Medical Education Case Study
The Case of the Cheater

The Case

At our medical school, we run a high-stakes examination schedule under a block type testing system. Students are tested only every few weeks and then have 4 days free before the exam, but on Friday of exam week receive a 300 question 6 part examination covering all academic subjects presented during the previous few weeks.

The test is administered in a large room where students are randomly seated with some rows vacant, but often a student can see some neighbor exam sheets. We have an Honor Code that states that any student caught cheating or observed cheating must be reported and anyone who observes cheating but does not report the incident is just as guilty.

We have a few monitors but the students are not observed constantly or even closely. We rely on the Honor Code.

After one such examination, an email came to the Chair of the testing committee that a student had been observed cheating from a neighbor and that “this was not the first case with the student and the class knew about this even last year”.

The chair of the examination committee forwarded this information (the accusing student did not want to be identified) to the Dean of Student Affairs, the Education Office and Associate Dean, and to course directors who participated in the exam. The chair of the examination committee also asked for suggestions on what to do in this case.

The Dean of student affairs wrote back quickly and said the chair of the examination committee should confront the student with the accusation. However, that person was the only one who recommended direct action. All the other parties involved recommended selective seating where cheating would be impossible.

In the meantime, the chair of the examination committee determined that the accused student was a good student who had good grades and good standing. A review of examination sheets from several sections of the exam for the accused student and the possible cheating targets were compared and there was no evidence of similar wrong answers or similar scores. The chair of the examination committee felt there was no hard evidence to accuse the student because the chair had not observed this activity directly, no faculty monitor had either and this was all based on a single accusation. The chair of the examination committee decided to segregate this student into a corner of the examination room and determine how the accused student’s test scores matched up to previous tests.

Questions:
1) Should the student be directly confronted on this evidence?
a. If so, by whom?
2) Was the decision by the chair of the examination committee correct?
3) What other decisions could be made?
4) Should the student be penalized or dismissed?

2)Was the decision by the chair of the examination committee correct?

Given the available information and feelings of the polled faculty members, the decision made effectively rectifies the practical concern associated with this problem, but does not appear to adequately address the ethical issue at hand.

In this case, the decision made by the chair of the examination committee reflects the common belief held by the vast majority of the committee members, and succeeds in removing the threat of future cheating by this student. Though this approach is effective at mitigating the concern of future cheating, it takes a rather ambivalent approach to the ethical conundrum at hand, sets a poor example for the student body and establishes a potentially dangerous precedent. I do not believe that simply assigning arranged seats is either prudent or sufficient given the potential recurrence of this behavior. This is almost a dismissive strategy and fails to directly engage the larger issue at hand: are the present ethics policies sufficiently strict, well known and enforced not only to identify cheating when it has occurred, but also to discourage and prevent it? Despite high standards for academic integrity and a strict honor code, numerous, often high-profile ethics violations have recently been observed at the nation’s military academies, where honor and honesty are considered among the foremost principles of the institution; if such a system fails in this environment, the expectation that it is enforceable and efficacious may be unrealistic.

Though the decision made is congruent with the recommendations of the other parties entrusted with overseeing examination integrity, my personal opinion on what disciplinary action should have ensued is more along the lines of the recommendation put forth by the Dean of Student Affairs. It is my belief that there exists little harm in discussing with the student the allegation of cheating at this juncture. It is within the rights of the offending student to be informed that the infraction was reported and that he/she is likely to be monitored closely; this in and of itself may act as a deterrent for future offences, if suspicious behavior did in fact occur. The warning also provides an opportunity to observe the student specifically in future examinations and find objective evidence for his dismissal if the event recurs. A formal review of the ethics policy and reiteration of the university’s zero tolerance approach to (confirmed) breaches of said policy should be made to the student body.

The collective opinion of the faculty that there is insufficient evidence based on the single complaint to justify pressing action carries some weight in the assessment of appropriateness of the incident. It is an understandable position, in the absence of a substantiated claim regarding the offence, that it would be unjust to penalize the student without proper investigation. In this respect, the committee chair’s decision was prudent in protecting the rights of the student given available information at the time. It is the duty of the chair to conduct an inquiry into the validity of the claim; however this may be fraught with difficulty. A retrospective review by hand of a 300 question, multiple choice exam is unlikely to demonstrate a pattern consistent with honor code violations, unless the volume of copied material was quite substantial and copied from only one source. Additionally, any simple criteria that could be enacted in order to assess for dishonest practice would likely be somewhat arbitrary, difficult to validate, and prone to under or over-classification based on the decided threshold. To combat this, statistical approaches to assessing academic dishonesty have been proposed (http://www2.sas.com/proceedings/sugi26/p257-26.pdf ) which may be useful in quantitatively determining the likelihood of cheating. It is only fair to uphold the most ethical principles in the investigation of breaches in academic dishonesty, and the most objective and impartial methods for determining guilt should be employed.

3)What other decisions could be made?

•Make mention of the present infraction in the student’s Student Affairs records
•Review with the entire student body the existing policy on academic integrity and punishment for violations – note all students not reporting a violation of the honor code are technically culpable. This may result in increased reporting, causing the initial claim to be substantiated.
•Internally review current policies and determine if more stringent or more specifically delineated protocols need to be introduced
•Recommendation of the case for review by the university ethics board (if one exits at the institution)
•Reexamination of the student on the material to demonstrate competency/mastery

4)Should the student be penalized or dismissed?

This likely depends on the exact circumstance. I believe that since the consensus of the faculty involved is that the evidence put forth is insufficient to pursue formal disciplinary action, a formal penalty is not justified. If, however, the claim was somehow to be substantiated and the student deemed guilty of the offene, probation and permanent notation to the student’s record is certainly justified and expulsion from the program would not be excessive, especially given the repetitive nature of the violation.

