Prevalence and attitudes toward plagiarism among medical students

Lidija Bilić-Zulle

Doctoral disertation

Introduction

• Importance of science:• real knowledge• cultural role• education• well-being and safety

• Biomedical science – influence on human life

• Integrity – the cornerstone of science

Scientific misconduct

Fabrication

Falsification

Plagiarism

Plagiarism

“Unauthorized appropriation of another’s work, ideas, methods, results or words without acknowledging the source and

original author.”

It is a theft and it is against the basic principles of science.

• MeSH subject – 1990

• 442 citation according to PubMed

• 61% of paper – last 10 years

• Google – more than 24 million links

• ORI – Office of Research Integrity

• Scientific conferences on research integrity and plagiarism

Plagiarism

Copyright © 2001 by Pyrczak Publishing. All rights reserved. Reproduced with permission.

Academic misconduct• Plagiarism, cheating,

fraud...

• Dishonest students = dishonest physicians

• Computer technology – “cyberplagiarism”

Copyright © 2001 by Pyrczak Publishing. All rights reserved. Reproduced with permission.

Cyberplagiarism among students

• Downloading a free research paper

• Buying from commercial paper mill (even theses!)

• Copying an article from Web

• Cutting and pasting from several sources

• ...

Detection of plagiarism

• Before computer technology – mainly by chance (or reported)

• Difficult to prove

• Computer technology – plagiarism detection software

Copyright © 2001 by Pyrczak Publishing. All rights reserved. Reproduced with permission.

“The Web giveth and the Web shall taketh...”

• Different techniques

• Text analysis (concordances)

• Web based services: searching the internet for source texts (Turnitin®, EVE) – language restricted

• Close procedure (Glatt Plagiarism Service) and

• WCopyfind – no language restriction; freeware

Attitudes toward plagiarism

• Important to understand

• Culturally influenced

• Lack of knowledge

• Rules, Ethical code

Purpose of the study

Studying prevalence of plagiarism among medical students and student attitudes

toward plagiarism, scientific and professional misconduct will contribute to

the development of the basis for university guidelines on responsible

studying, especially for medical students whose responsibility is all that greater as

their work and knowledge will have direct implications on human life.

Specific aims• To prove the existence and establish the

prevalence of plagiarism among medical students by use of student essays

• To determine how clear warning and punishment influence the rate of plagiarism

• To determine the attitudes of medical students toward different forms of plagiarism, scientific, academic and professional misconduct

• To examine the general attitudes of medical students toward scientific and academic integrity and intellectual property

• To determine the differences in prevalence and attitudes toward plagiarism among students with respect to their sex and academic achievement

Specific aims

Subjects and Methods

Subjects• All second-year medical students of Rijeka

University School of Medicine attending MI course (N=295, 63% woman, median age 21, range 19-27) during three academic years:

• 2001/2002 (N=114, 61% woman)

• 2002/2003 (N= 88, 69% woman)

• 2004/2005 (N=93, 60% woman)

• No difference in number, sex, age or academic achievement between three student samples

Methodes

The study consisted of three parts:• investigation of prevalence of plagiarism

using plagiarism detection software • investigation of attitudes towards six

different scenarios of dishonest academic, scientific and professional behavior

• investigation of general attitudes towards scientific integrity and intellectual property

Prevalence of plagiarismMethods

• Mandatory part of MI practicum, not graded

• Based on one of four provided source articles:

• two in e-format, two in hard copy format

• two with less and two with more complex topic

• Additional sources were not prohibited

Student essays

Additionally warned that essays

would be checked by

plagiarism detection

software and perpetrators

would be punished.

3rd student sample

(y. 2003/2004)

Instructions on plagiarism

2nd student sample (y. 2001/2002)

Explained what

plagiarism was and strictly

warned that it was

forbidden.

1st student sample (y. 2000/2001)

Informed that essay should be their original intellectual creation.

