The Need to Model Ethical Behavior in an Online Class

In the United States, 50 to 65% of physicians get sued at least once in their careers.1 Increasing numbers of malpractice claims and complaints are being filed by State medical boards for disciplinary action. Many of these complaints relate to the unprofessional and disrespectful way doctors and medical staffs refer to their patients. One doctor in Connecticut told his patient who was recovering from brain surgery to buy a pistol and shoot herself to end her suffering.2 Another doctor presented a workshop suggesting that the secret to surviving one’s patients is to stop listening to them.3 Entire hospital staffs invent their own language for inappropriate talk about patients, using acronyms such as CTD for Circling the Drain (meaning a patient is about to die), GPD (Good for Parts only), and TTFO (roughly translated as Told to Go Away).4 The number of disciplinary actions taken against practicing physicians for unethical behavior is on the rise.5

Much has been done in the traditional classroom to address the problem. Changes in admission standards have been made to help select ethical students; modeling and assessment strategies are practiced by faculty members; and incident reports and longitudinal observations have been instituted along with peer evaluations.6-9

There are over 3 million college-level students taking online classes.10 Considering the growth of online courses in undergraduate, graduate and post graduate health science education, professionalism needs to be addressed throughout the entire online spectrum of health science education from undergraduate courses through clinical rotations. Although much has been done to address the problem in the traditional classroom, there has been little attention to the assessment and modeling of professionalism in the online environment. According to Park, "The core business of the knowledge industry is handling information and ideas from different sources, so there is inevitably great scope for plagiarism within the academic world.”11 Student cheating, in general, is on the rise, prompting industry leaders to label current students as "the no-fear generation.”12 The types of academic dishonesty students seem to get away with include plagiarism, cheating on tests, fraudulent excuses, and falsifying data. Although based on hearsay more than actual research, many educators believe that character development and disciplinary actions are better addressed in the live classroom; perhaps, because "no one knows how to do that in a virtual community.”13 These same educators are fearful that "the electronic environment somehow opens a world of unscrupulous possibilities for students.”13

In contrast to the arguments and fears expressed by those educators who feel that increased opportunities for online programs will result in increased cheating, some educators actually believe that the online environment creates an opportunity for enhanced communication and less cheating. A study comparing teaching online versus face-to-face revealed, "Initial feelings of anonymity notwithstanding, over the course of the semester, one-to-one relationships may be emphasized more in online classes than in more traditional face-to-face settings.”14 There is less cheating in courses that establish stronger teacher-student and student-student relationships.

Grijalva, Nowell, & Kerkvliet discuss two types of cheating: panic and planned. Planned cheating involves cheat sheets, plagiarism, and copying homework.15 Panic cheating involves looking at another student’s answers during a test. Grijalva, Nowell, and Kervliet agree that planned cheating is worse than panic cheating and that most cheating observed in traditional classrooms is panic cheating. The online environment, according to these authors, actually has less opportunity for panic cheating.15 Both types of cheating create a "cheating culture” that develops on campus, creating an attitude among classmates that it is "normal” behavior.15 In online classes, students are often dispersed across broad geographic areas and never meet. Therefore, it would follow that a "cheating culture” is less apt to develop in the online environment.

The fear that online education encourages bad behavior is not substantiated in the literature. At least there is no reason to believe that the online student is any less ethical than the traditional student. In fact, research shows that there are multiple opportunities for the kind of interaction which discourages unprofessional behavior in the online environment. Whether online or face-to-face, it is important for instructors to act as both gatekeepers and models for professional behavior. The question is whether methods of modeling and assessment used in traditional face-to-face education can be applied or modified to meet the parameters of the online format, or whether an entirely new scheme needs to be developed. If we value the research that demonstrates the influence of academic dishonesty on later disciplinary actions, there is hope that by investigating novel ways to model, assess, and teach professionalism in the online environment, educators in the health sciences will contribute to better hospitals and better places to work and learn.


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  2. Associated Press. (2006, July 7). Court dismisses case against rude doctor. Retrieved November 29, 2006, from www.msnbc.msn.com/id/13749023
  3. Goldwyn, R.M. (2004). How to survive your patients [Electronic version]. Plastic and Reconstructive Surgery, 114(Supplement), 77 - 80.
  4. BBC News. (2003, August 18). Doctor slang is a dying art. Retrieved November 5, 2006, from news.bbc.co.uk/2/hi/health/3159813.stm
  5. Public Citizen Foundation. (2002). Ranking of state medical board serious disciplinary actions in 2002. The Health Research Group Publication #1658. Retrieved November 29, 2006 from www.citizen.org/publications/release.cfm?ID=7234
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  10. National Center for Education Statistics (NCES). (2001). Postsecondary Education Quick Information System (PEQIS). Retrieved November 30, 2006, from http://nces.ed.gov/surveys/peqis/publications/2003017/
  11. Park, C. (2003). In other (people’s) words: Plagiarism by university students-literature and lessons [Electronic version]. Assessment & Evaluation in Higher Education, 28(5), 471 - 488.
  12. Stahl, S. (March 18, 2006). Ethics and the no-fear generation. Information Week. Retrieved November 26, 2006 from www.informationweek.com
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  14. Smith, G.G., Ferguson, D., & Caris, M. (2001, April). Teaching college courses online vs. face-to-face. THE Journal. Retrieved November 26, 2006, from www.thejournal.com/the/printarticle/?id=15358
  15. Grijalva, T.C., Nowell, C. & Kerkvliet, J. (2006). Academic honesty and online course [Electronic version]. College Student Journal 40.1, 180 - 186.


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