Abstract
-
Purpose
Medical students are expected to cultivate professionalism as a core competency, which is reflected in their perceptions of academic ethics. This study examined how students’ perceptions of academic ethics, both for themselves and their peers, evolve during their time in medical school and whether these changes differ by sex.
-
Methods
We surveyed 87 medical students enrolled in a South Korean medical school in the years 2020 and 2023. The survey was designed to measure medical students’ perceptions of academic ethics and comprised questions regarding both self-perception and peer perception. Data analysis was performed using paired t-tests.
-
Results
Both male and female students reported continuous improvement in their academic ethics as they progressed through medical school. Female rated their academic ethics more highly than male and demonstrated a more significant change in scores over time. Additionally, female observed an increase in their peers’ academic ethics, whereas men perceived a decline. Notably, upper-year students rated their peers’ academic ethics more favorably than did lower-year students.
-
Conclusion
This study reveals differences in the evolution of academic ethics perceptions between male and female students, highlighting the need for sex-specific academic ethics education in medical school curricula. Moreover, it demonstrates how medical students’ perceptions of academic ethics evolve over time, emphasizing the importance of academic ethics education across school years. These findings offer practical insights for improving medical school curricula and underscore the potential of academic ethics education in fostering ethical awareness among future medical professionals.
-
Keywords: Professional, Professional misconduct, Medical ethics, Medical student, Medical education
Introduction
Cultivating professionalism in medical education has become increasingly important, as medical students are expected to develop core competencies that encompass ethical behavior and professionalism [
1]. These competencies are essential for maintaining respect and honesty with patients and begin with activities that reinforce desirable personality traits such as integrity and responsibility [
2]. Medical schools utilize various educational methods to instill professionalism in students and enhance their ethical awareness [
3,
4]. The perception of academic ethics among medical students is significant because they reflect values that are crucial in educational settings and can predict students’ professionalism once they enter practice [
5,
6]. The relationship between academic integrity during medical training and professional behavior after obtaining medical licenses is well documented [
7]. Practitioners are expected to demonstrate competence and adhere to ethical standards [
8], and medical education plays a vital role in nurturing these qualities through rigorous academic training and clinical practice.
Research on academic misconduct in medical schools has found that a lack of awareness regarding cheating often leads to the oversight of academic dishonesty [
1]. Dishonest behaviors, such as completing assignments for classmates or allowing others to benefit from one’s work, are frequently perceived as peer support, cooperation, or benevolence [
9]. Additionally, some studies have identified intense competition within medical schools as a significant contributor to academic dishonesty [
10]. In other words, academic competition can induce stress, anxiety, and depression, which may trigger instances of misconduct. Previous research has indicated that students who observe their peers cheating are more likely to engage in academic dishonesty themselves [
11,
12]. Conversely, as medical students become more aware of plagiarism and its detrimental effects, their engagement in such practices decreases [
13-
15]. These findings suggest that perceptions of academic misconduct can significantly influence the prevalence of cheating.
While numerous studies have been conducted on academic ethics and misconduct internationally, clarity regarding the professional conduct that medical students must adhere to in South Korean schools and hospitals is lacking. Additionally, the related curricula are poorly managed, and understanding of students’ perceptions and awareness of academic ethics is inadequate [
16]. This research begins with the question “Do perceptions of academic ethics change?” The study aims to determine whether medical students’ perceptions of their own and their peers’ academic ethics evolve as they progress through their years of study, and whether these changes differ between male and female students. In line with this objective, the specific research questions were as follows: (1) Do medical students’ perceptions of their academic ethics vary according to their year of study and sex? (2) Do medical students’ perceptions of their peers’ academic ethics vary according to their year of study and sex?
Methods
1. Participants
We conducted a survey of medical students at University of Ulsan College of Medicine in South Korea on two occasions, in 2020 and 2023, to examine changes in their perceptions of academic ethics. The first survey included 121 students from three academic years (first through third) enrolled in 2020, and the second survey was conducted in 2023 with the same cohort.
By 2023, the number of students had decreased to 114 due to academic leave, reinstatement, or probation. Among them, 87 students completed both surveys and were included in the final analysis. Responses that were incomplete or demonstrated inconsistencies (e.g., failure on attention-check questions or extreme response patterns such as identical ratings across all items) were excluded. The demographic characteristics of the excluded participants (n=27) were comparable to those of the included group in terms of sex and year level, minimizing the risk of selection bias.