Use of WCopyfind ver. 2.2 software

Preparing of the essays for text analysis:

• parts removed from manuscripts: student data, title, literature list, figures and tables (existed in 10% of essays)

• Croatian diacritical signs were replaced with international

Body texts of essays and source articles were compared.

Use of WCopyfind ver. 2.2 software

• Comparison rule parameters

Comparison Rule ParameterParameter

Value

Shortest phrase to match 6

Fewest matches to report 1

Shortest text string to consider 100

Most imperfections to allow 2

Minimum percentage (%) of matching words

80

Ignore all punctuation yes

Ignore numbers yes

Ignore letter case yes

Skip non-words and skip words longer than _____ characters

no

• Analyses of the essays:

• total number of words in each essay

• number of matching words

• percentage of copied text in essay (calculated)

• distribution of the chosen source article (with respect to availability – electronic or hard copy – and complexity)

Data collected

• Academic achievement of the students• based on MI exam grade (passed on the

1st attempt):• excellent students

◦ grade 5 (A – excellent) and 4 (B – very good)

• average students◦ grade 3 (C – good) and 2 (D – adequate)

• poor students◦ failed or did not take exam at least for one year

Data collected

Attitudes toward plagiarismMethods

Scenarios

• Six imaginary but possible scenarios of misconduct

• Questionnaire with 6 multiple choice questions (same for all scenarios)

• Epilogue (reversal of situation or aggravating circumstances)

• 7th logical question (different for each scenario)

Anonymous questionnaireYou consider the described behavior: A – appropriate,

B – wrong,

... and you consider it A – justified.B – unjustified.

Should the person who committed the act be punished?

A – no.B – yes, the perpetrator should be:

1 – given an oral warning.2 – taken away the benefit obtained by the act.3 – expelled from school, i.e., excluded from

health/scientific community.

Have you ever done anything similar to the described act?

A – no, because:1 – I did not have the opportunity.2 – I consider such an act unacceptable.3 – I’m afraid of punishment.

B – yes, because:1 – I had a good reason to do it.2 – I don’t think I did anything wrong.

Would you ever do anything similar to the described act?

A – no, never.B – I would in exceptional situation, if there were a real and

urgent need to do it.C – yes, always.

Do you have any knowledge of such or similar acts taking place in reality?

A – I have never heard of any similar act (I have no knowledge of any similar act).

B – I have heard of such (similar) a case.C – I have witnessed or experienced it in my environment or

participated in such an act.

Self-plagiarism• Scenario

At the sixth study year D. copied his student essay already submitted at third year of study and passed exam.

• EpilogueAs scientist, few years latter, D. submitted and publishes his already published paper and applies for higher academic position.

• 7th questionDo you think this is right?

Plagiarism with author’s consent

• ScenarioM. asks her colleague from senior study year for essay to copy it and submitted as own, and friend let her do it.

• EpilogueO. (the third person) noticed fraud and reported it to the instructor.

• 7th questionDo you think what O. did was right?Copyright © 2001 by Pyrczak Publishing. All rights

reserved. Reproduced with permission.

Plagiarism without author’s consent

• ScenarioJ. stole her roommate D.’s essay (graded A) from her computer while using it and submitted it as own without D.’s knowledge.

• EpilogueD. decided to publish essay as a student paper but J. beg her not to did it because plagiarism than probably would be revealed.

• 7th questionIf you were D. would you publish the essay? Copyright © 2001 by Pyrczak Publishing. All rights

reserved. Reproduced with permission.

Plagiarism by the superior• Scenario

Prof P.H. copied his student theses in his book without acknowledging the source or cites his student M.

• EpilogueM. submitted his theses as scientific paper but journal editor notice similarities with P.H.’s book and accused M. for plagiarism, reject manuscript and inform wider scientific community.

• 7th questionIf you were P.H., would you than admit that you plagiarized and that your student M. is author of the text?

Cheating on exam • Scenario

M. did not study, but he still takes the exam for attempt. During the exam he switch the test with his colleague who replies to questions that M. does not know the answer and M. passes the exam.

• EpilogueInstructor noticed the test switch but because he wants to avoid exhausting explanations he just ignores it and act as if nothing happened.

