Saturday, June 6, 2015

Academic Dishonesty as a Medical Student - How Prevalent? What Does the Future Hold for Them?

Earlier this evening, a media ‘exclusive’ was published in the Sydney Morning Herald.  The article is about my own institution, The University of Sydney.  This was a huge shock. This is the place where I was an undergraduate medical student and now the place where I am an academic surgeon who is intimately involved in hands on teaching of medical students.

The article makes the claim that students have been cheating in their Integrated Population Medicine assignment.  The first line of the article makes clear that this was going to be unhappy reading.

“Medical students at the University of Sydney invented patients, falsified records and even "interviewed" dead patients in a serious academic scandal which has shocked the respected medical school.”

Academic dishonesty does occur. No University and within them, no faculty can be totally immune to this.  However, in medicine, the thought of anybody cheating would not cross the minds of many.  There will in fact be some element of denial as we think of ourselves as having ethical and moral behavior as part of our DNA and we also believe that none of us should lack the intellectual capacity to pass an examinable task.   

Do we really have exemplary moral and ethical behavior that makes us stand out above the general population?  I think that see enough to the contrary in the press on an almost daily basis. It makes clear that we in the medical profession have the same human failings as any other group.  I do not need to bore you with the stories of doctors rorting the public purse, goading patients into thinking that they need cosmetic surgery, gross negligence in medical practice and more recently, the uncovering of rampant sexism and bullying culture in specialty training.  On the other hand, there are equally as many, if not more, stories of amazing things that the medical profession is doing for public health and individual patient care. The clear message is that in spite of the amazing things we can do,  we as medical students have the capability for academic dishonesty as anybody else.

However, why should we have a need for academic dishonesty as a medical student?  I am trying to get my head around this.

The pass rates for various subjects or assignments in the medical course are very high but this should not be surprising because it is regularly those who have been high academic achievers who gain entry into medical schools.  It is generally thought that if you can get into a medical course, then you should be more than capable of passing the course.  It has always been my view that if somebody ever failed a subject or assignment in the medical course, that it was a reflection of total lack of application or there being significant external distractions that have impacted upon attention to their studies, rather than anything to do with intellectual ability.  We are talking about less than 10% who might fail on their first attempt and most of these students will get through on a second attempt. Once again, there should be little need and therefore incentive for a medical student to cheat on their examinable tasks.

The SMH article asserts that there is “proven wide spread academic dishonesty.”  There is no citation or proof provided that this is the case. What follows in the next sentence is that the University has acknowledged that there have been three students who graduated last year who are under investigation for academic misconduct. The article also states “It is understood at least 70 students from a class of more than 200 were involved.”  There is no attribution to any organization or individual, even anonymously.  If we consider the class size as being say 350 students, this would suggest that we have 20% of our students who are dishonest and this simply does not fit in with my experience.

I have personally assisted students in identifying or advising them of the suitability of certain patients who would potentially volunteer to assist with their IPM assignment.  As a result of significant hands on teaching of medical students at my clinical school, I do get to know many of them quite well and to suggest that 20% of them were dishonest simply does not stack up.  In the absence of attributing a source whether anonymous or not, makes me suspicious about the validity of these claims.  I have asked the article journalist for a response through twitter and hopefully she will respond to clarify these points.

I am absolutely sure that academic dishonesty does occur in my own faculty and in my own university but I am to be convinced that it is widespread or highly prevalent.  I have personally found the vast majority of medical students that I have interacted with to be kind, personable, empathetic and committed to one day doing the best for their patients. 

If academic dishonesty is occurring whilst as a medical student, I do have concerns. If past behavior is to be the best predictor of future behavior, we have every reason to be concerned if these individuals were to be placed in a position where we count on their honesty.  Did they make up the blood test result that I asked them about because they forgot to look it up?  Did they tell me that the pedal pulses where present even though they didn’t check them and took a gamble that they probably would be?  And one day when a patient asks them as a specialist if they had spoken to the second opinion doctor as they had promised but had not, the line has already been crossed. 

When I think of senior doctors who behaviour rattles me, I think back to their behaviour either as medical students or junior doctors and in highsight I realise that nothing has really changed. This is not to say that people are not capable of change but it worries me.

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Henry Woo is a medical graduate of the University of Sydney.  He is a fractional salaried Associate Professor of Surgery of the Sydney Medical School of the University of Sydney.