Cheating at medical school

British Medical Journal, August 12, 2000 by Richard Savage

Justice must be done and seen to be done

Recently the BMJ received the following anonymous letter.

"Dear Sir,

I am a graduating student of Royal Free and University College London Medical School. During the finals of clinical exams I was witness to one of the most ugly scenes in my short but eventful life. One of my colleagues had in a brazen attempt to obfuscate the examiners made use of her Oxford Clinical Handbook during her long case. Unfortunately (or fortunately) for her, she was caught red handed. The deed was not looked on kindly by the authorities, especially when she attempted to extricate herself by claiming she had also done this in a previous examination and not been caught--thereby (or so she believed)justifying her act.... My colleagues and I were convinced that she would receive her comeuppance.

After meeting the disciplinary board, however, she was allowed to pass her exams without further ado. Fair play and honesty--two virtues I have always believed in--have been made monkeys of again. In future perhaps we should all do as she did. After all, look where it's got her."

We rang the medical school, and the subdean confirmed that the facts in the letter were correct except that the student did not say that she had used a book in a previous examination. The examining committee had decided to allow her to graduate but had held back distinctions and prizes that she might have won. She had been an exemplary student, and there was no indication that she had done this before.

It's easy to understand why the committee took the decision it did. The student would have been distressed. Some of the committee members must have known the student and themselves have been upset to find a star student cheating. They are no doubt kindly people, some with children the same age as the student. A few minutes with a book probably made little difference to her performance. The committee may have done the right thing to pass her, but it also made some mistakes.

The problem with cheating is that it destroys trust. Somebody who can cheat can also lie. Suddenly everything is uncertain. Perhaps they have cheated in previous exams. Perhaps they cheated in course work. Perhaps they've invented data in experiments. Perhaps achievements described in their curriculum vitae are false. When the police find somebody guilty of financial fraud they assume that everything else is fraudulent until proved otherwise. They investigate. Doctors, whose business is helping people not punishing them, are inclined to assume the opposite, but it is the police who have more experience of fraud.

The biggest mistake of the committee or the school was to fail to ensure that justice was not only done but seen to be done. It seems unlikely that the student who wrote to the BMJ is the only student who knows. It seems much more likely that all the students know. The gossip would spread fast in the highly charged atmosphere that accompanies final exams. The students expect the cheating student to "get her comeuppance"--but nothing happens. It seems unfair. Why should they play by the rules if nothing happens to those who cheat? Perhaps others are cheating and getting away with it. Maybe they are being disadvantaged by not cheating. What is a qualification worth if somebody can cheat and still be awarded it? To avoid a corruption of the whole process and the school, the school needed to explain its actions to the students--and it would need to be a very convincing explanation.

The committee has also failed to consider the broader context. The medical profession is in the dock. Self regulation is suspect. The public worries that doctors cover up for each other. It needs its confidence in doctors restored. Passing a student who is found cheating and failing to offer an adequate explanation for the action damages the culture of medicine.

Has the BMJ done the right thing to publicise this episode? The school thinks not. We understand that it thinks it has dealt justly with the student. But it has done so privately, and justice is not a private matter. It has not shown the rest of the students that it has dealt justly and therefore it has not dealt justly by them. We understand too that there is a risk that the student herself may end up being punished more by public exposure than she would have been had she been failed in her examination. But the actions of the school potentially undermine the credibility of medical education and so of medicine. The issue needs exposure and debate.

We ask all editorial writers to sign a declaration of competing interests (bmj.com/guides/confli.shtml#aut). We print the interests only when there are some. When none are shown, the authors have ticked the "None declared" box.