Exploring The Attitudes Of Medical Faculty Members And .
Exploring the attitudes of medical facultymembers and students in Pakistantowards plagiarism: a cross sectionalsurveyFarooq Azam Rathore1 , Ahmed Waqas2 , Ahmad Marjan Zia2 ,Martina Mavrinac3 and Fareeha Farooq41 Department of Rehabilitation Medicine, Combined Military Hospital, Lahore Cantt, Pakistan2 CMH Lahore Medical College and Dental College, Lahore Cantt, Pakistan3 Department for Medical Informatics, University of Rijeka, School of Medicine, Rijeka, Croatia4 Department of Biochemistry, Fatima Memorial Hospital Medical College, Shadman, Lahore,PakistanABSTRACTSubmitted 5 January 2015Accepted 26 May 2015Published 18 June 2015Corresponding authorAhmed Waqas,ahmedwaqas1990@hotmail.comAcademic editorElizabeth WagerAdditional Information andDeclarations can be found onpage 10DOI 10.7717/peerj.1031Objective. The objective of this survey was to explore the attitudes towardsplagiarism of faculty members and medical students in Pakistan.Methods. The Attitudes Toward Plagiarism questionnaire (ATP) was modified anddistributed among 550 medical students and 130 faculty members in 7 medicalcolleges of Lahore and Rawalpindi. Data was entered in the SPSS v.20 and descriptivestatistics were analyzed. The questionnaire was validated by principal axis factoringanalysis.Results. Response rate was 93% and 73%, respectively. Principal axis factoring analysis confirmed one factor structure of ATP in the present sample. It had an acceptableCronbach’s alpha value of 0.73. There were 421 medical students (218 (52%) female,46% 3rd year MBBS students, mean age of 20.93 1.4 years) and 95 faculty members(54.7% female, mean age 34.5 8.9 years). One fifth of the students (19.7%) trainedin medical writing (19.7%), research ethics (25.2%) or were currently involved inmedical writing (17.6%). Most of the faculty members were demonstrators (66)or assistant professors (20) with work experience between 1 and 10 years. Most ofthem had trained in medical writing (68), research ethics (64) and were currentlyinvolved in medical writing (64). Medical students and faculty members had a meanscore of 43.21 (7.1) and 48.4 (5.9) respectively on ATP. Most of the respondents didnot consider that they worked in a plagiarism free environment and reported thatself-plagiarism should not be punishable in the same way as plagiarism. Opinionregarding leniency in punishment of younger researchers who were just learningmedical writing was divided.Conclusions. The general attitudes of Pakistani medical faculty members and medical students as assessed by ATP were positive. We propose training in medical writingand research ethics as part of the under and post graduate medical curriculum.Copyright2015 Rathore et al.Distributed underCreative Commons CC-BY 4.0Subjects Ethical Issues, Science and Medical EducationKeywords Medical education, Plagiarism, Medical writing, Scientific writing, Ethics, Attitudes,PakistanOPEN ACCESSHow to cite this article Rathore et al. (2015), Exploring the attitudes of medical faculty members and students in Pakistan towardsplagiarism: a cross sectional survey. PeerJ 3:e1031; DOI 10.7717/peerj.1031
INTRODUCTIONPlagiarism is defined as “the deliberate or reckless use of someone else’s thoughts, wordsor ideas as one’s own, without clear attribution of their source” (Mason, 2009). It is aserious offense in academia and a major ethical concern which has received a lot ofglobal attention in biomedical writing. There has been an increase in the number ofmanuscripts published on plagiarism in the last one decade. However most of the workis from the developed nations of the world where research training is usually impartedat undergraduate level. In comparison, the research output from developing countriesincluding Pakistan is low, so there is a need to promote research education and training inthese regions.Plagiarism has been documented and reported mainly from the developed countrieswith a better research environment, stronger training and more common use of plagiarismdetection software. With advancement in plagiarism detection software, an ever-increasingnumber of plagiarized papers are being recognized, often leading to their retraction fromthe journals. Employing plagiarism detection software and manual verification, Baždarićet al. (2012) reported the prevalence of plagiarized manuscripts among manuscriptssubmitted to Croatian medical journal during 2009–2010 to be 11% (85/754). A recentstudy of 2,047 cases of retracted papers from PubMed indexed journals reported anencouraging trend in recognition and retraction of plagiarized articles (Steen, Casadevall& Fang, 2013). While these statistics are encouraging, but most of the time detectionafter publication cannot prevent the damage that had already been done to science ifplagiarized articles had already been cited. Retraction watch (http://retractionwatch.com/) is a blog which documents plagiarism, fabrication and retractions in the scientificcommunity. It mentions a high number of research