Intended for healthcare professionals


Staying safe by avoiding plagiarism

BMJ 2011; 342 doi: (Published 30 June 2011) Cite this as: BMJ 2011;342:d3963
  1. Harvey Marcovitch, associate editor, BMJ
  1. 1London
  1. h.marcovitch{at}


It is easy for doctors who need to write for training or research to fall into the trap of plagiarism. Harvey Marcovitch outlines ways to avoid the pitfalls

As a medical student or in continuing medical education you may be told to write an essay on patient confidentiality. It isn’t a topic to which you’ve given much thought, although you have vague memories of a lecture about it during your first week at clinical school.

You start where you always start by finding a definition on Wikipedia and jotting down a few ideas that are in your head. You have access to a number of journals, and searching “confidentiality” brings up dozens of citations. You browse the most promising, picking up ideas and storing them away for future use by some judicious copying and pasting. A helpful librarian produces a booklet from the General Medical Council (GMC) on confidentiality, and you are away.1

Plagiarism detection tool

When you start piecing together the collected data you run into a problem. You can’t recall where some of the copied material originated, so to avoid any charge of plagiarism you miss out a sentence or two and change some words in others. Feeling moderately satisfied with your efforts you are surprised when you receive a note asking you to see your academic supervisor, who informs you that the medical school submits essays randomly to the plagiarism detection tool, Turnitin ( He shows you its originality report on your work, and you are horrified to learn that three paragraphs and 21% of the whole represent already published material for which you have not included an attribution. Because you are new to the game, and it’s a first offence, the sanction is simply a verbal warning that if it happens again you could be in serious trouble. You come away bewildered because the techniques you applied in writing your essay were no different from those you were used to at school, where you were often commended for your writing.

You are in good company or, at least, quite big company. A survey by the Freshminds recruitment consultancy2 showed that 24% of students who responded admitted to plagiarism, when defined as “inserting sections of text from any outside source into your own work, whether they are left whole, or amended to conceal their origins.”

A less prescriptive definition is “presenting the work of others as if it were your own by not properly acknowledging the source.” Another way of putting it is that you have stolen someone’s intellectual property. The most serious form of plagiarism is, of course, to take another person’s original work and pretend that the new or critical data it provides are your own. There are cases of individuals, some in surprisingly senior positions, who have discovered somewhere in an archive a little-read doctoral thesis and blatantly republished parts of it under their own name.3

Innocent plagiarism

Of course, one can stray into plagiarism without malicious intent, a far greater risk for a medical student. Thus, you might simply include in your essay a verbatim paragraph or two from an existing publication either because you did not realise you needed to make it clear whose words they were or because you had simply forgotten where you obtained the extract.

Language difficulties might also produce problems. A frequent response to medical journal editors, alleging plagiarism in a paper submitted by someone whose mother tongue is not English, is that the author did not have the fluency to improve on the words already used in the source material.

Another explanation (or excuse) is that the paper described repeating an experiment whose results had been previously published; the method was identical so the author could not better the description in the original report. In certain parts of the world editors have been told in all seriousness that repeating the words of one’s seniors is a mark of respect, not an example of dishonesty.

Common knowledge versus original work

What it comes down to is the need to differentiate between what is universally accepted and regarded as common property, such as a dictionary definition or an acknowledged moral concept, from original statements by another person.

For example, you might want to make the point that, in dealing with a breach of confidentiality, negotiation is better than conflict. You illustrate the point by using the analogy of Winston Churchill’s phrase “Jaw-jaw is better than war-war.” The key idea is surely universal, so you have no need to burrow into history to see which ancient Greek might first have expressed it. But Churchill’s aphorism is original so you must attribute it to him.

Or take my first sentence in the previous paragraph, which so far as I know came straight out of my head even though it is scarcely an original concept. Once this article is published I have a right to my name and the source being quoted if you find the sentiment so felicitous you want to use it in an essay of your own. This you can achieve either by prefacing the sentence with “As Marcovitch stated . . .” or, if you prefer, simply repeating the sentence followed by a citation in conventional form, either as a superscript number or as the name of the author and date in brackets, referring to a full reference quoted at the end of the essay.

