Medical students see that academic misconduct is common

Editor—Rennie and Crosby found that the threshold for cheating is low among medical students.¹ In an accompanying editorial Glick commented that a “pervasive institutional culture of integrity is essential” to encourage professional conduct and minimise fraud.² Academics should be a role model in terms of good scientific practice, but we are far from this ideal.

In 2000 I introduced into the curriculum a seminar for fifth year medical students. We discussed principles of scientific integrity, according to guidelines of the German research council,³ which had just been put together after a high profile case of scientific fraud.

In 2000 I taught this course six times. On each occasion I distributed a 10-item questionnaire. Altogether 229 students completed it (response rate 97%). Of the 201 who had already done research for their MD dissertation, 12 “completely agreed,” on a 5-point Likert scale, with the statement that the climate in their research group was such that “students have to deliver the results that are expected by the supervisor.”

International authorship criteria demand that authors should have participated both in planning or conducting the research and in writing or critically revising the manuscript. Of the 51 students who had already been listed as coauthor of a research paper, 18 reported that at least one of these criteria had not been met in their own case and 24 said that at least one had not been met by at least one of the coauthors; 16 reported that the department head had been made an honorary author.

Sixteen students had been omitted as author from a publication despite having contributed work, and nine had been the victim of plagiarism. Five admitted that they had themselves taken words or ideas from other people without credits, five that they had presented results selectively, and seven that they had trimmed or falsified results.

Of the 201 students who had done research, a high proportion reported that they had observed others engaging in unethical practices. These included selective reporting (43%), trimming or falsifying results (36%), wrong or inappropriate authorship attribution (25%), multiple publication of the same result (“salami publication”) (18%), presentation of results in a wilfully misleading way (14%), and plagiarism (14%).

Certain forms of academic misconduct are still common. We may therefore have difficulties creating “a peer pressure in which certain behaviour simply is not acceptable.”² Medical students are being educated in an environment where the attitude “everyone does it” (frequently heard as an excuse by researchers engaging in misconduct⁴,⁵) is being fostered.