New Practitioners Forum Promoting academic integrity among ation can be compromised when scored examinations are returned to students health care students because these exams can be shared with other students, thereby compromising the existing test questions. Even if the heating is prevalent among activity, and to deliver a reduced quality exam is not returned, using the same ences students and of patient care. test questions year after year without undetected in most scenarios. 1, Alt Role of faculty and preceptors in adding new questions and updating the cheating is defined on a continuum based detecting and preventing cheating. order of questions can still offer stu- on intent, ranging from "negligent"or Faculty and preceptors play a vital role dents an advantage if they gain insight accidental"to"dishonest, it is impor- in maintaining a secure testing envi- from students who have already com tant for faculty to be aware of ways that ronment while proctoring assessments, pleted the class students cheat so they can prevent cheat- whether in a traditional classroom, ex- Faculty and preceptors may unin ing and promote academic integrity. The periential, or technology-enhanced set- tentionally invite cheating during test Accreditation Council for Pharmacy ting (e.g, distance learning, electronic administration as well. Students can sit ducation evaluates the ef- ear knowledgeable students when seating charts are of pharmacy to take into not used. This is especially account professional be- problematic if the exam havior and academic integ not proctored, such as in a rity in progression policies. distance-education setting Throughout all of profes- or during an introduct sional education . such as pharmacy education, integ ence(IPPE) or advanced rity is as essential as knowl harmacy practice experi- edge itself. Health sciend (APPE)exam with two students, such as pharmacy students during which the udents, must meet knowl preceptor may incorrectly edge, skills, and attitude ob- believe that active proctor- jectives before graduation ing is not needed. Allowing and flaws in the assessment students to leave and return to the testing environment copardize the validity of the curriculun online quizzing). Failure by is also troublesome if the student leaves and its final results. The prevention and and schools of pharmacy as unescorted, since he or she could access identification of cheating are valuabl by faculty members to delineate study materials on paper, on the Internet beyond the academic setting. Studies clear expectations before testing and or from friends. Another problem is al have found that students who demon- failure to maintain standardized proce- lowing students to write test answer let- strate academic misconduct in school are dures during student testing may result ters on a sheet of paper to check again more likely to demonstrate future profes- in academic dishonesty in three specific the answer key, as they may write dow sional misconduct, such as committing areas: test creation, test administration, additional information if the sheets of or failing to report fraudulent or illegal and test method. For example, test cre- paper are not consistently checked by the exam proctor. Another example of heating related to test administration is students' use of smartphones during the The New Practitioners Forum column features articles that address the special professional/ exam to communicate with classmates; needs of pharmacists early in their careers as they transition from students to practitioners. access saved information, such as charts Authors include new practitioners or others with expertise in a topic of interest to new or notes; or photograph the exam.Even Ictitioners. AJHP readers are invited to submit topics or articles for this colum to the if a testing policy exists whereby students 301-664-8821 or newpractitioners@ashp. org) 754 Am J Health-Syst Ph 70May1,2013
New Practitioners Forum 754 Am J Health-Syst Pharm—Vol 70 May 1, 2013 New Practitioners Forum The New Practitioners Forum column features articles that address the special professional needs of pharmacists early in their careers as they transition from students to practitioners. Authors include new practitioners or others with expertise in a topic of interest to new practitioners. AJHP readers are invited to submit topics or articles for this column to the New Practitioners Forum, c/o Jill Haug, 7272 Wisconsin Avenue, Bethesda, MD 20814 (301-664-8821 or newpractitioners@ashp.org). Continued on page 756 Promoting academic integrity among health care students C heating is prevalent among health sciences students and remains largely undetected in most scenarios.1,2 Although cheating is defined on a continuum based on intent, ranging from “negligent” or “accidental” to “dishonest,” it is important for faculty to be aware of ways that students cheat so they can prevent cheating and promote academic integrity. The Accreditation Council for Pharmacy Education evaluates the efforts of colleges and schools of pharmacy to take into