Faculty Response

1) Should the student be directly confronted on this evidence?
a. If so, by whom?

Cheating is, of course, a serious accusation and it is understandable why the Chair of the Examination Committee would insist upon a high level of evidence before penalizing the student solely on the basis of an anonymous tip. Apart from the Dean of Student Affairs (whose high-profile might incline them to decisive action in order to avoid a “scandal” that would embarrass the organization), the lower profile Course Directors and Examination Committee Chair quickly turned to their policies regarding the security of their examinations. Clearly, there was recognition by the course directors that their examination policies were lax. Perhaps they even reviewed this accusation as an opportunity to tighten up policies that they should be changed, but had been maintained by institutional inertia.

The finding, after review of the student’s academic record, that the student “had good grades and good standing” is really not relevant to the issue of cheating. If, in fact, the student had actually cheated and there was strong evidence to support that, the student should be considered for academic probation regardless of their prior level of scholarship. Therefore, prior academic performance is not appropriate grounds upon which to decide whether or not to confront the student with the accusation.

Likewise, if the student had been glancing at other students answer sheets during an examination, it is likely that this affected the answers to a small percentage of the 300 questions on the examination. It is unlikely that a statistical analysis of correct and incorrect answers from adjacent test-takers would be likely to reveal a strong enough correlation to confirm cheating. Therefore, statistical correlation with adjacent tests is not strong enough evidence to determine whether or not cheating actually occurred.

Therefore, my opinion is that the student should not be confronted on this evidence. Rather, I feel that the student should be informed of the accusation, and further informed that the available evidence is insufficient to prove or disprove whether the accusation occurred. The student should receive a letter of concern acknowledging that the evidence supporting the accusation is not strong, but that future reports of cheating will be dealt with more seriously. In addition, the letter should state that the student will have future segregation from the other students and closer monitoring during future examinations.

2) Was the decision by the chair of the examination committee correct?

I agree with the decision of the chair of the examination committee for the reasons mentioned above. In addition, informing (but not accusing) the student of the accusation leaves the door open for honorable behavior, and helps to cultivate the trust between students and faculty that was expressed when the faculty decided to rely on the Honor Code during examinations. In this way, the accusation creates an opportunity for professional growth and trust building.

3) What other decisions could be made?

The other principal options in this case are more decisive and authoritarian actions, with the most severe being the imposition of academic probation and the possibility of dismissal.

4)Should the student be penalized or dismissed?

On the basis of the evidence available in this case (namely an anonymous tip), I do not feel that the evidence is strong enough to support disciplinary action. In my opinion, a letter of concern followed by actions to secure testing in the future is the appropriate level of response.

As mentioned above, the examination policy for the medical school should be reviewed, and future examinations should be administered in a more secure manner.

Administrator’s Response

Questions:

1) It is my opinion that a faculty member needs to observe this infraction for a student to be confronted with it. If an accusation was received, it basically gives notice to keep the accused student on radar for all classes and exams. If something is noticed by a faculty member, then the student should be confronted by the faculty member first.
2)If the question is: do you think the person was correct in forwarding the accusation? My answer is yes. I think the faculty members overseeing the course and appropriate administrators need to be made aware of the situation so that they can continue to monitor it.
3)Other decisions that need to be made are:
a.Who gets the message with the accusation?
b.Is the accuser a reliable source?
c.Is this a repeat occurrence that has been observed by faculty or administrators? Or are there a number of incidences and different students reporting the situation?
d.Is the accuser a bad student with a reputation of getting others in trouble who needs to be monitored?
4)No. The student should not be penalized or dismissed based on no evidence from a faculty member and very little hard evidence from one accuser.

This issue is not foreign to medical schools. There are constant accusations from students about classmates cheating or having advantages that they do not have and the mindset that other students are taking shortcuts that will help them succeed or do better. The key to this case is the fact that one student is making the accusation with no other past or present evidence to back it up.

I have not worked at an institution that relies on the Honor Code for security of examinations. The institutions I work/worked for had examination policies that included discussions about cheating. In most policies, someone at the level of faculty member or greater proctored the examinations watching students closely and constantly and ensuring that a faculty member is always present. In this case, it seems that constant supervision was not provided. If no faculty member saw the incident, the next best evidence would be a track record of problems with the accused student but that was not shown either. The student had good grades and was in good standing. In addition, the sections of the exam that were reviewed against the accuser’s exam have no matching answers. The burden of proof has not been met and thus makes it hard for a dean or administrator to take the case to the next level.

In this situation, the chair of the examination committee was correct in forwarding the accusation on to appropriate faculty and administrators because a trail has to be established and the correct individuals need to take stock of the situation for future classes or examinations. However, segregating the student in a corner of the room seems unjustified based on the facts presented.

In summary, there is no reason for the accused student to be confronted with the evidence because there is no solid evidence to bring forward. Segregation of the student into a corner of the examination room without cause was unnecessary given the facts. A more appropriate set of actions could have been to make notes in both the accuser and the accused files to establish a track record and to have an administrator discuss the issue with the class in a general sense by indicating that an incident was reported, reiterating the policies on cheating, and reminding them of the Honor Code. Then, faculty could monitor both students more closely on future examinations and in future classes/clerkships.

Respondents

Student Respondent
Chris Massa, MS2 (MD/PhD candidate), UMDNJ – Robert Wood Johnson Medical School, Piscataway, NJ
Faculty Respondent
Gordon Woods, MD, MPHE, College Master and Associate Professor of Medicine, Department of Medical Education, TTUHSC-Paul L. Foster School of Medicine, El Paso, TX
Administrator Respondent
Dr. Machelle Davison, Director, Office of Educational Development, Oklahoma State University Center for Health Sciences, Tulsa, OK