title: Multi-institutional study of self-reported attitudes and behaviors of general surgery residents about ethical academic practices in test taking.
abstract: OBJECTIVE
  Correlation exists between people who engage in academic dishonesty as students and unethical behavior once in practice. Previously, we assessed the attitudes of general surgery residents and ethical practices in test taking at a single institution. Most residents had not participated in activities they felt were unethical, yet what constituted unethical behavior was unclear. We sought to verify these results in a multi-institutional study.
  
  
  METHODS
  A scenario-based survey describing potentially unethical activities related to the American Board of Surgery In-training Examination (ABSITE) was administered. Participants were asked about their knowledge of or participation in the activities and whether the activity was unethical. Program directors were surveyed about the use of ABSITE results for resident evaluation and promotion.
  
  
  RESULTS
  Ten programs participated in the study. The resident response rate was 67% (186/277). Of the respondents, 43% felt that memorizing questions to study for future examinations was unethical and 50% felt that using questions another resident memorized was unethical. Most felt that buying (86%) or selling (79%) questions was unethical. Significantly more senior than junior residents have memorized (30% vs 16%; p = 0.04) or used questions others memorized (33% vs 12%; p = 0.002) to study for future ABSITE examinations and know of other residents who have done so (42% vs 20%; p = 0.004). Most programs used results of the ABSITE in promotion (80%) and set minimum score expectations and consequences (70%).
  
  
  CONCLUSIONS
  Similar to our single-institution study, residents had not participated in activities they felt to be unethical; however the definition of what constitutes cheating remains unclear. Differences were identified between senior and junior residents with regard to memorizing questions for study. Cheating and unethical behavior is not always clear to the learner and represents an area for further education.
authors.affiliation: Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Valerie P
authors.initials: VP
authors.lastname: Grignol
authors.forename: Kevin
authors.initials: K
authors.lastname: Grannan
authors.forename: John
authors.initials: J
authors.lastname: Sabra
authors.forename: Robert M
authors.initials: RM
authors.lastname: Cromer
authors.forename: Benjamin
authors.initials: B
authors.lastname: Jarman
authors.forename: Daniel
authors.initials: D
authors.lastname: Dent
authors.forename: Robert P
authors.initials: RP
authors.lastname: Sticca
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Nelson
authors.forename: John S
authors.initials: JS
authors.lastname: Kukora
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Daley
authors.forename: Robert W
authors.initials: RW
authors.lastname: Treat
authors.forename: Paula M
authors.initials: PM
authors.lastname: Termuhlen
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D001290:Attitude; D002568:Certification / Q000941:ethics*; D003430:Cross-Sectional Studies; D004503:Education, Medical, Graduate / Q000941:ethics; D004995:Ethics, Professional; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000941:ethics*; D008297:Male; D020380:Needs Assessment; D018794:Problem-Based Learning; D012309:Risk-Taking; D057566:Self Report; D011795:Surveys and Questionnaires; D058013:Test Taking Skills; D014481:United States
keywords: Medical Knowledge; Practice-Based Learning and Improvement; Professionalism; academic dishonesty; professionalism; resident; surgery