The final sample consisted of 57 male students (65.5%) and 30 female students (34.5%), including 31 fourth-year students (35.6%), 28 fifth-year students (32.2%), and 28 sixth-year students (32.2%) (
Table 1).
This study was approved by the Institutional Review Board of Asan Medical Center (No. AMC 2024-0549). Since the analysis was conducted using retrospective research based on survey data collected from participating students, their consent was not required.
2. Measurement
This study analyzed survey data collected as part of the annual curriculum evaluation conducted by the University of Ulsan College of Medicine. The survey asked students to evaluate both their own and their peers’ levels of academic misconduct, including plagiarism, proxy attendance, cheating on examinations, and collusion in peer evaluation scores.
The two survey questions were (1) “How would you rate your own level of academic ethics?” and (2) “How would you rate your peers’ level of academic ethics?” Responses were recorded on a 5-point Likert scale (1=very low, 2=low, 3=neutral, 4=high, 5=very high).
3. Analysis
The first survey was administered from December 9 to 17, 2020, while the second survey was conducted from December 20 to 27, 2023. Both surveys utilized online tools. Descriptive statistics were employed to identify general characteristics and changes in perceptions. Skewness values ranged from −1.68 to 0.11, and kurtosis values ranged from −0.56 to 3.46, confirming adherence to established normality criteria (|skewness| ≤2, |kurtosis| ≤7) [
17].
The reliability (Cronbach’s α) of the first survey was 0.87, whereas that of the second survey was 0.59, reflecting the limited number of items (n=2) and the resulting restriction in internal consistency [
18]. Paired t-tests were conducted on the two datasets to examine changes in students’ perceptions of their own and their peers’ academic ethics. Effect sizes were reported as Cohen’s dz for paired samples, calculated as t divided by the square root of n, with positive values indicating higher scores in 2023 relative to 2020. All analyses were performed using IBM SPSS Statistics ver. 28.0 (IBM Corp., Armonk, USA).
Results
1. Medical students’ perceptions of their academic ethics
To examine changes in medical students’ perceptions of their own academic ethics, we compared the results of two surveys conducted in 2020 and 2023, analyzing the data by sex and year (
Table 2). Overall, the average score increased from 4.29 in 2020 to 4.54 in 2023, with this difference being statistically significant. The paired-samples effect size, Cohen’s dz, was 0.28, indicating a small practical effect. Male students’ perceptions of their academic ethics rose from 4.28 in 2020 to 4.42 in 2023; however, this change was not statistically significant. The corresponding effect size, Cohen’s dz, was 0.16, trivial to small. In contrast, female students’ perceptions increased from 4.30 in 2020 to 4.77 in 2023, which represents a statistically significant difference. The effect size, Cohen’s dz was 0.46, a small to moderate effect. Both male and female demonstrated an upward trend in their perceptions as they progressed through their studies, with female consistently achieving higher scores than did male.
In terms of year levels, the mean score increased from 4.23 to 4.42 for first-year students as they progressed to their fourth year, from 4.04 to 4.46 for second-year students advancing to their fifth year, and from 4.61 to 4.75 for third-year students transitioning to their sixth year. In 2020, second-year students rated their academic ethics the lowest at 4.04, but their mean score increased significantly to 4.46 in 2023, making the difference between the two periods statistically significant. Additionally, third-year students, who had the highest score in 2020 (4.61), maintained the highest score (4.75) in the 2023 survey. The corresponding effect sizes were as follows: first to fourth year Cohen’s dz was 0.20, small; second to fifth year was 0.43, small-to-moderate; third to sixth year was 0.19, small. Taken together, the largest practical gains were observed among female students and the second to fifth year cohort.
2. Medical students’ perceptions of their peers’ academic ethics
To examine changes in medical students’ perceptions of their peers’ academic ethics, we compared the survey results from 2020 and 2023 by sex and year (
Table 3). In 2020, students rated their peers’ academic ethics at an average of 4.18, which decreased to 4.06 in 2023. The paired-samples effect size, Cohen’s dz, for this overall change was −0.12, indicating a very small practical decrease. As students progressed through their academic years, their ratings of peers’ academic ethics generally decreased; however, this difference was not statistically significant. Men’s perceptions of their peers’ academic ethics declined from an average of 4.25 in 2020 to 3.96 in 2023, a difference that was statistically significant. The corresponding effect size was −0.31, a small decrease. In contrast, female’s perceptions of their peers’ academic ethics increased from an average of 4.07 in 2020 to 4.23 in 2023; nevertheless, this increase was not statistically significant. The corresponding effect size was 0.14, a trivial to small increase.
