F1000Research F1000Research 2046-1402 F1000 Research Limited London, UK 10.12688/f1000research.148694.6 Research Article Articles Knowledge of research misconduct amid North-African post-graduate dental students: A cross sectional study

[version 6; peer review: 1 approved, 4 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 2 3 Touzi Soumaya Conceptualization Methodology Writing – Original Draft Preparation 1 3 Harzallah Belhassen Methodology Writing – Original Draft Preparation Writing – Review & Editing 2 3 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 Department of Dental Anatomy. Dental clinic of Monastir, University of Monastir, Monastir, Tunisia Department of Fixed Prosthesis, Dental clinic of Monastir, University of Monastir, Monastir, Tunisia Research Laboratory LR16ES15: Occlusondontics and Ceramic Prostheses, Faculty of Dental Medicine, University of Monastir, Monastir, Tunisia Department of Dental Medicine, Fattouma BOURGUIBA University Hospital 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, Military Hospital of Tunis, Tunis, Tunisia Hôpital Farhat HACHED, Laboratoire de recherche LR12SP09, Insuffisance cardiaque, Universite de Sousse Faculte de Medecine de Sousse, Sousse, Sousse, Tunisia helmi.bensaad@rns.tn

No competing interests were disclosed.

 19 4 2026 2024 13 415 11 4 2026 Copyright: © 2026 Kallala R et al. 2026 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

Research misconduct (RM) in the academic community remains poorly understood among post-graduate dental students (PGDSs) in North Africa. Data on the knowledge of RM (KoRM) level in this population is lacking. This brief report assessed KoRM 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 ( i.e. ; Laval University quiz) with 11 questions on KoRM, 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 KoRM.

 Results

The mean±standard deviation KoRM score of the 106 students who accepted to participate in the study was 4.4±1.8, indicating a low-level of KoRM. The majority of PGDSs (85.85%) demonstrated a low-level of KoRM. A comparison between subjective and objective assessments of KoRM levels revealed that a significant percentage of PGDSs underestimated their knowledge (62.26% vs. 85.85%, respectively).

 Conclusion

North-African PGDSs have a low-level of KoRM. This emphasizes the need for further efforts to enhance awareness and promote better KoRM 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 5

In version 6, we made several changes based on the reviewer’s (Dharmashree Satyarup) recommendations and suggestions. We fully acknowledged that the Laval University quiz functions primarily as an educational resource rather than a formally validated psychometric tool, and we have strengthened this acknowledgment in the revised manuscript (see Methods - Applied questionnaire section and Limitations in Discussion). Specifically, we have (i) Added explicit language clarifying that while the quiz demonstrated face/content validity through expert review and prior use in a comparable population [previous University Hospital Doctors study], it lacks formal psychometric validation (reliability coefficients, factor analysis), (ii) Emphasized its selection rationale: French-language availability (critical for Tunisian PGDSs), brevity (15 minutes), prior local use, and focus on practical KoRM assessment despite validation limitations, and (iii) Expanded the Limitations section to discuss potential impacts on score reliability/validity and generalizability, while noting the study's descriptive aims align with the instrument's educational strengths. These revisions enhance transparency without altering our key findings. We believe this cross-sectional assessment provides valuable preliminary data on KoRM gaps among North-African PGDSs, supporting calls for targeted interventions. Revised text is highlighted inside the paper.

