Academic dishonesty, fraud and the law – why Sydney Uni medical students who fabricated patients and reports should have received much more than a warning

Introduction

The latest academic dishonesty scandal involves over 70 third-year medical students from the University of Sydney (“University”) who fabricated patients and fabricated reports in the compulsory subject Integrated Population Medicine (“IPM”). The internal academic review process has resulted in these students merely receiving warnings and having to do a substituted assignment. In this post I show why there is a need to crack down on academic dishonesty, particularly for students who are entering professions such as law and medicine where extremely high standards of honesty and conduct are expected from the respective professional bodies.

Details of the academic dishonesty

The compulsory subject IPM requires students to follow a patient with a chronic health condition over a 12 month period, meeting with the patient at least 5 times over the year. The subject is designed to help students with their professional development and awareness of the effects of chronic health conditions.

The academic dishonesty of IPM students included:

1.       Misrepresenting number of meetings with patients  - fabricating additional meetings to meet the required number of meetings;

2.       Forging patient signatures;

3.       Fabricating patients; and

4.       Misrepresenting meetings and reporting on “meetings” and “interactions” with a client after the patient has died from their chronic illness. 

The academic dishonesty was widespread, with the Sydney Morning Herald reporting 70 students from a class of 200 were involved in the dishonesty. The students were in the third year of their postgraduate degrees and would not have been new to the concept of academic dishonesty.

Students are contractually required to abide by University policies

When a student signs their acceptance to a University course, the student is also agreeing to abide by University policies. The policies are incorporated into the coursework contract. Academic dishonesty is therefore dealt with internally in the first instance by the University, as the University is enforcing a contractual agreement that the student will abide by University policies while enrolled in their course. The relevant policy at the University of Sydney is the Academic Dishonesty and Plagiarism in Coursework Policy 2012 (“Policy”). Other universities have very similar policies.

Academic dishonesty is defined in clause 3.1.1 as: “seeking to obtain or obtaining academic advantage (including in the assessment or publication of work) by dishonest or unfair means or knowingly assisting another student to do so”. Fabricating the existence of patients and patient’s signatures clearly comes within this broad definition, as the policy gives examples of academic dishonesty in clause 3.1.2 including “fabrication of data”.

In addition to being aware of the Policy, students are required to submit a statement of compliance with every assignment which states that their work does not breach the policy (clause 4.4.1). Students who knowingly fabricated patients details not only engaged in academic misconduct but also made a false declaration when submitting their assignment.

Academic dishonesty decision making procedure

Step 1: Potential academic dishonesty is identified

Staff tried to contact a patient to thank them for involvement in the IPM program. They were informed the person was in fact dead. The University launched an audit of the IPM subject designed to ensure patients existed and were alive when the task was done. Widespread potential academic misconduct was identified.

Where widespread academic dishonesty is identified, students are often given the opportunity to come forward and declare their dishonesty. All students in the relevant medical cohort were asked to come forward if they believed they had made misrepresentations in their IPM assignment. At this point, if students came forward and were honest about their misconduct, they would be given a substituted assignment but final marks and academic progress would not be compromised. This gives students the chance to develop an understanding of the importance of dishonesty.

Step 2: Preliminary view of academic misconduct is made

Each Faculty has a “Nominated Academic” who makes a preliminary determination of the student’s conduct. If the Nominated Academic forms the view that the allegations if proven would constitute academic misconduct, the case is progressed with the student being notified and invited to interview (Policy clause 5.3.4).

Step 3: Students are informed of the allegations

A key concept of procedural fairness is that the person under investigation is given a fair opportunity to respond to the allegations. Procedural fairness is taken very seriously by universities. If a student appeals the decision and takes the University through the judicial system, procedural fairness will be examined and a sound decision could be overturn on a small procedural irregularity.

Procedural fairness is covered in clause 5.2.1 of the Policy and includes the standard principles of administrative law procedural fairness. Students must be:

·         Given detailed information about the allegations against them;

·         Given sufficient time to respond to the allegations;

·         Informed of their rights under the Policy and the investigation procedure;

·         Advised they can bring a support person to meetings;

·         Advised the decision will be made impartially and without bias; and

·         Advised the investigation process will happen in a timely manner.

Step 4: Student is invited to an interview

The student will be notified of their interview time and place, the people who will be present at the interview and that they can bring a support person (Policy, clause 5.3.4).

Step 5: Final determination is made on academic misconduct

After the interview, the Nominated Academic considers all material available including material provided by the student at the interview to make a determination on whether academic misconduct occurred.

There are four determinations available under clause 5.4.2 of the Policy:

1.       No impropriety;

2.       Negligent plagiarism;

3.       Dishonest plagiarism; and

4.       Some other form of academic misconduct.

If academic conduct is found to exist but it is not serious enough to constitute “student misconduct”:

·         The student will receive an official warning and advised of the consequences of any subsequent breaches;

·         The student will be referred to student services for relevant assistance; and

·         May be required to redo the assignment, resubmit another assignment OR receive a fail grade for the assignment or subject (Policy 5.8.3).

Step 6: Preliminary determination is made on student misconduct

If academic misconduct is found to exist, the Nominated Academic will make a preliminary determination on whether the facts also support a determination of student misconduct. Serious academic misconduct can constitute student misconduct. The Nominated Academic will consider:

·         the extent of the conduct when measured against the student’s original contribution to the work;

·         the capacity of the conduct adversely to affect the student’s peers and or teachers;

·         the capacity of the conduct adversely to impact on the actual or perceived academic standards of the University; and

·         whether the student has previously received a written warning.

