Academic Integrity

Professional Integrity
Clinical Integrity
Student Handbook
Student Handbook
The Honor Code
 Honor Code: AAIMS and Cheating
The All American Institute of Sciences School of Medicine defines cheating as any effort on
the part of a student who willfully misrepresents themselves in an exam or other graded
assignments of required academic activities. These include, but are not limited, to:

• Copying or discussing answers during examinations, including take-home exercises

• Use of non-permitted materials, such as notes, books, or electronic devices, during an

exam or other graded exercise, including on-line or take-home closed book exercises
 Honor Code: AAIMS and Cheating
• Collaborating with others for on-line or take-home exercises when not
permitted

• Copying another person’s written or presented work and representing it as

one’s own (plagiarism)

• Falsifying: 1) clinical reports; 2) experimental results; 3) patient write-ups;

and 4) any other kind of written or presented material
 Honor Code: AAIMS and Cheating

• Providing assistance to other students on a graded exercise

• Preventing equal access to educational resources

• Engaging in behavior/s construed as violating exam conduct principles

• e.g., viewing confidential test information before an examination, looking at other students answer
sheet or talking during an examination, using non-permitted materials, using an excused break
during anexamination to secretly view information related to the examination.
 The Tattle Tale
• All members of the community must be active participants in the
enforcement of this code.
• Students who witness or perceive a violation of the code should always take action
(to tattle tale is commendable).
Student Statement of Rights and
Responsibilities
Academic Integrity and
Research
- BY
BOOBESH
MALAVI
LOLASWI
VINEETH
SURYESH
 Scott Reuben- “Medical Madoff”
◦“... Anaesthesiologist Scott Reuben revolutionized the way
physicians provide pain relief to patients undergoing
orthopaedic surgery for everything from torn ligaments to
worn-out hips. Now, the profession is in shambles after an
investigation revealed that at least 21 of his papers were
pure fiction, and that the pain drugs he touted in them may
have slowed postoperative healing.”

◦This statement was adapted from “A Medical Madoff:

Anesthesiologist Faked Data in 21 Studies
◦by Brendan Borrel, March 10, 2009
In February 2009 a major case of scientific misconduct was discovered. The American
pain researcher Dr. S. Reuben had published 21 papers over a period of 15 years that were
found to be fraudulent. Suddenly many advances in postoperative pain therapy which had
been assumed to be correct seemed questionable. In this review article the lessons which
can be learnt from this case are described.

There are times when it is almost impossible for reviewers or readers of scientific journals
to detect scientific fraud. However, several warning signs can be identified that might be
useful when reading clinical papers.

In retrospect many of these signs were detectable in Reuben’s studies. Based on the
fraudulent papers of Reuben it will be shown how and to what extent falsified results can
affect other types of literature, such as practice guidelines, meta-analyses, review articles
and oral presentations.
Scott S. Reuben, MD, of Baystate Medical center in Springfield, a pioneer in the area of
multimodal analgesia is said to have fabricated his results in at least 21, and perhaps many more
articles.

In addition to allegedly falsifying data, Dr. Reuben seems to have committed publishing forgery.
Evan Ekman, MD, an orthopaedic surgeon in Columbia, S.C., said his name appeared as a co-
author on at least two of the retracted papers, despite having no hand in the manuscripts.
Effects of falsifying research data

◦Fake trial data can substantially affect the conclusions of

meta analysis and can harm patients.

◦This can cause the public to lose confidence in the ability

and integrity of researches

◦Moreover, it can erode trust between researchers and

funding agencies, which may make it difficult for
researches to receive grants.
Effects of S. Reuben’s falsified data
Where is S. Reuben now?
Plagiarism

◦Plagiarism is presenting someone else work or ideas as

your own, with or without their consent, by
incorporating it into your work without full
acknowledgement.

◦Plagiarism may be intentional or reckless, or

unintentional.
 Plagiarism

◦Students who plagiarize or otherwise engage

in academic dishonesty face
serious consequences.

◦Sanctions may include, but are not limited to,

failure on an assignment, grade reduction or
course failure, suspension, and possibly
dismissal.
Falsification

Falsification is “manipulating research materials,

equipment, or processes, or changing or omitting data or
results such that the research is not accurately represented
in the research record.”
 Integrity and Practicing
Medicine. How far will you go?
“The doctor worked as a trainee and was
employed through a medical locum agency.