Using someone’s words is often—possibly even usually—a sign of sloppiness rather than dishonesty, especially in a naive writer. You can look at it as more akin to breaking the speed limit than to dangerous driving. What is much worse is to take not just words but the key ideas that are a critical aspect of someone’s work. Thus, when researching your essay on confidentiality, you found an interesting paper about assuring confidentiality in shared electronic records.4 It was not an issue you had ever thought about, and you find it intriguing so write about it. You need to stop and think. In your enthusiasm, have you presented McGilchrist et al’s ideas as your own by not making it clear that they were the source of your information?

How much copying is too much?

Some sentence constructions, especially in a common topic, such as patient confidentiality, may be so often repeated as to be inevitable. Is there a limit? Or, putting it more cynically, what can you get away with?

One clue comes from the plagiarism reference tariff, designed by the Plagiarism Advisory Service.5 Now used by an increasing number of universities to standardise their response to plagiarism, it assigns points on the basis of the amount or extent of copying; whether critical aspects (key ideas central to the assignment) are included; how senior is the student; how valuable the assignment; and whether there is evidence of a deliberate attempt to disguise plagiarism. Each criterion is allotted a score and the total defines the suggested sanction. Thus, if a senior student, as part of summative work, writes an essay in which four sentences have been plagiarised, albeit some words have been changed in an apparent attempt to defeat detection software, he or she would receive 290 points. This is sufficient for a formal warning and the assignment being awarded 0% with a requirement to resubmit. If, in a final year dissertation, a student plagiarised three paragraphs, including key ideas and tried to disguise the fact, he or she would receive 400 points, giving the medical school the choice of awarding 0% and requiring a resubmission, which would result in a capped or reduced mark, or of awarding 0% with no opportunity to resubmit.

Once registered, practitioners have to follow the precepts laid down by the GMC. Honesty in research and in publication forms part of those. Indeed, the GMC has erased at least one doctor from the UK medical register for taking data obtained in a research project performed by colleagues and then submitting it to a journal and having it published under his own name with an entirely fictitious co-author (on whom he tried to lay the blame). A senior medical academic was suspended for three months by the GMC, a sanction that its fitness to practise panel described as “sufficient to send out a signal to you, the profession and the public that plagiarism is unacceptable behaviour.”6

Recycling material

Can you plagiarise your own material? Logic demands the answer “No” because you cannot steal your own property. What you can do, however, is mislead readers into assuming that they have original material before them. What journalists sometimes refer to as “recycling” is unacceptable in medical publishing, where it is referred to not as plagiarism but as duplicate or redundant publication. Duplication of research trial material is particularly hazardous because it may corrupt the result of a subsequent systematic review. But even apparently harmless recycling of a review paper, especially if paid for or producing a reward such as a high mark in an assignment, has the feel of passing off second-hand goods as new, so is best avoided.


Related to plagiarism is the legal concept of copyright. Published work is the property of the author or of the publisher, depending on the contractual agreement they have reached. That means that it may be illegal to copy a substantial part of the material without permission from the copyright holder (who might charge for the privilege).

There are various defences, such as use of the material for non-commercial research, criticism, or review. What matters is whether the copied material represented a considerable proportion of the work in question, whether acknowledged or not. In English law there is no copyright in an idea but only in how that idea is expressed, so one can be a plagiarist but not infringe copyright and vice versa if you acknowledge the source but use a substantial amount of the material.7

Given the purposes to which an essay is put, it is highly unlikely that a student would face an allegation of breach of copyright, but you should be cautious, especially when reproducing illustrations such as charts, graphs, or the McDonald’s logo.

Communicate in your own words

In the end, the safest route is to ask yourself why you were asked to write the essay. Most likely it was not to entertain the examiner but to demonstrate your critical powers and your ability to analyse and communicate complex material. All of these are essential skills for the budding clinician or medical academic. Therefore, you need to show you can perform these tasks, and a gift for navigating the net and a facility for copying and pasting is not the solution even if it is a useful means to that end. If you can use published material to inform your own ideas on a topic and then to communicate it using your own words, limiting those of others to a minor degree and always with appropriate acknowledgment, then you are unlikely to offend even the most suspicious supervisor or rigorous plagiarism detection tool.


  • Competing interests: The author received travelling expenses for attendance at meetings of the Committee on Publication Ethics when chairman.

  • Adapted from the Student BMJ.


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