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MyView: Is cheating the new norm?

April 20, 2015

By Christian Piers

Christian Piers
According to an August 2007 survey published in the Journal of Dental Education, more than one-quarter of the more than 1,100 dental students surveyed had cheated on preclinical exams or tests.

Maybe you remember that statistic from the front-page article of August ASDA News. I'm writing this letter because months after the conversations sparked by that article, it seems little has changed.

We need to do more than just talk about cheating. That same ASDA News article reported that dental students have long complained that cheaters are seldom caught and even more rarely disciplined. So who's to blame?

Tort law addresses this situation with the term "attractive nuisance." To understand this concept, imagine a swimming pool in your backyard without a fence. If someone drowns in your pool, maybe the victim made a poor decision. But legally, you — the owner of the unfenced pool — are liable.

Today's enforcement of honor code violations presents an attractive nuisance. If the 2007 survey still holds true and one in every four dental students has cheated, it's no longer enough for schools to pepper the curriculum with stilted ethics courses and ask during interviews whether a student will cheat. Humans are designed to seek maximal gain for minimal cost — and part of minimizing the cost for cheating is acknowledging that people will seek the reward.

Students are ultimately responsible for deciding to cheat. But it's shortsighted to blame people while making no attempt to reform the environment. We hold Lance Armstrong responsible for doping, but we also acknowledge the role of the Tour de France doping culture in giving rise to further drug abuse.

I challenge dental students and dental schools to accept their culpability in creating this "culture of permission." One-quarter of dental students could eliminate cheating by deciding not to cheat, and the other 75 percent could do the same by reporting it. But self-policing isn't easy. Policies based on the confrontation clause — the right to face one's accuser — make anonymous reporting impossible. This means students must choose between staying quiet or reporting cheaters and living as outcasts among classmates they're forced to see more than loved ones. Dental students need help.

If we're really concerned about helping students make good ethical choices, maybe we just need to make it harder to make wrong ones. The more times a student does something wrong and is reinforced, the more likely that behavior will continue. The Joint Commission on National Dental Examinations has made significant progress in preventing cheating on the NBDE, so why do we find it less necessary to prevent cheating in dental school? Mandating multiple proctors and new technology like lockdown browsers could help, but larger solutions are needed. Meantime, the current system is teaching students that unethical decision-making is sometimes permissible to us as a profession. At the very least, we're saying it doesn't really bother us.

Whatever solutions we choose, we need to address this problem before it affects the way patients look at dentistry. If patients can't trust 25 percent of dentists, no amount of skill or knowledge will let any of us help them. There are no simple solutions. The first step will be acknowledging there's a problem, and then forming task forces to help students and administrations address this culture of permission together. This will take time. But we owe this work to our patients. We owe it to our profession.

This article is reprinted with permission from the American Student Dental Association. It originally appeared in the March 2015 issue of ASDA News. Mr. Piers is the current ASDA president. For more dental student news, visit