Cheating and the Illusion of Competency

In a blog post from 2014, Dr. Betty Chung, then a second-year resident physician at the University of Illinois Hospital and Health Sciences System in Chicago, recalled attending a residents’ forum the year prior and hearing from the President of the American Board of Pathology, who spoke about the use of “remembrances” for boards studying and how it was in fact cheating and a breach of the honor code.  

Most of the attendees in the audience, via text polling, disagreed that the memorization of questions from board certifications constituted cheating. 

Dr. Chung went on to give examples of observing firsthand some students receiving old exams from “2nd year big siblings” and the inequities involved. She explains how, to even the playing field, she scanned her old exams and made them available to a listserv. However, this led to serious repercussions, as another student, following her lead, sent out what he thought was an old exam but instead turned out as having been stolen from a professor.  

Over time, some of the students came to realize that some “old exam materials” were remembrances from a NBOME (National Board of Osteopathic Medical Examiners) shelf exam, and after coming forward and providing that information to a dean, the NBOME had to retire many of the exam questions. 

Dr. Chung then recalled how listening to the speaker at that forum led her to evaluate those experiences against what she was hearing. Did the end justify the means? In her case, she concluded that what the students had accomplished was passing a board exam, part of the medical certification process.

Such certifications are the types of credentials that subject matter experts lead with when expressing their authority. Indeed, in her current bio, Dr. Chung leads off with “board certified by the American Board of Pathology.” Her blog post is a positive reflection by a student on her schooling, and she talks about how important it is for practicing pathologists to truly comprehend the material they are studying. 

The opportunity to cheat does not end in medical school. Once doctors, nurses, lab technicians and other health professionals graduate, they must continuously be tested as to their competency. There are many quality management software programs on the market that provide health care professionals with online exams that test their knowledge and skills and maintain records of accreditations. In fact, the majority of these software programs range from good to excellent, with code in place to prevent the potential for cheating. 

However, it must be known that quality management software does exist where medical staff do have the opportunity to cheat. For example, with one such program, when an online test taker gets an answer wrong, the program shows him his error and highlights the correct answer. How is that learning? Additionally, with the same program, a health care professional required to review a new or revised procedure and confirm that she understands it, can quickly attest that she does…even if she hasn’t even scrolled down the page to actually find it and read it. 

Most of us are not cheaters.  But when given the opportunity to cheat, how many of us will succumb to its temptation? Quality control software programs should not give anyone the option to cheat. People’s lives depend on health professionals who have the skills and the knowledge to do their jobs.    Let’s put safeguards in place to avoid temptation and guarantee that health care professionals are up to date on the skills and knowledge they need to do their jobs right.  We support Senate Bill 9060, which would eliminate the ability to cheat on all quality management software programs.

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