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The Ethics of Cheating

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The very mention of cheating conjures up an image of a desperate student sitting amongst a hundred of his colleagues, peering over the shoulder of his neighbour trying frantically copy down his answers. However, cheating encompasses a wide range of unethical behaviour including plagiarism, and academic dishonesty. Cheating occurs at every level of education, from primary school to higher education. Its severity no doubt increases as one progresses up the education ladder, but it also depends on the cheaters behaviour (whether it is planned), as well as the implications of cheating in that particular test (i.e. the possible gains from performing well). While the classification of cheating behaviours are well characterised, the issue of how to deal with cheaters or to prevent its occurrence remains a grey area. (Baldwin et al. 1996) Cheating occurs across a wide range of subject areas.

However, at medical school, the issue is particularly challenging to deal with. Unethical behaviour can have negative implications at both the local level, where patient care is compromised, as well as a national level, where the mass media can affect public opinion of the medical profession. Indeed, the doctor-patient relationship and the trust in the medical profession by the public is based on the expectation that that practitioners will act with absolute integrity at all times.

Research conducted in the 90's in the US have found prevalence of cheating ranging from 1% to up to 56%. Such a large range is explained by the differences on the definition of unethical behaviour. The most recent study by Rennie & Crosby 2001 analysed data from a survey completed by 461 medical students at Dundee University. They showed that although only 2% of students engaged or considered engaging in more serious cheating such as copying answers at exams, up to 56% said so for copying directly from published text and only referencing it at the end of the paper.

Baldwin et al. (1996) surveyed students from 31 medical schools in the US, and found an average of 4.7% of students reporting seen or been involved with cheating at medical school.

In the period of 2000 to 2006, there have been 135 fitness to practice cases, with 30 cases relating to health, 29 cases of unprofessional behaviour, 17 criminal convictions or cautions, 16 persistence of inappropriate behaviour or attitudes, 10 dishonesty or fraud cases, and a small number for drugs and alcohol misuse, cheating/plagiarism, and violent or aggressive behaviour.

Medicine requires that a student synthesize and understand large amount of material within a short amount of time; moreover students experience a large amount of external and internal expectations to succeed (Bickel 1991). It is also not uncommon for medical students to find themselves in a competitive environment rather than a collaborative one.

In such a competitive environment, a successful cheat yields benefits both in the form of academic grades and social prestige. (Grijalva et al. 2006). On the other hand if a cheater is caught, one loses the moral high ground of the honest self-concept and self honour codes (Mazar et al. 2008; McCabe and Trevino, 2002), as well as risk being caught and suffer the consequences of an unsuccessful cheat, and thus risk losing position, social status, and negative reports. However, it has been shown in surveys that even when being caught was not a factor, the majority would not cheat (Baldwin et al 1996). Indeed, the long term consequences where a cheat may lead to unethical and dangerous practice override more in the minds of medical students than the short term gains of cheating (Baldwin et al. 1996).

Those who cheat are suggested to weigh these advantages against the disadvantages. However, it is believed that there are 2 different types of cheating, one which are pre-mediated or planned, and one which arises spontaneously out of panic. Planned cheating can be seen as more dishonest due to the time and effort spent, and as such, is at a much higher cost of one's honour code than panic cheating. Such ideas may explain the considerably high prevalence of panic cheating than planned.

GOOD MEDICAL PRACTICE
"Patients must be able to trust doctors with their lives and well-being. To justify that trust, we as a profession have a duty to maintain a good standard of practice and care to show respect for human life. In particular as a doctor you must: Be honest and trustworthy."

Cheating in a professional examination is inherently unprofessional. However, the main risk of allowing a culture of cheating to develop is how it affects those who remain honest. Where a culture of cheating is prevalent and unregulated, being honest would be disadvantageous and places pressure on non-cheaters to do so in order to remain competitive (McCabe 2005). In the short term, cheating could result in a doctor obtaining a professional qualification which he may not have otherwise been entitled to. Such untested gaps in knowledge may in itself pose a direct risk to patient health on the ward.

In the long term, unprofessional behaviour may be allowed continue throughout the cheater's career, having successfully cheated previously. These may vary in their level of perceived severity, ranging from financial incentives that influence best medical practice, to the fabrication of investigative results, examination findings, or falsifying death certificates. As such, the consequences of not dealing with cheaters will not just be a matter of honesty in passing undergraduate examinations, but poses multiple risks throughout their professional careers.

Faculty behaviour to cheating is important in fostering the environment at which core moral values are developed. In 2005, based on the many surveys and reviews conducted by himself and others on cheating amongst college and university students, McCabe published a review detailing the best course of action to promote academic integrity.

Of particular importance is the need to address any form of academic dishonesty. Such actions that negative consequences to those who do cheat, and sends a clear message to students that the faculty itself believes in strong academic core values. Preventing the development of a culture of cheating as students will realise that academic dishonesty is met with punishment, no matter how severe it is.

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