More than 270 medical students at the University of Glasgow had to resit their finals in spring 2017, after students in their year group were caught sharing information about an objective structured clinical examination (OSCE) with peers who were yet to take the exam. An investigation by the university found that over 40 students had shared details of the exam over social media and, as a result, several students were referred to the General Medical Council for fitness to practise hearings. Several media outlets described these students’ behaviour as “cheating,” while BMA news used a different “c” word—“collusion.” In this article we look at how cheating is defined in undergraduate medical education in the UK, the risks associated with cheating, and how to avoid cheating inadvertently. The GMC’s definition of cheating In its guidance, Achieving good medical practice: guidance for medical students, the GMC defines cheating as “sharing with fellow students or others, details of questions or tasks from exams you have taken.”The GMC puts cheating in the same category of unprofessional behaviours as plagiarism, violence, and substance abuse. It also says that cheating in exams raises broader questions about students’ “honesty, trustworthiness or character,” which could lead to a fitness to practise referral from their medical school. What happens at medical school It is common for past papers and some current exam questions from OSCE stations, multiple choice questions, and essay titles to be shared among students verbally or online. Lecturers also give students hints about what topics are likely to feature in upcoming exams. One anonymous final year student from a medical school in London told Student BMJ, “If you can get hold of the information [then other people can too]; other people are using it, and if you don’t use it, you just disadvantage yourself—it will be your loss and your mark that suffers.” Research into cheating at medical school is limited and there seems to be ambiguity around what constitutes cheating. The results of a survey published in The BMJ in 2001 from Dundee medical school found that many of the 461 respondents were unsure whether exchanging information about a current OSCE was wrong. More recently, Anne Tonkin, emeritus professor from the school of medicine at the University of Adelaide, summarised all the research published internationally about cheating at medical school and noted that the prevalence among medical students for self reported cheating was between 25% and 35% (6812 respondents across institutions worldwide). Students who shared information about upcoming exams ranged from 25% to 89% (among 68 144 respondents across institutions worldwide). A lecturer at a London medical school, who wanted to remain anonymous, admitted that “The problem is, we do not know how much of a problem cheating is—we are told by student representatives that it is ‘widespread,’ so we assume that the majority of people are doing it.” However, Katie Petty-Saphon, chief executive of the Medical Schools Council (MSC), says, “Medical schools invest a lot of time and resources into developing assessments. This is so that all parties can be confident that students have acquired the relevant knowledge and skills by the end of the course to be good doctors.” Most medical schools recognise that exam information will be shared between students and some give students a briefing the day before exams to ensure that everyone knows what the exam will cover—essentially levelling the playing field between candidates. Some medical schools switch OSCE stations from circuit to circuit to dissuade the sharing of information. Others change scenarios for morning and afternoon sittings, confiscate communication devices, or require students to sit in quarantine until their peers have completed their OSCE circuit. The risks of cheating Knowing the questions before you go into an exam may give you the upper hand, as you’ll know what to focus on when revising, but it isn’t a guarantee you will pass. In an OSCE you need to demonstrate a range of skills—you need to show that you are competent and safe, and how you arrived at your diagnosis using a systematic approach. A case study from the Royal of College Surgeons found that a group of candidates passed on details about a postgraduate exam to their peers. Despite having the exam questions in advance, the second cohort performed substantially worse than the candidates who sat the first exam. Being in possession of the answers or a mark sheet can also be more of a burden than a blessing. Appearing overly confident or reaching a diagnosis too quickly, without using a systematic approach, are telltale signs that a student might have insider information. This can create an additional level of stress—where you need to pretend that you don’t know what you know—which could affect your performance. A rapid response submitted to bmj.com in 2000 from two anonymous medical students, describes how 60% of their year group were in possession of the mark sheets for an upcoming OSCE. On results day, half the year were awarded a merit or distinction—a higher proportion than in recent years. In this instance, the students who cheated threatened the accuracy and validity of the assessment of their competency to practise medicine independently compared with their peers. It is unclear whether the students who cheated would have passed as well had they not been tipped off, and whether they gained an unfair advantage in the competition to secure specialty training posts. Who enforces the rules? The GMC sets the definition of what is a fitness to practise concern, but it is up to medical schools to conduct their own investigations and notify the GMC of any concerns. Petty-Saphon says, “Medical schools [should] make clear what is and is not acceptable, and [it is] the equal responsibility of medical students to be aware of guidance relating to professionalism.” However, the enforcement of GMC guidance seems to vary between medical schools. The Glasgow case raises the question of whether other medical schools scrutinise similar behaviours by the same measure. The Glasgow incident was escalated because the students who shared exam information on social media were implicated by two other students, who were caught by an invigilator discussing scenarios between OSCE stations during the exam. In this instance, the university’s hand was forced and it was compelled to do something about the sharing of exam information online. However, it remains to be seen whether other medical schools will follow suit and investigate students for similar behaviours in the future. How to avoid cheating inadvertently Make sure you are familiar with your medical school’s definition of cheating, and what specific behaviours would result in you being made to resit an exam or, worse, be reported to the GMC. Also, get clarification from your medical school about whether the sharing of past and current exam questions is deemed as cheating in their view. Be wary of sharing exam questions or putting others under pressure to divulge information about assessments you are about to sit. Although this might be acceptable practice within your peer group, this behaviour might be interpreted differently by your medical school or the GMC and cast aspersions on your honesty, trustworthiness, or character. Dishonest behaviour at medical school is an indicator of unprofessional behaviour in the future,something that the GMC is keen to identify and deal with before students go on the medical register. What to do if you are concerned about the sharing of exam content Marika Davies, medicolegal adviser, Medical Protection “If you are concerned about what is going on, you might want to discuss the issue with your tutor or educational supervisor. The medical school has a responsibility to create a fair examination system, and to satisfy itself that all students have gained sufficient knowledge to be entrusted with the care of patients. [The school] should aim to create an environment in which behaviour such as cheating is not acceptable. Culture change is not something you can achieve alone, but raising your concerns might help to move the process along.” Source