By year level, the mean score decreased from 4.10 to 3.71 for students advancing from the first to the fourth year, marking the lowest mean score among all groups in 2023. The effect size for this change was −0.34, a small to moderate decrease. In contrast, students progressing from the second to the fifth year saw an increase in their mean score from 4.07 to 4.14. The effect size was 0.06, negligible. Meanwhile, for students moving from the third to the sixth year, the mean score decreased slightly from 4.39 to 4.36. The effect size was −0.05, negligible. Taken together, the most notable practical change was a small decrease among male students and among the first to fourth year cohort, while changes in the other groups were minimal.
Discussion
As future physicians, medical students are expected to cultivate professionalism as a core competency, which can be reflected in their perceptions of academic ethics at the student level. This study examined changes in perceptions of academic ethics regarding themselves and their peers over a 3-year period, analyzing patterns based on sex and year level. The findings and discussion are as follows.
First, analysis of students’ perceptions of their own academic ethics showed continuous improvement across medical school years. Female students consistently rated their own academic ethics higher than did male students and demonstrated greater increases over time. These findings suggest that perceptions of academic ethics may strengthen as students’ progress in their studies. However, previous research has reported mixed results. For example, Hrabak et al. [
5] found higher misconduct rates among senior students, whereas Rennie and Rudland [
19] observed stronger recognition of misconduct among first-year students. Such discrepancies may reflect cultural and contextual differences. In particular, the timing of the first survey coincided with the coronavirus disease 2019 (COVID-19) pandemic, which disrupted academic norms through remote learning and alternative assessment practices. This context may have influenced how students perceived academic ethics across the study period.
Second, analysis of perceptions of peers’ academic ethics revealed contrasting gender patterns. Over time, female students reported slightly more favorable views of their peers’ ethics, whereas male students reported less favorable views. Perceptions of peers’ ethics were also generally higher during the clinical training years (fifth and sixth) compared with the preclinical years (first through third). These findings indicate that both sex and level of training may shape how students evaluate their peers’ academic ethics.
Interpretations of these differences should remain cautious. While prior studies suggest that factors such as self-bias and peer-bias influence evaluations [
20], the present study did not directly measure such mechanisms. Similarly, although pandemic-related shifts in learning environments may have played a role [
21], these influences cannot be confirmed within the current study design. Further research with more comprehensive measures is needed to clarify why male students tended to evaluate their peers’ ethics more negatively and to explore whether these differences reflect contextual, cultural, or individual factors [
22,
23].
By tracking the same cohort longitudinally, this study contributes to understanding how perceptions of academic ethics evolve during medical education and how they differ by sex and year level. The longitudinal design, following the same group of students across 3 years, reduces potential cohort effects and provides a clearer view of developmental changes in perceptions of academic ethics. Nonetheless, the modest reliability of the two-item instrument in 2023 (Cronbach’s α=0.59) represents an important limitation and should be considered when interpreting the results. Taken together, the findings highlight the importance of monitoring changes in ethical perceptions during medical training and tailoring educational interventions to support the development of professionalism.
This study has several limitations. First, it was conducted at a single medical school, which limits the generalizability of the findings. Second, the design involved measurement at only two time points, which constrains the ability to identify more nuanced developmental trajectories and makes it difficult to distinguish year-level effects from period effects. Third, the measurement instrument comprised only two items, and the reliability of the 2023 survey was modest (Cronbach’s α =0.59). This limited internal consistency reduces the robustness of the conclusions and should be taken into account when interpreting the results. Finally, contextual factors—such as the COVID-19 pandemic and changes in curriculum delivery—were not directly measured but may have influenced students’ perceptions.
Notes
-
Acknowledgements
We thank the Centre for Medical Education at the University of Ulsan College of Medicine for their assistance with the survey.
-
Funding
This research was funded by the University of Ulsan (grant number 2024-0449).
-
Conflicts of interest
Hyojin Kwon serves as an Editorial Board member of the Korean Journal of Medical Education but have (has) no role in the decision to publish this article. Except for that, no potential conflict of interest relevant to this article was reported.