• 7th questionDo you think that the instructor did the right thing?

Issuing a false medical report • Scenario

Dr. B.N. issued the medical report but did not examine a patient – his good friend A.B. who was to undergo a surgery, to spare him another visit to hospital.

• EpilogueFamily physician copies the medical report into A.B.’s medical file explaining how important the medical findings are for the course of surgery.

• 7th questionIf you were A.B. would you tell your family physician that you were not examined?

General attitudes toward academic and scientific

integrity and intellectual property

Methods

Anonymous questionnaire• six logical questions (yes/no)• completed after passed MI exam

- Have you as a student been introduced to the principles of academic and research integrity?

- Do you consider intellectual property equal to other forms of property?

- Should the School have clearly articulated rules against plagiarism included in the official documents?

- Do you think that a researcher has to be completely honest in his/her work, irrespective of circumstances?

- In your opinion, is it acceptable to ignore research results that are not very important or in accordance with most other (expected) results?

- Is the following statement true: who cheats once, will cheat again, at least when presented with the opportunity?

Results

Proportion of plagiarized text

• Median plagiarism rate 7% (5th-95th percentile = 0-84%)

Distribution of students with respect of plagiarized text

0 10 20 30 40 50 60 70 80 90 100

200

150

100

50

0

Proportion of plagiarised text [%]

Nu

mb

er

of

stu

den

ts

Proportion of plagiarised text

• No difference between female and male students (8% vs. 6%)

• No difference between hard copy and electronic format of source (14% vs. 6%)

• No difference between simpler and more complex topic of source (7% vs. 10%)

Proportion of plagiarized text• Warning against plagiarism (student sample)

Difference between 2004/2005 student sample and the others (17% vs. 21% vs. 2%, P<0.001)

100

80

60

40

20

0

Student sample

Perc

en

tag

e o

f p

lag

iari

zed

text

[%

]

2001/20022002/20032004/2005

Proportion of plagiarized text• Academic achivement (overall)

No difference beetwen poor, average and excelent students (6% vs. 12% vs. 6%)

100

80

60

40

20

0

Academic achivement

Perc

en

tag

e o

f p

lag

iari

zed

text

[%

]

poor average excellent

Proportion of plagiarized text• Academic achivement (only 2001/2002 and 2002/2003

sample)Difference between excellent students and the others (25 % vs. 22% vs. 12 %, P=0.015)

100

80

60

40

20

0

Academic achivement

Perc

en

tag

e o

f p

lag

iari

zed

text

[%

]

poor average excellent

Availability of source article

Student sample

P<0.001

Complexty of topic of source article

Student sample

P<0.001

Length of essay (number of words)• Difference between all three student samples

(455 vs. 553 vs. 399, P<0.001)

2000

1600

1200

800

400

0

Student sample

Nu

mb

er

of

word

s

2001/20022002/20032004/5005

Attitudes toward various scenarios

Copyright © 2001 by Pyrczak Publishing. All rights reserved. Reproduced with permission.

on plagiarism,academic andproffesionalmisconduct

Appropriateness

Scenario Appropriate Wrong

Self-plagiarism 65 30

Plagiarism with author’s consent

18 77

Plagiarism without author’s consent

5 90

Plagiarism by the superior 16 67

Cheating on exam 25 65

Issuing a false medical report 7 83Percentage (%) of students presented.

Do not add up to 100% because of missing values.

Justifiability

Scenario Justified Unjustified

Self-plagiarism 75 16

Plagiarism with author’s consent

55 32

Plagiarism without author’s consent

28 64

Plagiarism by the superior 21 59

Cheating on exam 57 30

Issuing a false medical report 17 69Percentage (%) of students presented.

Do not add up to 100% because of missing values.

Punishement

Scenario NoJust

verbal

Take the

benefit away

Expell

Self-plagiarism 79 9 7 0

Plagiarism with author’s consent

43 26 23 0

Plagiarism without author’s consent

15 41 37 2

Plagiarism by the superior 25 21 32 4

Cheating on exam 51 14 25 0

Issuing a false medical report 24 56 7 2Percentage (%) of students presented.

