Knowledge, attitudes, and plagiarism-related behaviors among postgraduate medical trainees: A cross-sectional study

INTRODUCTION

Publication ethics are essential to maintaining integrity and advancing relevant research. Genuine research findings help identify potential areas for further research and, in the long run, develop careers. The three crimes of academics, according to the U.S. National Science Foundation, are plagiarism, falsification, and fabrication.^[1] According to the Oxford Dictionary, plagiarism is “The practice of taking someone else's work or ideas and passing them off as one's own”.^[2] This includes all forms of published and unpublished material. It can be intentional or unintentional. It is evident that students unintentionally commit plagiarism due to limited subject knowledge.^[3] If it was intended, it is considered severe publication misconduct, for which the author can be blocklisted, and the concerned University can take necessary action against them.

More than 85% of postgraduate research is considered wasteful and inefficient.^[4] The postgraduate research appears to lack relevance at various levels, including inappropriate design and methods, an inability to address local needs, the inaccessibility of complete reports, and numerous breaches of publication ethics.^[5] Despite increasing emphasis on research ethics, evidence suggests a persistent gap between knowledge and ethical practice, particularly among medical trainees in low- and middle-income settings. Many studies are probing students' knowledge and attitudes towards plagiarism, but few involve medical postgraduates. While awareness of plagiarism has increased, evidence suggests a persistent gap between knowledge and ethical practice, particularly among medical trainees. Understanding this gap is essential for designing effective educational interventions. We aimed to assess knowledge and attitudes towards plagiarism among postgraduate students at a Medical College in Dakshina Kannada, Karnataka.

MATERIAL AND METHODS

A cross-sectional study was conducted among all postgraduate students (complete enumeration) who have joined the MD/ MS course in the academic years 2018, 2019, and 2020 at Yenepoya Medical College in Mangalore, Dakshina Kannada, Karnataka, India. A total of 241 students have enrolled in the MD/MS program. As a census approach was adopted, no formal sample size calculation was performed.

Study tool: The questionnaire was adapted from a previously validated instrument developed by Mavrinac et al. and modified to suit the local context.^[6] Face and content validity were assessed by a panel of five experts in medical education, research methodology, and ethics. Based on their feedback, minor modifications were made to improve clarity and contextual relevance. A pilot test was conducted among a small group of postgraduate students (not included in the final analysis) to ensure comprehensibility. However, formal reliability testing, such as internal consistency (Cronbach’s alpha), was not conducted, which is acknowledged as a limitation. The study questionnaire is provided as Supplementary Material.

Knowledge scores were calculated by assigning 1 point per correct response (range: 0–7). Attitude was assessed using a 5-point Likert scale. For positively worded statements, scores ranged from 1 (strongly agree) to 5 (strongly disagree), and reverse scoring was applied for negatively worded items. Total attitude scores were computed by summing individual item scores. Higher attitude scores indicated a more ethically appropriate attitude toward plagiarism.

RESULTS

The sample size was 241, of whom 221 (91.7%) completed the Google Forms. Students who completed their MD courses in two years (Diploma holders) and participants who did not give informed consent were excluded, along with seven students who were on extended leave during the study.

The mean age of the students who participated in the study was 27.77 ± 2.71 years, with the youngest student aged 23 and the oldest aged 45. There were 73, 77, and 91 students in the 2018, 2019, and 2020 batches, respectively, of whom 66 (90.4%), 70 (90.9%), and 85 (93.4%) participated in this study.

Table 1 shows the year-wise distribution of students across specialties based on the revised Indian Competency-Based Medical Education (CBME) guidelines (n=221). Specialty groups were divided into 3: anatomy, biochemistry, physiology, pathology, microbiology, pharmacology, and forensic medicine, grouped as pre- and para-clinical subjects. Medical and allied subjects include dermatology, internal medicine, pediatrics, psychiatry, radiology, respiratory medicine, and community medicine. Surgical allied subjects include anesthesia, ophthalmology, otorhinolaryngology, obstetrics and gynecology, orthopedics, and general surgery. More students (50.2%) were enrolled in surgical allied postgraduate courses than in medical (36.7%) or pre- and para-clinical subjects (13.1%).

Table 2 shows medical postgraduates' responses to questions about knowledge on plagiarism (n=221). More than 90% of students could identify the appropriate definition of plagiarism, but only 41% could correctly identify the definition of salami publication. Nearly 75% of students were able to locate the definition of self-plagiarism. Less than half the participants did not know what a salami publication was. On average, 84% of students correctly identified the appropriate writing style to avoid plagiarism when preparing an assignment, a PowerPoint presentation, and a protocol. Compared with other students, fewer students could identify the proper form of citing a definition.

Table 3 shows the responses of medical postgraduates to questions about their attitudes towards plagiarism (n=221). A meagre 59.3% of students considered plagiarism as scientific misconduct. Over 80% of students supported scientific journals should not accept plagiarized articles. Nearly 77% of students knew plagiarism was not ethical in scientific research. Among participants with experience as manuscript reviewers, 78% agreed to reject articles found to contain plagiarism. Only 48% disagreed that the definition may be word-for-word without citing the source, while an equal number affirmed the statement. Just 48% opposed the idea that plagiarism committed in articles with well-known contributions to health care may be ignored. Nearly 58% disagreed with serving as a co-investigator on a study that accepts plagiarism.