account professional behavior and academic integrity in progression policies.3 Throughout all of professional education, such as pharmacy education, integrity is as essential as knowledge itself. Health sciences students, such as pharmacy students, must meet knowledge, skills, and attitude objectives before graduation, and flaws in the assessment of these competencies may jeopardize the validity of the curriculum and its final results.4 The prevention and identification of cheating are valuable beyond the academic setting. Studies have found that students who demonstrate academic misconduct in school are more likely to demonstrate future professional misconduct, such as committing or failing to report fraudulent or illegal activity, and to deliver a reduced quality of patient care.1,5 Role of faculty and preceptors in detecting and preventing cheating. Faculty and preceptors play a vital role in maintaining a secure testing environment while proctoring assessments, whether in a traditional classroom, experiential, or technology-enhanced setting (e.g., distance learning, electronic polling, online quizzing). Failure by colleges and schools of pharmacy as well as by faculty members to delineate clear expectations before testing and failure to maintain standardized procedures during student testing may result in academic dishonesty in three specific areas: test creation, test administration, and test method.6 For example, test creation can be compromised when scored examinations are returned to students because these exams can be shared with other students, thereby compromising the existing test questions. Even if the exam is not returned, using the same test questions year after year without adding new questions and updating the order of questions can still offer students an advantage if they gain insight from students who have already completed the class. Faculty and preceptors may unintentionally invite cheating during test administration as well. Students can sit near knowledgeable students when seating charts are not used. This is especially problematic if the exam is not proctored, such as in a distance-education setting or during an introductory pharmacy practice experience (IPPE) or advanced pharmacy practice experience (APPE) exam with two students during which the preceptor may incorrectly believe that active proctoring is not needed. Allowing students to leave and return to the testing environment is also troublesome if the student leaves unescorted, since he or she could access study materials on paper, on the Internet, or from friends. Another problem is allowing students to write test answer letters on a sheet of paper to check against the answer key, as they may write down additional information if the sheets of paper are not consistently checked by the exam proctor. Another example of cheating related to test administration is students’ use of smartphones during the exam to communicate with classmates; access saved information, such as charts or notes; or photograph the exam. Even if a testing policy exists whereby students
New Practitioners Forum Continued from page 75 The goal of raising faculty and recep Pay close attention to student behavior, tors'awareness of cheating is to encourage especially at the beginning and end of an need to leave personal belongings at the them to be proactive instead of reactive. assessment. front of the testing room, a smartphone Being proactive starts at the beginning of se a secure browser such as LockDown is easily concealed and accessible during the semester, IPPE, or APPE when faculty Browser( Respondus, Redmond, wA)if an exam, especially when the students document clear expectations and policies th desk has a modesty panel or when the in their syllabus. These policies should be Have one proctor supervise or escort classroom is large and has only one exam documented in writing and make clear students who need to leave the exam proctor. Requiring students to leave their faculty members' expectations for atten- environment smartphone face-down on their desk in dance and group work and collaboration, Avoid using an answer key that students plain view is not an absolute deterrent, as well as quiz and examination guidelines, can complete and remove from the test because students could bring in a"fake" audience-response-system use guidelines, Supervise exam reviews after the exam is phone to place on the desk while retain- and closed-exam (no exams returned) graded to ensure that no students write ing their working smartphone. Students procedures. In addition, faculty should down questions or take pictures of the exam. taking IPPE or APPE assessments should provide a policy that includes fair and Conduct class exam reviews by discussing also leave their belongings and smart- appropriate consequences for instances general concepts covered by the exam ver- phone in a room separate from the proc- of academic misconduct. For example, sus specific exam questic tored test environment instructors could state that any student Whether in the classroom orexperien- caught