 Abbreviations list CI

Confidence Interval

 FDMM

Faculty of Dental Medicine of Monastir

 KoRM

Knowledge of Research Misconduct

 PGDSs

Post-graduate Dental Students

 MeSH

Medical Subject Heading

 RM

Research Misconduct

 SD

Standard Deviation

 UHDs

University Hospital Doctors

 Introduction

There are several known types of research misconduct (RM), such as plagiarism, paraphrase, publishing ethics, and classroom cheating. 1 , 2 – 4 Plagiarism, derives from the Latin term “plagiarius”, which means “kidnapper” or “abductor”. 1 , 5 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”. 6 , 7 Restating someone else's thoughts or words in one's own words while maintaining their original meaning and giving due credit is known as paraphrasing. 8 The latter is usually treated as one form of plagiarism within broader academic integrity or cheating studies. 3 , 4 , 9 Publication ethics refers to the standards and principles governing the responsible reporting of research, including honesty, originality, accurate authorship, avoidance of plagiarism and duplicate publication, appropriate data reporting, and adherence to journal and international guidelines. 2 Cheating in classrooms is a form of academic dishonesty in which students obtain or attempt to obtain academic advantage by dishonest means, such as copying during exams, using unauthorized materials, or helping others to cheat. 3 , 4 , 10 The aforementioned forms of RM are prevalent across various fields such as arts, literature, medicine, dentistry, and engineering, 11 , 12 and their consequences can lead to article retractions. RM is considered as a serious violation of academic integrity and a scholarly misbehavior, as emphasized by Clarke et al. 11 Therefore, addressing RM is essential to enhance the quality of education, and avoiding this phenomenon has been incorporated as a target under Sustainable Development Goal number 4. 11 Achieving the latter targets in higher education institutions requires addressing the issue of RM. 11 Furthermore, upholding academic integrity is made more difficult by the changing digital landscape, which is marked by the ease of access to online information and the rise of advanced artificial intelligence (AI) tools. 13 According to recent research, AI has the potential to both enable new types of RM and be an effective tool for identifying it. 14 – 16 This change to digital technology may make accidental RM more likely and calls for a modern definition of RM that goes beyond conventional guidelines. 14 – 16

Despite the widespread occurrence of RM during the last decades ( e.g.; between 1996 and 2026), 11 studies focusing on this phenomenon remain scarce. As of April 8, 2026, a search in PubMed using the following request “(((plagiarism [Title/Abstract]) OR (paraphrasing [Title/Abstract])) OR (publication ethics [Title/Abstract])) OR (cheating in classrooms [Title/Abstract])” yielded only 2857 papers, with 34.9% (n=999) of them published in the last five years ( i.e.; 2021-2026). Several factors contribute to researchers resorting to RM, including the easy availability of data 11 and the increased accessibility to information on the Internet. 17 The pressure to publish can also drive individuals to engage in RM. For example, 18 Memon et al. 19 have compared RM, mainly 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 RM among medical students. 20 The lack of education about RM in educational institutions is a major factor contributing to its proliferation. 21 In 2023, RM was widely considered one of the most persistent matters faced by higher education establishments. 1 In recent years ( i.e.; after 2020), the phenomenon of RM has emerged as a significant ethical problem, especially among medical students, as evidenced by various studies. 2 – 4 , 6 , 9 , 10 , 22 – 36 This misconduct in research writing has become widespread worldwide, with high prevalence reported among students from different continents, including America, 37 Europe, 30 Asia, 32 , 38 , 39 and Africa. 40 , 41 Regarding the African continent, Rohwer et al. 42 examined biomedical research journal articles and reported evidence of RM in 63.2% of the 495 African papers studied.

A 2020-systematic review, focusing on RM 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. 43 Since 1994, Lynch 2 emphasized ethical publication in dental research, requiring presentations to uphold standards of honesty, originality, and fairness to advance human well-being. The author have highlighted issues like duplicate publication, illegitimate authorship, and misleading statistics, advocating education, institutional practices, and journal requirements to mitigate them. 2 Ultimately, ethical publication relies on the integrity of the individual investigator dedicated to truth. 2 Al-Dwairi & Al-Waheidi 4 reported that 85% of Jordanian dental students viewed nine of thirteen cheating behaviors as serious, based on a 100% response rate survey across years two to five. Graham et al. 9 surveyed U.S. dental schools post-2006-07 cheating incidents, and documented a threefold rise in reported cheating since 1998 and recommended ethics curricula with case scenarios, plagiarism training, test security software, and clinically relevant assessments. Asokan et al. 10 have examined attitudes toward cheating at six Indian dental colleges, and identified differences between students and teachers; students more often justified cheating for better grades, while teachers favored warnings over punishment. Hughes et al. 3 addressed academic misconduct in U.S. dental schools as a threat to education and the profession, prompted by some scandals, and urged educators to develop strategies to reduce cheating. Therefore, it appears that teaching students to avoid RM is crucial for promoting academic integrity and ensuring the production of acceptable academic work. 11 However, studies identifying the knowledge of RM (KoRM) levels among dental students are limited and present discrepancies. 4 , 9 , 10 , 22 – 28 For instance, while a Brazilian study reported that 100% of students enrolled in a dentistry course at a university acknowledged that RM constitutes a crime, 24 an Australian study reported that 44% of post-graduated dental students (PGDSs) did not consider it to be a problem. 23 These disparities can be attributed to methodological differences in the questionnaires used to assess RM understanding and/or knowledge, and variations in student populations. 22 – 28 Although there are studies evaluating RM understanding and/or knowledge among North-African dental academics, 6 , 7 to the best of the authors’ knowledge, no research has been conducted in this area among North-African dental students.

