When Comedy Central’s Stephen Colbert coined the word “truthiness,” he was using it as a playful way to think about an important issue.1 The purpose of this session is to discuss the serious issue of academic dishonesty in the context of developing integrity as a core value of the physical therapy profession and a key factor in creating effective leaders. This session also describes the use of a novel classroom activity that tests students’ current moral character and provides an opportunity for them to examine their beliefs and perceptions about integrity. Faculty from two institutions will share lessons learned from their experiences using a Jar of Truthiness.
Methods and/or Description of Project
Academic integrity is defined as “adherence to moral and ethical principles; soundness of moral character; honesty,” as it relates to behaviors in the education setting.2 Integrity as a core value is, according to the APTA, steadfast adherence to high ethical principles or professional standards; truthfulness, and fairness.3 It is also a key to continued success in personal and professional life after school.2 Not only do patients expect integrity from health care professionals, integrity is associated with effective leadership and increased hierarchical status within organizations.4,5 Physical therapy educators were recently challenged to create leaders by teaching doctoring professionals how to be, in addition to what to know6. Physical therapy faculty identified integrity along with clinical reasoning and honesty as the top three most important professional skills for physical therapists;7 however, integrity remains difficult to teach and monitor.
Integrity in the academic setting is nothing new to medical professions. Literature from medicine, nursing, and other health professions programs identifies academic integrity as a key component of professional development.8,9 Students in health professions programs appear to have varied understanding of what constitutes cheating, and may see cheating as a way to help themselves or peers in the face of a high pressure environment.10
Student behavior as related to this important aspect of professionalism is also worth noting. Unprofessional behavior seen in medical education can transfer to practice and impact patient outcomes.8 Medical literature has identified that those who were disciplined by state medical boards were two times more likely to have had problematic behavior during their professional education.11 In addition to the known relationship between individual professionalism, the impact of professional deviance can extend beyond the student and into a class cohort.
As educators in physical therapy we are tasked with training the next generation of professional leaders, yet how to best assess and understand integrity as a component of professional development remains unclear. Various frameworks of professionalism have been proposed. Virtue-based professionalism, behavior-based professionalism, and professional identity formation are three such frameworks.12 Each of these can be used during professional education whereby integrity of the professional trainee can be assessed, challenged, and ultimately strengthened.
Two basic psychological frameworks described in the literature reinforce the importance of developing integrity in the context of the academic setting. Students are typically either principled or pragmatic when it comes to their decisions about cheating.13 Students who are principled are more likely to resist temptation to cheat because they believe it is wrong. It violates the value of integrity, and they feel guilty when they cheat. Students who take a pragmatic or situation-based approach are more like to justify cheating with a rationale.14 They do not feel cheating is wrong if there is a good reason to do it, such as to avoid failure and academic dismissal.
Academic institutions often attempt to limit cheating by securing the test via organizational controls. For example, Universities may use multiple exam versions, assign student seating, or proctor exams.15 Some develop honor codes and display those on examinations.16 These controls may help to create the culture that integrity is important, but at the end of the day, they are all focusing on controls extrinsic to the student. Development of a sound moral character with integrity is another strategy to limit cheating by decreasing the student’s drive to do wrong. These strategies involve controls against cheating that are intrinsic to the student, i.e. integrity development. Some examples of this strategy include education on the psychology of cheating, how cheating as a student leads to fraud or malpractice as a professional, and providing students with strategies to help them avoid future unethical behavior through examining ethical case studies 17.
The Jar of Truthiness activity, described in this session, is one way to introduce the important topic of integrity. This presentation describes a class activity in which students are given a low stakes take-home quiz. They are instructed not to use sources or consult with peers while taking the quiz, although there is certainly an opportunity to cheat. Following the quiz, students are asked to anonymously report whether or not they cheated using a blank piece of paper placed into a jar (Jar of Truthiness). The results are shared with the class and the students are provided an opportunity to reflect on their feelings. While students process the reasons they may have cheated, the faculty member facilitates discussion on integrity as a core value; identifying connections to professionalism, legality of practice, and patient outcomes.
This activity has been used with both first and second year doctor of physical therapy students at two different institutions. At each of the participating institutions students confessed to cheating on the quizzes. Faculty and students had a positive experience when the activity was used early in the curriculum; however, when used later in the curriculum and when cheating was suspected, the students experienced negative emotions and faculty did not feel the activity was successful. These reports, although anonymous, provided an opportunity for faculty to engage students in active reflection of their professional growth.
