Intended for healthcare professionals


“Lifting the carpet” on cheating in medical school exams

BMJ 2015; 351 doi: (Published 18 August 2015) Cite this as: BMJ 2015;351:h4014
  1. Anne L Tonkin, emeritus professor1
  1. 1School of Medicine, The University of Adelaide, Adelaide 5005, South Australia
  1. anne.tonkin{at}
  • Accepted 16 June 2015

A recent case in Australia highlights that cheating is a real challenge for academic medical educators. Anne Tonkin finds both a sketchy literature and a culture that perpetuates cheating—both research and action are needed

A case of exam cheating was reported at an Australian medical school in November 2013. Local and international media coverage followed, with calls for severe penalties, including expulsion, from the profession and the general public.1 Senior students had taken screenshots of a multiple choice question exam that was undertaken using tablet computers and passed them on to students who had not yet sat the exam. Twenty four students were disciplined, with penalties ranging from writing a reflective piece on an ethical topic to failing the exam. Academic staff, including myself, had been aware for about 10 years that students were using a type of “exam recall” to collect questions from multiple choice question exams. In retrospect we did not take it seriously enough because the reproduced questions were inaccurate and did not appear to pose a threat to the integrity of the exams. However, developments in technology have resulted in a highly efficient system for students to recall entire exams with great accuracy. The medical school re-used exam questions from past years, so this cheating was a serious breach of security, providing students with access to some of the questions that they would face in the exam. As such it called into question the school’s ability to certify that graduating students were competent and knowledgeable.

Cheating is known to occur at medical schools, and it can be swept under the carpet by some teaching staff.2 Cheating matters because it threatens the accuracy of assessment decisions, and because unprofessional behaviour in medical school has been associated with later unprofessional behaviour by practitioners. A case-control study …

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