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LETTERS

Allegations of cheating roil Dartmouth medical school

A May 2018 file photo of Dartmouth College campus in Hanover, N.H.
A May 2018 file photo of Dartmouth College campus in Hanover, N.H.Ian Thomas Jansen-Lonnquist for the Boston Globe

No surprise: Their research finds students value success above all

I wish I were surprised about the article “Cheating accusations shake medical students: Dartmouth says it’s upholding code; others see rush to judgment” (Page A1, April 16).

Based on more than 20 years of research into how individuals think about responsibilities in their work, we at The Good Project at the Harvard Graduate School of Education know that at a young age, students value personal success above anything else. Even though high school students confront ethical dilemmas taking a test or editing a newspaper, they are often focused on what is good for “I,” not “we.”

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In our recent national study of higher education, most students say that while cheating is rampant, they don’t see it as important as other issues directly affecting them. College students are unabashedly preoccupied with getting high grades and building resumes. Even before COVID-19 and online tests, they rationalized cheating if it “helped” them.

Medical students about to take an oath to “do no harm” are no different than any other student, except that they might have even more ambition in order to aspire to one of the most sacred professions. I would certainly not appreciate being treated by someone who had cheated his or her way through medical school.

Our high schools and colleges need to take responsibility for teaching students that doing the right thing is for now, and not for later.

Wendy Fischman

Cambridge

The writer is the coauthor, with Howard Gardner, of the forthcoming book “The Real World of College.”


Complex technologies also raise questions in medical practice

The cheating scandal unfolding at the Geisel School of Medicine at Dartmouth seems curiously similar to certain situations in medical practice administration that also involve inappropriate use of complex technologies, the workings of which, like most technologies, are not thoroughly understood by the users. Examples include, among other issues, billing, regulation, and obtaining prior approval for medications or procedures.

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Without getting into excessive detail, these issues have led to a never-ending battle among insurers, regulators, and physicians. Electronic medical records have evolved that bend the rules to serve overly simplistic standards, and at the same time to facilitate physicians showcasing the bullet points needed to maximize billing and to achieve approvals, rather than to provide clinical functionality for the benefit of the patient.

Who is right, who is wrong, and who is simply misunderstanding the situation?

The lines are very blurred.

Dr. Richard M. Bargar

Methuen

The writer is a retired orthopedic surgeon.


Medicine is an open-computer activity — exams should be geared to this

The issue of possible cheating by using computers on exams at Dartmouth’s medical school raises an important question about medical education. After all, the actual practice of medicine is an open-computer activity.

Evaluation drives the medical-education system. In the 1950s, when I was a medical student, our exams were short answer or essay, even the exam for medical licensure in Ohio. Answering these questions required recall and problem-solving.

By the 1970s, when I was teaching immunology, most exams in medical school consisted predominantly of multiple-choice questions. Problem-solving multiple-choice questions are much harder to write, so the majority of these questions required only recognition and recall. This drives medical students to memorization of facts rather than understanding. I found that even students who had done well on basic-science exams often could not apply that information when seeing patients in the immunology clinic with me.

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Today a computer search will obtain needed facts in seconds. Today’s evaluation system should be geared to this. If all exams were open-computer, faculty would be driven to devise genuine problem-solving multiple-choice questions or even perhaps revert to essay questions. Students would graduate better prepared to practice medicine.

Dr. Parker A. Small Jr.

Newton

The writer is a professor emeritus in the departments of pediatrics and pathology at the University of Florida.


Dartmouth graduate urges public trust to be upheld

As a proud graduate of Dartmouth’s medical school, I was dismayed and saddened to read about the scandal surrounding potential cheating at the school. I trust that the administration will do a thorough and fair investigation. If found guilty, these students should be expelled. The public trust in the institution of medicine is precious yet fragile, and we need to demonstrate that we can and will enforce the highest levels of ethical conduct among our own.

Dr. Timothy Wu

Dover