Step 7: Final determination on student misconduct

The Nominated Academic will refer the matter to the Registrar who will refer the matter to the Vice-Chancellor. The Vice-Chancellor will then direct the Registrar to conduct an investigation or direct the matter back to the relevant Faculty (Policy, clauses 5.7.3, 5.7.4 and 5.7.5).

Outcome of the internal academic dishonesty process

Some IPM students were determined to have breached the Policy and have engaged in academic misconduct. The process stopped at Step 5 above, as the conduct was not considered serious enough to constitute “student misconduct”.  Students received a warning and were required to redo the relevant assignment. No major breaches of the Policy that would constitute “serious misconduct” were identified.

Are there any “defences” to academic dishonesty?

In short, no. The Policy does not allow for any defences. The media reported IPM students complained of being under significant pressure. Being under pressure is not a legitimate excuse. Do medical students think that a qualified doctor is not under any pressure? Medicine is a highly stressful profession and students need to be able to cope with this pressure without resorting to dishonesty. Dishonesty is not acceptable as a medical professional and it should not be acceptable for medical students. The media has also reported IPM students have complained the IPM unit was flawed in that it was meaningless and useless. This is not an excuse for academic dishonesty. If your patient dies half way through the year, you should inform the course coordinator, not fabricate meetings, responses and signatures.

Can decisions be appealed?

Another principle of procedural fairness is that decisions made against an individual should be able to be appealed. Students have a few appeal options:

1.       Make formal application to the Faculty – for academic misconduct determinations;

2.       Appeal to the Student Appeals Body (see the University of Sydney (Student Appeals against Academic Decisions) Rule 2006 (as amended) – for academic misconduct determinations;

3.       Appeal to the Student Disciplinary Appeals Committee, a body created by s78 of the University of Sydney By-Law 1999 (NSW), which is made up of a current or former judge, a Fellow, and a lawyer with at least 5 years post-admission experience – for serious student misconduct determinations;

4.       Make a complaint to the NSW Ombudsman;

5.       Commence legal proceedings in the Supreme Court. This is a difficult option in practice as you will need a cause of action and be able to establish damages. A student is likely to struggle with breach of contract arguments, as it is the student who contracted to abide by university policies upon enrolling. Procedural fairness arguments are unlikely to be successful, as universities are very careful to follow the procedural fairness steps provided for in policies.

Academic dishonesty and criminal law

The medical students who engaged in academic misconduct such as forging signatures and creating patient details are also potentially liable under the NSW criminal justice system. The Crimes Act 1900 (NSW) lists a number of offences that could apply to the student’s academic misconduct including fraud, identity offences and forgery. However, many of these statutory offences have an additional element that the fraud or forgery occur to obtain a financial or property benefit, which would rule out certain offences from applying to academic dishonesty conduct. There may be some common law criminal offences that apply where the additional element to fraud and forgery is not required. Even if there were clear cut criminal offences that would apply to forging signatures in the academic context, police and enforcement agencies are likely to view academic misconduct as a contractual matter between the University and students and not intervene.

What about the students who have graduated and are working?

Three of the students involved in the academic misconduct have now graduated and are working as medical professionals. Having “got away” with dishonest conduct while at University, these medical professionals may struggle with coping appropriately with the pressures of the profession, including abiding by the Australian Medical Association’s Code of Conduct. The Code of Conduct is an ethical guide for practitioners, but has been used by courts to determine the scope of a doctor’s duties to clients. In particular, students who disengaged from the IPM subject which aims to teach students about the difficulties chronically ill patients face may struggle with the “Dying Patient” clauses in the Code of Conduct:

“1.4 The Dying Patient

1. Remember the obligation to preserve life, but, where death is deemed to be imminent and where curative or life-prolonging treatment appears to be futile, try to ensure that death occurs with dignity and comfort.
2. Respect the patient's autonomy regarding the management of their medical condition including the refusal of treatment.
3. Respect the right of a severely and terminally ill patient to receive treatment for pain and suffering, even when such therapy may shorten a patient's life.
4. Recognise the need for physical, psychological, emotional, and spiritual support for the patient, the family and other carers not only during the life of the patient, but also after their death.”

Generally speaking dishonest conduct is unethical conduct. Principle 2.1 of the Code of Conduct actually requires medical professionals to report unethical conduct for Peer Review. Academic dishonesty by medical students should be taken seriously, as further down the career path, the doctor and patient are potentially at risk by the fact dishonesty was not appropriately reprimanded at University.

Why was a cautious approach taken?

The outcome for the IPM medical students who engaged in academic dishonesty was that students received a warning and had to redo the assignment. To me, this seems inadequate for the nature of the conduct as reported in the media which included forging patient signatures and reporting about consultations and patients that did not take place. The inadequacy of the academic dishonesty outcome is even more pronounced when you consider the increasingly widespread prevalence of academic dishonesty and the need to deter students.

The main reason a cautious approach is taken by universities is image control. Having academic dishonesty in the media is terrible press. Sydney Medical School has a reputation as being one of the best medical schools in Australia, and such widespread academic misconduct is incredibly damaging. By merely providing students with a warning and a new assignment rather than escalating the conduct to “student misconduct”, where students would appeal and may extend adverse media attention, the University is saving face. There is a real gap between society’s ethical expectations that doctors will act honestly and with integrity and the way medical students are treated when they display obvious signs of dishonesty and misconduct.

While academic dishonesty continues to be treated as a private matter between universities and their students, one of the only ways for universities to deter academic misconduct is to actually use the policy mechanisms they have in place. This will involve escalating serious matters to “student misconduct”. Deterring students from academic dishonesty and teaching students basic concepts of honesty should be valued ahead of any adverse PR consequences.