F1000Research F1000Research 2046-1402 F1000 Research Limited London, UK 10.12688/f1000research.148694.2 Research Article Articles Knowledge of misconduct amid North-African post-graduate dental students: A cross sectional study

[version 2; peer review: 2 not approved]

 Kallala Rim Conceptualization Data Curation Formal Analysis Investigation Methodology Supervision Validation Visualization Writing – Original Draft Preparation Writing – Review & Editing https://orcid.org/0000-0003-2120-9009 1 2 3 Khemiss Mehdi Conceptualization Data Curation Investigation Methodology Supervision Validation Writing – Original Draft Preparation Writing – Review & Editing https://orcid.org/0000-0001-7366-9934 4 5 Azzouzi Ines Methodology Writing – Original Draft Preparation 6 Gassara Yosra Conceptualization Methodology Writing – Original Draft Preparation https://orcid.org/0000-0002-5945-7764 1 2 Touzi Soumaya Conceptualization Methodology Writing – Original Draft Preparation 1 3 Harzallah Belhassen Methodology Writing – Original Draft Preparation Writing – Review & Editing 1 2 Ben Saad Helmi Conceptualization Formal Analysis Investigation Methodology Project Administration Supervision Validation Visualization Writing – Original Draft Preparation Writing – Review & Editing https://orcid.org/0000-0002-7477-2965 a 7 Research Laboratory LR16ES15: Occlusondontics and Ceramic Prostheses, Faculty of Dental Medicine, University of Monastir, Monastir, Tunisia Department of Fixed Prosthesis, Dental clinic of Monastir, University of Monastir, Monastir, Tunisia Department of Dental Anatomy. Dental clinic of Monastir, University of Monastir, Monastir, Tunisia Research Laboratory LR12SP10: Functional and Aesthetic Rehabilitation of Maxillary, Farhat HACHED University Hospital of Sousse, Université de Sousse, Sousse, Tunisia Department of Dental Medicine, Fattouma BOURGUIBA University Hospital of Monastir, University of Monastir, Monastir, Tunisia Department of Dental Medicine, Military Hospital of Tunis, Tunis, Tunisia Université de Sousse, Hôpital Farhat HACHED, Laboratoire de recherche LR12SP09 «Insuffisance cardiaque», Université de Sousse, Sousse, Sousse, Tunisia helmi.bensaad@rns.tn

No competing interests were disclosed.

 21 10 2024 2024 13 415 27 9 2024 Copyright: © 2024 Kallala R et al. 2024 This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background

Misconduct in the academic community remains poorly understood among post-graduate dental students (PGDSs) in North Africa. Data on the knowledge of misconduct (KoM) level in this population is lacking. This study assessed KoM of Tunisian PGDSs’.

 Methods

A cross-sectional study was conducted at the Faculty of Dental Medicine of Monastir, involving 147 PGDSs registered in 2022. Students were recruited via email invitations and convenience sampling at a medical congress. A French survey with 11 questions on KoM, offering three-choice answers (yes/no/maybe) was administered. Each correct answer received one point, and a total score below six indicated a low-level of KoM.

 Results

The mean±SD KoM score of the 106 students who accepted to participate in the study was 4.4±1.8, indicating a low-level of KoM. The majority of PGDSs (85.85%) demonstrated a low-level of KoM. A comparison between subjective and objective assessments of KoM levels revealed that a significant percentage of PGDSs underestimated their knowledge (62.26% vs. 85.85%, respectively). The two groups of PGDSs with low (n=91) and acceptable or excellent (n=15) KoM levels showed comparable characteristics in terms of age, sex, discipline, post-graduate-level, experience-level, graduation-status, and survey-response modality.

 Conclusion

This study identified a low-level of KoM among North-African PGDSs. This emphasizes the need for further efforts to enhance awareness and promote better KoM in this population.

 Academic misconduct Attitudes Awareness gap Dental education Plagiarism assessment The author(s) declared that no grants were involved in supporting this work. Amendments from Version 1

In version 2, we made several changes based on the reviewers' recommendations. The title was revised from “Understanding of plagiarism amid North-African post-graduate dental students: A cross-sectional pilot study” to “Knowledge of misconduct amid North-African post-graduate dental students: A cross-sectional study.” We corrected erroneous data in the abstract, such as the mean ± SD of the Knowledge of Misconduct score and the percentage of students with a low level of knowledge, as identified by the first reviewers, who pointed out errors in our Excel file. In the introduction, we added a substantial paragraph as requested by the first reviewers. In the methods section, we provided a more detailed description of our project and improved Figure 1. We also expanded on the questionnaire, detailing the four forms of misconduct identified. Additionally, we included a new subsection titled “Why we have chosen the Laval University quiz?” as per the reviewers' suggestions. In the results section, we added a new table (Table 3), which presents the results for questions from the University of Laval quiz and the four forms of misconduct among post-graduate dental students, as recommended. The discussion was expanded with a new paragraph discussing the four forms of misconduct and another paragraph on the importance of descriptive methods in understanding variable distribution, both in response to the reviewers’ feedback. In the study limitations subsection, we added the lack of inferential statistics and an interventional program as additional limitations, addressing the second reviewers' concerns. We also removed the old Table 5, which provided ten recommendations for preventing plagiarism, as requested. Finally, we updated almost all the extended data.

 Abbreviations list BDSc

Bachelor of Dental Science

 BOralH

Bachelor of Oral Health

 CI

Confidence Interval

 FDMM

Faculty of Dental Medicine of Monastir

 KoM

Knowledge of Misconduct

 PGDSs

Post-graduate Dental Students

 SD

Standard Deviation

 SDG4

Sustainable Development Goal number 4

 UHDs

University Hospital Doctors

 Introduction

Plagiarism, a form of research misconduct, 1 derives from the Latin term “plagiarius”, which means “kidnapper” or “abductor”. 2 This longstanding issue, 3 which involves the act of stealing ideas without proper attribution or crediting the original source, 2 can apply to textual content, articles, or words. 4 Since 1990, the term “plagiarism” has been included as a medical subject heading ( MeSH) in the PubMed database search engine, with a definition as “passing off as one’s owned the work of another without credit”. 4 Plagiarism is prevalent across various fields such as arts, literature, medicine, dentistry, and engineering, 5 , 6 and its consequences can lead to article retractions. 7 Despite the widespread occurrence of plagiarism between 2000 and 2024, 5 studies focusing on plagiarism remain scarce. As of August 27, 2024, a search in PubMed using the MeSH term “plagiarism” yielded only 1483 papers, with 12.7% (n=188) of them published in the last five years ( i.e. ; 2019-2024). Several factors contribute to researchers resorting to plagiarism, including the easy availability of data 5 and the increased accessibility to information on the Internet. 8 The pressure to publish can also drive individuals to engage in plagiarism. 9 Memon et al. 10 compared plagiarism awareness among medical and non-medical students, finding statistically significant differences between them, with medical students being more susceptible to these behaviors. The literature reports a high prevalence of plagiarism among medical students. 11 The lack of education about plagiarism in educational institutions is a major factor contributing to its proliferation. 12 In 2023, plagiarism is widely considered one of the most persistent matters faced by higher education establishments. 1 In recent years ( i.e. ; after 2000), the phenomenon of plagiarism has emerged as a significant ethical problem, 7especially among medical students, as evidenced by various studies. 4 , 13 – 27 This misconduct in research writing has become widespread worldwide, with high prevalence reported among students from different continents, including America, 28 Europe, 21 Asia, 23 , 29 , 30 and Africa. 31 , 32 Regarding the African continent, Rohwer et al. 33 examined biomedical research journal articles and found evidence of plagiarism in 63.2% of the 495 African papers studied. Plagiarism is considered a serious violation of academic integrity and a scholarly misconduct, as emphasized by Clarke et al. 5 Addressing plagiarism is essential to enhance the quality of education, and avoiding plagiarism has been incorporated as a target under Sustainable Development Goal number 4 (SDG4). 5 Achieving the targets of SDG4 in higher education institutions requires addressing the issue of plagiarism. 5

A 2020-systematic review, focusing on plagiarism in the dental field, concluded that this phenomenon is inevitable, but varies in terms of intent, ranging from deliberate misconduct to unintentional repetition of previous ideas. 34 Teaching students to avoid plagiarism is crucial for promoting academic integrity and ensuring the production of acceptable academic work. 5 Consequently, assessing the knowledge of misconduct (KoM) among students, especially those in dental education, holds significant importance. However, studies identifying the KoM levels among dental students are limited and present discrepancies. 13 – 19 For instance, while a Brazilian study reported that 100% of students enrolled in a dentistry course at a university acknowledged that plagiarism constitutes a crime, 15 an Australian study reported that 44% of post-graduate dental students did not consider plagiarism to be a problem. 14 These disparities can be attributed to methodological differences in the questionnaires used to assess plagiarism understanding and/or KoM, and variations in student populations. 13 – 19 Although there are studies evaluating plagiarism understanding and/or KoM among North-African dental academics, 4 , 7 to the best of the authors’ knowledge, no research has been conducted in this area among North-African dental students.

Given that KoM is recognized as the first step in preventing plagiarism and misconducts, and considering the aforementioned points, the primary objective of this study was to evaluate the KoM level among a specific sample of North-African post-graduate dental students (PGDSs).

 Methods

This study is a component of a broader research project titled “plagiarism knowledge and understanding in Tunisian universities” led by two university hospital doctors (UHDs) [ i.e. ; a dentist and a physiologist ( MK and HBS, in the authors’ list, respectively)]. The project encompasses two distinct studies. The first focused on evaluating the plagiarism understanding among 96 North-African UHDs (22% were dentists). 4 The findings of the aforementioned study revealed a lack of awareness regarding plagiarism among North-African UHDs, with 74% of them demonstrating a low-level of plagiarism understanding. 4 Building upon these results, the present study aims to investigate KoM among a different group of participants, such as PGDSs. Two of the team members of this study ( MK and HBS in the authors’ list) are the authors of the abovementioned study. 4 Moreover, the same instrument ( i.e. ; an online quiz accessible on the Laval University website 35 ) was used in both studies.

Study design

The study was conducted following the guidelines established by the STROBE statement. 36 This cross-sectional study was conducted at the Faculty of Dental Medicine of Monastir (FDMM), Tunisia, from May 2, 2022, to October 30, 2022. The research protocol was determined to be exempt from human subjects’ research review by the FDMM Ethics Committee, and therefore, formal approval was not required. For the “paper method” ( Figure 1), informed written consent was obtained from each participating student. For the “electronic method” ( Figure 1), the fact that the participant responded to our email and sent us the filled questionnaire as an attached file indicates his/her consent to participate in the study. The survey was administered anonymously, ensuring confidentiality. Detailed information regarding the study objectives was provided to the students, ensuring their understanding of the research purposes.

Study flowchart.

TAOM: Tunisian Association of Oral Medicine. PGDSs: Post-Graduated Dental Students.

 Study population

The study population consisted of all PGDSs enrolled at the FDMM during the 2022 academic year. The FDMM is the sole institution in Tunisia that offers dental medicine education, admitting approximately 30 to 40 new PGDSs each year. PGDSs are residents who have completed their 5-years of medical studies, and passed the Tunisian national exam to obtain a specialist diploma. For the specific year under investigation ( i.e. ; 2022), the total number of PGDSs was 147, distributed as follows: 38 in the 1 st year, 33 in the 2 nd year, 38 in the 3 rd year, and 38 in the 4 th year.

All 147 PGDSs were invited to participate in the survey, and a five-step recruitment process, outlined in Figure 1, was implemented. To summarize, the following three recruitment methods were utilized: i) Individual emails were sent to all 147 PGDSs; ii) Announcements were disseminated through the Facebook pages of the 14 medical dental departments of the FMDM; and iii) Convenience sampling was employed, where questionnaires were distributed to PGDSs who had attended the medical congress of the Tunisian Association of Oral Medicine (n=32) or were acquainted with authors involved in the study ( i.e. ; 15 colleagues chosen from the 147 PGDSs ‘list and who had not taken the survey before). During steps 1 to 3, which involved the electronic enrolment method, 59 PGDSs were recruited. In steps 4 and 5, which involved the paper-based enrolment method, an additional 47 PGDSs were recruited. During the paper-based enrolment method ( i.e. ; steps 4 and 5), two researchers ( RK and MK in the authors’ list) asked the PGDSs if they had taken the survey before. If they had not, the researchers administered the questionnaire and collected the surveys from the PGDSs upon completion.

 Sample size calculation

The sample size was estimated using the following formula 37 : n = [(Z α/2) 2 × P × (1 - P) × D]/E 2; where « n » is the required number of students, « P » is the proportion of the main event of interest ( i.e. ; KoM low-level), « E » is the margin of error, « Z α/2 » is the normal deviate for a two-tailed alternative hypothesis at the desired level of significance, and « D » represents the design, which is equal to 1 for simple random sampling.

According to a study conducted in Saudi Arabia, 19 it was found that 17.9% of dental students ( p = 0.179) were unaware of the meaning of the term “plagiarism” among a sample of 246 participants. Assuming a confidence interval (CI) of 99.9% ( Z α/2 = 3.29) and a « E » of 0.065, the calculated sample size ( n) was determined to be 376 students [376 = [(3.29) 2 × 0.179 × (1 – 0.179) × 1]/0.065 2]. However, since our descriptive study involves a finite population ( i.e. ; a population with a limited number of students), a correction was applied to the sample size. 19 The number of students to be included after correction is given by the formula n’ = (N x n)/(N + n), where “ n ’” represents the corrected sample size, “ N ” is the size of the finite population ( which is 147 in our study), and “ n ” is the sample size calculated from the standard formula (n=376). Therefore, the corrected minimum sample size (n’) is equal to 106 students [106 = (147 x 376)/(147+376)].

