Cheating the system- Tackling the problem at UCL

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In March 2017, more than 270 final-year medical students from the University of Glasgow were forced to retake their OSCE finals after collusion was discovered. Over 40 students were caught using social media including Facebook and Whatsapp to share classified information about their OSCE stations with friends who had not taken the exam. While the whole cohort faced the consequences of having to retake the exam, two students with direct involvement in the sharing of information also faced fitness to practice procedures.

While this case was particularly high profile, cheating has surprisingly been discovered to be common practice in medical schools all over the world. In fact, a similar incident occurred at UCLMS last year, where “live assessment materials” were circulated during the exam period. Although a specific year group was implicated this time, evidence points to the fact that collusion, or attempts to gain an unfair advantage, may be more common than one might think.

Cheating in its wider context

Exam item recall has been an existing method of “cheating” for years, where students recall and record questions faced in their exams, and subsequently disseminate this information to their peers who have yet to sit the exam or to the upcoming year of students. This form of cheating has seen limited success until the more recent use of collaborative technology platforms such as Google Drive, resulting in a highly systematic and efficient system to collate questions that are likely to reappear in future examinations. What makes things worse is the fact that due to a range of reliability reasons, medical schools are reusing questions from previous years in exams.

These are the reasons why SBAs are being reused from year to year:

  1. SBAs that perform well as discriminators in key curriculum areas are difficult to write well.
  2. National exam preparation involves having a Medical Schools Council (MSC) common question bank – partner medical schools (this includes UCL) agree to include questions from this bank.
  3. The Cronbach’s alpha is a statistical method used by the GMC to test the reliability or internal consistency of the assessments – this means that a higher Cronbach’s alpha value indicates that the combination of questions in the test are more “inter-related”, and thus serve to measure the same construct better. The medical school needs to ensure that this value remains above 0.8, which is number that is deemed acceptable for high stakes examinations such as the summative exam. It is therefore problematic to use only new questions, as there is no guarantee how they might perform to discriminate between the highest and lowest performing students, while not being too difficult.

Professor Chris McManus, professor of Psychology and Medical Education at UCL, has published research on cheating in medical schools and even up to the level of MRCP exams. He described observing all sorts of cheating methods in his years of experience, from the simple peek-at-the-paper-next-to-you, to people transmitting answers halfway across the globe using a Google Glass. He suspects that the rates of cheating in Medicine, albeit high, are probably lower than that in the general public. However, cheating matters a lot more in Medicine – the consequences of having an incompetent doctor are much more drastic compared to having an under-qualified French translator. This is why more people care about these scarily high incidences of academic misconduct among medical students and doctors, and why it tends to be reported more.

Professor McManus describes this situation as a “technology arms race” – as more and more people use technology to cheat, others are having to invent more innovative ways to detect it. In fact, he developed a computer system, which was piloted in 2005, which functions to flag up statistically-higher-than-expected similarities in answers between pairs of students in exams – this system has since been used to detect cheating in MRCP(UK) exams. Quite “punnily”, he named this software “Acinonyx” after Acinonyx jubatus, the scientific name of the cheetah (read: cheater). He also explained that the cheetah is “the only big cat that never withdraws its claws” which is something he hopes this system does in the context of detecting and controlling cheating.

Perspectives within UCLMS

When medical schools reuse exam questions from the same question bank each year, the unclassified release of questions results in a profound breach of the academic integrity of these exams. When this occurs, how will exams adequately serve their purpose of certifying the competency of students who are ultimately graduating to become qualified doctors?

In response to the most recent incident of collusion, UCLMS:

  1. a) has set up an Assessment and Feedback Working Group – consisting of staff and student representatives – to discuss changes to assessment activities and processes
  2. b) will release details of all OSCE/OCaPE assessments from the last five years, along with SBA questions they believe have been compromised
  3. c) has formed an Assessment and Materials Amnesty, where students are encouraged to anonymously submit materials in their possession that may result in an unfair advantage to them or their peers (submitted materials will be sifted through; materials that are deemed to be helpful will be collated and shared with the whole student body, while inappropriate materials will be destroyed)

We turned to current medical students to share their thoughts on this matter.

