Integrity during Medical Studies

Ofer Bat

Background. Doctors’ unprofessional behavior is a problem, which can be

identified during the period of medical training. A recently published study in the

United States, in 20057, found that there was a strong correlation between

unprofessional behavior of medical students and subsequent disciplinary actions once

they entered professional practice. Medical educators, and the institutions responsible

for licensing and certification of physicians have come to recognize the need for

teaching medical students and residents about professionalism during the period of

undergraduate and postgraduate medical education. The integrity of students during

their professional training has been investigated in a number of faculties in Israeli

universities; this study represents the first attempt to document the integrity of Israeli

medical students during their training.

Purpose. This research sought to investigate: 1) extent of the dishonesty behavior

among medical students at the Hebrew University; 2) faculty estimates of the extent

of students’ dishonest behavior; and 3) invigilators' estimates of the cheating

phenomenon.

Methods. An anonymous questionnaire was distributed to medical students in both

the pre-clinical (years 1, 2) and the clinical years (years 4, 5), to both senior and

junior teachers in the medical school, and to exam invigilators. The student

questionnaire was based on a questionnaire developed by Yoel Heshin who

investigated the integrity of students in a Faculty of Law. The questionnaire was

modified and validated for utilization in the medical school. The questionnaire was
given to 300 students with a 90% compliance rate, 100 staff members with a 31%

compliance rate, and 27 exam invigilators with a 63% compliance rate. The statistical

analysis is based on the distribution of the answers to each question as well as

additional analysis of the answers in relation to selected demographic variables.

Results. A majority of the students in the Faculty of Medicine report that they or

their peers violated the medical school's rules and regulations and those stipulated

by the university with regard to cheating, and that they behaved dishonestly during

tests or while studying. The perceptions of both faculty and exam invigilators would

appear to support the above findings. Many students indicated that they viewed the

chance of being caught cheating as not being very high. A large number of the faculty

members think that the rules and regulations with regard to cheating fail to serve as

an effective determent, and in addition that the actual enforcement of these rules and

regulations is low. It would also appear that for many faculty members the

enforcement of these rules and regulations is perceived as a potential threat to the

manner in which students might evaluate their teaching. Both pre-clinical and clinical

faculty members hold the view that dishonesty is prevalent among medical students.

Conclusions. The findings of this thesis suggest that phenomenon of dishonesty is

widespread in both the pre-clinical and the clinical years of training. Furthermore, it

would appear that both members of faculty and students believe that insufficient

attention is given to teaching professional values during the period of undergraduate

training. A majority of the exam invigilators indicated that they reported to their

supervisors about students who cheated during examinations. However, they believed

that no disciplinary action was taken against these students. Students indicated that

they are less likely to engage in dishonest activity when they believe that the

punishment for the violation is likely to be severe. Dishonesty amongst the students

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in the medical school of the Hebrew University would appear to be as pervasive, as

has been found to be the case in other faculties in Israel that have been studied. (For

example, the Law Faculty of the Hebrew University). The medical school should

conduct a self-evaluation of its enforcement polices and methods for teaching

professional behavior, in order to prevent students from indulging in dishonest

behavior and improve the integrity of its students during medical studies.

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