Promoting Academic Integrity in the Health Sciences

Donald McCabe, PhD
Summer 2009 Forum

Although I was originally a law-and-order candidate concerning academic integrity, I’ve learned over the past 20 years that students in general are mostly confused about issues of cheating.

“Today, I am an advocate for helping students understand the value and meaning of academic integrity, as opposed to emphasizing the punishment.”

New students look at what others are doing - how faculty reacts

As students arrive on campus, they look to see what others are doing and how faculty reacts; that sets the tone. It’s one of the bigger issues where we can help as faculty members and as members of the profession. When students cheat in a mild way, they are not always clear that what they’ve done is really cheating. We need to be forgiving and willing to rehabilitate that student. I would put that in the category of erring and even drifting.

The student who clearly, intentionally, and knowingly cheats – the one who downloads papers from the Internet and submits it as their own work or buys an exam ahead of time – is quite different. They have engaged in reckless acts of academic integrity and need to be taken to task.

International research on students and cheating

My research has expanded over the past several years and now includes, in addition to the United States, schools in Australia, Egypt, Greece, Lebanon, United Arab Emirates and the United Kingdom. It is becoming a more international database.

Results for health science majors

I conduct a one-day survey and am getting a range of 15% to 20% of students as my response. These are 20-minute, written surveys, which are difficult to implement and labor intensive. For those reasons, some schools do not want to participate. Still, I believe the relevant comparisons are good. This particular survey of health science majors is culled from 45,000 undergraduate students (excluding freshmen, who did not have a full year’s experience at the school). Narrowing the number to the health science majors, and excluding nursing, narrows the number of responses to 3,500 who are currently studying health sciences or health professions.

• The most noticeable trend is that the students' definition of what constitutes cheating is changing. Many students are convincing themselves that things that you and I might consider cheating are okay. Some students think it is acceptable to cut and paste - to plagiarize - from the Internet and to collaborate with other students even when asked to do work individually and represent the work as their own.
• I would have suspected that the results would be affected by the number of schools included that had instituted academic honor codes. It turned out that some schools without an honor code nonetheless convinced students that academic integrity was an important element of their education. On the other hand, some schools had an honor code in name only. Some honor code schools had high levels of cheating, while some schools that did not have an honor code had low levels of cheating. The cheating culture turned out to be more important than the honor code.
• One suspicion that was verified was that if students believed other students would not report their cheating, or if the penalty for cheating was insignificant, more cheating took place. Conversely, if students are in an environment where they are likely to get caught and where the punishments are more severe and will actually be implemented, there is less cheating.
• Students involved on a board are less likely to find another student guilty. However, once they are convinced that the student is guilty, they will throw the book at him much more harshly than faculty or administrators in terms of what that punishment should be. That’s because the cheating affects the other students’ GPA.
• Four years ago it appeared more men were cheating than women. That is no longer true. The difference is no longer significant and there have been studies that suggest that females are now reporting significantly higher levels of test and exam cheating.
• In several schools, there was a feeling that African-American students were being reported for cheating more often than non-African-Americans, but when corrected for grade point average, that difference disappears. It was exactly the same. One suspicion that may be real is the issue of collaboration among Asian students. They believe they have to help each other out and they are used to helping each other out.
• Students who are competing to be No. 1 in their class or competing to go to a top graduate school tend to cheat more often than average students, as do students at the bottom levels – students who are trying to get parents off their back or trying to remain athletically eligible.
• Health science students still rise above the average in cheating. There is tremendous pressure to succeed or excel. They realize they have to be in the top X% to move on to the full program. They know they are going to miss the cut and think, “I’ve done everything I was supposed to do. I did it honestly and the people who were cheating are going to get ahead of me and that’s not fair.” It becomes a motivator for them to cheat towards the end of that program in hopes of moving through to the next level. It’s called leveling the playing field, and I hear it again and again from students. This is especially true if they believe the course is trivial or irrelevant. A lot of students make a decision that it’s not fair that a certain course is going to affect their GPA when it has nothing to do with what they want to be when they grow up.
• Some students cheat with the excuse that the course is too hard. I include this because I think it’s humorous in a way. A course is supposed to be hard. We’re going to certify you with something; we need to be certain you have a certain bank of knowledge. Actually, I am somewhat sympathetic to students. Faculty will occasionally test on material that wasn’t covered in class and give assignments for the sake of having assignments. There is no coordination among the faculty to try to even the workload for all of its students. Students are also critical of faculty members who do not speak good English. The student rationalizes that if they can’t take good notes, they can’t do well. So students decide they will do what they have to do.
• Business students tell us, “It isn’t important how I get the job done, but that I get it done. That’s what companies want.” It’s a real excuse for business students.
• PT and OT majors said it was very common to get information from someone who had previously taken the test, and they didn’t think it was wrong. Students who give the test information think it’s okay because they will be reciprocated by someone who took another test in an earlier period. It evens out. PT and OT students have more pressure on them with the minimum GPA standard, which may result in a higher incidence of cheating.
• If students sense that faculty will follow up on cheating, much less cheating occurs because students are afraid of the consequences.
• In early 2007, I surveyed about 2,000 members of the National Honor Society and I asked them that if they were plagiarizing material from a written source, what would it be? About 77% were using the Internet either exclusively or primarily, 17% were using it interchangeably with written plagiarism, and only 6% were using written plagiarism is their primary means. So the Internet clearly has become the method of choice and has led to higher levels of plagiarism as well. I don’t think it has led to dramatic increases in the number of students who plagiarize, but it has led to a very significant increase in how much is occurring. Once you start using the Internet so easily, you do more of it.

