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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.

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Presentation on theme: "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."— Presentation transcript:

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?

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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 % 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 Brand NameGeneric Name FDA-Approved Indications Adderall® amphetamine/dextroamphet amine ADHD, narcolepsy Focalin®dexmethylphenidateADHD Dexedrine®dextroamphetamineADHD, narcolepsy Desoxyn®methamphetamineADHD, obesity Ritalin®, Methylin®, Metadate®, Concerta® methylphenidateADHD Provigil®modafinilNarcolepsy, obstructive sleep apnea with excessive daytime sleepiness, shift work sleep disorder

8 Survey Response Rate DisciplineSent ToRespondedResponse Rate Medicine % Pharmacy % RT331958% ANP %

9 Survey Response Rate DisciplineSent ToRespondedResponse Rate Medicine % Pharmacy % RT331958% Total* % *Advanced Nursing omitted from data analysis secondary to poor response rate (10%)

10 Prevalence of Rx Stimulant Misuse DisciplineMisusers, n (%)* Medicine (n = 128)14 (11%) Pharmacy (n = 225)22 (10%) RT (n = 19)5 (26%) Total (n = 372)44 (11%) ¶ *p = by Chi-square test for difference between disciplines ¶ Three responders did not disclose their discipline

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

12 Rationale for Rx Stimulant Misuse Reasons for Rx Stimulant Misuse (n = 44) (responders could select more than 1 reason) To enhance alertness or energy66% To improve academic performance57% To experiment19% To get high or use recreationally5%

13 Adverse Drug Reactions (ADRs) Reported by Responders ADRNo. (%) Lack of appetite30 (68.2%) Difficulty sleeping24 (54.5%) Racing heart15 (34.1%) Anxiety7 (15.9%) Tremor7 (15.9%) Headache6 (13.6%) Dependence on prescription stimulants for concentration 4 (9.1%)

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


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