authorship in the context of 
the project. This approach ensures that all potential authors 
know the expectations—and potential consequences of not 
meeting them—from the start.

Establish Authorship Responsibilities
In planning authorship, discuss and clearly define the roles 
and responsibilities of each author (ie, who will do what), 
with the caveat that these contributions may change as the 
project evolves. These discussions could be facilitated by 
creating a modifiable authorship grid that clearly outlines 
the responsibilities and contributions of each potential 
author.18 This grid could be informed by standard taxono-
mies of author contributions.19,20

Agree on How to Resolve Disputes
Before a potential dispute occurs, discuss how the team 
will resolve disputes that may arise. This discussion will 
ensure that the team has an objective approach to manage 
a dispute. For example, the team could agree to resolve dis-
putes with a neutral third-party, such as an administrator or 
researcher far removed from the work.12 Or the team could 
get creative, as the Stanford researcher did, by having 2 
authors play a game to determine the author order.16

Keep Track of Contributions
As the project and writing progress, keep track of every-
one who contributed to the work and how they contrib-
uted. Then, at regular intervals or major milestones, discuss 
authorship and whether your team might need to make 

adjustments to ensure all contributors qualify for author-
ship based on the ICMJE guidelines. If the team is using 
an authorship grid18 or other tracking method, be sure to 
update the tracker with each discussion.

Document Discussions About Authorship
To ensure a smooth authorship process, summarize all dis-
cussions in an email or document so they can be tracked. 
Ask all potential authors to review this document and agree, 
in writing, with the described details. This approach will 
ensure all authors stay aware of their contribution to the 
project. Then, when submitting the manuscript, declare 
the authorship contributions (and even clarify the order of 
authors)12 in the manuscript where appropriate.

CONCLUSIONS
Authorship can be a source of tension among research 
teams. This tension may be related to the rise in the number 
of authors, knowledge of authorship guidelines, experience 
in research, power dynamics and work culture, and even 
unethical practices among teams. With guidance from med-
ical writers and editors who are well versed in authorship 
best practices, research teams can adopt procedures for eth-
ically granting authorship and fairly ordering authors based 
on their contribution to the work.

Author declaration and disclosures: The author does not have 
any commercial associations that may pose a conflict of interest 
related to this article.

Author contact: crystal.herron@redwoodink.com

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