Choice GP

Cheating

Sometimesoften inadvertentlya publication touches a raw nerve. Editors can tell because the phone starts ringing and letters pour in. Now, because of the rapid responses on bmj.com, every BMJ reader with web access (most of you) can tell. We clearly touched a very raw nerve with our editorial last August on cheating at medical school. The article received 101 responses, 21 of them on one day. In this issue we publish 12 letters in response to the editorial (p 296) and a summary of the other responses (p 299), together with some new material.

The editorial may have evoked such a strong response because it dealt with an actual case and posed two moral questions. An anonymous student from the Royal Free and University College London Medical School described how he or she had seen a student cheating during the final exams. The students expected something to happen to the cheating student, but as far as they knew nothing did. The student graduated and is now presumably a practising doctor. The medical school confirmed the broad facts of the case butmost interestinglynever contributed to the debate that followed the editorial. The moral questions were: Should the medical school have done more? And should the BMJ have publicised the issue?

Respondents were divided, but most thought that the medical school should have done more and that the BMJ was right to publish. Another thread in the debate was that final exams are outdated and students should be allowed to access information during exams. (Otherwise, it encourages the false notion that doctors can carry in their heads all the information they need.) Most disturbing were the responses, some of them anonymous, that added further examples of cheating at medical school.

Shimon Glick in an editorial writes: "There are troubling, if inconclusive data, that suggest that during medical school the ethical behaviour of medical students does not necessarily improve; indeed, moral development may actually stop or even regress" (p 250). A questionnaire answered by 461 students in Dundee shows that many students disagree about what's right and wrong and that many would be willing to do things that they regard as wrong (p 274). For example, only 75% agree that it would be wrong to write "Nervous systemexamination normal" when it hadn't been done (despite it being a lie), and 32% would be willing to do it.

Glick discusses why students might cheat and what might be done about it. Role models are vital, and those who want to pursue this further might access a chilling editorial in this month's studentBMJ on the effects on students of witnessing unethical conduct (http://www.studentbmj.com/back_issues/0201/editorials/2.html).

Footnotes

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