It’s a familiar situation in education: a first-year orthodontic resident is offered a copy of last year’s board questions from the preceding class. Should he accept the questions and use them to give himself an advantage on the examination? If he declines them, he is certainly at a disadvantage because others in his class might already have received the questions. Should he report the issue to his program director? If he does so, what is his program director’s proper course of action?
Academic impropriety, including the unauthorized dissemination of examination questions, has become a source of consternation for many, and even a prospect of revenue for some. Dozens of Web sites offer a plethora of papers for undergraduate students to access. Two sites boast of 50,000 term papers at a nominal fee. In response, commercial Web sites aimed at identifying plagiarists have also surfaced. Therefore, the issue has become a lucrative commercial opportunity for both sides.
The solution to this conundrum is elusive at best. The problem is not unique to the orthodontic specialty. The American Board of Orthopedic Surgeons (ABOS) has answered the problem by copyrighting ABOS board questions and pursues legal action against any person in possession of test questions. This board also is aware of eBay sales of the ABOS test questions and has pursued legal recourse to deter the Web site from such activity.
The American Board of Internal Medicine (ABIM) has identified at least 139 internists who have gained access to board questions from a board-review firm (Arora Board Review). This firm has requested that previous examinees report examination questions to them after taking the test. The ABIM estimated that the inappropriate actions cost it over $75,000 to create more test questions in response to the problem, but other boards have estimated much higher costs for developing new questions for their examinations. The ABIM has brought legal action against 5 physicians for infringing on copyright rules and “misappropriating trade secrets and breach of contract.” The ABIM’s leadership is especially dismayed because no examination candidates reported the inappropriate behavior despite widespread knowledge of the improprieties. The ABIM has also brought action against Arora Board Review because Arora’s review questions were almost identical to authentic ABIM questions.
The registrants of most boarding examinations, including the Written Examination of the American Board of Orthodontics (ABO), sign a pledge to abstain from revealing examination questions and communicating other aspects of examination content. Hence, an examinee who violates the pledge is in violation of the basic ethical rule of Fidelity , which is “the belief that it is morally right to keep promises and other commitments, both implied and explicit. . . . Fidelity is believed by some to be the foundation of the duty of confidentiality.” The importance of confidentiality in health care is paramount.
The American Student Dental Association defines ethical and professional behavior of dental students as “characterized as honesty, fairness, and integrity in all personal circumstances, respect for the rights, differences, and property of others . . . and preservation of confidentiality in all situations when this is warranted” (Web site, www.asdanet.org ).
Clearly, dissemination of previous test questions constitutes an ethical violation. But is the examinee obligated to report his or her advance knowledge of the questions to referees?
The answer to this ethical dilemma lies in several possible solutions. The best way to address the problem is to eliminate the temptation for unethical behavior. Test development and question restructuring to eliminate repeated questions would be a significant step forward. This is a daunting task, considering the effort and cost required to establish valid and reliable test questions. If every question of each examination was replaced, it would be almost impossible to compare degrees of difficulty among different examinations.
The ideal vehicle for the generation of new questions is the educators themselves. Not only would questions generated by the nation’s teachers and research talent provide a “leading-edge” examination, but also the diversity of the examination would provide a thorough assessment of a resident’s knowledge of the specialty. It also is an opportunity for the educators to become a part of the examination process. Motivated contributors to the question bank can send referenced questions to the ABO at its Web site: www.americanboardorthodontics.com .
A second option is obvious: give the examinees thousands of test questions to simultaneously direct them toward topics for study and eliminate the chance that some examinees view previous questions and other do not. Such a suggestion is not novel and has been implemented by other boards. This action would “level the playing field” by providing access for all examinees to the same information. The examining board would still have the prerogative of modifying details of the questions to probe the examinee’s understanding of a full array of topics. Pretest collaboration would be welcomed instead of discouraged.
Finally, more seminars in ethics, exploring both appropriate behavior in patient care as well as professional conduct, are needed in seminar and interactive (group discussion) formats. Faculty must be role models for ethical behavior, since they are certainly scrutinized by all levels of students and residents.
An unsettling and haunting consequence of inappropriate collaboration could pose a nagging question: does the dishonesty involved in board examinations translate into dishonesty of future practitioners? Does this behavior indicate a pattern of inappropriate action that has persisted through an examinee’s graduate education, continuing into the unmonitored arena of private practice? If the profession of dentistry is to remain well trusted by the public, as Gallup polls indicate, the profession needs to contend with this potential. After all, the public continues to entrust their most valuable possession to us: the health of their loved ones and themselves.
Now, back to the initial dilemma: how should our young resident approach colleagues when exam questions are offered? If the ABO develops new questions via the assistance of the nation’s educators, this problem will be reduced. But if the ABO decides to disseminate a multitude of questions to its examinees, the issue will be obsolete.