He was referred to the GMC following a

criminal conviction for providing a falsified
reference whilst applying for locum
employment.

His fraudulent actions were reported after a

colleague expressed concerns about the
doctor’s clinical performance during a
locum shift, which led him to take steps to
verify the doctor’s references.
Enquiries were made to the
nominated referee who indicated
that he had not provided the
reference, nor had it been sent
from his email address.

The doctor admitted that he had

created both the reference and
email address from which it was
sent.”
This statement is from a real-life case and
was adapted from:

Analysis of cases resulting in doctors

being erased or suspended from the medical
register. Report prepared for: General
Medical Council. October 2015.
Falsification of documents
Falsification of documents
is intentionally altering
documents and presenting
them as true.

It may also be used for the

purpose of deceiving a
person.
What are the implications of
falsifying personal documents such
as CV?
The implications of falsifying personal
documents such as CV could mean
more than just losing credibility.

It could lead to loss of job, loss of

credentials or licensing, suspension
from practicing and even
imprisonment.
Working in a field you are not
competent is dangerous. There is a high
risk of patient morbidity and mortality.

Negative effects on doctor-patient trust

relationship.

It can also lead to fear among the

patients and colleagues.
Falsification of documentation in
medical records and the implications.
a. Copying previously entered notes by
colleagues

i. History
ii. Physical Examination
iii. Differential Diagnoses
Copying previously entered medical record notes
entered by colleagues (such as history, Physical
Examination, and differential diagnosis) and
passing is off as your own is considered as
falsification and can lead to loss of job as well as
credentials.

It can also put the patient at risk as the current

information on physical examination is not
reported.

Depending on the severity, it can also lead to

imprisonment.
b. Altering/Destroying previously
entered notes in medical records

This is a criminal offense.

Falsification of prescriptions e.g.
writing prescriptions with fake”
names

Falsification of prescriptions is a
criminal offense which can lead to
imprisonment .
Falsification of documentation in
medical school

e.g. forging signatures on

procedure checklist, presenting
fictional cases as “real” cases.

This is breach of academic

integrity.
Falsification of a medical
record with any kind of alteration
or destruction is considered as
tampering with evidence in
a medical malpractice case.

It is a criminal offense.
Honesty with respect to
competence and its implications

Be honest to self and colleagues.

Know your limits!!!

Honesty corresponds to reality, to
the way the world really is.

Truth-telling or honesty is seen as a

basic moral principle, rule, or
value.
The physician must be able to take
a judgement whether the truth
telling is benefiting the patient or it
is harming the patient by worsening
his medical conditions.
Physicians should be honest.
THANK YOU !
MEDICAL ETHICS AND
LEADERSHIP

INEGRITY AND HONESTY GROUP PRESENTATION

PRESENTED BY: GAYATHRI RAJI

SIVAPRASATH
SATHYA
HARISH
 INTEGRITY AND
PATIENT CARE
Fictional case:

Female surgical resident Dr. Integra spent the last evening

celebrating her 25th birthday at a local bar. She had multiple
alcoholic beverages. Dr. Integra returned home at 4:00am
and fell asleep. At 7:30am she woke up frantic, realizing she
was running late for consultant ward rounds.

The surgical team had a morning routine. The Junior

Resident (in this case KF) would perform a preliminary ward
round at 7:00am (with the intern) then present her findings
and results of past 24hr investigations during consultant
rounds (beginning at 8:00am). The team would then discuss
each case and formulate a management plan.
INTEGRITY AND
PATIENT CARE

 Dr. Integra arrived on the ward at 7:55am, just

enough time to gather medical records.

 Her intern was present since 7:00am and followed

through the regular routine.

 The consultant rounds began as scheduled. The

details of the first patient are as follows:
A 34-year-old woman was admitted for an infected wound on her right foot 2 days
ago. She has a past medical history of type 2 diabetes mellitus. She has had
overnight temperature spike to 101°F, but she has otherwise been asymptomatic
with stable vital signs.