cheating on an assignment, quiz, Role of students in reporting aca- tial setting, traditional paper and pencil or exam may receive a zero on that assign- demic misconduct. Faculty and pre- altiple-choice testing may be the most ment, quiz, or exam and a failing grade ceptors are not the only groups that are mmon type of testing, but additional in the course, IPPE, or APPE. Preceptors concerned about and capable of de testing methods, such as performance- should also include specific consequences tecting cheating. Previous research has ased assessments, written assessments, for falsification of experiential hours (e.g, found that failure to detect cheating and and technology-driven assessments, can accidental or intentional reporting of discipline students who cheat may lead also unintentionally invite cheating if hours not completed) to student dissatisfaction if behaviors expectations are unclear or standardized In the classroom or experiential set- are rampant. Students have two op procedures are not used. If students are ting, proctoring has been identified as tions for reporting academic misconduct participating in performance-based as- the primary deterrent to cheating dur- when they witness it. They can contact essments such as objective structured ing traditional testing. Therefore, fac- the course coordinator or preceptor and clinical examinations, policies should ulty should establish and consistently confidentially report the misconduct. state and proctors should reinforce that uphold clear exam-proctoring policies. Because the reporting student,'s coopera- alking ar rohibited Examples of such policies include the tion is necessary to investigate the situa- luring the test. If faculty or preceptors following tion further, anonymous reporting is un- use written assessments or assignments, available at most academicinstitutions. If a log of previous report topics should Secure the testing room (look at chairs the student is uncomfortable contacting be maintained to avoid reuse of reports. and desks for concealed handouts, study the course coordinator or preceptor, he The instructor should also check the stu sheets, and other test aids) before students or she may contact the institutions aca- dent's references to ensure that content enter the room demic integrity council and reque est con- is appropriately summarized and cited Ask students to leave personal belongings tacts specific to each college/school and and consider using antiplagiarism soft- in the front of the room or other desig. its departments. The academic integrity ware such as TurnItIn(iParadigms LLC, ouncil is a committee of students who Oakland, CA)that may be available from the college or school. Advise students what type of clothing is promote academic integrity on cam- Students may collaborate when in prohibited in the room(e. g, baseball hats, puses to improve student accessibility to resources and foster a healthy academic structors deliver homework, quizzes, or hooded sweatshirts, coats) exams online in an unproctored environ Advise students about exam entry, exiting, environment. The name of this type of ay vary by ment, especially if the rules for student questioning, and talking policies in writ- honor council)and may be synonymous collaboration are unclear. Instructors ing at least 24 hours in advance. ith the academic misconduct board who use audience response systems Have at least two active exam proctors in which often consists of faculty and stu- (e.g, clickers) may have cheating occur the classroom who are watching students dents who hear cases and make decisions if they use the clickers for summative instead of tending to personal work. about academic misconduct. Other qual assessments, such as graded quizzes, at Use multiple versions of the exam ities that may differ among institutions tendance, or participation, because one Adopt a closed-exam policy include the role of each committee in in- student can record answers for multiple . Use a seating chart to eliminate students' vestigation, judication, or advocacy and students by bringing the absent students' intentional seating arrangements. the ratio of faculty, students, and staff Have adequate spacing between students. who comprise each committee. In gener 756 Am J Health-Syst Pharm--Vol 70 May 1, 2013
New Practitioners Forum 756 Am J Health-Syst Pharm—Vol 70 May 1, 2013 Continued from page 754 need to leave personal belongings at the front of the testing room, a smartphone is easily concealed and accessible during an exam, especially when the student’s desk has a modesty panel or when the classroom is large and has only one exam proctor. Requiring students to leave their smartphone face-down on their desk in plain view is not an absolute deterrent, because students could bring in a “fake” phone to place on the desk while retaining their working smartphone. Students taking IPPE or APPE assessments should also leave their belongings and smartphone in a room separate from the proctored test environment. Whether in the classroom or experiential setting, traditional