articles based on fake data, imagemanipulation, self-plagiarism, fake peer reviews and disputed authorships that are beingretracted frequently from reputable journals (Marcus & Oransky, 2014). Unfortunately, thismisconduct not only involves novice researchers, doctorate and post doc scholars frommiddle income countries but also scientists and institutes from Europe, Americas andJapan enjoying international fame and prestige. Plagiarizing research work often leads togreat setbacks in one’s careers.Although the prevalence of intentional plagiarism in low resource countries has notbeen reported, it can be argued that it might be more prevalent in countries like Pakistandue to “a general lack of information regarding plagiarism among medical studentsand faculty members” (Shirazi, Jafarey & Moazam, 2010). However, the probability ofintentional plagiarism both in the faculty and students also cannot be ignored. Prevalenceof plagiarism is very hard to measure but the investigations of attitudes can also give usan insight in this phenomenon. This opinion is reinforced by Ajzen’s theory of plannedbehavior which assumes that human beings are rational: A preceding intention entailingattitudes, subjective norms and perceived behavioral control, is necessary to perform aspecific behavior (Ajzen, 1991).A number of studies conducted in Romania (Badea-Voiculescu, 2013), Pakistan (Shirazi,Jafarey & Moazam, 2010), Croatia (Mavrinac et al., 2010), Norway (Hofmann, Myhr &Rathore et al. (2015), PeerJ, DOI 10.7717/peerj.10312/12
Holm, 2013) and Iran (Ghajarzadeh et al., 2012; Ghajarzadeh et al., 2013) have reporteda high prevalence of positive attitude among both students and faculty members towardsplagiarism.Ghias’ survey on academic dishonesty in Pakistani medical students reported a highprevalence of medical students who were involved in copying verbatim from online orpublished sources, senior peers, class mates with or without their consent, fabricatingdata to show desirable results, forging professors’ signatures, faking health certificatesto justify absence and other such behaviors (Ghias et al., 2014). Poorolajal et al. (2012)reported an overall prevalence of plagiarism as 38% in an Iranian University. This trenddecreased by 13% with one unit increase in knowledge of plagiarism. Similarly in India, ahigh prevalence of plagiarism was attributed to pressure to publish and lack of facilities andfunding in private institutions (Singh & Guram, 2014). This calls for serious educationalreforms and implementation of strict policies regarding plagiarism not only in universitycurriculum but also in lower grades.Although many studies specifically on plagiarism have been published abroad, inPakistan research on this specific subject is lacking. This study was conducted on arelatively large sample of medical students and faculty in seven private and public medicalcolleges. The Attitudes Towards Plagiarism questionnaire (ATP) was chosen to exploreknowledge and attitudes of faculty members and medical students towards plagiarism.The original ATP had 29 items assessing positive, negative and subjective attitudes towardsplagiarism (Mavrinac et al., 2010). This questionnaire was based on Ajzen’s theory ofplanned behavior and has been validated in Croatia (Mavrinac et al., 2010). Subsequentlyit was extensively used in other countries for example, India (Gomez, Nagesh & Sujatha,2014), Iran (Ghajarzadeh et al., 2012) and Romania (Badea-Voiculescu, 2013).The current study was designed with two aims: (1) To explore the attitudes of Pakistanimedical students and faculty towards plagiarism; (2) To study the association betweenformal training in research ethics, medical writing and attitudes towards plagiarism.MATERIAL AND METHODSA cross sectional survey was designed and conducted in three private and four publicmedical colleges in Lahore and Rawalpindi (August 2013–January 2014). Permission wasobtained from the Institutional review board of CMH Lahore Medical College.QuestionnaireTo collect data, we used a questionnaire divided in of three sections. The first sectiondocumented demographics. The second had questions on participants’ interest and formaltraining in research methodology, research ethics and involvement in medical writing.The third section consisted of modified version of ATP (Mavrinac et al., 2010). Thequestionnaire was used with permission and modified for our study population. It wasnot translated from the original English version, as English is the language of instruction inall medical schools in Pakistan.Rathore et al. (2015), PeerJ, DOI 10.7717/peerj.10313/12