-
Author contributions
Conception or design of the work: HJK, SJC. Data collection: HJK. Data analysis: HJK. Interpretation: HJK, SJC. Drafting the article: HJK, SJC. Critical revision of the article: HJK, SJC. Final approval of the version to be published: SJC.
Table 1.Basic Information of the Study Participants
Table 1.
|
Variable |
Year
|
Analyzed students |
|
2020 |
2023 |
|
Sex |
|
|
|
|
Male |
77 (63.6) |
72 (63.2) |
57 (65.5) |
|
Female |
44 (36.4) |
42 (36.8) |
30 (34.5) |
|
Year level |
1st: 37 (30.6) |
4th: 40 (35.1) |
1st → 4th: 31 (35.6) |
|
2nd: 45 (37.2) |
5th: 38 (33.3) |
2nd → 5th: 28 (32.2) |
|
3rd: 39 (32.2) |
6th: 36 (31.6) |
3rd → 6th: 28 (32.2) |
|
Total |
121 (100.0) |
114 (100.0) |
87 (100.0) |
Table 2.Perceptions of Academic Ethics among Medical Students by Sex and Year Level (2020–2023)
Table 2.
|
Variable |
Year
|
t-value |
p-value |
Cohen’s dz |
|
2020 |
2023 |
|
Sex |
|
|
|
|
|
|
Male (n=57) |
4.28±0.90 |
4.42±0.73 |
-1.240 |
0.220 |
0.16 |
|
Female (n=30) |
4.30±0.92 |
4.77±0.50 |
-2.536 |
0.017*
|
0.46 |
|
Year level |
|
|
|
|
|
|
1st → 4th (n=31) |
4.23±0.81 |
4.42±0.77 |
-1.099 |
0.280 |
0.20 |
|
2nd → 5th (n=28) |
4.04±1.11 |
4.46±0.64 |
-2.274 |
0.031*
|
0.43 |
|
3rd → 6th (n=28) |
4.61±0.69 |
4.75±0.59) |
-1.000 |
0.326 |
0.19 |
|
Total (n=87) |
4.29±0.90 |
4.54±0.68 |
-2.570 |
0.012*
|
0.28 |
Table 3.Perceptions of Peers’ Academic Ethics among Medical Students by Sex and Year Level (2020–2023)
Table 3.
|
Variable |
Year
|
t-value |
p-value |
Cohen’s dz |
|
2020 |
2023 |
|
Sex |
|
|
|
|
|
|
Male (n=57) |
4.25±0.93 |
3.96±0.89 |
2.301 |
0.025**
|
-0.031 |
|
Female (n=30) |
4.07±1.01 |
4.23±0.77 |
-0.740 |
0.465 |
0.14 |
|
Year level |
|
|
|
|
|
|
1st → 4th (n=31) |
4.10±1.11 |
3.71±0.86 |
1.882 |
0.070*
|
-0.034 |
|
2nd → 5th (n=28) |
4.07±1.01 |
4.14±0.80 |
-0.311 |
0.758 |
0.06 |
|
3rd → 6th (n=28) |
4.39±0.63 |
4.36±0.78 |
0.273 |
0.787 |
-0.05 |
|
Total (n=87) |
4.18±0.96 |
4.06±0.85 |
1.118 |
0.266 |
-0.12 |
References
- 1. Pupovac V, Popović S, Blažina V. What prevents students from reporting academic misconduct?: a survey of Croatian students. J Acad Ethics. 2019;17(4):389-400. https://doi.org/10.1007/s10805-019-09341-5.
- 2. Kwon HJ, Lee YM, Lee YH. Development of an inventory assessing medical students’ attitudes towards academic misconduct. Korean J Med Educ. 2013;25(3):211-220. https://doi.org/10.3946/kjme.2013.25.3.211.
- 3. Kim MJ, Kim J, Kim SK. Reinforcing professionalism through medical ethics education based on arete. Korean J Med Ethics. 2021;24(4):409-422. https://doi.org/10.35301/ksme.2021.24.4.409.
- 4. Park HJ, Kang EC. The development of an educational program for improving the ethical problem-solving ability of medical students. Korean J Med Ethics. 2016;19(2):175-184. https://doi.org/10.35301/ksme.2016.19.2.175.
- 5. Hrabak M, Vujaklija A, Vodopivec I, Hren D, Marusić M, Marusić A. Academic misconduct among medical students in a post-communist country. Med Educ. 2004;38(3):276-285. https://doi.org/10.1111/j.1365-2923.2004.01766.x.