 Applied questionnaire

The study employed a questionnaire written in French (See extended data Appendix A 38 for the French version and Appendix B 39 for the English version), and participants were not given a time limit for completing it. The questionnaire was divided into two sections. The first focused on gathering general characteristics of the students, including age (in years), sex ( i.e. ; male/female), department such as biomaterials, dental anatomy, general anatomy, microbiology, oral physiology, oral radiology, dental surgery, endodontics, fixed prosthodontics, maxillofacial prosthesis, orthodontics, pedodontics, periodontology, and removable prosthodontics, discipline ( i.e. ; differentiating between basic sciences and clinical sciences), post-graduate level ( i.e. ; 1 st year, 2 nd year, 3 rd year, 4 th year), experience level (arbitrarily defined as non-experienced for 1 st and 2 nd years, and experienced for 3 rd and 4 th years), response modality ( i.e. ; electronic or paper), and dental doctor graduation ( i.e. ; yes, not yet).

The second section of the questionnaire focused on the French survey, which comprised 11 questions related to KoM. 35 The survey was an online quiz accessible on the Laval University website. 35 Each question provided three answer choices ( i.e. ; yes, no, may be), with one point awarded for each correct answer. 35 A total score was calculated for each participant and based on this score, three KoM’ levels were identified:

Excellent level (score between 9 and 11): Participants at this level demonstrated the ability to use and cite sources honestly and effectively when writing a paper.

Acceptable level (score of 7 or 8): Participants at this level need to pay attention to certain points, and consulting literature about plagiarism may be beneficial.

Low level (score ≤ 6): Participants at this level are required to be vigilant when writing papers about plagiarism and consulting literature books on the topic is imperative.

For statistical purposes, two objective KoM’ levels were considered: “excellent or acceptable” and “low”. 4

An additional question regarding KoM self-assessment by the PGDSs was added at the beginning of the questionnaire 4 : how do you evaluate your KoM? Is it “low”, “acceptable” or “excellent”? Two subjective KoM’ levels were retained: “excellent or acceptable” and “low”. 4

The 11 questions explore the following four forms of misconduct: Verbatim plagiarism (questions 1 to 3), paraphrasing (question 4), publication ethics (questions 5 to 8), and cheating in classrooms (questions 9 to 11). Scores for each question (i.e. ; 11 questions) and for the four forms of misconduct were calculated. The percentages of participants who responded correctly to each question (i.e. ; 11 questions) and to all questions of each form of misconduct were calculated.

Why we have chosen the Laval University quiz 23 ?

While various tools have been established and recommended to assess plagiarism, particularly in terms of, attitudes, acceptance, and practice, 16 , 23 , 24 , 35 , 40 – 44 evaluating KoM is also important, especially among PGDSs. Assessing KoM helps promote academic integrity, ensures ethical research practices, cultivates critical thinking skills, and enhances the quality and originality of scholarly work. Our study appears to be the first to apply a virtual quiz to assess students’ KoM. 35 We opted for the Laval University quiz 35 to evaluate KoM among Tunisian PGDSs for several reasons. First, the quiz was previously used in a local study involving UHDs. 4 Second, all available surveys used to assess understanding; attitudes, practices, and knowledge related to plagiarism were in English and lacked a certified French version. 16 , 23 , 24 , 40 – 44 Since French is the second language in Tunisia, and since medical teaching is in French, the French Laval quiz appeared to be more suitable for Tunisian PGDSs without the need for translation or validation. Third, the Laval quiz 35 is not time-consuming, requiring thoughtful responses, with an average of 15 minutes needed to answer the 11 questions.

 Statistical analysis

The distribution of variables was analyzed using the Kolmogorov-Smirnov test. 28 The latter involves comparing the cumulative distribution functions of the observed data with those of a theoretical distribution, typically a standard distribution like the normal or uniform distribution. 28 It assesses whether the observed data follow the specified distribution or not. 28 Quantitative data were presented as mean ± standard deviation (SD) with 95% CI and range (minimum-maximum). Categorical data were presented as relative frequencies. The two-sided Chi-2 test was used to compare the percentages of PGDSs based on subjective (self-assessment) and objective (survey) assessments of KoM. All statistical procedures were performed using a statistical software (StatSoft, Inc. (2014). STATISTICA (data analysis software system), version 12. www.statsoft.com, RRID: SCR_014213). The significance level was set at 0.05.

 Results

Out of the 147 PGDSs invited to participate, 106 (72.11% participation rate) completed the survey. The latter was completed by 59 students (55.1%) through electronic mails and by 47 students (41.9%) through paper-based questionnaires ( Figure 1).

The characteristics of the 106 PGDSs are presented in Table 1. The majority of the sample consisted of female students (76.42%), and most of the PGDSs belonged to the clinical sciences (87.74%).

Characteristic of the 106 post-graduate dental students.
Variable Unit/Category Values
Age b Year 27±2 [27 to 28]
Sex a Female 81 (76.42)
Discipline a Basic sciences 13 (12.26)
Clinical sciences 93 (87.74)
Post-graduate level a First year 32 (30.19)
Second year 19 (17.92)
Third year 30 (28.30)
Fourth year 25 (23.58)
Experience level a Experienced 55 (51.89)
Not-experienced 51 (48.11)
Response modality a Electronic 59 (55.66)
Paper 47 (44.34)
Graduation a Yes 62 (58.49)
Not yet 44 (41.51)

Number (%).

Mean ± standard deviation [95% confidence interval].

Table 2 displays the results of the KoM assessment. The mean±SD [95% CI] (range) of the KoM’ score was 4.4±1.8 [4.1 to 4.8] (1-9), indicating a low-level of KoM. A high percentage of PGDSs (n=91, 85.85%) demonstrated a low-level of KoM, and only two PGDSs (1.87%) demonstrated an excellent-level of KoM. A comparison between subjective and objective assessments revealed that a significant proportion of PGDSs underestimated their low-level of KoM.

Knowledge of misconduct (KoM) amid post-graduate dental students (n=106).
Evaluation Level of knowledge Number (%)
Subjective: Self-assessment Low-level a 66 (62.26)
Acceptable-level a 39 (36.79)
Excellent-level a 1 (0.94)
Acceptable- or Excellent- level a 40 (38.68)
Objective: Using the questionnaire Low-level a 91 (85.85)
Acceptable-level a 13 (12.26)
Excellent-level a 2 (1.87)
Acceptable- or Excellent- level a 15 (14.15)
P-value 0.0001
Score of KoM b 4.4±1.8 [4.1 to 4.8] (1-9)

Number (%).

Mean ± standard deviation [95% confidence interval] (minimum-maximum). P-value (2-sided Chi-2 test): subjective vs. objective evaluation of KoM.

Table 3 displays the results for the 11 and the four forms of misconduct (i.e. ; verbatim plagiarism, paraphrasing, publication ethics, and cheating in classrooms). The percentages of students having correct answers to each question varied from 17.9% (question 11) to 61.3% (questions 8 and 10). The percentages of students having correct answers to questions of each form of misconduct varied from 0.0% (verbatim plagiarism and publication ethics) to 36.8% (paraphrasing). Only one student answered correctly to the three questions related to cheating in classrooms.

Results for questions of the University of Laval quiz and for four forms of misconduct amid post-graduate dental students (n=106).
Question N° Mean±SD (95% CI) % of students having correct answer
1 0.49±0.50 (0.39 to 0.59) 49.1
2 0.37±0.48 (0.27 to 0.46) 36.8
3 0.56±0.50 (0.46 to 0.65) 55.7
4 0.37±0.48 (0.27 to 0.46) 36.8
5 0.32±0.47 (0.23 to 0.41) 32.1
6 0.27±0.45 (0.19 to 0.36) 27.4
7 0.37±0.48 (0.27 to 0.46) 36.8
8 0.61±0.49 (0.52 to 0.71) 61.3
9 0.28±0.45 (0.20 to 0.37) 28.3
10 0.61±0.49 (0.52 to 0.71) 61.3
11 0.18±0.39 (0.11 to 0.25) 17.9
Misconduct forms Mean±SD (95% CI) % of students having correct answer
Verbatim plagiarism (questions 1 to 3) 1.42±0.84 (1.25 to 1.58) 0.0
Paraphrasing (question 4) 0.37±0.48 (0.27 to 0.46) 36.8
Publication ethics (questions 5 to 8) 1.58±1.02 (1.38 to 1.77) 0.0
Cheating in classrooms (questions 9 to 11) 1.08±0.70 (0.94 to 1.21) 0.9

CI: Confidence Interval. SD: Standard Deviation. %: Percentage.

Table 4 provides the characteristics of the PGDSs categorized based on their objective level of KoM ( i.e. ; low vs. acceptable or excellent). The two groups exhibited comparable ages and comparable percentages of PGDSs in terms of sex, discipline, post-graduate level, experience level, graduation status, and response modality.

Characteristics of the 106 post-graduate dental students divided according to the objective level of knowledge of misconduct (KoM): low-level (n=91, 85.85%), acceptable- or excellent-level (n=15, 14.15%).
Variable Unit/Category Low-level Acceptable- or excellent-level P-value
KoM score b - 3.9±1.3 [3.6 to 4.2] (1.0-6.0) 7.5±0.7 [7.1 to 7.9] (7.0-9.0) 0.001
Age b Year 27±2 [27 to 28] (24-31) 28±2 [26 to 29] (25-35) 0.645
Sex a Female 68 (74.72) 13 (86.66) 0.312
Discipline a Basic sciences 10 (10.99) 3 (20.00) 0.324
Clinical sciences 81 (89.01) 12 (80.00)
Post-graduate level a First year 29 (31.87) 3 (20.00) 0.396
Second year 15 (16.48) 4 (26.67)
Third year 24 (26.37) 6 (40.00)
Fourth year 23 (25.27) 2 (13.33)
Experience level a Experienced 47 (51.65) 8 (53.33) 0.904
Not-experienced 44 (48.35) 7 (46.67)
Response modality a Electronic 52 (57.14) 7 (46.67) 0.449
Paper 39 (42.86) 8 (53.33)
Graduation a Yes 53 (58.24) 9 (60.00) 0.898
Not yet 38 (41.76) 6 (40.00)

Number (%).

Mean ± standard deviation [95% confidence interval)] (minimum-maximum). P-value (Student test or 2-sided Chi-2 test): “low-level” vs. “Acceptable- or Excellent-level”.

 Discussion

This study was conducted on a convenient sample of 106 PGDSs from FDMM, as they represent future academic doctors and are required to write scientific papers. The main concerning finding of this study was that 85.85% of Tunisian PGDSs demonstrated a low-level of KoM. Although the study was limited to Tunisia, it sheds light on the nature and extent of this problem in the North-African and/or Maghreb region. Our results reflect the magnitude of the KoM issue among North-African PGDSs.

There is a scarcity of studies specifically assessing KoM among dental students. 13 – 19 Table 5 provides a detailed overview of seven related studies. 13 – 19 Nevertheless, to the finest of the authors’ awareness, this is the first Tunisian and North-African study to examine the issue of KoM among PGDSs.

Designs and characteristics of some studies aiming to assess plagiarism knowledge (PK) or practice (PP) or attitudes (PA) among dental students.
1 st author(s) Andrews Ford & Hughes Guedes & Gomes Filho Naveen Manjiri Zakirulla Lingam Sai
Reference 13 14 15 17 16 13 18
Yr of publication .2007 .2012 .2015 .2017 .2017 .2020 .2020
Yr of the study .2005 .NR .2013 .2015 .NR .NR .NR
Country .USA/Canada .Australia .Brazil .India .India .Saudi Arabia .India
Main aims: To assess the .Degree to which academic integrity issues currently exist in the dental schools .Perceptions and experience of plagiarism and the usefulness of the workshops .PK of dental students .PK and PA among post graduate students .PK, PA, and PP of Master degree students .PK and plagiarism awareness .Perception of plagiarism among the dental students
Study design .Descriptive .Descriptive .Descriptive .Cross-sectional .Cross-sectional .Cross-sectional .Cross-sectional
Recruitment method .Exhaustive sample .Exhaustive sample .Exhaustive sample .Exhaustive sample .Exhaustive sample .Convenience sample .Random sample
Population .Dental students .Undergraduate students .Students enrolled in a dentistry course of university .Dental post-graduate students .Dental 1 st, 2 nd and 3 rd Master degree students .Dental students .Dental students (1 st, 2 nd, 3 rd, 4 th yr and interns)
Target population .Dental students of 62 dental schools (n=NR) .n=188 .110: 1 st yr of the BOralH and BDSc program .69: 5 th yr of the BDSc program .9: Postgraduate students .n=199 .n=600 .n=412 .NR .NR
Total number of participants .1153 .154 .103: 1 st yr of the BOralH and BDSc program .43: 5 th yr of the BDSc program .9: Postgraduate students .186 .452 .248 .246 .102
Sex (M/F) .569/491 .NR .66/120 .156/296 .138/110 .179/67 .NR
Age (Yrs) .NR .NR .23 [18-39] a .NR .NR .[20-25] b :202 .[26-30] b :24 .[31-35] b :20 .NR
Plagiarism training .NR .NR .129 .NR .NR .NR .NR
Sample size .Not calculated .Not calculated .Not calculated .Not calculated .Not calculated .Calculated .Not calculated
Questionnaires .Non-standardized .Self-administered .70 Likert-type items .7 requested responses to open-ended questions .No reference .Non-standardized .Self-administered .No reference .Non-standardized .Self-administered .13 multiple-choice questions .3 discursive questions .Reference: 41 .Non-standardized .Self-administered .31 multiple-choice questions .25 regarding PK .10 regarding PA .No reference .Non-standardized .Self-administered .18 multiple-choice questions .6 regarding PK .5 regarding PA .7 regarding PP .No reference .Standardized: References: 16 , 40 .Valid/reliable .15 questions regarding PK .Non-standardized .Self-administered .10 multiple-choice questions .No reference
Way of answer .Sent via mail .Distributed directly .Direct answer .Distributed directly .Web links mailed .NR .Sent via mail
Explored items .Plagiarism perception .Cheating perception .Plagiarism understanding .Academic integrity .PK .Attitude about copyright laws .PK (scores from 1 to 15) .PA .PK .PA .PP .PK .PA .PK
Mains results .47 c : students should be held responsible for monitoring the academic integrity of other students .31 c : cheating is a serious problem at the university Plagiarism is not a problem .44 c : Post-graduate students .37 c : Yr 5 students .17 c : Yr 1 students School has clear guidelines in place for dealing with plagiarism .90 c : Yr 1 students .56 c : Post-graduate students .44 c : Yr 5 students .100 c : plagiarism constitutes a crime .78 c : do not respect image copyrights .56 c : author must be correctly referenced .52 c : knew the 3 types of plagiarism .31 c : knew the meaning of paraphrase .26 c : knew the meaning of direct quote PK: .Total score: 6.9±3.3 d .Good knowledge:40.5 c .Very good knowledge:41.2 c .Excellent knowledge:18.4 c .PK increases as the age increases and the participants progressed in academic year .88 c : knew the meaning of the term “plagiarism” .84 c : plagiarism is an act of academic malpractice .74 c : aware of mandatory dental council of India point system for scientific publications in academics .51 c : knew that plagiarism has adverse effect on the health of the community .51 c : knew that software are available to check plagiarism .49 c : plagiarism as a punishable offence .PK scores: M: 10.4±1.1 d F: 10.5±1.2 d .PA scores: M: 13.6±1.6 d F: 13.8±1.3 d .77 c : it is justified to use previous descriptions of a method .56 c : self-plagiarism is not punishable because it is not harmful .53 c : plagiarized parts of a paper maybe ignored if it is of great scientific value .48 c : it is justified to use one’s own previously published work without providing citation .45 c : I am not doing anything bad if a colleague of mine allows me to copy because I have his/her permission