paper and pencil multiple-choice testing may be the most common type of testing, but additional testing methods, such as performancebased assessments, written assessments, and technology-driven assessments, can also unintentionally invite cheating if expectations are unclear or standardized procedures are not used. If students are participating in performance-based assessments such as objective structured clinical examinations, policies should state and proctors should reinforce that talking among students is prohibited during the test. If faculty or preceptors use written assessments or assignments, a log of previous report topics should be maintained to avoid reuse of reports. The instructor should also check the student’s references to ensure that content is appropriately summarized and cited and consider using antiplagiarism software such as TurnItIn (iParadigms LLC, Oakland, CA) that may be available from the college or school. Students may collaborate when instructors deliver homework, quizzes, or exams online in an unproctored environment, especially if the rules for student collaboration are unclear. Instructors who use audience response systems (e.g., clickers) may have cheating occur if they use the clickers for summative assessments, such as graded quizzes, attendance, or participation, because one student can record answers for multiple students by bringing the absent students’ remotes to class.7 The goal of raising faculty and preceptors’ awareness of cheating is to encourage them to be proactive instead of reactive. Being proactive starts at the beginning of the semester, IPPE, or APPE when faculty document clear expectations and policies in their syllabus. These policies should be documented in writing and make clear faculty members’ expectations for attendance and group work and collaboration, as well as quiz and examination guidelines, audience-response-system use guidelines, and closed-exam (no exams returned) procedures. In addition, faculty should provide a policy that includes fair and appropriate consequences for instances of academic misconduct. For example, instructors could state that any student caught cheating on an assignment, quiz, or exam may receive a zero on that assignment, quiz, or exam and a failing grade in the course, IPPE, or APPE. Preceptors should also include specific consequences for falsification of experiential hours (e.g., accidental or intentional reporting of hours not completed). In the classroom or experiential setting, proctoring has been identified as the primary deterrent to cheating during traditional testing.3 Therefore, faculty should establish and consistently uphold clear exam-proctoring policies. Examples of such policies include the following: • Secure the testing room (look at chairs and desks for concealed handouts, study sheets, and other test aids) before students enter the room. • Ask students to leave personal belongings in the front of the room or other designated area. • Advise students what type of clothing is prohibited in the room (e.g., baseball hats, hooded sweatshirts, coats). • Advise students about exam entry, exiting, questioning, and talking policies in writing at least 24 hours in advance. • Have at least two active exam proctors in the classroom who are watching students instead of tending to personal work. • Use multiple versions of the exam. • Adopt a closed-exam policy. • Use a seating chart to eliminate students’ intentional seating arrangements. • Have adequate spacing between students. • Pay close attention to student behavior, especially at the beginning and end of an assessment. • Use a secure browser such as LockDown Browser (Respondus, Redmond, WA) if the exam is online. • Have one proctor supervise or escort students who need to leave the exam environment. • Avoid using an answer key that students can complete and remove from the test. • Supervise exam reviews after the exam is graded to ensure that no students write down questions or take pictures of the exam. • Conduct class exam reviews by discussing general concepts covered by the exam versus specific exam questions. Role of students in reporting academic misconduct. Faculty and preceptors are not the only groups that are concerned about and capable of detecting cheating. Previous research has found that failure to detect cheating and discipline students who cheat may lead to student dissatisfaction if behaviors are rampant.3 Students have two options for reporting academic misconduct when they witness it. They can contact the course coordinator or preceptor and confidentially report the misconduct. Because the reporting student’s cooperation is necessary to investigate the situation further, anonymous reporting is unavailable at most academic institutions. If the student is uncomfortable contacting the course coordinator or preceptor, he or she may contact the institution’s academic integrity council and request contacts specific to each college/school and its departments. The academic integrity council is a committee of students who promote academic integrity on campuses to improve student accessibility to resources and foster a healthy academic environment. The name of this type of committee may vary by institution (e.g., honor council) and may be synonymous with the academic misconduct board, which often consists of faculty and students who hear cases and make decisions about academic misconduct. Other qualities that may differ among institutions include the role of each committee in investigation, judication, or advocacy and the ratio of faculty, students, and staff who comprise each committee. In gener-