Consequently, assessing the KoRM among students, especially those in dental education, holds significant importance. However, as of April 8, 2026, only one Chines study was found by searching PubMed with the following query: “(“Research Misconduct”[Mesh]) AND “Students, Dental”[Mesh]”. 44 According to the authors, of the 1514 dental undergraduates, almost 70% learn about scientific integrity through coursework and political and ideological instruction, while the remaining students learn about scientific integrity through other sources like books and conferences, and 80–90% of students are against scientific misconduct. 44 Given that KoRM is recognized as the first step in preventing RMs, and considering the aforementioned points, the primary objective of this study was to evaluate the KoRM level among a specific sample of North-African PGDSs.

 Methods

This study is a component of a broader research project titled “Plagiarism and research misconduct 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). 6 The findings of the aforementioned study revealed a lack of awareness regarding plagiarism among North-African UHDs, with 74% demonstrating a low-level of plagiarism understanding. 6 Building upon these results, the present study aimed to investigate KoRM 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. 6 Moreover, the same instrument ( i.e. ; an online quiz accessible on the Laval University website 45 ) was used in both studies.

Study design

The study was conducted following the guidelines established by the STROBE statement. 46 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 47 : 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. ; low-level of KoRM), « 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, 28 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. 28 The number of students to be included after correction is given by the formula n’ = (N × 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 × 376)/(147 + 376)].

 Applied questionnaire

The study employed a questionnaire written in French (See extended data Appendix A 48 for the French version and Appendix B 49 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 is accessible on the Laval University website. 45 The questionnaire is called the “Laval University quiz” because it was developed and hosted by Laval University (Faculty of Business Administration) as part of their educational resources on RM and academic integrity. 45 The name reflects its institutional origin rather than implying a formal, externally validated research instrument. 45 Therefore, the “Laval University quiz” essentially means it is a quiz from Laval University rather than a generic or externally validated questionnaire. The quiz comprised 11 questions related to KoRM. 45 Each question provided three answer choices ( i.e. ; yes, no, may be), with one point awarded for each correct answer. 45 A total score was calculated for each participant and based on this score, three KoRM’ 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 RM may be beneficial.

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

An additional question regarding KoRM self-assessment by the PGDSs was added at the beginning of the questionnaire 6 : how do you evaluate your KoRM? Is it “low”, “acceptable” or “excellent”? Two subjective KoRM’ levels were retained: “excellent or acceptable” and “low”. 6

The 11 questions explore the following four forms of RM: 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 RM were calculated. The percentages of participants who responded correctly to each question ( i.e. ; 11 questions) and to all questions of each form of RM were calculated.

Why we have chosen the Laval University quiz 39 ?

While various tools have been established and recommended to assess RM, particularly in terms of, attitudes, acceptance, and practice, 25 , 32 , 33 , 44 , 45 , 50 – 53 evaluating KoRM is also important, especially among PGDSs. Assessing KoRM helps promote academic integrity, ensures ethical research practices, cultivates critical thinking skills, and enhances the quality and originality of scholarly work. Although numerous validated instruments exist to assess RM, tools specifically measuring KoRM—particularly in French—are scarce. Our study appears to be the first to apply a virtual quiz to assess students’ KoRM. 45 We opted for the Laval University quiz 45 to evaluate KoRM among Tunisian PGDSs for several reasons. First, the quiz was previously successfully used in a comparable Tunisian UHDs population. 6 It demonstrated face and content validity via expert review of its 11 items covering core RM domains. Second, all available surveys used to assess understanding; attitudes, practices, and knowledge related to RM were in English and lacked a certified French version. 25 , 32 , 33 , 44 , 50 – 53 Since French is the second language in Tunisia, and since medical teaching is in French, the French Laval University quiz appeared to be more suitable for Tunisian PGDSs without the need for translation/back-translation or validation. Third, the Laval quiz 45 is not time-consuming, requiring thoughtful responses, with an average of 15 minutes needed to answer the 11 questions. Therefore, this brevity is suitable for busy PGDSs. While acknowledging that the quiz lacks formal psychometric validation (e.g., Cronbach’s alpha, test-retest reliability, confirmatory factor analysis), its educational design effectively identified knowledge gaps for our descriptive study.

 Statistical analysis

The distribution of variables was analyzed using the Kolmogorov-Smirnov test. 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. It assesses whether the observed data follow the specified distribution or not. 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 or Fisher’s exact test were used to compare the percentages of PGDSs based on subjective (self-assessment) and objective (survey) assessments of KoRM. 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].