BDSc: Bachelor of Dental Science. BOralH: Bachelor of Oral Health. F: Female. M: Male. Max: Maximum. Min: Minimum. NR: Not-Reported. SD: Standard Deviation. Yr: Year.

Mean [Minimum-Maximum].

[Minimum-Maximum].

%.

Mean±standard deviation.

 Discussion of results KoM’ level

The KoM mean score was low at 4.4±1.8, with 85.85% of PGDSs showing a low-level of KoM. Of concern was the finding that a significant percentage of PGDSs underestimated their KoM level ( Table 2). These alarming results closely resemble those reported in a previous study conducted among Tunisian UHDs. 4 Using the same French survey, 35 Khemiss et al. 4 reported that UHDs had a low score of KoM (mean±SD: 5.4±1.9), with 74% of them demonstrating low-level of KoM. Our findings suggest that Tunisian PGDSs have not received adequate guidance regarding plagiarism and misconduct, a growing issue with the widespread availability of Internet resources and artificial intelligence. 45 This low-level of KoM may be a primary reason for the prevalence of plagiarism in North-African states, such as Tunisia. 4 The findings also confirm a lack of KoM among both academics and students in Tunisian universities.

The observed low mean score of KoM (4.4±1.8 out of 11 questions) was intermediate compared to studies conducted among postgraduate and undergraduate dental students ( Table 5). On one hand, our score was consistent with an Iranian study involving 452 PGDSs, where the mean number of correct answers to 25 plagiarism knowledge questions was low at 6.9±3.3 17 ( Table 5). On the other hand, our score contradicted findings from a Saudi Arabian study involving 246 dental students, where the mean plagiarism knowledge scores, assessed through 15 questions, 16 , 40 were high at 10.4±1.1 for males and 10.5±1.2 for females 36 ( Table 5).

The high percentage of PGDSs displaying a low-level of KoM (85.85%) was also intermediate compared to percentages reported in the literature ( Table 5). On one hand, our percentage aligned with findings from some studies 13 , 15 , 16 , 18 ( Table 5). For instance, 53% and 69% of 1153 dental students from 62 American and Canadian dental schools believed they should not be responsible for monitoring the academic integrity of other students and did not consider cheating a serious problem at the university. 13 In a Brazilian study involving 186 dental students, 78%, 74%, 69%, 48%, and 44% of students reported a lack of respect for image copyrights, a lack of understanding of direct quotes and paraphrasing, ignorance about the different types of plagiarism, and the belief that authors can be wrongly referenced, respectively. 15 An Indian study of 248 dental master’s degree students revealed that 51%, 49%, and 49% of students did not recognize plagiarism as a punishable offense, were unaware of its adverse effects on the community’s health, and did not know that software is available for plagiarism checking, respectively. 16 Similarly, an Iranian study involving 102 dental students, found that 77%, 56%, 53%, 48%, and 45% of students believed using previous method descriptions was justified, self-plagiarism was not punishable, plagiarized parts of a paper could be ignored if they had scientific value, using one’s own previously published work without citation was allowed, and copying with a colleague’s permission was not wrong, respectively. 18 On the other hand, the percentage in our study differed from that in some reported studies 14 – 16 ( Table 5). For instance, among Australian undergraduate students, 56% of nine postgraduate students considered plagiarism a problem, and 90% of 103 first-year students in the Bachelor of Oral Health (BOralH) and Bachelor of Dental Science (BDSc) program reported that their school had clear guidelines for dealing with plagiarism. 14 In addition, 88%, 84%, and 74% of Indian dental master’s degree students were familiar with the term “plagiarism”, recognized it as an act of academic malpractice, and were aware of the mandatory dental council of India point system for scientific publications in academics. 16 Some authors also reported that 100% of Brazilian students enrolled in a dentistry course were aware that plagiarism constitutes a crime. 15

A significant percentage of PGDSs underestimated their low-level of KoM. While 62.26% of PGDSs considered their KoM level to be low, objective evaluation increased this percentage to 85.85% ( Table 2). No previous study has evaluated this issue in dental students. Our result was similar to that reported for Tunisian UHDs, where 44.8% of them perceived their KoM level as low, but objective evaluation raised this percentage to 74.0%. 4 Our finding was partially aligned with another study comprising doctoral candidates at the Faculty of Medicine and comparing attitudes towards scientific misconduct and self-reported behavior ( e.g. ; plagiarized publication). 46 This discrepancy between subjective and objective evaluations can be explained by the Kruger-Dunning effect, 47 a cognitive bias in which individuals with low ability or knowledge in a particular domain tend to overestimate their competence in that domain. 48 The overestimation of KoM observed in our study aligns with results reported in various subject areas, such as logical reasoning aptitude among university students and clinical practice among specialist physicians. 47 – 50

It appears that 100%, 100%%, 99.1%, and 63.2% of our PGDSs have low-levels of knowledge concerning verbatim plagiarism, publication ethics, cheating in classrooms, and paraphrasing ( Table 3 ). The percentages of medical and dental students with low-levels of knowledge concerning the above-cited four forms of misconduct vary depending on the specific study and population sampled ( Table 5 ). However, several studies have reported concerning levels of ignorance or misunderstanding in these areas. First, approximately 53.2% of medical students were unaware of what constitutes verbatim plagiarism. 51 This lack of knowledge indicates a significant gap in understanding academic integrity. Second, around 50% of health science students lacked sufficient knowledge of publication ethics key concepts, including authorship and conflicts of interest. 52 Third, in a survey of dental students, 29% displayed a limited understanding of what constitutes cheating. 53 Finally, many students struggle with understanding proper paraphrasing, with studies indicating that 30-50% of medical and dental students could not accurately paraphrase academic content without inadvertently plagiarizing. 54

Which factors influence the KoM level of Tunisian PGDS?

The two groups of PGDSs with “low” and “acceptable or excellent” levels of KoM showed comparable characteristics, including age, sex, discipline, post-graduate level, experience level, graduation, and response modalities ( Table 4). To the best of the authors’ knowledge, while several studies have tried to identify the influencing factors of plagiarism and misconduct in higher education, 14 , 17 , 55 – 61 no previous specific study has aimed to identify the factors that influence the KoM’ level of PGDS. Our finding aligns with a 2017 study that evaluated the role of plagiarism in 761 conference abstracts written by graduate students and early- to late-career faculty from approximately 70 countries. 55 The study examined patterns of plagiarism and misconduct among professional academic writers and identified that demographic categories such as geographical location of the current institution, geographical location of the institution where the highest degree was obtained, rank, position, citizenship information, sex, and discipline were not consistent indicators of text-matching. 55 However, it appears that the post-graduate level, academic year, and students’ age influence the KoM’ level of dental students 14 , 17 ( Table 5). First, one study 14 reported that the percentages of Australian undergraduate students who considered plagiarism a problem were 56%, 63%, and 83% among post-graduate students, fifth-year students of the BDSc program, and first-year students of the BOralH and BDSc program, respectively. Second, in the same study, 14 the percentages of undergraduate students who believed their school had clear guidelines for dealing with plagiarism were 90%, 56%, and 44% among first-year students of the BOralH and BDSc program, post-graduate students, and fifth-year students of the BDSc program, respectively. Third, an Indian study 17 identified that KoM increased as the age and academic year of dental post-graduate students progressed. In contrast to our study, some authors 56 reported that first-year medical dental students exhibited the highest negative attitude towards plagiarism, followed by second-year and then third-year students. Fourth, Perkins et al. 58 identified other factors that influence KoM, including English language abilities, personality traits, and student experience and education on plagiarism. Finally, in an empirical study, 62 hospitality students advanced six key factors in order to explain cases of extreme plagiarism including a poor time management, fear of failure, improve grade point average, personal/family problems, poor level of English, and unsure about referencing and plagiarism policy.

 How to explain the low-level of KoM among Tunisian PGDSs?

Four factors may contribute to the observed low-level of KoM amid Tunisian PGDSs. First, there appears to be a perception of permissiveness towards plagiarism within dental medical faculties, with institution leaders exhibiting tolerance towards plagiarists, despite Tunisia implementing initiatives to combat this issue. 63 Although a decree was introduced in 2008 allowing universities to autonomously sanction plagiarists, research integrity remains under-discussed, and there is a lack of initiatives to address this concern. 4 The absence of comprehensive policies may explain the low-level of KoM among PGDSs. Sixteen years after the decree’s publication, 63 it is crucial to evaluate whether policies against plagiarism and misconduct in the medical field are being effectively implemented in Tunisia. Second, a significant reason for the prevalence of plagiarism and misconduct is the inadequate emphasis by institutions on addressing these problems. 64 The absence of mandatory training modules on research and medical writing within medical curricula may account for the observed low-level of KoM. 65 Writing a thesis, article, or dissertation is a complex task for medical students, requiring training and practice similar to any other academic skill. 20 , 66 , 67 PGDSs require support from qualified supervisors to improve the quality of their academic and scientific work. 66 , 67 Qualified supervisors play a vital role in ensuring the integrity of manuscripts produced by their students, as responsibility for suspected plagiarism/misconduct is shared between senior researchers and young scientists. 68 Our results in term of low-level of KoM are expected since some previous Tunisian studies including UHDs from different specialties including dentistry, reported a low-level of awareness regarding misconduct. 4 , 7 These results reinforce the notion that academics who themselves lack knowledge or understanding in a particular subject are less likely to effectively teach or transmit that knowledge to their students. The adage “One who lacks something cannot give it” aptly applies. Third, the low-level of KoM may be attributed to the lack of plagiarism/misconduct detection software tools in medical faculties. 69 The implementation of plagiarism detection tools has the potential to reduce the prevalence of plagiarism/misconduct within institutions. 4 , 70 , 71 However, it is important to consider different perspectives on the effectiveness of these tools. While Stappenbelt and Rowles. 72 identified that allowing students to check their own work can be beneficial and improve their skills, Youmans 73 reported that the availability of such software for students does not necessarily reduce plagiarism/misconduct in their own work. Additionally, Rodafinos 74 concluded that expecting students to self-check their work might inadvertently encourage them to “cheat” by avoiding matches with the original sources. Since 2022, the FDMM has implemented plagiarism checker software ( i.e. ; Turnitin), providing all teachers with access to this tool. This initiative aims to effectively raise awareness about plagiarism/misconduct among students, encouraging them to use the software to check their theses and articles prior to submission. The faculty authorities are committed to promoting awareness of plagiarism/misconduct and provide training to prevent their occurrence. Ford and Hughes 14 reported that dental students and staff expressed support for the use of Turnitin across all courses. However, a significant proportion (44%) of PGDSs expressed uncertainty regarding their stance on the use of Turnitin. 14 However, it is important to note that existing plagiarism/misconduct detection software tools are often limited to specific languages and can only identify copied words, while figures and other content may not be adequately compared. 4 , 68 , 75 , 76

Discussion of the methodology

The sample size calculation for this study (n=106) appears to be acceptable. It was slightly higher than the sample size of a previous Indian study, which included 102 dental students. 18 However, it was lower compared to the sample sizes of other relevant studies, such as 154 Australian undergraduate students, 14 186 Brazilian students enrolled in a dentistry course at a university, 15 246 Saudi Arabian dental students, 19 248 Indian dental Master’s degree students 16 ; 452 Indian dental post-graduate students, 17 and 1153 American/Canadian dental students. 13 Among the aforementioned seven studies, only one 19 reported the sample size calculation. Calculating the sample size is crucial as it ensures the study has a sufficient number of participants to generate statistically significant results, increases the study’s power to detect meaningful effects, enhances the reliability of findings, and improves the generalizability of the results to the target population. 37

Descriptive methods are crucial for understanding the distribution and characteristics of variables within a population. 77 , 78 In the context of assessing the KoM level among PGDSs, the information provided by descriptive methods are important for at least two reasons, which are determination of baseline knowledge and characterization and identifying patterns and trends. 77 , 78 First, descriptive methods provide a clear picture of the current state of knowledge or behavior within a population. 78 For example, when studying KoM among PGDSs, descriptive statistics can reveal the average level of KoM, the distribution of responses, and the frequency of various levels of awareness or misunderstanding about misconduct. This baseline understanding helps identify the extent of the issue and characterize the population’s knowledge. It can highlight areas where students have strong knowledge or significant gaps. This information is crucial for tailoring educational interventions and improving training programs to address specific issues. Second, descriptive methods allow for the identification of patterns and trends within the data. 78 For instance, descriptive statistics can show if there are particular subgroups ( e.g. ; based on year of study or previous training) that have higher- or lower- levels of KoM. 78 Recognizing these patterns helps in understanding how KoM varies across different segments of the student population. It can guide targeted efforts to address specific groups with lower knowledge levels, ensuring that interventions are more effective and relevant. Overall, descriptive methods are foundational for summarizing and interpreting data, which informs further analysis and decision-making.