Pilot surveyA pilot survey was conducted and feedback received from faculty and students during thepilot survey resulted in removal of 4 items in order to adopt the scale to Pakistani cultureand academic environment. It was further modified from five-point to a three-point Likerttype scale (agree (coded as 3), neutral (coded as 2) and disagree (coded as 1)) to facilitatethe responses. Factorial analysis was performed to confirm the factor structure of themodified questionnaire.ParticipantsConvenience sampling technique was employed. Sample size was calculated at 95%confidence level and 5% confidence interval. Questionnaires were distributed among550 medical students and 130 faculty members in 07 public and private medical colleges ofLahore and Rawalpindi. All participants read and signed informed consent forms, whichwere returned with each completed questionnaire. Forms were personally distributed andcollected by two of the authors (AM, AW). Response rate was 93.45% and 73.05% formedical students and faculty members respectively. Ninety three forms were discarded(Incomplete or missing data, duplicate entries etc.).Data analysisData was analyzed by SPSS v 20. To confirm the factor structure of the questionnaireprincipal axis factoring analysis was used. The reliability of the questionnaire wascalculated using Cronbach’s alpha.Descriptive and inferential statistical test were employed to analyze the data. Anindependent sample T-test was run to analyze associations between formal training inresearch ethics, medical writing (yes/no) and scores on ATP (continuous variables). ChiSquare goodness-of-fit statistics was run to analyze association between score ranges ofATP and respondent group (faculty/student). One way ANOVA was run between scores onATP and job designation, experience and education level of faculty members.RESULTSCharacteristics of respondentsCharacteristics of respondents and their training in medical writing are given in Table 1.There were 421 medical students and 95 faculty members. Most of the students werefemales 218 (51.8%) and 3rd year MBBS students 192 (45.6%).Questionnaire validationPrincipal axis factor analysis was run to confirm the factor structure of the Pakistanversion of the ATP. However, unlike Croatian version of ATP, the three factor structurewas not confirmed. In present study, one factor structure was determined by the Scree-test(Fig. 1), interpretability criteria and the reliability of the factor calculated with Cronbach’salpha (α 0.73). The obtained factor represents an overall attitude towards plagiarismconsisting of positive attitudes, negative attitude and subjective norms. Table 2 presentsthe factor structure of the Attitudes Towards Plagiarism questionnaire with factor loadings.Rathore et al. (2015), PeerJ, DOI 10.7717/peerj.10314/12
Table 1 Demographic characteristics of medical students and faculty members (n DemonstratorAssistant ProfessorAssociate ProfessorProfessorMBBS/MDMasters DegreeFellowshipEducation from abroadMedian age (min–max)Training in medical writingTraining in research ethicsCurrently writing an articleMean score and SD on ATPMedical studentsFacultymembers203 (48.2%)218 (51.8%)––––––––21 (17–28)83 (19.7%)106 (25.2%)74 (17.6%)43.21 (7.1)43 (45.3%)52 (54.7%)66 (69.4%)20 (21.1%)6 (6.3%)3 (3.2%)46 (48.4%)26 (27.4%)19 (20%)15 (15.8%)32 (23–61)68 (71.6%)64 (67.4%)64 (67.4%)48.4 (5.9)Figure 1 Scree plot for the obtained one factor structure.Items 11, 12, 13 are not included in the final factor structure and analyses because oflow factor loading ( 0.10). The one factor structure explained 10.93% of variance in thequestionnaire and average Inter-Item Correlation was .112. Total scores were obtainedby summing all the statements. The mean score was divided into 3 ranges by 2 cut offs at33.33%, 66.66% of scores on the ATP. Thus, scores on modified ATP were divided intoRathore et al. (2015), PeerJ, DOI 10.7717/peerj.10315/12
Table 2 Factor structure of the attitudes towards plagiarism questionnaire with factor loadings.StatementsFactor loading1. Since plagiarism is taking other people’s words rather than tangible assets; it shouldNOT be considered as a serious offence.2. It is justified to use previous descriptions of a method, because the method itselfremains the same.3. Self-plagiarism is not punishable because it is not harmful (one cannot steal fromoneself).4. Plagiarized parts of a paper may be ignored if the paper is of great scientific value.5. Self-plagiarism should not be punishable in the same way as plagiarism is.6. Young researchers who are just learning the ropes should receive milder punishmentfor plagiarism.7. I could not write a scientific paper without plagiarizing.8. Short deadlines give me the right to plagiarize a bit.9. It is justified to use one’s own previously published work without providing citationin order to complete the current work.10. Authors say they do NOT plagiarize, when in fact they do.11.a Plagiarists do not belong in the scientific community.12.a The names of the authors who plagiarize should be disclosed to the scientific community13.a In times of moral and ethical decline, it is important to discuss issues likeplagiarism and self-plagiarism.14. A plagiarized paper does no harm to science.15. Sometimes one cannot avoid using other people’s words without citing the source, because there are only so many ways todescribe something16. If a colleague of mine allows me to copy from her/his paper, I’m NOT doinganything bad, because I have his/her permission.17. Those who say they never plagiarized are lying.18. Sometimes I’m tempted to plagiarize, because everyone else is doing it (students,researchers, physicians).19. I keep plagiarizing because I haven’t been caught yet20. I work (study) in a plagiarism-free environment.21. Plagiarism is not a big deal.22. Sometimes I copy a sentence or two just to become inspired for further writing.23. I don’t feel guilty for copying verbatim a sentence or two from my previous papers.24. Plagiarism is justified if I currently have more important obligations or tasks to do.25. Sometimes, it is necessary to plagiarize. 