Do not add up to 100% because of missing values.

Students who have NOT done anything similar to described scenario

ScenarioDid not

have opportunity

Consider it unacceptab

le

Because of punishmen

t

Self-plagiarism 55 7 3

Plagiarism with author’s consent

48 28 6

Plagiarism without author’s consent

32 49 8

Plagiarism by the superior 49 28 2

Cheating on exam 45 20 9

Issuing a false medical report 59 27 1Percentage (%) of students presented.Do not add up to 100% because of missing values.

Scenario Because of good reason

It is not wrong

Self-plagiarism 8 21

Plagiarism with author’s consent

9 1

Plagiarism without author’s consent

3 2

Plagiarism by the superior 2 1

Cheating on exam 9 6

Issuing a false medical report 1 1Percentage (%) of students presented.Do not add up to 100% because of missing values.

Students who have already done something similar to described scenario

Would you ever do anything similar to the scenario?

Scenario NeverExceptionally (in need)

Always

Self-plagiarism 6 60 29

Plagiarism with author’s consent

24 66 3

Plagiarism without author’s consent

37 57 1

Plagiarism by the superior 40 39 4

Cheating on exam 20 56 13

Issuing a false medical report 39 48 3Percentage (%) of students presented.Do not add up to 100% because of missing values.

Knowledge of such or similar event in reality

Scenario Never heard of

Just heard

of

Witnessed or

experienced

Self-plagiarism 13 35 46

Plagiarism with author’s consent

17 45 32

Plagiarism without author’s consent

20 44 31

Plagiarism by the superior 46 33 4

Cheating on exam 19 33 38

Issuing a false medical report 29 44 17Percentage (%) of students presented.Do not add up to 100% because of missing values.

Inconsistency in attitudes and 7th question confusion

?

??

?

??

?

?

? ????

??

?

Self-plagiarismWhen done by student... When done by instructor...

Punishment

Plagiarism with author’s consentWhen done by student... Is whistleblower right...

Punishment

Plagiarism without author’s consentWhen done by student... Would you publish the

essay...

Punishment

Plagiarism by the superiorIs it appropriate... Would you admit...

Punishment

Cheating on examWhen done by student... When instructor ignores

it...

Punishment

Issuing a false medical reportWould you tell your doctor...

Punishment

Is it appropriate...

General attitudes towardresearch and academic integrity and intelectual property

©

Q: Were you as a student introduced to the principles of research and academic integrity?

Q: Do you consider intellectual property equal to other forms or property?

Q: Should a school have clearly articulated rules against plagiarism included in the official documents?

Q: Do you think that a scientist has to be completely honest in her or his work irrespective of the circumstances?

Q: Is it permissible in research to ignore individual results that are not very important and do not correspond to the expected results?

Q: Is the following true: Once a cheater, always a cheater, or at least when there is an opportunity?

Results on general attitudes

• Answers – socialy diserable

• No difference beetwen men and women in distribution of answers to any question

• No difference beetwen student sample in distribution of answers to any question

Conclusions• Plagiarism is present among medical students

• The proportion of plagiarized text – not influenced by the availability of the source or by the complexity of the essay topic

• Significant reduction – only by awareness of objective check methods and punishment

• Just teaching and clear warning not enough

Conclusions• Student attitudes are worrisome – need for

teaching and promotion of the principles of academic integrity among students.

• Inconsistency in student attitudes – indicates the lack of knowledge and recognition of an act as wrong.

• General attitudes – socially desirable answers, in contradiction with their behavior

Conclusions• Academic achievement – influenced the

plagiarism in student essays only if they were not warned about the subsequent computer-check of their work and punishment

• Faculty awareness of the inappropriate attitudes of students toward academic misconduct – education and promotion of the highest standards of academic integrity

Plagiarism as well as other forms of misconduct should be recognized and

must not be tolerated.

Thank you all...