Following a similar approach to a previous North-African study involving UHDs, 4 we combined the PGDSs with acceptable- and excellent-levels KoM. We made this decision for two reasons. First, the number of students with an excellent-level of KoM was low (n=2). Second, including three separate groups in a single study raises concerns about the comparability of sex distribution and postgraduate levels among the groups. 4

Questionnaires have proven to be advantageous and consistent tools for evaluating attitudes, practices, and knowledge related to plagiarism/misconduct. 16 , 40 , 41 , 43 , 79 Some previous studies that aimed to assess KoM among students in the medical or engineering fields chose to use quizzes. 80 – 82 In other related studies ( Table 5), non-standardized questionnaires were predominantly used, 13 – 18 with the exception of one study from Saudi Arabia. 20 Moreover, only two studies 15 , 19 provided references for the questionnaires used. 16 , 45 , 76

Similar to a previous Indian study, 17 our study exclusively focused on PGDSs. However, in other related studies ( Table 5), authors included dental students without providing further specifics, 13 , 15 , 16 , 18 , 19 or both undergraduate and postgraduate students. 14 In our study, we decided to concentrate on PGDSs due to their requirement to complete a medical thesis as part of their graduation process. This decision was made with the intention of creating a more homogeneous sample, as PGDSs undergo a distinct academic milestone that has the potential to influence their attitudes and behaviors within our research context.

 Study limitations

This study has some limitations that need to be addressed. Firstly, as with any questionnaire-based study, the questionnaire utilization 35 introduces subjectivity into the responses, and there is a possibility that some questions may have been answered randomly. 4 This introduces the potential for measurement bias, which should be considered when interpreting the results. Secondly, the use of a French quiz, 35 derived from a Western academic culture within a sample representing an Eastern culture should be acknowledged. Despite the Tunisian PGDSs’ fluency in the French language, their understanding of quizzes derived from Western academic culture may differ. 83 This aspect needs to be considered when interpreting the results. Additionally, the undergraduate experience and educational practices of Tunisian PGDSs occur within a culturally distinct context compared to the Canadian university system. While integrity is universally valued, its manifestations and practices may vary across different countries and cultures. 83 This variation could partially explain the low-level of KoM among Tunisian PGDSs. Research has shown that educational practices related to honesty and quality in teaching and learning differ across cultures. 83 , 84 For example, textual reproduction of learned content may be considered dishonorable and substandard in one culture, while it may be deemed acceptable and even necessary in another. 83 Thirdly, considering the fact that our participants are dentistry students, it would have been better to design the questions relevant for their subject area. In the Laval quiz, 35 the questions can be considered “far away” from the realities of KoM. Fourthly, the convenience sampling used in this study may introduce result bias, as it is not representative of the entire target population, potentially leading to skewed or inaccurate findings. 85 Initially, an electronic data collection method was chosen, but due to a stagnant response rate ( Figure 1), the recruitment approach was modified to incorporate convenience sampling, similar to a relevant study conducted in Saudi Arabia. 19 Consequently, it is important to note that our findings solely pertain to the included PGDSs. 86 Caution must be exercised when interpreting the results as this sample may not be representative of all PGDSs in North-Africa. A fifth limitation is the absence of data regarding the number of publications and/or communications in medical congresses among the PGDSs. 4 Including this information would have provided a more comprehensive understanding of the students’ characteristics and allowed for a more nuanced analysis by categorizing them based on their publication and communication activity. Future studies should consider collecting such data to enhance the interpretation of findings and provide a more detailed characterization of the participants. 4 Sixthly, it would have been beneficial to include an additional validated questionnaire, such as the “Attitude toward Plagiarism” questionnaire, 43 as utilized in a previous study. 19 This would have enhanced the scientific rigor of our research by providing a more comprehensive assessment of students’ attitudes towards plagiarism. By incorporating established measurement tools, we could have gained valuable insights and comparisons that would contribute to the validity and generalizability of our findings. Seventhly, it was better to perform inferential statistics, in addition to the descriptive ones. The primary advantage of inferential statistics over descriptive statistics lies in its ability to make generalizations and predictions about a population based on sample data. 87 Inferential statistics allow researchers to extend findings from a sample to the broader population from which the sample was drawn, help to assess the reliability of observed patterns, and make predictions or generalizations with quantifiable confidence. 87 Eighthly, it was better to check the students’ language ability, since they often claim that English language ability is one of the main reasons why they commit plagiarism/misconduct offences. 88 Some authors reported statistically significant differences in the English language abilities of students who have previously committed plagiarism/misconduct offences, compared to students who have not. 88 Finally, it was better to complete the study by an interventional program in order to objectively measure the effectiveness of the intervention. 89 This method is particularly useful in situations where students start with a low-level of KoM, as it allows for a clear demonstration of progress and the effectiveness of educational strategies aimed at improving awareness and understanding of misconduct. 89 By assessing students’ KoM before the program (pre-test) and after its completion (post-test), it was possible for the authors to determine the extent of learning and the impact of the intervention on our students’ KoM.

Recommendations

Misunderstanding plagiarism/misconduct is a common occurrence, and the lack of clarity surrounding the concept makes KoM essential to prevent it. However, it should be noted that KoM alone is not sufficient. As highlighted by Iloh et al. 31 despite the awareness of plagiarism/misconduct among Nigerian students, instances of violations were still detected. Therefore, it is crucial to focus on enhancing researchers’ knowledge and attitudes towards plagiarism/misconduct, particularly among junior researchers. According to Poorolajal et al. 79 there is a significant association between the prevalence of plagiarism/misconduct and an increase in scores of knowledge and attitude towards plagiarism/misconduct, with a decrease of 13% and 16% per one-unit increase, respectively. This highlights the importance of researchers’ awareness regarding plagiarism/misconduct. Therefore, it is crucial for scholastic programs to focus on enhancing knowledge and improving the attitude of researchers, particularly junior ones, towards plagiarism/misconduct. Achieving the following three goals, as proposed by Muthanna, 90 should be the target: i) Develop skills in creative, critical, and scientific thinking; ii) Encourage creative writing, translation, and publication across various disciplines; and iii) Advance knowledge through scientific research in all fields. To address these concerns, it is recommended to organize workshops, seminars, and scientific writing courses specifically focused on plagiarism/misconduct. 20 , 90 Interactive seminars have shown effectiveness in addressing this issue, as suggested by Marshal et al. 91 Dedicated modules on medical research ethics and writing, and learning outcomes for educational courses on plagiarism/misconduct should be integrated into undergraduate medical curricula in North-Africa to proactively prevent plagiarism/misconduct. 4 Combatting plagiarism/misconduct is a shared responsibility, and each medical school should establish its own institutional policies to effectively address this growing phenomenon. 90

Conclusion

The KoM’ level among Tunisian PGDSs is alarmingly low, necessitating urgent action to improve it. Our results have practical value as evidence for formulating educational programs on plagiarism/misconduct. Our study serves as an urgent call to raise awareness among North-African officials in dental faculties regarding the prevalence of plagiarism/misconduct in the medical dental field. It is imperative that institutions make dedicated efforts to investigate instances of plagiarism/misconduct, as dental medical faculties possess the capacity to identify fraudulent manuscripts and subsequently implement appropriate disciplinary measures against plagiarists.

 Ethical approval

The research protocol was determined to be exempt from human subjects’ research review by the Ethics Committee of the Faculty of Dental Medicine of Monastir, and therefore, formal approval was not required. Our study adhered to the Declaration of Helsinki ( https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/).

 Informed consent

For the “paper method”( Figure 1), informed written consent was obtained from each participating student. For the “electronic method” ( Figure 1), the fact that the student responded to our email and sent us the filled questionnaire as an attached file indicates his/her consent to participate in the study.

 Data availability Underlying data

Zenodo: Excel data of the 106 Tunisian post-graduate dental students [Data set]. DOI: https://doi.org/10.5281/zenodo.13212820. 92

The project contains the following underlying data:

Data Excel Knowledge of misconduct (n=106).xlsx [Excel data of the 106 Tunisian post-graduate dental students]. 92

Extended data

Zenodo: Questionnaire (version française): état de connaissance en matière de plagiat: enquête auprès des résidents en médecine dentaire. DOI: https://zenodo.org/records/10992113. 38

Zenodo: Questionnaire (English version). Knowledge of misconduct amid Tunisian post-graduate dental students. DOI: https://zenodo.org/records/10992137. 39

The project contains the following extended data:

[ Appendix A: Copy of the French questionnaire] (Applied questionnaire). 38

[ Appendix B: Copy of the translated English questionnaire]. 39

Reporting guidelines

Zenodo: STROBE checklist for “Knowledge of misconduct amid North-African post-graduate dental students: A cross sectional study”. Doi: https://zenodo.org/records/10692067. 93

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

 Acknowledgments

In order to correct and improve the academic writing of our paper, we have used the language model ChatGPT 3.5. 94 Authors wish also to express their sincere gratitude to all students for their cooperation.

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Epub 2023/06/05. 38372545 10.5256/f1000research.171301.r333442 Reviewer response for version 2 Pupovac Vanja 1 Referee https://orcid.org/0000-0003-1485-6283 Depope Ana 1 Co-referee University of Rijeka, Rijeka, Croatia

Competing interests: No competing interests were disclosed.

 24 10 2024 Copyright: © 2024 Pupovac V and Depope A 2024 This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. recommendation reject

Dear Authors,

Thank you for addressing our recommendations. While your revisions have substantially improved the article, some significant issues remain.

First, the statistical analysis and presentation of results need further refinement. Specifically, Table 2 employs an inadequate statistical method, as two categories contain fewer than five observations. Additionally, Table 3 lacks appropriate indicators of descriptive statistics, and the process of frequency calculation in the second part of Table 3 is unclear. Furthermore, the discussion on page 13 regarding these results is confusing. Lastly, the comparison of the KoM scores between KoM categories in Table 4 is unnecessary.

The literature cited in the discussion is not relevant to the study design and results, especially after the title changed from "Understanding Plagiarism" to "Knowledge of Misconduct." Much of the referenced literature focuses solely on plagiarism and does not consistently assess knowledge but rather attitudes and perceptions. As noted in our previous review, we believe that Table 5 is redundant.

Another drawback in the discussion section is the lack of a precise analysis of the results obtained in this study. For instance, the subtitle "Which factors influence the KoM levels of Tunisian PGDS?" is superfluous, as this was not examined in your study.

Instead of separate sections for "Discussion of the Methodology" and "Study Limitations," it would be more effective to focus solely on the limitations of your empirical work. Much of the text currently labeled as "Study Limitations" is more suitable as recommendations for future research.

Considering all the above mentioned, we believe that this article is more appropriate for a Brief report publication category. 

Best regards,

Ana Depope

Vanja Pupovac

Is the work clearly and accurately presented and does it cite the current literature?

Partly

If applicable, is the statistical analysis and its interpretation appropriate?

Partly

Are all the source data underlying the results available to ensure full reproducibility?

Yes

Is the study design appropriate and is the work technically sound?

Partly

Are the conclusions drawn adequately supported by the results?

Partly

Are sufficient details of methods and analysis provided to allow replication by others?

Partly

Reviewer Expertise:

research integrity, plagiarism, methodology

We confirm that we have read this submission and believe that we have an appropriate level of expertise to state that we do not consider it to be of an acceptable scientific standard, for reasons outlined above.

BEN SAAD Helmi Université de Sousse, Tunisia

Competing interests: No

 1 11 2024

Dear Reviewer,

Thank you for your constructive comments that have undoubtedly contributed to orient us towards a better version of our manuscript. Please find below your responses to your questions and suggestions: Sincerely yours.

COMMENT N° 1.

Thank you for addressing our recommendations.

While your revisions have substantially improved the article, some significant issues remain.

RESPONSE.

Thank you for your thoughtful review and for acknowledging the improvements made in response to your recommendations. We appreciate your continued attention to enhancing the quality of the article. We have addressed the significant issues reported in your review. In brief, we have changed our paper to a brief report, we have shorten it by deleting tables 4 and 5, and by deleting some subsection such as discussion of the methodology subsection and the subsection "Which factors influence the KoM levels of Tunisian PGDS?"

COMMENT N° 2.

The statistical analysis and presentation of results need further refinement. Specifically, Table 2 employs an inadequate statistical method, as two categories contain fewer than five observations.

