Director, The Salem Institute of Experimental Biology
Salem - 636 001, INDIA.
24 Manickam Street, Salem-636 001, India.
- S. Omer Sheriff and M.ManopriyaEubios Journal of Asian and International Bioethics 10 (2000), 6-8.
Academic dishonesty is one of the grave ethical concerns of present day education. Fraud in biomedical research due possibly to a 'publish or perish' attitude is much publicized and written about (1). Cheating is one of the common forms of academic dishonesty, which has taken grave proportion in different countries. It is felt that cheating must be a grave ethical and moral concern for society when seen among medical students for moral behavior is considered to be the 'sine qua non of medical practice' (2). Yet in a present set up where majority practice can create a new moral rule, this should never be true for medical education. Sporadic reports of cheating in examination among medical students in the literature call for a real evaluation of our examination set up in India. A recent episode of a medical student being scientifically cut into pieces after he was murdered by another medical student whom had training in human anatomy in the South calls for an introspection of the state affairs concerning medical education (3).
The aims of medical education must be to impart true knowledge to the student, make him attain basic clinical skills apart from developing a character of honesty and trustworthiness. The well-being of a patient depends upon his/her autonomy. The autonomous patient needs to ask questions, make choices, get a second opinion and finally select a trustworthy physician. The character of a physician includes the element of trust, honesty and moral sensitivity. The moral attributes honesty and trust play a very vital role in the process of healing and physician -patient relationship. Therefore apart from the academic excellence of a student, the personality of the physician-student plays a vital role particularly in a mechanized world of medicine. It is taken for granted that a student who studies Medicine must be academically brilliant and morally more sensitive (4). With a greater commercialization of education the amalgamation of merit-based and money-oriented students warrant greater consideration of moral dimension of the personality of the medical student (5).
Keeping these concerns in mind the present study was carried out in a medical institution with the following objectives in mind:
1. To elicit appropriate responses from faculty and students regarding student's behaviour as ethical or unethical with respect to academics;
2. To determine possible differences between the opinions of two groups concerning the behavior of students in the present context;
3. To estimate the prevalence of cheating among students;
4. To provide possible grounds for discussion to find ways and means to understand such actions;
5. To suggest possible solutions
to counter such practices.
Samples taken for the Present Study
to medical (N: 170) and paramedical institutions (Physiotherapy
110 +; Pharmacy 90= 200) were surveyed in this study. The Faculty
Members who responded to the study were (N: 95 M.D.s, 75 Ph.D.s).
The questionnaire prepared for the study and filled by the students and staff had the following points in the questions to be responded to: Copying from Another Student; Allowing another student to copy from you; Observing another student copying; Copying from a `crib sheet'; Taking an exam for another student; Previewing a stolen copy of the next day examination; Delaying in taking an exam under a false pretext; Changing a response/answer from the answer sheet after the script is corrected; Working as a group to write an assignment; Writing a Practical Exercise in the record without doing it; Removing a reference book from the shelf to prevent others to learn from it; Reporting a Lab/X-ray finding as normal without looking at the findings.
Analyses of the responses given by the responders showed that majority felt that cheating does happen in the examinations (88%). The responses revealed that 1-5% of student's resort to such practice. Quite a percentage of staff members were uncertain about the practice of cheating in the examination (20-30%).
Cheating is not a new phenomenon, although there is a evidence to suggest that the incidence may be increasing. In ancient times, the Chinese locked their rising scholars and civil service examinees in individual cells to prevent copying, and the death penalty was in effect for examinees as well as examinees if an individual was found guilty of cheating. Despite these severe punishments and precautions taken cheating reportedly invariably took place (6).
There appears to be a marked recent increase of public concern regarding unethical behavior on the part of elected and appointed officials of State and National Government, businessmen and professionals. Physicians are not therefore immune to these concern and has been implicated in a broad spectrum of dishonest activities ranging from the fabrication of research data to the double billing of Medicare
In academic circles, cheating is the common form of dishonesty. Although cheating has
been studied in virtually every academic venue, much of the literature involves college students. Studies over the last few decades indicate that a shocking proportion of students are reported to be involved in cheating in different parts of the world (8).
Cheating among medical students
one would assume would be significantly lower than that among
undergraduates. A profession historically viewed as highly ethical
would be expected to attract students with strong codes of personal
ethics. Unfortunately such a thing does not appear to be the case.
Studies related to cheating does reveal quite a percentage of
students copy at least once during their study of medical education.
One study showed that those who cheated in the first year were
more likely to cheat during their tenure of undergraduate education
later and seniors are found to be more tolerant of dishonest clinical
behavior than lay men (8).
Why Do Students Cheat?
Why do students cheat? One of the key elements that influences and determines is peer approval and disapproval among students. The dominant influence of the social milieu and moral climate of the institution and family do play a significant role on student's behavior including cheating. Recent attention has been paid to faculty member's attitudes and responsibilities and the importance of an unambiguous institutional policy in fostering or preventing such phenomenon of academic dishonesty (9). In addition to the efforts to define environmental factors that foster cheating, considerable effort has also been made to define the personal characteristics of cheaters, with sometimes - contradictory results. Few of the characteristics that are highlighted are that cheaters, in comparison with their non-cheating peers, tend to score lower on " IQ'' tests and have lower grade-points averages, and are less self-sufficient, more neurotic, more extroverted, over ambitious (10).