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

Knowledge of research misconduct (KoRM) amid post-graduate dental students (n=106).
Level of knowledge Evaluation P-value
Subjective: Self-assessment Objective: Using the questionnaire
Low-level 66 (62.26) 91 (85.85) 0.0001 *
Acceptable-level 39 (36.79) 13 (12.26) 0.0001 *
Excellent-level 1 (0.94) 2 (1.87) 0.5651

Date were number (%).

P-value (2-sided Chi-2 test) < 0.05: subjective vs. objective evaluation of KoRM ( i.e. ; Low vs. Low; and Acceptable vs. Acceptable).

P-value (Fisher’s exact test) < 0.05: subjective vs. objective evaluation of KoRM ( i.e. ; Excellent vs. Excellent).

Table 3 displays the results for the 11 questions and for the four forms of RM ( 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 the 11 questions of the Laval University quiz, and for the four forms of research misconduct amid post-graduate dental students (n=106).
Question N° Percentage of students having correct answer to each question
1 49.1
2 36.8
3 55.7
4 36.8
5 32.1
6 27.4
7 36.8
8 61.3
9 28.3
10 61.3
11 17.9
Research misconduct forms Percentage of students having correct answer to all questions of the research misconduct forms
Verbatim plagiarism (questions 1 to 3) 0.0
Paraphrasing (question 4) 36.8
Publication ethics (questions 5 to 8) 0.0
Cheating in classrooms (questions 9 to 11) 0.9
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 KoRM. 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 KoRM issue among North-African PGDSs.

The literature on dentistry education has addressed several forms of RM including plagiarism, paraphrasing, publishing ethics, and classroom cheating, which are separate but connected facets of academic integrity. 2 – 4 However, there is a scarcity of studies assessing KoRM among dental students. 2 – 4 , 22 – 28 , 54 To the finest of the authors’ awareness, this report is the first North-African study to examine the issue of KoRM among PGDSs.

KoRM’ level

The KoRM mean score was low at 4.4±1.8, with 85.85% of PGDSs showing a low-level of KoRM. Of concern was the finding that a significant percentage of PGDSs underestimated their KoRM level ( Table 2). On one hand, the observed aforementioned low KoRM score was intermediate compared to studies conducted among postgraduate and undergraduate dental students, and evaluating KoRM. 25 , 26 , 44 , 46 On the other hand, our alarming results closely resemble those reported in a previous study conducted among Tunisian UHDs. 6 Using the same French survey, 45 Khemiss et al. 6 reported that UHDs had a low score of KoRM (mean±SD: 5.4±1.9), with 74% of them demonstrating low-level of KoRM. Our findings suggest that Tunisian PGDSs have not received adequate guidance regarding RM, a growing issue with the widespread availability of Internet resources and AI. 55 This low-level of KoRM may be a primary reason for the prevalence of RM in North-African states, such as Tunisia. 6 The findings also confirm a lack of KoRM among both academics and students in Tunisian universities.

The high percentage of PGDSs displaying a low-level of KoRM ( i.e. ; 85.85%) was also intermediate compared to percentages of several RM forms and scientific integrity reported in the literature. On one hand, our percentage aligned with findings from some studies. 22 , 24 , 25 , 27 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. 22 In a Brazilian study involving 186 dental students, 69% and 48% of students reported a lack of understanding of direct quotes and paraphrasing, and ignorance about the different types of plagiarism. 24 An Indian study of 248 dental master’s degree students revealed that 51% of students did not recognize plagiarism as a punishable offense. 25 Similarly, an Iranian study involving 102 dental students, found that 56%, 53%, 48%, and 45% of students believed 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. 27 On the other hand, the percentage in our study differed from that in some reported studies analyzing different KoRM. 23 – 25 For instance, 56% of nine Australian postgraduate students considered plagiarism a problem. 23 In addition, 88%, and 84% of Indian dental master’s degree students were familiar with the term “plagiarism”, and recognized it as an act of academic RM. 25 Some authors also reported that 100% of Brazilian students enrolled in a dentistry course were aware that plagiarism constitutes a crime. 24

A significant percentage of PGDSs underestimated their low-level of KoRM. While 62.26% of PGDSs considered their KoRM 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 comparable to that reported for Tunisian UHDs, where 44.8% of them perceived their KoRM level as low, but objective evaluation raised this percentage to 74.0%. 6 Our finding was partially aligned with another study comprising doctoral candidates at the Faculty of Medicine and comparing attitudes towards RM and self-reported behavior ( e.g. ; plagiarized publication). 56 This discrepancy between subjective and objective evaluations can be explained by the Kruger-Dunning effect, 57 a cognitive bias in which individuals with low ability or knowledge in a particular domain tend to overestimate their competence in that domain. 58 The overestimation of KoRM 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. 57 – 60