RESPONSE.

Thank you for your valuable feedback on the statistical analysis and presentation of results. We understand the concern regarding the use of an inappropriate statistical method in Table 2, especially with categories containing fewer than five observations. We revised the analysis using a more suitable statistical method, such as Fisher’s exact test, which is better suited for small sample sizes. Concerning Table 2, in the initial version we have compared subjective vs. objective evaluation of KoM for low levels (n=66 and n=91, respectively) and Acceptable- or Excellent- levels (n=40 and n=15, respectively). In all cases, number of participants were higher than five. In the actual revised version (R3), we have compared subjective vs. objective evaluation of KoM for the three levels (please see the revised Table):

*P-value (2-sided Chi-2 test) < 0.05: subjective vs. objective evaluation of KoM (ie; Low vs. Low; and Acceptable vs. Acceptable)

#P-value (2-sided Fisher’s exact test) < 0.05: subjective vs. objective evaluation of KoM (ie; Excellent vs. Excellent)

Additionally, we ensured that all results are presented clearly and appropriately. Please see the revised version of Table 2. As you can see, we have deleted Table 4.

COMMENT N° 3.

Table 3 lacks appropriate indicators of descriptive statistics, and the process of frequency calculation in the second part of Table 3 is unclear.

RESPONSE.

            Sorry for the unclear parts. To make table 3 clearer we have kept only the percentage of students having correct answer to the eleven questions of the quiz, and to the all questions of the four forms of the misconduct. We have clarified all needed information inside the paper. We have added the following sentences

Inside the paper: The percentages of participants who responded correctly to each question (i.e. ; 11 questions) and to all questions of each form of misconduct were calculated.

Please see table 3.

COMMENT N° 4.

The discussion on page 13 regarding these results is confusing.

RESPONSE.

            All the discussion section was revised taking into account all your remarks, mainly remarks number 6 to 8. Discussion related to the findings reported in Table 3 changed. Please see the revised version (discussion section, sentence ( Table 3 revealed that the ………………content without inadvertently plagiarizing. 54 )

COMMENT N° 5.

The comparison of the KoM scores between KoM categories in Table 4 is unnecessary.

RESPONSE.

Since we opted for a brief report ( your remark number 9), and since we have deleted the subsection "Which factors influence the KoM levels of Tunisian PGDS?" ( your remark number 7), we have deleted table 4 and all related text overall the paper. The aim was to keep the paper as short as possible (a brief report) focusing on only one message.

COMMENT N° 6.

The literature cited in the discussion is not relevant to the study design and results, especially after the title changed from "Understanding Plagiarism" to "Knowledge of Misconduct." Much of the referenced literature focuses solely on plagiarism and does not consistently assess knowledge but rather attitudes and perceptions.

As noted in our previous review, we believe that Table 5 is redundant.

RESPONSE.

            First, table 5 was deleted from our paper.

Second, we kept only references that focused on knowledge of plagiarism among students, mainly dental students. We have added the following sentence inside the paper: As of October 27, 2024, a search in PubMed using the following request “("Scientific Misconduct"[Mesh]) AND "Students, Dental"[Mesh]” yielded no paper. Moreover, there is a scarcity of studies assessing plagiarism and misconduct format among dental students. 13 – 19 To the finest of the authors’ awareness, this brief report is the first North-African study to examine the issue of KoM among PGDSs.

COMMENT N° 7.

Another drawback in the discussion section is the lack of a precise analysis of the results obtained in this study. For instance, the subtitle "Which factors influence the KoM levels of Tunisian PGDS?" is superfluous, as this was not examined in your study.

RESPONSE.

            The subsection "Which factors influence the KoM levels of Tunisian PGDS?" was deleted from our brief report. In the revised version, we have shortened our paper, and the discussion section is focused on KoM and compared with “similar” few papers.

COMMENT N° 8.

Instead of separate sections for "Discussion of the Methodology" and "Study Limitations," it would be more effective to focus solely on the limitations of your empirical work. Much of the text currently labeled as "Study Limitations" is more suitable as recommendations for future research.

RESPONSE.

Thank you for this advice. We have considered your remark and we have

i) deleted the discussion of methodology subsection,

ii) kept some limitations, and

iii) moved a large part of the “study Limitations" subsection to the subsection named “Recommendations for future research”.

Please consult the revised version.

COMMENT N°9.

Considering all the above mentioned, we believe that this article is more appropriate for a Brief report publication category.

RESPONSE.

            We accept your suggestion to change the article to a brief report.

We have done all needed changes inside the paper and we ask F1000 research editorial board to change the category of our paper a Brief report publication category.

 10.5256/f1000research.171301.r333441 Reviewer response for version 2 Başar Gezgin Ulaş 1 Referee https://orcid.org/0000-0002-6075-3501 Dinçşahin Şakir 1 Co-referee Istanbul Galata University, Istanbul, Turkey

Competing interests: No competing interests were disclosed.

 22 10 2024 Copyright: © 2024 Başar Gezgin U and Dinçşahin Ş 2024 This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. recommendation reject

I am not satisfied with the revision. They didn't revise the original study or conducted another follow-up research. They just mentioned my criticisms in the limitations. The same criticisms apply to this new version. Thus, I don't approve this paper.

Is the work clearly and accurately presented and does it cite the current literature?

Yes

If applicable, is the statistical analysis and its interpretation appropriate?

No

Are all the source data underlying the results available to ensure full reproducibility?

Yes

Is the study design appropriate and is the work technically sound?

No

Are the conclusions drawn adequately supported by the results?

Yes

Are sufficient details of methods and analysis provided to allow replication by others?

Yes

Reviewer Expertise:

cognitive science, social science, humanities, art, psychology, sociology, anthropology, Asian studies, Vietnam, South East Asia, Peace Studies, Education, Urban Planning, literature, Poetry, Marxism, Communication, Media Studies, Cultural Studies, China Studies, Political Psychology, Social Psychology, Environmental Psychology, Economic Psychology, Cognitive Psychology, Narratology, Art Criticisms, Critical Psychology, Marxist Psychology, Sustainability, Sustainable Development, Experimental Economics, Urban Heritage, Colonialism, Personality Theory, Translation, Social Media Studies, Psychology of Art, Psychology and Urban Planning, Psychology and Architecture , Philosophy, Philosophy of Science, Sociology of Science, Critical Approaches to Science, Stories, Fairy Tales, Film Stories, Film Studies, Scenarios, Children's Literature, Novels, Humor, Comedy, Operas, Librettos, Short Stories , Novellas, China, Asia, Film Psychology, Film Analysis, Poetry Criticism, Poetry Analysis, Novel Analysis, Novel Criticism, Fairy Tale Analysis, Story Criticism, Story Analysis, Historiography, Alternative History, Historical Dialectics, Revisionist History, Anti-colonial History, Multicultural Education, Democratic Education, Istanbul Studies, Mediterranean Studies, Black Sea Studies, Latin American Studies, Turkish Studies, Caucasian Studies, Linguistics, Socio-linguistics, Cognitive linguistics, World Poetry, Poetry Anthologies, Spanish Poetry, Latin American Poetry, Latin American Literature, Russian Novels, Russian Poetry, Songs, Musicology, Psychology of Music, Sociology of Music , Critical Pedagogy, Georgian Literature, Emotions, Social Cognition, Media Psychology, Social Media Psychology, Psychology of Communication, Cross-cultural Psychology, Intercultural Communication, Political Analysis, Class Analysis, Tourist Psychology, Tourist Sociology, Mass Media Studies, Ethics, Media Criticism, Discourse Analysis, Human Rights, Peace Journalism, Media Literacy, Future Studies, Decolonialization, Sinification, Empowerment, Precarization, Industrial Relations, Labor Studies, Degendering, Transdisciplinarity, Environmental Science, Enviromental Futures, Ethnography, Oral History, Life Narratives, Gerontology, Geronto-Anthropology, Wisdom, International Relations, International Relations in Asia, Organizational Studies, Critical Thinking, Creativity, Teaching Philosophy, Teaching Sociology, Teaching Psychology

We confirm that we have read this submission and believe that we have an appropriate level of expertise to state that we do not consider it to be of an acceptable scientific standard, for reasons outlined above.

BEN SAAD Helmi Université de Sousse, Tunisia

Competing interests: No competing interests were disclosed.

 23 10 2024

Dear Reviewer,

Thank you for your the time to review our revised manuscript.

We would like to clarify that our study is a quantitative study, and as such, it does not allow for the application of the qualitative suggestions you proposed. While we appreciate your insightful comments, incorporating those into the methodology would not align with the research design and objectives of our study. Therefore, we addressed your criticisms by acknowledging them in the limitations section.

We hope this clarifies our approach, and we remain open to further constructive feedback.

 10.5256/f1000research.163040.r299554 Reviewer response for version 1 Başar Gezgin Ulaş 1 Referee https://orcid.org/0000-0002-6075-3501 Dinçşahin Şakir 1 Co-referee Istanbul Galata University, Istanbul, Turkey

Competing interests: No competing interests were disclosed.

 26 7 2024 Copyright: © 2024 Başar Gezgin U and Dinçşahin Ş 2024 This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. recommendation reject

I appreciate efforts by the researchers, but there are fundamental issues about this paper. 

For one thing, the definition of plagiarism should be inclusive of various academic misconduct cases. But this paper focuses on a particular form of plagiarism.

Secondly, the statistics used is descriptive. That is possibly due to the design of the questionnaire. But it is known that the information to be provided by descriptive methods is limited. I would have expected the researcher to use inferential statistics.

Thirdly, even the use of inferential statistics would allow limited conclusions. Thus, this research study had to be complemented by an intervention program where post and pre tests were considered. This intervention program could have been a form of training.

Fourthly, we had shown in our study that plagiarism is also related to limited language ability. The questionnaire is in French. The questions, I guess, are unintentionally measuring language ability. That had to be checked by a language test score.

Finally, we need to consider the fact that the participants are dentistry students. It would have been better to design the questions relevant for their subject area. In this form, the questions are too far away from the realities of plagiarism.

Thus, for these reasons, I think this paper shouldn't be indexed.

Thank you very much,

Best regards,

Is the work clearly and accurately presented and does it cite the current literature?

Yes

If applicable, is the statistical analysis and its interpretation appropriate?

No

Are all the source data underlying the results available to ensure full reproducibility?

Yes

Is the study design appropriate and is the work technically sound?

No

Are the conclusions drawn adequately supported by the results?

Yes

Are sufficient details of methods and analysis provided to allow replication by others?

Yes

Reviewer Expertise:

cognitive science, social science, humanities, art, psychology, sociology, anthropology, Asian studies, Vietnam, South East Asia, Peace Studies, Education, Urban Planning, literature, Poetry, Marxism, Communication, Media Studies, Cultural Studies, China Studies, Political Psychology, Social Psychology, Environmental Psychology, Economic Psychology, Cognitive Psychology, Narratology, Art Criticisms, Critical Psychology, Marxist Psychology, Sustainability, Sustainable Development, Experimental Economics, Urban Heritage, Colonialism, Personality Theory, Translation, Social Media Studies, Psychology of Art, Psychology and Urban Planning, Psychology and Architecture , Philosophy, Philosophy of Science, Sociology of Science, Critical Approaches to Science, Stories, Fairy Tales, Film Stories, Film Studies, Scenarios, Children's Literature, Novels, Humor, Comedy, Operas, Librettos, Short Stories , Novellas, China, Asia, Film Psychology, Film Analysis, Poetry Criticism, Poetry Analysis, Novel Analysis, Novel Criticism, Fairy Tale Analysis, Story Criticism, Story Analysis, Historiography, Alternative History, Historical Dialectics, Revisionist History, Anti-colonial History, Multicultural Education, Democratic Education, Istanbul Studies, Mediterranean Studies, Black Sea Studies, Latin American Studies, Turkish Studies, Caucasian Studies, Linguistics, Socio-linguistics, Cognitive linguistics, World Poetry, Poetry Anthologies, Spanish Poetry, Latin American Poetry, Latin American Literature, Russian Novels, Russian Poetry, Songs, Musicology, Psychology of Music, Sociology of Music , Critical Pedagogy, Georgian Literature, Emotions, Social Cognition, Media Psychology, Social Media Psychology, Psychology of Communication, Cross-cultural Psychology, Intercultural Communication, Political Analysis, Class Analysis, Tourist Psychology, Tourist Sociology, Mass Media Studies, Ethics, Media Criticism, Discourse Analysis, Human Rights, Peace Journalism, Media Literacy, Future Studies, Decolonialization, Sinification, Empowerment, Precarization, Industrial Relations, Labor Studies, Degendering, Transdisciplinarity, Environmental Science, Enviromental Futures, Ethnography, Oral History, Life Narratives, Gerontology, Geronto-Anthropology, Wisdom, International Relations, International Relations in Asia, Organizational Studies, Critical Thinking, Creativity, Teaching Philosophy, Teaching Sociology, Teaching Psychology

We confirm that we have read this submission and believe that we have an appropriate level of expertise to state that we do not consider it to be of an acceptable scientific standard, for reasons outlined above.

BEN SAAD Helmi Université de Sousse, Tunisia

Competing interests: No Competing Interests

 31 8 2024

COMMENT

I appreciate efforts by the researchers, but there are fundamental issues about this paper. 

RESPONSE

.Thank you for your effort to revise our paper.

.We tried to consider all your remarks, when it is possible.

.Taking into account the remarks of the first reviewers, and yours, we hope that our paper is improved and can be candidate for a publication.

COMMENT

For one thing, the definition of plagiarism should be inclusive of various academic misconduct cases. But this paper focuses on a particular form of plagiarism.