Her blood cultures and wound culture up to last night were still pending. On
admission, she was examined the intern, the senior resident and the consultant.
Aside from her infected wound at the time, her entire physical examination was
unremarkable.

This morning, her physical examination was again reported as normal by Dr.
Integra who was late on arrival and left her stethoscope at home. The intern
had examined the patient and found a harsh 3/6 holosystolic murmur at the
cardiac apex, along with expansion of the wound’s surrounding erythema.

***Of note, the new murmur and elevated temperatures overnight suggested a
diagnosis of infective endocarditis requiring urgent attention.
SUMMARY

 A 34-year-old woman presents with a lower extremity

wound infection.

 The following morning, the medical student notes a new

cardiac murmur and increased erythema surrounding the
wound.

 During rounds, the surgical intern falsifies his physical

examination by reporting a normal cardiac examination.

 The medical student knows that the surgery intern did not
fully examine the patient as he arrived late and was without
a stethoscope.
 What did the intern do wrong,
and what are the implications?

 Clinical Dishonesty

 Patient suffers
 Misdiagnosis
 Late diagnosis
 Significant Morbidity
 Mortality

 Dishonest behavior significantly increases the cost of medical

care provision.
 CLINICAL DISHONESTY

A complex problem that threatens the health and safety of patients. It involves a
disposition to deceive or defraud while engaging in medical practice.

Examples:
 Sharing confidential issues of patients with others

 Lying to the colleagues about mistakes made

 Fabricating examination findings as with the current case

 Carrying out medical treatment without the consent from the patient

● Doing a procedure for financial gain only

● Eg. Perfoming an unnecessary Cesarean Section surgery fabricating to earn money in
excess of a normal delivery while falsifying the indication for surgery.
The implications of clinical dishonesty

To err is human. So if any mistake is made, it should be brought to notice. Hiding

them and lying to colleagues is not a good thing.

I
What should the intern do?
Legal implications for the intern if knowledge of dishonesty is
withheld?
Whistle-blower
A Whistleblower is

 A whistleblower typically works inside of the organization

where the wrongdoing is taking place; however, being an
agency or company “insider” is not essential to serving as a
whistleblower.

 What matters is that the individual discloses information

about wrongdoing that otherwise would not be known.

 In the case study the intern would be considered the

whistleblower
Will the intern be protected as a Whistleblower?

Acts have been passed to protect the whistleblowers

 The Public Interest Disclosure Act (PIDA) of 1998, passed to

protect whistle blowers, also US and Europe commission
acknowledges them.

 Institutional policies are designed also to protect whistleblowers

Example of Whistleblower

Dr. Fata (well known oncologist) was falsely diagnosing patients

with cancer and then administering expensive chemotherapy.
Dr. Soe Maunglay informed the practice manager, George
Karadsheh, and the two gathered diagnostic and treatment records
to use as evidence. Karadsheh notified the FBI of the scheme.
Shortly after, Fata was arrested and his clinic was shut down. It
turned out that he had victimized over 500 patients with his
scheme, causing severe injury and untimely death to many of
them.

Fata’s scheme had been going on for years, and he was good at
hiding it. Sadly, it is sometimes the most successful healthcare
providers that are in the best position to hurt patients without
scrutiny. If Dr. Maunglay hadn’t meticulously gathered evidence
and spoken up to Karadsheh, even more patients could have been
harmed. Fata was sentenced to 45 years in prison in 2015. He was
also ordered to pay back the tens of millions of dollars he stole
from public insurance programs.
REFERENCES
■Rafati, F., Bagherian, B., shahrbabaki, P. M., & Goghary, Z. I. (2020, May 14). The
relationship between clinical dishonesty and perceived clinical stress among nursing
students in southeast of Iran. BMC Nursing.
https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-020-00434-w.

■Alford, C. Fred (2001). "Whistleblowers and the Narrative of

Ethics". Journal of Social Philosophy. 32 (3):402–418. doi : 10.1111/0047-
2786.00103
https://www.whistleblowers.org/what-is-a-whistleblower/

■The meaning and origin of the expression: Whistle-blower" . The Phrase

Finder. Gary Martin. Retrieved 27 January 2017.
https://www.whistleblowerattorneys.com/blog/healthcare-whistleblowers-stories