The medical school considers sharing details of questions or tasks from exams you have taken as cheating. This is based on GMC guidance.
I agree that gaining information about assessments that you have not yet taken can lead to an unfair advantage and that action should be taken against this. So yes, I agree that having information before your exam that could get you an unfair advantage is morally wrong. However, I can understand why people may want to still go down this route.
Perhaps they were stressed during exams and their concerns were not adequately addressed. UCL Medical School does have a very good support system but many students are unaware of means of accessing support. Perhaps this is something that needs to be made clearer so that students feel supported. Perhaps they felt that the medical school did not provide sufficient revision materials or resources to adequately prepare students for exams.
In a cohort of 300+ students, it is easy to feel left out and the easiest method is to resort to “cheating”. However, I believe that this issue can be prevented by making sure there is transparency and that students are reassured. This includes things like offering more tutorials, more one-to-one support on any academic issues, details of past questions being released and circulated by UCL, etc.
Of course, it will be more difficult as it requires additional resources but it is a matter of making students feel adequately prepared so that they don’t have to breach regulations in order for them to feel reassured.Abhiyan Bhandari, Year 3
It seems to be the culture that exam advice is passed down the years. Coming to medical school, you really don’t know what to expect and therefore it’s so reassuring having advice from people who have gone through it themselves. Although the lectures delivered by the medical school explain the exam process, it’s a very clinical and procedural description, with little practical advice.
The transition from A-Levels to Medical School is difficult in terms of adapting your learning style. The volume of information seems overwhelming and therefore having older students passing down past questions really helps to direct our focus.
There are very few questions available, and not being able to keep formative papers or access SBAs makes it difficult to know what to expect in the summative exams. Although the Moodle quizzes provide some questions, these aren’t representative of the SBAs in the real exams.
Handing in all of the resources made by students, although may ensure everyone has the same access to revision questions and material is standardised, may also mean that those who are proactive are penalised. Spending time creating resources for younger students is something that we not only do to aid their learning, but to aid our own. Being criticised for this seems counter-productive.
We as students clearly felt there was a lack of revision material and therefore turned to fellow students for help. Addressing student concerns regarding the lack of resources may have prevented this whole issue.
The amnesty may ensure everyone has the same access to resources. However, as students we can only trust the Medical School releases the resources thoroughly and in due time.Anonymous, current medical student

A number of students have expressed the view that they sometimes feel reassured by having a sample of questions provided by others who have more experience with medical exams. Others have voiced the fact that choosing not to utilise the widely circulating materials (despite recognising that this is “dodgy” practice) will merely disadvantage them, since no action has thus far been taken against those that do use these materials, although the action currently being taken by UCLMS is now likely to wipe out this feeling of being disadvantaged. A professor from the University of Adelaide published an alternative explanation for collusion in the BMJ – she described a student culture in which exam recall is perceived as being “owed by one cohort of students to the next”, especially since the collusion observed in her medical school occurred in the context where results are provided as non-graded passes or fails, making competition a far less relevant factor. She believes that students are not motivated by personal gain per se, but by social norms that make passing down information an obligation.

UCLMS has decided not to “make an example” of the group of students implicated in the recent incident, and this ‘learn not blame’ culture must be commended, since it mirrors that which is being contended for in the medical profession. We can only hope that this successfully curbs the issue of collusion in the future, since now, the medical school’s stand has been made clear:

“[The medical school] considers sharing information about assessments you have not yet taken and receiving information and using that to gain an unfair advantage as cheating… circulating memorised or copied real exam questions not released for unrestricted use, is considered cheating.”

Response from Professor Deborah Gill, Director of UCLMS:

We know assessment is one of the most stressful parts of studying medicine. High-achieving students want to do their very best in exams and they arrive from A-levels where past papers were the standard way to prepare. The fantastic levels of camaraderie that are typical amongst medical students and that create so much caring and support are central to thriving at medical school. However, in the context of the stress of exams a line can be breached whereby support becomes collusion or cheating and where some students gain an unfair advantage.

It is important that we graduate doctors who are safe and knowledgeable and who are trustworthy and so cheating has to be taken seriously.  

What is really sad for us is that UCL medical students are really bright and don’t need to cheat to pass our exams. The consequences of cheating, particularly as the GMC become more involved in assessments, are so much greater that the consequences of  any anticipated poor exam performance.

I think we need to do four things here at UCLMS: we need to emphasize more that medicine is a pass/ fail subject and that deciles and rankings are pretty meaningless; we need to restore confidence in the assessment system so that people don’t feel everyone else is gaining an unfair advantage; we need to make the ‘red line’ clearer: defining better what is support, guidance and assessment-based revision and what is unacceptable; and importantly support students more around the assessment process.


By Justina Cheh Juan Tai