Table 4 shows the association between knowledge and attitude scores with various independent variables in plagiarism (n =221). The median knowledge score was 6 (5-7), with a minimum of 1 and a maximum of 7. The median attitude score was 26 (23-28), ranging from 16 to 35. No significant association was found between knowledge and attitude scores and gender, authoring an article, academic year of joining, or type of specialty.

Applying linear regression to knowledge and attitude scores showed that, for every unit increase in knowledge, attitude improves by only 0.077 units, and this association was not statistically significant (p = 0.257). It was also found that, with every unit increase in age, knowledge increases by 0.027 times and attitude decreases by 0.045 times, but neither was statistically significant (p = 0.691 for knowledge, 0.504 for attitude). It was found that with every unit increase in the academic year, knowledge increases by 0.033 times and attitude worsens by 0.046. Still, neither was statistically significant (p = 0.692 for knowledge and 0.496 for attitude).

DISCUSSION

This study assessed the knowledge and attitudes toward plagiarism among medical postgraduate students and identified a critical gap between awareness and ethical orientation. While most participants demonstrated adequate knowledge of plagiarism, their attitudes were inconsistent and, in some instances, permissive of unethical practices.

A high proportion of participants correctly identified the definition of plagiarism (91.4%) and self-plagiarism (76.9%), indicating satisfactory baseline awareness. However, only 41.2% were familiar with the concept of salami publication, suggesting limited understanding of more nuanced forms of research misconduct. This pattern reflects superficial knowledge, where commonly discussed aspects of plagiarism are recognized, but deeper conceptual clarity is lacking. Similar findings have been reported in previous studies among medical trainees and health professionals, indicating that knowledge of plagiarism does not necessarily extend to its varied manifestations.^[3,7-9]

Despite adequate knowledge, attitudes toward plagiarism were less robust. Although most participants acknowledged that plagiarism is unethical and supported rejection of plagiarized manuscripts, a substantial proportion expressed tolerance in specific contexts. Nearly one-third of participants indicated that plagiarism in influential research could be overlooked, and almost half were willing to be co-investigators in studies where plagiarism was accepted. These findings highlight a disconnect between cognitive understanding and ethical decision-making. Similar inconsistencies between awareness and attitude have been observed in earlier studies.^[8,10-13]

Several factors may explain this discrepancy between knowledge and attitude. First, the increasing pressure to publish during postgraduate training may incentivize quantity over quality, leading to the normalization of questionable practices. Second, inadequate mentorship and a lack of structured training in scientific writing may contribute to uncertainty in applying ethical principles. Third, the hidden academic environment, where unethical practices may be observed but insufficiently addressed, can shape attitudes more strongly than formal teaching. These concerns are supported by previous literature emphasizing the role of educational approaches, institutional culture, and publication pressure in plagiarism-related behavior.^{[4,5,14–17]}

The absence of a significant association between knowledge and attitude in this study further reinforces that awareness alone is insufficient to influence ethical behavior. Similar observations have been reported in some studies, while others have shown that better knowledge may positively influence attitudes, suggesting that contextual and institutional factors may play an important role.^[9,10,12,13]

No significant association was observed between knowledge or attitude scores and demographic variables, including age, gender, academic year, or prior publication experience. This suggests that exposure to research activities alone does not guarantee ethical competence. Comparable findings have been reported elsewhere, where demographic characteristics were not consistently associated with plagiarism-related knowledge or attitudes.^[9,10]

LIMITATIONS

A key strength of this study is the inclusion of postgraduate students across multiple specialties and academic years, using a census approach, thereby enhancing the representativeness of the findings. The use of case-based scenarios in the questionnaire provided better insight into applied knowledge of plagiarism. However, studying has certain limitations. The questionnaire, although based on a previously validated tool, underwent only face and content validation, and reliability measures such as internal consistency were not assessed. The self-reported nature of responses may also introduce social desirability bias. Additionally, the study was conducted in a single institution, which may limit generalizability. It is essential to acknowledge that there is variability in scientific writing skills among individuals. Ensuring that all team members receive appropriate support and resources can help enhance their writing proficiency.

CONCLUSION

This study demonstrates that while medical postgraduate students possess adequate knowledge of plagiarism, their attitudes toward ethical research practices remain inconsistent.

The low awareness of salami publication may reflect limited exposure to advanced concepts of publication ethics during postgraduate training, where emphasis is often placed on conventional plagiarism. Although participants demonstrated adequate knowledge, this did not consistently translate into ethical attitudes, suggesting that awareness alone is insufficient to influence behavior. Factors such as publication pressure, perceived academic expectations, and institutional culture may contribute to the acceptance of questionable research practices. These findings highlight the need for a structured research integrity curriculum that extends beyond knowledge acquisition to ethical decision-making. Promoting academic integrity should be viewed as a shared institutional responsibility, supported by effective mentorship, clear policies, and regular ethics training.