Lies students tell
CMAJ 1997;156:1267
In response to: B.R. Taylor; M.A. Healey; M. Austin; S. Tigchelaar
The writers raise some interesting issues. I would like to emphasize Dr. Taylor's important point that, despite the flaws and imperfections in our existing CaRMS program, it is still a very good system. I chose to focus particularly on one issue: how the system may reward dishonesty. My intent was to stimulate discussion of an issue that has not been addressed in the literature.
Taylor draws our attention to a very precise example of how the system allows, if not encourages, applicants to behave dishonestly. Currently, candidates have the option of either sending their reference letters to programs via CaRMS or directly. Specific letters can be directed to specific programs, thereby masking the applicant's true intentions. Although Taylor may be correct in contending that an applicant's true intentions may be revealed in the list of electives required on the CaRMS general application, a candidate may have done electives in 2 closely linked specialties such as obstetrics/gynecology and family medicine, which complement each other. This would still allow the candidate to appear interested in either option. Perhaps we should consider returning to the previous and perhaps more honest system in which an applicant used the same 3 reference letters for each program.
Dr. Healey addresses important points about the source of lying behaviours. I feel these issues merit further discussion separate from the issues that I have raised. I do not seek to analyse, understand or justify the behaviour of students who lie: I am only observing a behaviour that the system unwittingly endorses by
reward. Dr. Austin argues that deception is justifiable in the CaRMS process because it is a necessary skill for the "real world," which is a "jungle." I do not believe that any benefit of lying can justify its action. Dishonesty should not be accepted in medical practice simply because it is found in other professions. Our profession, which professes truthfulness as a value, must not institutionalize incentives for lying.
I appreciate Dr. Tigchelaar's support for my view of the inherent dishonesty in the resident-selection process. In her case, truthfulness brought her deserved success. Despite the weighty factors that regrettably take priority over integrity, her reminder that honesty begins within each candidate should be heeded by all. However, what about those who were honest and did not get their first choice as she did? If only Tigchelaar's anecdotal case could be generalized and could make every applicant feel confident that choosing honesty will bring the highest chance of success. This is a goal worth striving for.
Tara A. Young, MD
Resident
Department of Ophthalmology
University of Toronto
Toronto, Ont.
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