0.39 0.23 0.39 0.36 0.13 0.19 0.40 0.48 0.39 0.200.090.010.02 0.37 0.30 0.31 0.37 0.32 0.23 0.16 0.52 0.41 0.32 0.52 0.51Notes.aItems 11, 12, 13 are not included in the final factor structure, because of to low ( 0,10) factor loading.three categories; low ( 42), moderate (43–47) and high ( 48). According to this scale,increasing score represents a positive leaning towards plagiarism.Attitudes towards plagiarismIndependent sample T-test revealed that those medical students who had been formallytrained in medical writing were associated with low scores on the ATP (Mean group1 43.61 (SD 6.92), mean group 2 41.58 (SD 7.51), P .05), whereas studentsRathore et al. (2015), PeerJ, DOI 10.7717/peerj.10316/12
Table 3 Frequency distribution of medical students and faculty members in score ranges of ATP.RespondentLow ( 42.0)Medical student 190 (45.1%)Faculty member 14 (14.7%)Moderate (43–47)High ( 48)Total (n)χ 2 value (P-value)112 (26.6%)32 (33.7%)119 (28.3%)49 (51.6%)421 (100%)95 (100%)26.5 (P .001)19.3 (P .001)who were trained in research ethics (P .936) or were currently writing a research paper(P .674) did not differ from their counterparts on ATP scores.The frequency distribution of medical students and faculty members between scoreranges is given in Table 3. According to Chi Square goodness-of-fit statistics, a statisticallyhigher percentage of faculty members had ATP scores in moderate 32 (33.7%) or highcategory 49 (51.6%) than low category 14 (14.7%) (P .001). A higher proportion ofstudents had ATP scores in the low (45.1%) or moderate category (26.6%) than in the highcategory (28.3%) (P .001).Pearson Chi-Square revealed that faculty with foreign qualifications had better formaltraining in research ethics (p 0.05). According to it, all of the faculty member who wereeducated abroad (n 15) had received formal education in research ethics. More thanhalf (61.2%) of faculty members educated in Pakistan had a formal education in researchethics.No statistically significant difference was found between mean scores on ATP scoresand job designation (P 0.734), experience levels (P 0.208) education level (P .068).Independent sample T test revealed no significant association between ATP scores andtraining in research ethics (P .87), medical writing (P .17) or current involvement inmedical writing (P .99).Table S1 gives response percentage of faculty members and students on modified ATP.DISCUSSIONThe study revealed that the majority of medical students (55%) and faculty members(82.7%) had moderate or high scores on the ATP. This represents their approval ofplagiarism. This finding is in consonance with previous studies conducted in Pakistan.Lower scores on ATP in medical students were associated with training in medicalwriting whereas ATP scores were not significantly associated with formal education inresearch ethics or current involvement in medical writing. Factor analysis revealed aone-factor structure representing attitude towards plagiarism with 22 statements andgood reliability. This version of ATP is valid and reliable for use on Pakistani population.Shirazi, Jafarey & Moazam (2010), have attributed lack of training in researchmethodology and referencing techniques among Pakistani students and faculty ratherthan malice as a cause of plagiarism in most cases. Shashok has also noted that many casesof plagiarism are unintentional and arise from lack of knowledge of citation practices,pressure to increase publication output, and inability to write and communicate ideas inEnglish (which may lead to copy-pasting to improve use of language in the manuscript)(K Shashok, pers. comm., 2011).Rathore et al. (2015), PeerJ, DOI 10.7717/peerj.10317/12
Formal training in research methodology, medical and publication ethics at theundergraduate level is generally lacking in Pakistan. Even the faculty members are notclear about the definition, types and implications of plagiarism and unethical practicesin medical writing and research. The mandatory training workshops of the college andphysicians and surgeons in Pakistan for the trainees and supervisors
Exploring the attitudes of medical faculty members and students in Pakistan towards plagiarism: a cross sectional survey Farooq Azam Rathore1, Ahmed Waqas2, Ahmad Marjan Zia2, Martina Mavrinac3 and Fareeha Farooq4 1 Department of Rehabilitation Medicine, Combined M
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