RESPONSE

.As you can see, we have changed plagiarism by knowledge of misconduct (as suggested by the first reviewers) and we have identified four forms of misconduct: ( i.e. ; verbatim plagiarism, paraphrasing, publication ethics, and cheating in classrooms).

COMMENT

a. Secondly, the statistics used is descriptive. That is possibly due to the design of the questionnaire. But it is known that the information to be provided by descriptive methods is limited.

b. I would have expected the researcher to use inferential statistics.

RESPONSE

a. We partially agree with the reviewers’ that our statistics are only descriptive.

.On the one hand, as you can see in Table 4, we have compared the characteristics of the 106 PGDSs divided according to the objective level of KoM.

.On the other hand, descriptive methods are crucial for understanding the distribution and characteristics of variables within a population. Here are two main importance of the information provided by descriptive methods, particularly in the context of assessing the level of KoM among PGDSs:

1. Baseline understanding and characterization:

- Importance : Descriptive methods provide a clear picture of the current state of knowledge or behavior within a population. For example, when studying KoM among PGDSs, descriptive statistics can reveal the average level of knowledge, the distribution of responses, and the frequency of various levels of awareness or misunderstanding about misconduct.

-Benefit : This baseline understanding helps identify the extent of the issue and characterize the population's knowledge. It can highlight areas where students have strong knowledge or significant gaps. This information is crucial for tailoring educational interventions and improving training programs to address specific issues.

2. Identifying patterns and trends:

-Importance : Descriptive methods allow for the identification of patterns and trends within the data. For instance, descriptive statistics can show if there are particular subgroups (e.g., based on year of study or previous training) that have higher or lower levels of KoM.

-Benefit : Recognizing these patterns helps in understanding how KoM varies across different segments of the student population. It can guide targeted efforts to address specific groups with lower knowledge levels, ensuring that interventions are more effective and relevant. Overall, descriptive methods are foundational for summarizing and interpreting data, which informs further analysis and decision-making.

.The following references argued our scientific response:

       Bland JM, Altman DG. Measurement error. BMJ. 1996 Jun 29;312(7047):1654. doi: 10.1136/bmj.312.7047.1654. Corrected and republished in: BMJ. 1996 Sep 21;313(7059):744. doi: 10.1136/bmj.313.7059.744. PMID: 8664723; PMCID: PMC2351401

           Trochim W, Donnelly JP, Arora, K. Research Methods: The Essential Knowledge Base. 2 nd Edition. 2016. Cengage Learning

b. We understand the expectation of the reviewers to see inferential statistics. The primary advantage of inferential statistics over descriptive statistics lies in its ability to make generalizations and predictions about a population based on sample data. While descriptive statistics summarize and describe the features of a dataset, such as measures of central tendency and variability, inferential statistics use sample data to draw conclusions about a larger population, making it possible to test hypotheses, estimate parameters, and make predictions. While descriptive statistics provide a snapshot of the data, which is limited to summarizing the characteristics of the sample or dataset at hand, they do not offer insights beyond the data collected, nor do they account for sampling variability or uncertainty. In contrast, inferential statistics allow researchers to extend findings from a sample to the broader population from which the sample was drawn. Inferential statistics help to assess the reliability of observed patterns and make predictions or generalizations with quantifiable confidence.

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a. Inside the paper, in the discussion of the methods we have added the following sentence (Lines 403-422):

Descriptive methods are crucial for understanding the distribution and characteristics of variables within a population. 77, 78 In the context of assessing the KoM level among PGDSs, the information provided by descriptive methods are important for at least two reasons, which are determination of baseline knowledge and characterization and identifying patterns and trends. 77, 78 First, descriptive methods provide a clear picture of the current state of knowledge or behavior within a population. 78 For example, when studying KoM among PGDSs, descriptive statistics can reveal the average level of KoM, the distribution of responses, and the frequency of various levels of awareness or misunderstanding about misconduct. This baseline understanding helps identify the extent of the issue and characterize the population's knowledge. It can highlight areas where students have strong knowledge or significant gaps. This information is crucial for tailoring educational interventions and improving training programs to address specific issues. Second, descriptive methods allow for the identification of patterns and trends within the data. 78 For instance, descriptive statistics can show if there are particular subgroups (e.g. ; based on year of study or previous training) that have higher- or lower- levels of KoM. 78 Recognizing these patterns helps in understanding how KoM varies across different segments of the student population. It can guide targeted efforts to address specific groups with lower knowledge levels, ensuring that interventions are more effective and relevant. Overall, descriptive methods are foundational for summarizing and interpreting data, which informs further analysis and decision-making.

b. In the study limitations subsection, we have added the following sentence ( Lines 480-490)

Seventhly, it was better to perform inferential statistics, in addition to the descriptive ones. The primary advantage of inferential statistics over descriptive statistics lies in its ability to make generalizations and predictions about a population based on sample data. 87 Inferential statistics allow researchers to extend findings from a sample to the broader population from which the sample was drawn, help to assess the reliability of observed patterns, and make predictions or generalizations with quantifiable confidence. 87 Eighthly, it was better to check the students’ language ability, since they often claim that English language ability is one of the main reasons why they commit plagiarism/misconduct offences. 88 Some authors reported statistically significant differences in the English language abilities of students who have previously committed plagiarism/misconduct offences, compared to students who have not. 88

COMMENT

Thirdly, even the use of inferential statistics would allow limited conclusions. Thus, this research study had to be complemented by an intervention program where post and pre tests were considered. This intervention program could have been a form of training.

RESPONSE

.We understand the point of view of the reviewers

.Your remarks are added in the manuscript in the section named “study limitation”

.As now, we have a general idea about the phenomenon of low KM among PGDSs, we are planning to perform an interventional study where post- and pre- tests will be considered.

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.We have added this sentence in the Study limitations subsection (Lines 490-497):

Finally, it was better to complete the study by an interventional program in order to objectively measure the effectiveness of the intervention. 89 This method is particularly useful in situations where students start with a low-level of KoM, as it allows for a clear demonstration of progress and the effectiveness of educational strategies aimed at improving awareness and understanding of misconduct. 89 By assessing students' KoM before the program (pre-test) and after its completion (post-test), it was possible for the authors to determine the extent of learning and the impact of the intervention on our students' KoM.

COMMENT

Fourthly, we had shown in our study that plagiarism is also related to limited language ability. The questionnaire is in French. The questions, I guess, are unintentionally measuring language ability. That had to be checked by a language test score.

RESPONSE

.First, it was unclear for the reviewers to understand what the reviewers mean by “our study”. For that reasons, we performed several research and we retained some references where “Gezgin UB” was cited as an authors. We found the following 3 papers:

1.Perkins M, Gezgin UB, Roe J. Reducing plagiarism through academic misconduct education. Int J Educ Integr. 2020 2020/05/01;16(1):3.

2.Perkins M, Gezgin UB, Roe J. Understanding the Relationship between Language Ability and Plagiarism in Non-native English Speaking Business Students. Journal of Academic Ethics. 2018 2018/12/01;16(4):317-28.

3.Perkins M, Gezgin UB, Gordon R. Plagiarism in higher education: classification, causes and controls. Pan-Pacific Management Science. 2019;2:3-20

.We have also found 3 other interesting papers:

1.Holm S, Hofmann B. Investigating the Reliability and Factor Structure of Kalichman's "Survey 2: Research Misconduct" Questionnaire: A Post Hoc Analysis Among Biomedical Doctoral Students in Scandinavia. J Empir Res Hum Res Ethics. 2017 Oct;12(4):199-205. PubMed PMID: 28707501. Epub 20170714.

2.Jereb E, Perc M, Lämmlein B, Jerebic J, Urh M, Podbregar I, et al. Factors influencing plagiarism in higher education: A comparison of German and Slovene students. PLoS One. 2018;13(8):e0202252. PubMed PMID: 30096189. Pubmed Central PMCID: PMC6086479. Epub 20180810. eng.

3.Patil VL, Ganganahalli P. Perception of Plagiarism Among Medical Postgraduate Students: An Observational Study. Cureus. 2024 Jul;16(7):e64513. PubMed PMID: 39139346. Pubmed Central PMCID: PMC11320932. Epub 20240714. eng.

.We have added some of these references in the manuscript.

.Concerning your remark, we have consulted your paper (Perkins M, Gezgin UB, Roe J. Understanding the Relationship between Language Ability and Plagiarism in Non-native English Speaking Business Students. Journal of Academic Ethics. 2018 2018/12/01;16(4):317-28.), and we agree with the reviewers that English language ability is one of the main reasons why students commit plagiarism offences. We have noted that the authors of the above-cited paper reported statistically significant differences in the English language abilities of students who have previously committed plagiarism offences, compared to students who have not. However, this is not the case in Tunisia, since the questionnaire was in French, and French is the second language in Tunisia and medical teaching is in French

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.We have considered your remark as a study limitation, and we have added the following reference: Perkins M, Gezgin UB, Roe J. Understanding the Relationship between Language Ability and Plagiarism in Non-native English Speaking Business Students. Journal of Academic Ethics. 2018 2018/12/01;16(4):317-28.

.Please see lines 486-490:

Eighthly, it was better to check the students’ language ability, since they often claim that English language ability is one of the main reasons why they commit plagiarism/misconduct offences. 88 Some authors reported statistically significant differences in the English language abilities of students who have previously committed plagiarism/misconduct offences, compared to students who have not. 88

COMMENT

Finally, we need to consider the fact that the participants are dentistry students. It would have been better to design the questions relevant for their subject area. In this form, the questions are too far away from the realities of plagiarism.

RESPONSE

.Thank you for your excellent remark

.Again, we have added the reviewers’ remark as a study limitations

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.Taking into account the remarks of the first reviewers ( Remark N°1), we have added the following paragraph inside the paper (Lines 161-175):

Why we have chosen the Laval University quiz 23?

While various tools have been established and recommended to assess plagiarism, particularly in terms of, attitudes, acceptance, and practice, 16 , 23 , 24 , 35 , 40 - 44  evaluating KoM is also important, especially among PGDSs. Assessing KoM helps promote academic integrity, ensures ethical research practices, cultivates critical thinking skills, and enhances the quality and originality of scholarly work. Our study appears to be the first to apply a virtual quiz to assess students’ KoM. 35 We opted for the Laval University quiz 35 to evaluate KoM among Tunisian PGDSs for several reasons. First, the quiz was previously used in a local study involving UHDs. 4 Second, all available surveys used to assess understanding; attitudes, practices, and knowledge related to plagiarism were in English and lacked a certified French version. 16 , 23 , 24 , 40 - 44 Since French is the second language in Tunisia, and since medical teaching is in French, the French Laval quiz appeared to be more suitable for Tunisian PGDSs without the need for translation or validation. Third, the Laval quiz 35 is not time-consuming, requiring thoughtful responses, with an average of 15 minutes needed to answer the 11 questions.

.The following sentence was added in the study limitations subsection (Lines 459-461):

Thirdly, considering the fact that our participants are dentistry students, it would have been better to design the questions relevant for their subject area. In the Laval quiz 35, the questions can be considered “far away” from the realities of KoM.

COMMENT

Thus, for these reasons, I think this paper should not be indexed.

RESPONSE

.While we respect your point of view and your decision at this stage, we have significantly improved the scientific quality of our paper, which includes (as any scientific paper) some limitations. However, we have previously published a similar paper including university hospital doctors (see Khemiss M, et al. Understanding of plagiarism among North-African university hospital doctors (UHDs): A pilot study. Account Res. 2019 Feb;26(2):65-84. PubMed PMID: 30572716. Epub 20190110. Eng). The latter paper was cited 9 times (Scopus).

.In brief, we respect your point of view, and we which that you change it taking into account the effort we performed to revise our paper.

COMMENT

Is the work clearly and accurately presented and does it cite the current literature?

Yes

Is the study design appropriate and is the work technically sound?

No

Are sufficient details of methods and analysis provided to allow replication by others?

Yes

If applicable, is the statistical analysis and its interpretation appropriate?

No

Are all the source data underlying the results available to ensure full reproducibility?

Yes

Are the conclusions drawn adequately supported by the results?

Yes

RESPONSE

.Thank you.

.We have noted that we received 4 YES (67%) and 2 NO (33%)

 10.5256/f1000research.163040.r289631 Reviewer response for version 1 Pupovac Vanja 1 Referee https://orcid.org/0000-0003-1485-6283 Depope Ana 1 Co-referee University of Rijeka, Rijeka, Croatia

Competing interests: No competing interests were disclosed.

 26 6 2024 Copyright: © 2024 Pupovac V and Depope A 2024 This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. recommendation approve-with-reservations

Is the work clearly and accurately presented and does it cite the current literature?

The paper could benefit from some structural modifications:

Page 7, the beginning of the Discussion, should be moved to the Introduction as they are general information more appropriate at the beginning of the article.

On page 13, Discussion of the methodology and study limitations, paragraph 3 – why you chose this questionnaire should be moved under Methods.

Data presented in Table 4 should be integrated as a text either in the Introduction or Discussion.

The literature used is comprehensive and up-to-date.

Please, when you refer to your previous studies explain that one of the team members is the author of the study and that the same instrument was used (page 12, paragraphs 2 and 3).

Is the study design appropriate and does the work have academic merit?

The study design is appropriate for measuring knowledge about different forms of misconduct in the academic community. Therefore, we suggest modification in the title of the paper. Please, instead of plagiarism use misconduct in the academic community.

Also, please explain why you refer to your study as a pilot study. Additionally, on page 3, paragraph 4, you mentioned that the study was a part of the broader research project, so it would be advised to provide the title and funding organization of the project.