New Practitioners Forum al, the incident may require the academic 2. Rabi SM, Patton LR, Fjortoft N et al. Melissa S. Medina, Ed D, Presidential misconduct board to meet, hear the case, Professor and assistant Dean for and render a decision of academic Assessment and evaluation Summary Cheating can occur in the Educ. 20 duc. 2006; 70: article 73 classroom or experiential setting and, 3. Accreditation Council for Pharmacy University of Oklahoma onsequences for the future professional guide lin es for th e adr life of the student and his or her patients gra m in phar may leading to the docter po. Bx zh to newal Avenue It is important to note that the examples accredit. org/pdf/ACPE_Revised_PharmD_ First Floor, Room 125 Standards_Adopted_Jan152006doc ma City, OK 73190 vite cheating through their test creation, 4. Austin z. Collins D. Remillard a et al. melissa-medinaceouhsc edu administration, and method. Faculty nfluence of attitudes toward curriculum Director of Preparing Future Faculty must be proactive and make every at on dishonest academic behavior. Am J Graduate College tempt to prevent cheating by document- 5. Ryan G, Bonanno H, Krass I et al University of Oklahoma ing clear and consistent expectations, Undergraduate and postgraduate phar-WeiC.Yuet,Pharm.DCandidate policies, and consequences in their sylla macy students' perceptions of plagiarism bus and maintain a secure environment d academic honesty. Am/ Pharm Educ. University of oklahoma during assessments in order to uphold 6. Rovai ap online and traditional assess. academic integrity nents: what is the difference? Internet The authors have declared no potential High educ.20003:141-51. inflicts of interest. 1.Hardigan PC. First-and third-year phar- 7. Medina MS, Medina Ph, Wanzer DS et al. macy students'attitudes toward cheating Use of an audience response system(ARS) behaviors. Am J Pharm Educ. 2004; 68: ar- dual-campus environment. Am/ DOI 102146/ajhp120 ticle 110 Pharm Educ. 2008: 72: 38 Am J Health-Syst Pharm-Vol 70 May 1, 2013 757
New Practitioners Forum Am J Health-Syst Pharm—Vol 70 May 1, 2013 757 al, the incident may require the academic misconduct board to meet, hear the case, and render a decision. Summary. Cheating can occur in the classroom or experiential setting and, regardless of the setting, can have dire consequences for the future professional life of the student and his or her patients. It is important to note that the examples herein are just a few ways faculty may invite cheating through their test creation, administration, and method. Faculty must be proactive and make every attempt to prevent cheating by documenting clear and consistent expectations, policies, and consequences in their syllabus and maintain a secure environment during assessments in order to uphold academic integrity. 1. Hardigan PC. First- and third-year pharmacy students’ attitudes toward cheating behaviors. Am J Pharm Educ. 2004; 68:article 110. 2. Rabi SM, Patton LR, Fjortoft N et al. Characteristics, prevalence, attitudes, and perceptions of academic dishonesty among pharmacy students. Am J Pharm Educ. 2006; 70:article 73. 3. Accreditation Council for Pharmacy Education. Accreditation standards and guidelines for the professional program in pharmacy leading to the doctor of pharmacy degree, 2007. www.acpeaccredit.org/pdf/ACPE_Revised_PharmD_ Standards_Adopted_Jan152006.doc (accessed 2012 Nov 26). 4. Austin Z, Collins D, Remillard A et al. Influence of attitudes toward curriculum on dishonest academic behavior. Am J Pharm Educ. 2006; 70:article 50. 5. Ryan G, Bonanno H, Krass I et al. Undergraduate and postgraduate pharmacy students’ perceptions of plagiarism and academic honesty. Am J Pharm Educ. 2009; 73:article 105. 6. Rovai AP. Online and traditional assessments: what is the difference? Internet High Educ. 2000; 3:141-51. 7. Medina MS, Medina PJ, Wanzer DS et al. Use of an audience response system (ARS) in a dual-campus environment. Am J Pharm Educ. 2008; 72:38. Melissa S. Medina, Ed.D., Presidential Professor and Assistant Dean for Assessment and Evaluation College of Pharmacy University of Oklahoma University of Oklahoma Health Sciences Center 1110 North Stonewall Avenue P.O. Box 26901 First Floor, Room 125 Oklahoma City, OK 73190 melissa-medina@ouhsc.edu Director of Preparing Future Faculty Graduate College University of Oklahoma Wei C. Yuet, Pharm.D. Candidate College of Pharmacy University of Oklahoma The authors have declared no potential conflicts of interest. DOI 10.2146/ajhp120598
