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Are "tomorrow's doctors" honest? Questionnaire study exploring medical students' attitudes and reported behaviour on academic misconduct

S C Rennie, final year medical student, J R Crosby, curriculum facilitator. 

Dundee University Medical School, Curriculum Office, Ninewells Hospital and Medical School, Dundee DD1 9SY

Correspondence to: J R Crosby j.r.crosby{at}dundee.ac.uk

Honesty and integrity are key characteristics expected of a doctor, although academic misconduct among medical students is not new.¹ A survey of 428 American students in 1980 found that 58% reported cheating during medical school.² We assessed students' attitudes and behaviours on "cheating" and aimed to raise awareness of academic misconduct.

	Methods and results

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The survey was initiated, designed, and conducted by students. An anonymous questionnaire was distributed to 676 medical students in all years at Dundee medical school (only half of the fourth years were present at this time). The questionnaire was completed at the end of a lecture and collected by the main researcher (SCR). The questionnaire had 14 scenarios in which a fictitious student, "John," engaged in dishonest behaviour. Students were asked to give their gender, year, and views on informing faculty about misconduct and signing a written declaration.

For each scenario, students were asked whether they felt John was wrong and whether they had done or would consider doing the same. Responses were recorded "yes," "not sure," and "no" (students were not given the opportunity to distinguish between "have done" and "would consider doing"). Results were analysed with SPSS by using percentage frequency responses.

A total of 461 students (68%) completed the questionnaire. Most students' attitude was that most of the scenarios were wrong. The exceptions were resubmitting work from a previous degree, chatting to a student about an objective structured clinical examination that one student has completed and the other is about to do, lending work to other students to look at, and copying text directly and simply listing the source in a reference list.

The proportion of students reporting that they had engaged in or would consider engaging in the scenarios varied from 2% (95% confidence interval 1-3%) for copying answers in a degree examination to 56% (51-61%) for copying directly from published text and only listing it as a reference. About a third of students reported that they had engaged in or would consider engaging in the behaviour described in four of the scenarios: chatting about an objective structured clinical examination, writing "nervous system examination normal" when this hadn't been performed, lending work to others to look at, and copying text directly from published sources and simply listing the source in a reference list.

	Comment

Top Methods and results Comment References

Students consider dishonest behaviour to be wrong and would not engage in it. However, that some students did report engaging in dishonest behaviour is seen as important and worrying. Fewer students consider it wrong to reference published text correctly compared with copying in exams, submitting a senior student's work, or copying another student's work. The responses for some of the scenarios involving plagiarism may indicate students' lack of understanding regarding referencing text appropriately and also a need for clear guidelines. Large proportions of students were also unsure whether exchanging information regarding an objective structured clinical examination was wrong. This may reflect confusion concerning the acceptability of swapping information and a lack of guidance given to students about appropriate behaviour.

Explaining to students what is acceptable behaviour is important when trying to reduce dishonesty. ^{3 4} Shifting the emphasis from assessment to the learning process may result in a decrease in fraud and plagiarism.¹ Academic misconduct is contrary to the ideals of academic and professional integrity and devalues the system of course assessment. It needs to be taken seriously by medical schools as it casts doubt on the validity of qualifications.⁵

	Acknowledgments

We thank Professor D A Levison, dean of Dundee medical school, for supporting this study and proofreading our manuscripts; Professor I K Crombie, professor of epidemiology and public health, for his advice on the questionnaire design and statistical analysis of the results; Elizabeth Brown for her input into the questionnaire design; and the students of Dundee medical school for participating.

Contributors: SCR had the original idea and was the principal researcher, designing and distributing the questionnaire and doing the statistical analysis. JRC commented on the questionnaire and results. SCR and JRC designed the study, did the data entry and validation, and wrote the paper. JRC and SCR are the guarantors.

	Footnotes

Funding: None.

Competing interests: None declared.

The survey used in this study appears on the BMJ's website

	References

Top Methods and results Comment References

1.	Anderson RE, Obenshain SS. Cheating by students: findings, reflections, and remedies. Acad Med 1994; 69: 323-332[Medline].
2.	Sierles F, Hendrickx I, Circle S. Cheating in medical school. J Med Educ 1980; 55: 124-125[Medline].
3.	Baldwin Jr DC, Daugherty SR, Rowley BD, Schwarz MD. Cheating in medical school: a survey of second-year students at 31 schools. Acad Med 1996; 71: 267-273[Medline].
4.	Wagner Jr RF. Medical student academic misconduct: implications of recent case law and possible institutional responses. Acad Med 1993; 68: 887-889[Medline].
5.	Walker J. Students' plagiarism in universities: what are we doing about it? Higher Education Research and Development 1998; 17: 89-106.

(Accepted 18 September 2000)