Considering the lack of studies about knowledge of plagiarism among Tunisian students, the results of this study are a valuable addition to the discussion about plagiarism. Even more, we believe that results have practical value as evidence for formulating educational programs on misconduct.

Are sufficient details of methods and analysis provided to allow replication by others?

We believe that this study could be replicated if the following modifications are conducted.

Modifications regarding the instrument:

Because questions in the instrument do not only describe scenarios of plagiarism but also some topics from publication ethics (Q5, Q7), and cheating in classrooms (Q9, Q10, and Q11) we suggest the authors provide a more detailed description (presumably, in Method section) of all forms of misconduct presented in the questionnaire such as verbatim plagiarism Q1, paraphrasing Q4, etc...  Furthermore, it would be more appropriate to say that you measured knowledge of misconduct instead of understanding of plagiarism. Additionally, please add results for each question/scenario separately as it will show which forms of misconduct are the most and least understood. Presenting results in this way will substantially contribute to the clarity and distinctiveness of this article.

Modifications regarding the sample:

Figure 1., the study flowchart, is well organized and very informative, however the procedure regarding Step 5 – recruitment of the friends of the participants remains unclear:

It is unclear who those friends are – are they also from your target population of PGDS at the FDMM? If yes, it would be clearer for the readers if they were called “colleagues” and not friends.

Also, who administered the test to them – the researchers or their friends and if so, how did they give their survey to the researchers? How did you control that someone didn’t take the survey twice or that only the other students from FDMM took the survey?

 Additionally, on page 4, under Study Design, paragraph 2 it should state “…PGDS who had attended TAOM congress” and not “a congress” since it was a specific congress.

Page 7, Discussion, paragraph 1 – The first sentence should state: “The study was conducted on a convenient sample of PGDS from FDMM…”, and not “a sample of North-African PGDS” as it is not precise.

Sample size calculation:

Even though, you state the general purpose of the sample size calculation (pg. 13, paragraph 2) it is unclear why you used it because the study population is smaller than the recommended sample size calculation.

If applicable, is the statistical analysis and its interpretation appropriate?

Comments regarding the presentation of results:

Due to ethical concerns (your participants could be easily identified) we would suggest removing the distribution of participants according to the Department and Post-graduate level from Table 2. Also, please explain what Experience level means.

Moreover, please check the correct percentages for low levels of UP, in Table 2 you say it’s 81,13%, but then on page 7 paragraphs 1 and 4, you write 80,4% of students had low UP.

Understandably, you decided to group excellent and acceptable levels in the statistical analysis, however, in Table 2 where you show descriptive statistics, it would be better to separate those categories to show frequencies for each category (excellent, acceptable, and low) for the objective and self-assessment of UP even if you are going to merge them in the analysis. 

We would also advise you to please include frequencies of answers for each of the scenarios in the questionnaire and perform further analysis, for example, differences in responses regarding participants’ gender, experience, response modality, and disciplines for each question or summarize results for questions with similar scenarios (e.g., Q2 and Q5 – respect for editorial rules).

Comments regarding the interpretation of results:

Please discuss the main result of your study - the lack of statistically significant difference in the level of knowledge of misconduct regarding all socio-demographic characteristics of participants (see Table 3.) Furthermore, it is not appropriate to state that you have identified the profile of the low UP students (the subchapter What is the profile of a Tunisian PGDS with a low level of UP?) when no differences were found.

Your study measured only knowledge of misconduct. However, in the discussion, you often compared your results with the perception of the severity of misconduct perceived responsibility for monitoring academic integrity, or knowledge of university guidelines for dealing with plagiarism,  (page 11, paragraph 3, continues on page 12).  

Are all the source data underlying the results available to ensure full reproducibility?

Yes, both the survey data and the questionnaire (in French and translated English versions) are available.

However, we must emphasize our major concern regarding data presented in the supplement material of the article – Data set (Zenodo: Excel data of the 106 Tunisian post-graduate dental students [Data set]. DOI: https://zenodo.org/records/10642001.75)  More precisely, it is not clear why 6 students were given 6 points on Q5 in the Excel table (cells R100, R103-107) while all other answers are 0 and 1 (and you have mentioned that they were given a point for each correct answer). If you remove those 6 points they would be in another UP category.

Are the conclusions drawn adequately supported by the results?

The recommendations organized in Table 5 are overreaching the results of the study. We suggest that recommendations be more specific, for example, you could suggest learning outcomes for educational courses on misconduct.

Is the work clearly and accurately presented and does it cite the current literature?

Partly

If applicable, is the statistical analysis and its interpretation appropriate?

Partly

Are all the source data underlying the results available to ensure full reproducibility?

Yes

Is the study design appropriate and is the work technically sound?

Partly

Are the conclusions drawn adequately supported by the results?

Partly

Are sufficient details of methods and analysis provided to allow replication by others?

Partly

Reviewer Expertise:

research integrity, plagiarism, methodology

We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however we have significant reservations, as outlined above.

BEN SAAD Helmi Université de Sousse, Tunisia

Competing interests: No Competing Interests

 31 8 2024

Comment N° 1.

Is the work clearly and accurately presented and does it cite the current literature?

The paper could benefit from some structural modifications:

a. Page 7, the beginning of the Discussion, should be moved to the Introduction as they are general information more appropriate at the beginning of the article.

b. On page 13, Discussion of the methodology and study limitations, paragraph 3 – why you chose this questionnaire should be moved under Methods.

c. Data presented in Table 4 should be integrated as a text either in the Introduction or Discussion.

d. The literature used is comprehensive and up-to-date.

e. Please, when you refer to your previous studies explain that one of the team members is the author of the study and that the same instrument was used ( page 12, paragraphs 2 and 3).

RESPONSE

.Thank you for all your excellent remarks. All structural modifications requested by the reviewers were applied.

a. We have moved the beginning of the Discussion to the Introduction

b. We have moved the paragraph 3 related to “why we chose this questionnaire” from the Discussion s to the Methods

c. Data presented in Table 4 are integrated as a text in the Discussion

d. Thank you for this positive feedback

e. Thank you for this remark pertinent. In the paper, when we referred to our previous study, we have explained that 2 authors of the team members are the authors of the study and that the same instrument was used

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a. The sentence ( please, see below ) was moved from the Discussion to the beginning of the Introduction , and we have applied all needed arrangements (Lines 24-35):

In recent years ( i.e. ; after 2000), the phenomenon of plagiarism has emerged as a significant ethical problem, 7especially among medical students, as evidenced by various studies. 4 , 13-27 This misconduct in research writing has become widespread worldwide, with high prevalence reported among students from different continents, including America, 28 Europe, 21 Asia, 23 , 29 , 30 and Africa. 31 , 32 Regarding the African continent, Rohwer et al. 33 examined biomedical research journal articles and found evidence of plagiarism in 63.2% of the 495 African papers studied. Plagiarism is considered a serious violation of academic integrity and a scholarly misconduct, as emphasized by Clarke et al. 5 Addressing plagiarism is essential to enhance the quality of education, and avoiding plagiarism has been incorporated as a target under Sustainable Development Goal number 4 (SDG4). 5 Achieving the targets of SDG4 in higher education institutions requires addressing the issue of plagiarism. 5

b. We have moved the paragraph 3 related to “why we chose this questionnaire” from the Discussion to the Methods . We have applied all needed arrangements (Lines 161-175):

Why we have chosen the Laval University quiz 23?

While various tools have been established and recommended to assess plagiarism, particularly in terms of, attitudes, acceptance, and practice, 16 , 23 , 24 , 35 , 40 - 44  evaluating KoM is also important, especially among PGDSs. Assessing KoM helps promote academic integrity, ensures ethical research practices, cultivates critical thinking skills, and enhances the quality and originality of scholarly work. Our study appears to be the first to apply a virtual quiz to assess students’ KoM. 35 We opted for the Laval University quiz 35 to evaluate KoM among Tunisian PGDSs for several reasons. First, the quiz was previously used in a local study involving UHDs. 4 Second, all available surveys used to assess understanding; attitudes, practices, and knowledge related to plagiarism were in English and lacked a certified French version. 16 , 23 , 24 , 40 - 44 Since French is the second language in Tunisia, and since medical teaching is in French, the French Laval quiz appeared to be more suitable for Tunisian PGDSs without the need for translation or validation. Third, the Laval quiz 35 is not time-consuming, requiring thoughtful responses, with an average of 15 minutes needed to answer the 11 questions.

c. Data presented in Table 5 (which was old Table 4) are integrated as a text in the Discussion. Please see when we often refer to Table 5. For example, the following sentence exists in the Discussion (Lines 233-236):

There is a scarcity of studies specifically assessing KoM among dental students. 13 – 19 Table 5 provides a detailed overview of seven related studies. 13 – 19 Nevertheless, to the finest of the authors’ awareness, this is the first Tunisian and North-African study to examine the issue of KoM among PGDSs.

d. No action is needed.

e. When we referred to our previous study ( reference 4), we have explained that 2 authors of the team members are the authors of the previous study, and that the same instrument was used (Lines 65-68):

Two of the team members of this study (MK and HBS in the authors’ list) are the authors of the abovementioned study. 4 Moreover, the same instrument (i.e. ; an online quiz accessible on the Laval University website 35) was used in both studies.

Comment N° 2. Is the study design appropriate and does the work have academic merit?

a. The study design is appropriate for measuring knowledge about different forms of misconduct in the academic community. Therefore, we suggest modification in the title of the paper. Please, instead of plagiarism use misconduct in the academic community.

b. Also, please explain why you refer to your study as a pilot study.

c. Additionally, on page 3, paragraph 4, you mentioned that the study was a part of the broader research project, so it would be advised to provide the title and funding organization of the project.

d. Considering the lack of studies about knowledge of plagiarism among Tunisian students, the results of this study are a valuable addition to the discussion about plagiarism. Even more, we believe that results have practical value as evidence for formulating educational programs on misconduct.

RESPONSE

a. Thank you for your positive feedback. We have accepted your suggestion and instead of plagiarism we have used, overall the paper knowledge of misconduct (abbreviated as KoM)

b. We have deleted the term pilot from the title and all the paper

c. Our study was a part of a broader research project titled: plagiarism knowledge and understanding in Tunisian university. The project has no funding organization

d. Thank you for your positive feedback

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a. The new title is :

Knowledge of misconduct amid North-African post-graduate dental students: A cross sectional study

b. We have deleted the term pilot from the title and all the paper.

c. We have added the following sentence in the text (Lines 57-68):

This study is a component of a broader research project titled “plagiarism knowledge and understanding in Tunisian universities” led by two university hospital doctors (UHDs) [i.e. ; a dentist and a physiologist (MK and HBS, in the authors’ list, respectively)]. The project encompasses two distinct studies. The first focused on evaluating the plagiarism understanding among 96 North-African UHDs (22% were dentists). 4 The findings of the aforementioned study revealed a lack of awareness regarding plagiarism among North-African UHDs, with 74% of them demonstrating a low-level of plagiarism understanding. 4 Building upon these results, the present study aims to investigate KoM among a different group of participants, such as PGDSs.

d. We have added the following sentence in the conclusion (Lines 526-527):

Our results have practical value as evidence for formulating educational programs on plagiarism/misconduct.

Comment N° 3. Are sufficient details of methods and analysis provided to allow replication by others?

a. We believe that this study could be replicated if the following modifications are conducted. Modifications regarding the instrument: Because questions in the instrument do not only describe scenarios of plagiarism but also some topics from publication ethics (Q5, Q7), and cheating in classrooms (Q9, Q10, and Q11) we suggest the authors provide a more detailed description (presumably, in Method section) of all forms of misconduct presented in the questionnaire such as verbatim plagiarism Q1, paraphrasing Q4, etc... 

b. Furthermore, it would be more appropriate to say that you measured knowledge of misconduct instead of understanding of plagiarism.

c. Additionally, please add results for each question/scenario separately as it will show which forms of misconduct are the most and least understood. Presenting results in this way will substantially contribute to the clarity and distinctiveness of this article.

RESPONSE

a. We have accepted your suggestion. In the Methods, we have provided a more detailed description of all forms of misconduct presented in the questionnaire such as

.Verbatim plagiarism: Q1 to Q3

.Paraphrasing: Q4

.Publication ethics: Q5 to Q8

.Cheating in classrooms: Q9 to Q11

b. We agree with the reviewers. Please see our response to your comment N°2a

c. Thank you for this excellent suggestion. We have added a Table including results for each question (questions 1 to 11) and the four forms of misconduct. We agree with the reviewer that presenting results in this way will substantially contribute to the clarity and distinctiveness of our article

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a. We have added the following sentence inside the Methods (Lines 155-160):

The 11 questions explore the following four forms of misconduct: Verbatim plagiarism (questions 1 to 3), paraphrasing (question 4), publication ethics (questions 5 to 8), and cheating in classrooms (questions 9 to 11). Scores for each question ( i.e. ; 11 questions) and for the four forms of misconduct were calculated. The percentages of participants who responded correctly to each question ( i.e. ; 11 questions) and to all questions of each form of misconduct were calculated.

.Moreover, see the discussion part reserved to the 4 forms of misconduct

b. Please see the revised version of our paper and our response to your   comment N°2a

c. Please, see the new added Table : now Table 3 and related text in the Results . We have added the following sentence (Lines 207-213):

Table 3 displays the results for the 11 and the four forms of misconduct ( i.e. ; verbatim plagiarism, paraphrasing, publication ethics, and cheating in classrooms). The percentages of students having correct answers to each question varied from 17.9% (question 11) to 61.3% (questions 8 and 10). The percentages of students having correct answers to questions of each form of misconduct varied from 0.0% (verbatim plagiarism and publication ethics) to 36.8% (paraphrasing). Only one student answered correctly to the three questions related to cheating in classrooms.

