Declining Discipline in Medical Schools: Chide the Cheating!
Cheating in medical schools is a ubiquitous phenomenon which has plagued medical schools since long. Academic honesty and integrity are the key characters sought in a doctor, but with cheating being so rampant in medical schools, there is potential of producing incompetent physicians which are more likely than others to continue acting dishonestly with their colleagues and patients. At that time it won’t be about ‘just passing an exam’ but the life of a patient will be at stake. Our profession, in addition to knowledge and skills, demands students to demonstrate high ethical and moral standards.
Cheating in medical context is defined as copying information from another student, taking help from unauthorized notes or electronic devices during exam, submitting someone else’s work as your own, falsifying histories and clinical examinations when they are actually not done. According to a study by Hrabak et al, about 94% of medical students admitted cheating at least once in their college life. Dyrbe et al found that about 27% of students in US medical schools engaged in cheating and dishonest behavior. In a parallel research in Karachi, about 55% medical students admitted academic misconduct.
About 83% admitted telling their friends about questions on OSCE stations. Students widely reported writing fake histories and physical examinations which they did not perform in the first place. The results of these studies are alarming. Medical students in Pakistan go through a rigorous selection process and only a handful of brilliant minds can make it to a medical college.
However, something happens in the course of medical education that changes the behavior of many students and betrays their innocent yearnings. The behaviors which lead students to indulge in such misconduct are multifactorial. In a society where bribes and dishonest behavior are a norm, students are more likely to consider it an easy platform to gain rewards as compared to the one which imbues high ethical standards. Cheating is rampant in institutions where no strict disciplinary action is taken against the offenders because students have the confidence they can get away with almost anything without being punished or reprimanded.
Studies found that peer behavior and pressure to succeed are strong determinants of cheating among students. Burn outs and depression also increase the likelihood of cheating. Students with lower grades and GPA report more cheatings as compared with toppers. McCabe et al found that peer and parental pressure, desire to excel, lower GPA and lack of character are all related to higher rates of academic misconducts. Use of mobile phones and modern gadgets to share answers in examination hall has increased the gravity of situation.
There should be zero tolerance of cheating in a profession which is based on trust and on which human lives depend. There are no easy solutions to this complex problem but each institution should develop strict policies to curb this menace. If the institutions do not prevent or discourage students from cheating then it is more likely that it would act as a predictor for future practice. Research shows that institutions which use a functional honor code are less likely to have cheating incidences.
Medical college faculty must educate students about ethics and morality and it should be integrated throughout medical curriculum. In addition, establishing strict policies against academic misconduct and implementing harsh penalties will greatly help lower the incidence. Objectively structured clinical examination (OSCE) is widely used nowadays. It should be made fool proof as large numbers of cheating cases have been reported during that.
Student skills can be monitored by using multiple clinical evaluations during their study years like mini CEX. In addition healthy grading policies should be introduced and stress learning should be discouraged. Teachers should emphasize on learning rather than grades. This has been supported by research that such measures are associated with lower levels of burn outs and other factors which incentivize cheating.
The reported incidence of cheating is highly variable in different institutions around the globe and both individual and institutional factors contribute to dishonest behaviors among medical students. A culture of honesty and integrity thus needs to be instilled in all students and faculty members. Future of medical profession depends on preserving and restoring public trust in doctors but that trust must be duly deserved and earned.
About the Author: Raiya Rehman is a 4th year MBBS student at Ayub Medical College. She can be reached at [email protected]
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