Med Students Think It's Acceptable to Forge Signatures

Medical students think it is acceptable to forge signatures, pass off previous work as new, and falsify patient information, reveals research carried out at one medical school, and published in the Journal of Medical Ethics.

The increasing pressures on medical students to succeed, and the nature of undergraduate medical training itself, may be rather more to blame for these attitudes than any inherent lack of integrity, suggest the authors.

The research team surveyed 676 medical students at one Scottish medical school across all five years of training, using an anonymous questionnaire. This contained 14 different scenarios in which a fictitious student 'John' engaged in various forms of academic misconduct.

'John' forged signatures on his assessments; cheated in exams; said that physical examinations were normal, when he had not carried them out; lent work to other students to copy; and passed off previously submitted work as new.

Students were asked whether they felt John was wrong and whether they had, or would, commit similar transgressions, using a three point scale of 'yes,' 'not sure,' and 'no.' Altogether, 461 students completed the questionnaire.

For five out of the 14 scenarios, there were significant differences in attitude across the various years, particularly forging a doctor's signature on assignments, passing off previously submitted work as new, and falsifying physical exam information. Differences in attitude were also apparent in the willingness to plagiarise.

While most medical students in their first year of undergraduate training would not consider such behaviour acceptable, students in subsequent years took a more relaxed attitude to these transgressions.

The exception was falsifying physical exam information. In year 1 virtually all students thought this was wrong, but by year 4 only just over half thought so. By year 5, however, almost three out of four students disapproved of this behaviour.

The authors point out that the need to acquire signatures from busy and frequently unavailable clinicians to certify completion of tasks for portfolio, rather than exam, assessment in years 4 and 5, may pressure students into forgery.

Steps have been taken to address the issues at the medical school in question as a result of the findings, but the authors make some broader points about medical school education in general.

The medical school environment may also dehumanise students, they say. "Could it be that medical schools, instead of developing integrity and honesty in students, may inadvertently be promoting dishonesty and a lack of integrity?" they ask.

"The concern is not only the engendering of inappropriate attitudes and behaviour at an undergraduate level, but that these attitudes and behaviours may become inculcated into medical practice," they add.

Better strategies to combat academic misconduct are needed, they say.

Click here to view the full paper: http://press.psprings.co.uk/jme/april/me022337.pdf