Abstract:

Aim:
To determine the underlying reasons for academic misconduct among medical students in a predominantly Catholic EU country.

Methods:
Medical students at the University of Malta (UM) responded to an online questionnaire about academic misconduct scenarios. Five Year 4 students volunteered to take part in a focus group to explore possible explanations for the results. Focus group findings were coded using free nodes for content (words) and meaning. Thematic analysis was utilised to generate simple themes within the dataset.

Results:
The response rate was 10% (n=75; 57% female). Approximately 10% of students admitted copying during exams, copying others word-for-word or writing work for other students; 18% had/would forge signatures on official records. Just over one third of all students and 15% of Year 5 students reported that it was not wrong to inform others about a just completed OSCE (p=0.0004); 10% admitted having done it (p=0.001). One third would not inform faculty of serious misconduct and 41% were unsure whether they should.

The overarching finding theme that emerged from the focus group was an overall feeling of immense pressure and lack of understanding of the student teaching/learning experience on the part of the faculty, which was felt to justify why their colleagues resorted to copying during exams and plagiarism. Four main themes emerged. First, lack of information/education about academic dishonesty among medical students. Participants reported that collusion is a “passive wrongdoing” and that “extreme circumstances make it more acceptable” to copy word-for-word. Second, participants highlighted systemic failures and being “expected to be perfect in an imperfect system” thus pushing students to act dishonestly. They reported that the “feeling of responsibility is missing” among medical students as “nobody really cares about you, so why should you care”. Another participant justified falsely reporting that parts of the clinical examination had been performed with “if I don’t get it right, I am the only one that suffers”. Participants generally felt that the rules imposed by the faculty were excessively rigid. Third was fear of negative consequences. Hiding a conviction was justified by “I would be scared that they would not be willing to give me a second chance”. Fourth was observing dishonest behaviour among the faculty, thus reflecting a “monkey see monkey do” approach.

Conclusions:
In spite of the relatively low response rate, focus group participants reported that the quantitative findings were consistent with their own views, suggesting that students were most likely to have been honest about the extent of their dishonesty. These results show that there is room for a great deal more education about what constitutes academic honesty, collusion and plagiarism among medical students in the smallest EU country.

Keywords:

Academic honesty, misconduct, plagiarism, collusion, medical education.