In this context it is important to acknowledge that marked changes have taken place in the moral education of students at all levels during the past several decades. The traditional educational emphasis on western moral tradition began to give way to a new morality that was, and is, "silent about virtue'' in some countries like USA. In both public schools and colleges in the United States there seems to the emergence of two moral ideologies:
1. The values clarification movement based upon the notion that none of us has the 'Right' set of values to pass along to other peoples children, the role of the teacher is to help students discover their own feelings, their own ideas, their own beliefs, so that the choices and decisions that they make are conscious and deliberate, based upon their own value system."
2. The cognitive moral development movement championed by Kolberg and based on the premise that children possess certain cognitive structures that come into play in predictable fashion as the individual develops. Not all children develop at the same rate, however, and not all persons attain the same level of moral maturity (11,12). In a general sense the 'Old bag of virtues' is replaced by 'ragbag' of another set of values.
The present educational system has kept its distance from traditional virtues. Unencumbered by the '' old bag of virtues,'' the students arrive toting a ragbag of virtues whose contents may be roughly itemized as follows : psychological egoism (the belief that the primary motive for action is selfishness), moral relativism (the doctrine that what is praiseworthy or contemptible is a matter of cultural conditioning), and radical tolerance ( the doctrine that to be culturally and socially aware is to understand and excuse the putative wrongdoer). Another item in the bag is the conviction that the seat of moral responsibility is found in society and its institutions, not in individuals.
But the practice of medicine continues to be based upon this ''old bag of virtues"- compassion, dedication, honesty, integrity, courage, wisdom, self - sacrifice - these are the virtues we continue to associate with the physician. And not just a good physician, but all physicians. Today's college graduates educated under the new morality arrive at medical school morally confused at best, and given that limited moral maturation occurs during medical school, we have a profession that, in the opinion of many, may well be in moral disarray. In such a situation can we teach ethics without virtue though it is not equally impossible to practice medicine without a code of ethics based upon virtue ?
I think that is why in ancient times physicians had a firm grasp of moral teaching through their religious and cultural background. Many learnt as a part of their curriculum Greek and Latin classics, Treatises on Philosophy and Moral Education.
The moral and ethical consequences
of these shifts in the backgrounds of current medical students
and the growing absence of a shared understanding of the moral
values essential for the students and practice of medicine need
to be seriously taken into account. Some faculty may feel that
some of their students' ignorance of moral values and cultural
diversity of other students are impassable barriers ; other faculty
may see these conditions as opportunities for teaching. One must
remember it would be unconscionable to permit students to graduate
ignorant of the core moral values that the practice of medicine
requires. These values are common to most of the moral system
which include honesty, compassion, dedication, integrity, and
self - sacrifice.
What can we do improve our value system in institutions
1. More effort must be made to integrate new students into the social fabric of the institution. Clearly the emotional ambiance of an academic environment is an important influence on students' behaviors. In general, all are interested in the character of each class but make little or no effort to influence it. We have the usual welcome party, and Annual Day functions. Faculty must realize that it is in the students' best interest to define the culture that they think should characterize the institution, and then should develop a strategy to ensure that this culture will be experienced and hopefully internalized by each and every students. Characteristics such as "supportive", "compassionate", "thoughtful," and "moral" come to mind as important ones in the sought - for institutional culture.
2. Greater emphasis on learning and less on evaluation must be laid. Group learning efforts by students are not intrinsically harmful except when an individual fails to accept an appropriate degree of personal responsibility for his or her learning. Highly individualized evaluation removes much of the opportunity to cheat. (For example, students' performances on pass - fail examinations, which are designed to roam about a body of knowledge in a highly interactive mode, can be used to assess students' capacities to think through unfamiliar problems.) Above all, we need to judge our students on an absolute rather than a relative basis. The later tends to promote a zero - sum situation with a guaranteed " loser " to match each and every winner.
3. Engage faculty and students alike
in a series of discussions regarding the ethical foundations and
core values of the practice of medicine. We emphasize both faculty
and students for two reasons. First, one interpretation of the
remarkable congruence of opinion between the two groups at our
school in regard to the behaviors described on our questionnaire
is that students are adopting faculty values. If such is the case,
then it is clear that the faculty constitute the ethical ballast
of our institution and probably of others. With this role, it
is important for faculty to promote, as far as possible, a clear
and unambiguous set of values for the educational process. This
may be difficult; for example, a significant number of our faculty
appeared to condone behaviors that we consider unethical. While
complete agreement among faculty and between faculty and students
may be impossible, an ongoing discussion of moral and ethical
issues can only have a salutary effects.
Personal honesty has no survival value when everyone else is dishonest - This is an observation made by one of the behaviour analysts earlier. It was felt that there is no intrinsic individual advantage to moral behavior ---- the advantage is to the group; and, in medicine, the attendant benefits are shared by all of society. Moral behavior is the sine qua non of medical practice. However, it is a learned behavior, not a genetic trait; and as already stated, many students do not begin medical school at the desired level of moral knowledge.
One cannot regulate the selection process on moral grounds alone looking for students who all possess the requisite moral principles upon which to base a lifetime of moral actions. Particularly it is difficult at a time when education has become a trade with lots of money game involved in it.
is a field where one cannot compromise on value systems. It is
difficult to change the system but it is possible to change the
attitudes of our students who in spite of wide variations in their
personal characteristics want to learn and become good human beings.
This is reinforced and motivated by the value system that the
institution where they learn adopts to propagate its academic
goals along with the teachers' attitudes towards their profession.
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