- 6. Hafeez K, Laiq-Uz-Zaman Khan M, Jawaid M, Haroon S. Academic misconduct among students in medical colleges of Karachi, Pakistan. Pak J Med Sci. 2013;29(3):699-702. https://doi.org/10.12669/pjms.293.3300.
- 7. Papadakis MA, Teherani A, Banach MA, et al. Disciplinary action by medical boards and prior behavior in medical school. N Engl J Med. 2005;353(25):2673-2682. https://doi.org/10.1056/NEJMsa052596.
- 8. Vengoechea J, Moreno S, Ruiz A. Misconduct in medical students. Dev World Bioeth. 2008;8(3):219-225. https://doi.org/10.1111/j.1471-8847.2007.00194.x.
- 9. Cronan TP, Mullins JK, Douglas DE. Further understanding factors that explain freshman business students’ academic integrity intention and behavior: plagiarism and sharing homework. J Bus Ethics. 2018;147(1):197-220. https://doi.org/10.1007/s10551-015-2988-3.
- 10. Mubeen SM, Ghayas R, Adil Rizvi SH, Khan SA. Knowledge of scientific misconduct in publication among medical students. Educ Health (Abingdon). 2017;30(2):140-145. https://doi.org/10.4103/efh.EfH_221_16.
- 11. Arshad I, Zahid H, Umer S, Khan SY, Sarki IH, Yaseen MN. Academic dishonesty among higher education students in Pakistan. Elem Educ Online. 2021;20(5):5334-5345. https://doi.org/10.17051/ilkonline.2021.05.597.
- 12. Mak-van der Vossen M, Teherani A, van Mook W, Croiset G, Kusurkar RA. How to identify, address and report students’ unprofessional behaviour in medical school. Med Teach. 2020;42(4):372-379. https://doi.org/10.1080/0142159X.2019.1692130.
- 13. Althobaiti MH, Alkhaldi LH, Alotaibi WD, et al. Knowledge, attitude, and practice of medical ethics among health practitioners in Taif government, KSA. J Family Med Prim Care. 2021;10(4):1759-1765. https://doi.org/10.4103/jfmpc.jfmpc_2212_20.
- 14. Alhadlaq AS, Dahmash AB, Alshomer F. Plagiarism perceptions and attitudes among medical students in Saudi Arabia. Sultan Qaboos Univ Med J. 2020;20(1):e77-e82. https://doi.org/10.18295/squmj.2020.20.01.011.
- 15. Findyartini A, Sudarsono NC. Remediating lapses in professionalism among undergraduate pre-clinical medical students in an Asian Institution: a multimodal approach. BMC Med Educ. 2018;18(1):88. https://doi.org/10.1186/s12909-018-1206-2.
- 16. Chung EK, Lee YM, Chae SJ, et al. Korean medical students’ attitudes toward academic misconduct: a cross-sectional multicenter study. Korean J Med Educ. 2019;31(4):309-317. https://doi.org/10.3946/kjme.2019.141.
- 17. Kline P. An easy guide to factor analysis. London, UK: Routledge; 2014:https://doi.org/10.4324/9781315788135.
- 18. Seong TJ. Validity and reliability. Seoul, Korea: Hakjisa Corporation; 2010.
- 19. Rennie SC, Rudland JR. Differences in medical students’ attitudes to academic misconduct and reported behaviour across the years: a questionnaire study. J Med Ethics. 2003;29(2):97-102. https://doi.org/10.1136/jme.29.2.97.
- 20. Torres-Guijarro S, Bengoechea M. Gender differential in self-assessment: a fact neglected in higher education peer and self-assessment techniques. High Educ Res Dev. 2017;36(5):1072-1084. https://doi.org/10.1080/07294360.2016.1264372.
- 21. Stoesz BM, Quesnel M, De Jaeger AE. Student perceptions of academic misconduct amongst their peers during the rapid transition to remote instruction. Int J Educ Integr. 2023;19(1):14. https://doi.org/10.1007/s40979-023-00136-1.
- 22. Ford RC, Richardson WD. Ethical decision making: a review of the empirical literature. J Bus Ethics. 1994;13(3):205-221. https://doi.org/10.1007/BF02074820.
- 23. Whitley BE, Nelson AB, Jones CJ. Gender differences in cheating attitudes and classroom cheating behavior: a meta-analysis. Sex Roles. 1999;41(9):657-680. https://doi.org/10.1023/A:1018863909149.