Conclusions/Relevance to the conference theme: Through the Looking Glass: Transforming Physical Therapy Education
Through the combined experiences of the faculty at the participating institutions, participants in this session will be able to consider the importance of integrity, as well as identify a novel way to engage students in an activity related to this aspect of developing effective leaders. Participants will be challenged to think differently about their own educational approaches and encouraged to discuss teaching experiences during the session. Stakeholders in physical therapy education cannot afford to deny the importance of addressing this important topic, and ultimately one opportunity to transform physical therapy education.
1. Press A. “Truthiness” Pronounced 2006 Word of the Year. December 2006. http://www.foxnews.com/story/2006/12/08/truthiness-pronounced-2006-word-year.html. Accessed March 28, 2017.
2. ICAI. http://www.academicintegrity.org/icai/integrity-1.php. Accessed April 6, 2017.
3. American Physical Therapy Association. Professionalism in Physical Therapy: Core Values. July 2012. http://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/Judicial_Legal/ProfessionalismCoreValues.pdf.
4. Old A, Adams B, Foley P, White HD. Society’s expectation of the role of the doctor in New Zealand: results of a national survey. N Z Med J. 2011;124(1342):10-22.
5. Storr L. Leading with integrity: a qualitative research study. J Health Organ Manag. 2004;18(6):415-434.
6. Stokes E. Walk with the Dreamers. 2016.
7. Davis DS. Teaching professionalism: a survey of physical therapy educators. J Allied Health. 2009;38(2):74-80.
8. Mueller PS. Incorporating professionalism into medical education: the Mayo Clinic experience. Keio J Med. 2009;58(3):133-143.
9. Miller A, Shoptaugh C, Wooldridge J. Reasons Not to Cheat, Academic-Integrity Responsibility, and Frequency of Cheating. J Exp Educ. 2011;79(2):169-184.
10. Montuno E, Davidson A, Iwasaki K, et al. Academic Dishonesty among Physical Therapy Students: A Descriptive Study. Physiother Can. 2012;64(3):245-254.
11. Papadakis MA, Hodgson CS, Teherani A, Kohatsu ND. Unprofessional behavior in medical school is associated with subsequent disciplinary action by a state medical board. Acad Med. 2004;79(3):244-249.
12. Irby DM, Hamstra SJ. Parting the Clouds: Three Professionalism Frameworks in Medical Education. Acad Med. April 2016. doi:10.1097/ACM.0000000000001190.
13. Wowra S. Integrity and Mental Health: Examining the Relationship Between a Student’s Ethical Beliefs and Levels of Psychological and Emotional Adjustment. http://www.academicintegrity.org/icai/assets/wowra.pdf. Accessed April 7, 2017.
14. McCabe DL. The influence of situational ethics on cheating among college students. Sociol Inq. 1992;62(3):365-374.
15. Stonecypher K, Willson P. Academic policies and practices to deter cheating in nursing education. Nurs Educ Perspect. 2014;35(3):167-179.
16. Randall K, Hoppes S, Bender D. Developing an honor statement for university students in graduate professional programs. J Allied Health. 2008;37(2):121-124.
17. Gelfand SD. Using Insights from Applied Moral Psychology to Promote Ethical Behavior Among Engineering Students and Professional Engineers. Sci Eng Ethics. 2016;22(5):1513-1534.
1. Define integrity, as related to the APTA Core Values, and in the context of academic integrity.
2. Identify how integrity relates to leadership and professionalism, and consider the relationship between professionalism and patient outcomes.
3. Discuss the importance of professionalism and integrity in physical therapy education, and how integrity can be integrated into the classroom.
4. Consider the reasons for cheating among students in professional programs.
5. Consider a novel way to engage students in an activity designed to develop integrity.
6. Share ideas about class activities or assignments to cultivate leaders with integrity among audience members.
Lecture, discussion, question & answer
10 Minutes: Overview of session and introduction to the topic of integrity
15 Minutes: Background, correlation to Leadership, Core Values, and professionalism
10 Minutes: Reasons students may cheat and how academic institutions may control cheating
15 Minutes: Impact of professionalism on practice and therapy education
15 Minutes: Description of the Jar of Truthiness activity and results from each institution
15 Minutes: Lessons learned, reflection
25 Minutes: Audience dialogue, question and answer
5 Minutes: Conclusion