The faculty factor

“Faculty members are far and away the primary influence on students.”

Yet faculty repeatedly cop out of dealing with cheating with reasons such as, “The associate dean didn’t support me,” “The department doesn’t back us up” or “The faculty is uncomfortable with confronting students.” So students are convincing themselves it’s okay to cheat, and the faculty – whom students cite as their major influence – do not respond. On my survey, I asked faculty members if they’ve ever ignored a case of cheating in the past two years, and 40% say they have done so, primarily because of the bureaucracy involved or the difficulty in proving it.

Confront the cheating; help the student

There is a deeper underlying problem than just the cheating itself and as a colleague of that student, you have an obligation to help them resolve it. You are confronting the cheating rather than the individual. You’re trying to help the individual. I am more in favor of that than, “I am going to report you if you don’t report yourself,” which is a policy at a few schools. Just discussing academic integrity with students is crucial.

Include students in developing the cheating policy

It’s amazing how many schools just impose a policy on students. Students today resent that. They want to have some role in the development of the policy and implementation of the policy. If it’s their policy, they’re going to accept more responsibility for it.

Respond to academic dishonesty

We need to respond to academic dishonesty when it occurs. It’s important that we enforce significant sanctions. We must develop fair and efficient process and procedures in response to the fact that faculty doesn’t want to get involved because it takes so much time.

Develop global principles for physical therapy programs

It makes sense to develop some global principles for physical therapy programs concerning academic integrity. You’ve got control over those programs. What would a viable honor code look like? Students would respond very positively to having clear expectations about the rules and knowing what’s required of them. It might create a greater sense of fairness among students competing for advancement in the program.

Clarify expectations

As faculty, we need to be more forthcoming about our expectations. We must have clear forms of assessment, not surprise tests which cover material we haven’t covered in class. We need to base our tests on thinking, not memorizing. Students really resent the fact that grades may be based on the ability to memorize, rather than the ability to use the material and apply it. I would agree with the students.

Don McCabe, PhD is a professor of management in global business at Rutgers University. In his extensive research on college cheating, he surveyed 175,000 students at more than 170 colleges and universities. He is the founding president for the Center for Academic Integrity, a consortium of 350 schools at Clemson University in South Carolina.