Case Vignette

1. Case Vignette • ‘Annie’ is in her first year of a professional health program and is having trouble staying awake to do the required reading. She has a 4.0 GPA and experiences a lot of pressure from family to maintain this excellent performance. She decides to start using a prescription stimulant medication, Ritalin, during finals week so she can stay awake longer and concentrate better, despite having never been diagnosed with an illness requiring Ritalin. • Does this constitute academic dishonesty?

3. The Elephant in the Room: Use and Misuse of Cognitive Enhancers by Students at an Academic Health Science Center (ETSU)

4. Previous Studies of Undergraduate Students McCabe et al (2005): • 6.9% lifetime prevalence of nonmedical prescription stimulant use • Use correlated with an environment of competitive admissions standards and individuals with perfectionist personality traits

5. Previous Studies in Graduate Health Science Students Tuttle et al (2010): Medical students - 10.1% lifetime history and 5% use during medical school Lord et al (2009): Pharmacy students - 5% McNeil et al (2011): Dental students - 10%

6. ETSU Survey • Objective: determine prevalence of Rx stimulant misuse (use without a prescription) • Methods • Anonymous, electronic survey distributed via SurveyMonkey to health sciences students • IP address capture was disabled • Identifiable demographic data not collected (e.g., age, race) • Medicine (n = 269) • Pharmacy student (n = 319) • Cardiopulmonary science or “RT” (n = 33) • Advanced nursing (n = 165) • Incentive: chance to win one of ten $50 gift cards

7. Rx Stimulants

8. Survey Response Rate

9. Survey Response Rate *Advanced Nursing omitted from data analysis secondary to poor response rate (10%)

10. Prevalence of Rx Stimulant Misuse *p = 0.087 by Chi-square test for difference between disciplines ¶Three responders did not disclose their discipline

11. GPA Analysis (n = 329) p = 0.18 using Student’s t-test

12. Rationale for Rx Stimulant Misuse

13. Adverse Drug Reactions (ADRs) Reported by Responders

14. Is a health sciences student using cognitive enhancers cheating? 55.8% of responders believe ‘Annie’ as engaging in academic dishonesty. • However, cheating is defined as, “the intentional violation of a rule in order to gain an unfair advantage over others.” • ETSU does not explicitly forbid the use of cognitive-enhancers • Therefore, not clear that ‘Annie’ is cheating

15. Do cognitive enhancers provide an unfair academic advantage? 59.9% of responders believe that cognitive enhancers provide some students with an unfair academic advantage. What constitutes an unfair advantage? • Nicotine? • Coffee? • quiet apartment • Better laptop?

16. “Do as I say, not as I do.”

17. Professionalism ACGME • Professional Behavior • Ethical Principles • Cultural Competence

18. Professionalism West and Shanafelt (2007): • Physician self-care and wellness • Integral role of environmental influences

19. Case Vignette • ‘Annie’ is in her first year of a professional health program and is having trouble staying awake to do the required reading. She has a 4.0 GPA and experiences a lot of pressure from family to maintain this excellent performance. She decides to start using a prescription stimulant medication, Ritalin, during finals week so she can stay awake longer and concentrate better, despite having never been diagnosed with an illness requiring Ritalin. • Does this constitute academic dishonesty? • 56% agreed this is academic dishonesty • 60% agreed that using Rx stimulants provides an unfair advantage