Comment N° 4. Modifications regarding the sample: Figure 1., the study flowchart, is well organized and very informative, however the procedure regarding Step 5 – recruitment of the friends of the participants remains unclear:

a. It is unclear who those friends are – are they also from your target population of PGDS at the FDMM? If yes, it would be clearer for the readers if they were called “colleagues” and not friends.

b. Also, who administered the test to them – the researchers or their friends and if so, how did they give their survey to the researchers? How did you control that someone didn’t take the survey twice or that only the other students from FDMM took the survey?

c. Additionally, on page 4, under Study Design, paragraph 2 it should state “…PGDS who had attended TAOM congress” and not “a congress” since it was a specific congress.

RESPONSE

4. Thank you for your positive feedback concerning Figure 1. Procedure regarding Step 5 is improved: please, see the new Figure 1:

a. Yes, “friends” were also from our target population of PGDS at the FDMM? We have renamed them “colleagues”

b. Thank you for your excellent remarks. Two researchers (RK and MK in the authors’ list) administered the test to the PGDSs. All additional information were added inside the paper

c. The sentence was corrected inside Figure 1 and text

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4. Please, see the revised Figure 1.

a. Please see the revised Figure 1 and note that we have reported:

STEP 5: Paper method (October 1, 2022)

Questionnaires directly delivered to a selected group of colleagues chosen from the 147 PGDSs list (n=15 who had not taken the survey before).

b. We have added the following sentence (Lines 93-106):

All 147 PGDSs were invited to participate in the survey, and a five-step recruitment process, outlined in Figure 1, was implemented. To summarize, the following three recruitment methods were utilized: i) Individual emails were sent to all 147 PGDSs; ii) Announcements were disseminated through the Facebook pages of the 14 medical dental departments of the FMDM; and iii) Convenience sampling was employed, where questionnaires were distributed to PGDSs who had attended the medical congress of the Tunisian Association of Oral Medicine (n=32) or were acquainted with authors involved in the study ( i.e. ; 15 colleagues chosen from the 147 PGDSs ‘list and who had not taken the survey before). During steps 1 to 3, which involved the electronic enrolment method, 59 PGDSs were recruited. In steps 4 and 5, which involved the paper-based enrolment method, an additional 47 PGDSs were recruited. During the paper-based enrolment method ( i.e. ; steps 4 and 5), two researchers (RK and MK in the authors’ list) asked the PGDSs if they had taken the survey before. If they had not, the researchers administered the questionnaire and collected the surveys from the PGDSs upon completion.

c. The following sentence was added (Lines 98-99):

…. who had attended the medical congress of the Tunisian Association of Oral Medicine (n=32) or were

Comment N° 5. Page 7, Discussion, paragraph 1 – The first sentence should state: “The study was conducted on a convenient sample of PGDS from FDMM…”, and not “a sample of North-African PGDS” as it is not precise.

RESPONSE

.Thank you. Correction done

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.The sentence was corrected (Lines 227-228):

This study was conducted on a convenient sample of 106 PGDSs from FDMM, as they represent future academic doctors and ……

Comment N° 6. Sample size calculation: Even though, you state the general purpose of the sample size calculation (pg. 13, paragraph 2) it is unclear why you used it because the study population is smaller than the recommended sample size calculation.

RESPONSE

.Thank you for this remark

.We calculated the sample size to inform the readers about the confidence interval of our study ( ie ; 99.9%) and mainly to know when to stop the recruitment of students

.Before the beginning of the study, we have consulted an experienced statistician who helped us writing this important section

.We are aware that the study population is smaller than the recommended sample size calculation. This is explained by the fact that our study involves a finite population (ie; a population with a limited number of participants), and therefore a correction was applied to the sample size. In practice, to calculate the sample size in a finite population, we use a formula that accounts for the finite population correction (FPC). This correction is necessary when the population size is small relative to the sample size because it reduces the required sample size compared to what would be needed for an infinite population. The FPC is necessary when the sample is a significant fraction of the population (usually more than 5-10% of the population). Without this correction, the sample size would be overestimated, leading to inefficiencies. Please see: Kish, L. (1965). Survey Sampling. New York: John Wiley & Sons

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.No action is needed.

Comment N° 7. If applicable, is the statistical analysis and its interpretation appropriate? Comments regarding the presentation of results:

a. Due to ethical concerns (your participants could be easily identified) we would suggest removing the distribution of participants according to the Department and Post-graduate level from Table 2.

b. Also, please explain what Experience level means.

RESPONSE

a. Thank you for this important ethical concern. We have removed the distribution of participants according to the Department (but not according to Post-graduate level) from Table 1. Since there are several students in each post-graduate level, it is impossible to identify them

b. Experience level was arbitrarily defined as; non-experienced for 1 st and 2 nd years of study, and experienced for 3 rd and 4 th years of study

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a. We have removed the distribution of participants according to the Department and from Table 1. In addition, all needed changes inside the Methods were done

b. We have reported the following sentence inside the paper (Lines 133-135):

experience level (arbitrarily defined as non-experienced for 1 st and 2 nd years, and experienced for 3 rd and 4 th years),

Comment N° 8. Moreover, please check the correct percentages for low levels of UP, in Table 2 you say it’s 81,13%, but then on page 7 paragraphs 1 and 4, you write 80,4% of students had low UP.

RESPONSE

.Thank you for your remark and sorry for this mistake

.After taking into consideration all your excellent remarks, we have corrected all the percentages

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.In the revised version, and after taking into account all your remarks, the percentage for low KoM level is 85.85% .

Comment N° 9. Understandably, you decided to group excellent and acceptable levels in the statistical analysis, however, in Table 2 where you show descriptive statistics, it would be better to separate those categories to show frequencies for each category (excellent, acceptable, and low) for the objective and self-assessment of UP even if you are going to merge them in the analysis. 

RESPONSE

.Thank you for your remark and sorry for this mistake

.All needed corrections were done

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.In Table 2 you can see the frequencies for each category (excellent, acceptable, and low) for the objective and self-assessment of KoM. Please see the revised Table 2.

Comment N° 10. We would also advise you to please include frequencies of answers for each of the scenarios in the questionnaire and perform further analysis, for example, differences in responses regarding participants’ gender, experience, response modality, and disciplines for each question or summarize results for questions with similar scenarios (e.g., Q2 and Q5 – respect for editorial rules).

RESPONSE

.Thank you for these suggestions

.First, we have included frequencies of answers for each of the scenarios in the questionnaire and for the 4 forms of misconducts (what you rename questions with similar scenarios): Table 3

.Second, your suggestion to perform further analysis, for example, differences in responses regarding participants’ gender, experience, response modality, and disciplines for each question is interesting. However, in order to send a clear message and keep the paper as short as possible, we decided to plane these analyses during an upcoming study. Thank you for the excellent idea

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.Please see the new Table 3.

Comment N° 11. Comments regarding the interpretation of results:

a. Please discuss the main result of your study - the lack of statistically significant difference in the level of knowledge of misconduct regarding all socio-demographic characteristics of participants (see Table 3)

b. Furthermore, it is not appropriate to state that you have identified the profile of the low UP students (the subchapter What is the profile of a Tunisian PGDS with a low level of UP?) when no differences were found.

c. Your study measured only knowledge of misconduct. However, in the discussion, you often compared your results with the perception of the severity of misconduct perceived responsibility for monitoring academic integrity, or knowledge of university guidelines for dealing with plagiarism,  (page 11, paragraph 3, continues on page 12).  

RESPONSE

a. In the revised version, we have discussed the lack of statistically significant difference in the KoM level regarding all socio-demographic characteristics of participants. For that reason, we have consulted the following references:

1.Perkins M, et al. Reducing plagiarism through academic misconduct education. Int J Educ Integr. 2020 2020/05/01;16(1):3.

2.Perkins M , et al. Plagiarism in higher education: classification, causes and controls. Pan-Pacific Management Science. 2019;2:3-20

3.Holm S, Hofmann B. Investigating the Reliability and Factor Structure of Kalichman's "Survey 2: Research Misconduct" Questionnaire: A Post Hoc Analysis Among Biomedical Doctoral Students in Scandinavia. J Empir Res Hum Res Ethics. 2017 Oct;12(4):199-205.

4.Jereb E, et al. Factors influencing plagiarism in higher education: A comparison of German and Slovene students. PLoS One. 2018;13(8):e0202252.

5.Patil VL, Ganganahalli P. Perception of Plagiarism Among Medical Postgraduate Students: An Observational Study. Cureus. 2024 Jul;16(7):e64513.

RESPONSE

b. We agree with the reviewer that it is not appropriate to state that we have identified the profile of the students with low KoM level when no differences were found. Changes were introduced in the paper.

c. We agree that our study measured only KoM. However, since the pioneer character of our study, we sometimes compared our results with the perception of the severity of misconduct perceived responsibility for monitoring academic integrity, or knowledge of university guidelines for dealing with plagiarism.  Needed changes were introduced in the Discussion.

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a. We have added the following sentence ( Lines 315-345):

Which factors influence the KoM level of Tunisian PGDS?

The two groups of PGDSs with “low” and “acceptable or excellent” levels of KoM showed comparable characteristics, including age, sex, discipline, post-graduate level, experience level, graduation, and response modalities (Table 4). To the best of the authors’ knowledge, while several studies have tried to identify the influencing factors of plagiarism and misconduct in higher education. 14 17 55 - 61, no previous specific study has aimed to identify the factors that influence the KoM’ level of PGDS. Our finding aligns with a 2017 study that evaluated the role of plagiarism in 761 conference abstracts written by graduate students and early- to late-career faculty from approximately 70 countries. 55 The study examined patterns of plagiarism and misconduct among professional academic writers and identified that demographic categories such as geographical location of the current institution, geographical location of the institution where the highest degree was obtained, rank, position, citizenship information, sex, and discipline were not consistent indicators of text-matching. 55 However, it appears that the post-graduate level, academic year, and students’ age influence the KoM’ level of dental students 14 , 17 (Table 5). First, one study 14 reported that the percentages of Australian undergraduate students who considered plagiarism a problem were 56%, 63%, and 83% among post-graduate students, fifth-year students of the BDSc program, and first-year students of the BOralH and BDSc program, respectively. Second, in the same study, 14 the percentages of undergraduate students who believed their school had clear guidelines for dealing with plagiarism were 90%, 56%, and 44% among first-year students of the BOralH and BDSc program, post-graduate students, and fifth-year students of the BDSc program, respectively. Third, an Indian study 17 identified that KoM increased as the age and academic year of dental post-graduate students progressed. In contrast to our study, some authors 56 reported that first-year medical dental students exhibited the highest negative attitude towards plagiarism, followed by second-year and then third-year students. Fourth, Perkins et al. 58 identified other factors that influence KoM, including English language abilities, personality traits, and student experience and education on plagiarism. Finally, in an empirical study, 62 hospitality students advanced six key factors in order to explain cases of extreme plagiarism including a poor time management, fear of failure, improve grade point average, personal/family problems, poor level of English, and unsure about referencing and plagiarism policy.”

b. The subtitle “What is the profile of a Tunisian PGDS with a low level of UP?” was changed by “Which factors influence the KoM level of Tunisian PGDS?”

c. The Discussion was improved taking into account your remarks and those of the second reviewers.

Comment N° 12. Are all the source data underlying the results available to ensure full reproducibility?

a. Yes, both the survey data and the questionnaire (in French and translated English versions) are available.

b. However, we must emphasize our major concern regarding data presented in the supplement material of the article – Data set (Zenodo: Excel data of the 106 Tunisian post-graduate dental students [Data set]. DOI: https://zenodo.org/records/10642001.75). More precisely, it is not clear why 6 students were given 6 points on Q5 in the Excel table (cells R100, R103-107) while all other answers are 0 and 1 (and you have mentioned that they were given a point for each correct answer). If you remove those 6 points they would be in another UP category.

RESPONSE

a. Thank you.

b. Yes, the reviewers have right and we thank them for identifying this major concern regarding data presented in the supplement material of the article. We have corrected the mistakes and two authors reevaluated all statistics. When we have removed the 6 points, all levels were changed.

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a. No action is needed

b. Please see the revised results and Tables 2, 3, and 4 . We have uploaded a revised version of our Data set. Please see the revised reference 75.

Comment N° 13. Are the conclusions drawn adequately supported by the results?

a. The recommendations organized in Table 5 are overreaching the results of the study.

b. We suggest that recommendations be more specific, for example, you could suggest learning outcomes for educational courses on misconduct.

RESPONSE

a. We agree with the reviewer that our recommendations organized in Table 6 are overreaching the results of the study. For that reason, we have deleted them.

b. We agree with the reviewers’ suggestion that recommendations must be more specific, for example, we have suggested learning outcomes for educational courses on misconduct.

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a. The table was deleted.

b. As recommended, we have suggested learning outcomes for educational courses on misconduct. Please see the following sentences (Lines 518-521):

Dedicated modules on medical research ethics and writing, and learning outcomes for educational courses on plagiarism/misconduct should be integrated into undergraduate medical curricula in North-Africa to proactively prevent plagiarism/misconduct. 4

Comment N° 14.

Is the work clearly and accurately presented and does it cite the current literature?

Partly

Is the study design appropriate and is the work technically sound?

Partly

Are sufficient details of methods and analysis provided to allow replication by others?

Partly

If applicable, is the statistical analysis and its interpretation appropriate?

Partly

Are all the source data underlying the results available to ensure full reproducibility?

Yes

Are the conclusions drawn adequately supported by the results?

Partly

RESPONSE

.Thank you again for your positive and constructive remarks and suggestions.

.We hope that our revised version is now acceptable.