Cheating at medical school: reprobates or victims
Perhaps the system is at fault
After cheating in her finals exam, a student at the Royal Free and University College London Medical School was allowed to qualify as a doctor this year.1 An anonymous letter arrived at the BMJ two weeks ago, detailing the event, which we later confirmed with the school. The student had indeed been caught with an Oxford Clinical Handbook two minutes before her long case finals exam. She did not go unpunished. The distinction and prizes she was due to receive were revoked, but she was allowed to graduate with her year.
"Dear Sir,
"I am a graduating student of Royal Free and
University College London Medical School. During
the finals of clinical exams I was witness to one of the
most ugly scenes in my short but eventful life. One of
my colleagues had in a brazen attempt to obfuscate
the examiners made use of her Oxford Clinical
Handbook during her long case. Unfortunately (or
fortunately) for her, she was caught red handed. The
deed was not looked upon kindly by the authorities,
especially when she attempted to extricate herself by
claiming she had also done this in a previous
examination and not been caught - thereby (or so she
believed) justifying her act.... My colleagues and I
were convinced that she would receive her
comeuppance.
"After meeting the disciplinary board, however, she
was allowed to pass her exams without further ado.
Fair play and honesty - two virtues I have always
believed in - have been made monkeys of again. In
future perhaps we should all do as she did. After all,
look where it's got her."
Other students were not informed of the incident, although the anonymous letter we received proved that rumours had already spread. The author(s) of the letter were primarily concerned about why the student had still been allowed to qualify. The decision ultimately lay with the disciplinary board, but the concern expressed in this letter raises the question-was covering up the incident the best thing to do? Perhaps the authorities felt the need to protect this student from the psychological harm that would follow disclosure, conveniently ignoring the widespread, and longer lasting damage done by a cover up. Difficult problems do not go away because they are buried, and medical school authorities should be wise enough to appreciate this. At the very least they have lost the opportunity for some mutual learning. This could have been an opportunity for students and examiners to appreciate why a student may be driven to cheat, the dangers of needing to succeed at all costs, and how medical teachers and the curriculum can be changed so students aren't driven to such extremes.
The danger is that this pattern of behaviour might continue throughout our professional careers. Any vice practised often enough and by enough people soon becomes the moral norm,2 and we will certainly not be under less pressure as doctors than as students. The pressure to perform might lead to cheating on grant applications, paper submissions, and CVs. Research fraud is said to be flourishing in Britain,3 and a correlation between cheating and falsification of clinical information has been reported.2 A recent survey suggested that 36% of medical students would be prepared to cheat in exams, falsify patient information, plagiarise other people's work, or forge signatures.4 One American student even said: "Everyone has cheated except maybe Jesus. Cheating to survive medical school is different from cheating to make money or attain glory."5 Schools and hospitals cannot afford to encourage this type of thinking. They could be stricter with cheats, but perhaps that is avoiding the real problem. Do all the factors that compel some students to cheat need to be there? If not, perhaps it's time for change.
Integrity in medicine is learnt by continually practising within the bounds of ethical medicine. 6 This can be achieved only in a culture of open discussion. The issue for debate is not whether this particular student was adequately punished, but whether the system caused this predicament in the first place.
See also the article 'Cheating at medical schools' by the editor of the BMJ Richard Smith
Jason O'Neale Roach, editor, studentBMJ
studentBMJ 2000;08:303-346 September ISSN 0966-6494
- Smith R. Cheating at medical schools. BMJ 2000;321:398.
- Pellegrino ED. In search of integrity. JAMA 1991;266:2454-5.
- Farthing M. Fraud in medicine: coping with fraud. Lancet 1998;352:S5.
- Christie B. Panel needed to combat research fraud. BMJ 2000;319:1222.
- Dans PE. Self-reported cheating by students at one medical school. Academic Medicine 1996;71:S1.
- Vargo D. How we can deter cheating in medical school. JAMA 1991;266:2456.