Research findings must be shared ethically—that is, in accordance with accepted norms of integrity, originality, and justice in dental journals—in order to promote human well-being. 2 Table 3 revealed that the percentages of students having correct answers to questions related to the four form of RM were low at 0.0% for verbatim plagiarism and publication ethics, 0.1% for cheating in classrooms, and 36.8% for paraphrasing. The percentages of medical and dental students with low-levels of KoRM vary depending on the specific study and population sampled. 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. 61 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. 62 In dental publishing, one paper highlighted specific unethical practices ( e.g. ; duplicate publication, inappropriate or “gift” authorship, and misleading statistical presentation), and concluded that while journal policies and institutional rules are important, ethical publication ultimately depends on the individual dental investigator’s commitment to truth and patient welfare. 2 Third, in a survey of dental students, 29% displayed a limited understanding of what constitutes cheating. 63 A cross-sectional questionnaire study including 200 undergraduate dental students and assessing their attitudes toward 13 cheating behaviors and satisfaction with studying dentistry, reported that about 85% considered 9 of the 13 behaviors serious; and that a substantial proportion had engaged in or witnessed cheating, indicating that cheating is a recognized and prevalent concern in dental education. 4 A descriptive cross-sectional study compared attitudes of dental students and teachers toward specific cheating behaviors, reasons for cheating, and preferred sanctions. 10 It appears that students most commonly justified cheating as a way to pass exams (59.3%) or obtain better grades (31.3%), while teachers preferred warning and counseling rather than purely penal measures, showing a gap between student motivations and educator responses but also an emphasis on moral development. 10 A position paper has reviewed reported “scandals” of student RM in U.S. dental schools and framed RM (including cheating on examinations and assignments) as a serious threat to the profession. 3 The authors called for comprehensive strategies in dental schools, including policy development, consistent enforcement, and curricular initiatives, to reduce cheating and strengthen a culture of integrity. 3 Some studies demonstrated that cheating in dental classrooms is frequent, multifactorial, and perceived differently by students and staff, and they underpin much of the current discussion on academic integrity in dental education. 3 , 4 , 10 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. 64 Two previous studies on the academic integrity of dental students specifically identify plagiarism and incorrect paraphrasing as types of RM, and they advise training good paraphrasing strategies to lessen plagiarism in written work. 3 , 8 According to these studies, professional ethics and research methods courses should incorporate teaching on ethical paraphrasing. 3 , 8 Dental schools are also progressively incorporating content on RM and writing abilities into their ethics curricula. 3 , 8 The standards and guidelines governing the responsible reporting of research, such as integrity, originality, accurate authorship, avoidance of plagiarism and duplicate publication, appropriate data reporting, and adherence to journal and international guidelines, are referred to as publication ethics. 2

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

Four factors may contribute to the observed low-level of KoRM amid Tunisian PGDSs. First, there appears to be a perception of permissiveness towards RM within dental medical faculties, with institution leaders exhibiting tolerance towards RM, despite Tunisia implementing initiatives to combat this issue. 65 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. 6 The absence of comprehensive policies may explain the low-level of KoRM among PGDSs. Eighteen years after the decree’s publication, 65 it is crucial to evaluate whether policies against RM in the medical field are being effectively implemented in Tunisia. Second, a significant reason for the prevalence of RM is the inadequate emphasis by institutions on addressing this problem. 66 The absence of mandatory training modules on research and medical writing within medical curricula may account for the observed low-level of KoRM. 67 Students are required to change from being knowledge consumers to knowledge creators at the crucial point of transitioning from undergraduate to graduate school. 68 This change necessitates the concurrent growth of writing and ethical research skills. 68 The observed low-level KoRM shows a large gap in this transition, indicating that the current educational framework may not effectively equip PGDSs with the required abilities for ethical scholarship. 68 Instead of thinking that research integrity will be learned implicitly, educational theories suggest that explicit, integrated training is essential for this developmental leap. 68 Writing a thesis, article, or dissertation is a complex task for medical students, requiring training and practice similar to any other academic skill. 29 , 69 , 70 PGDSs require support from qualified supervisors to improve the quality of their academic and scientific work. 69 , 70 Qualified supervisors play a vital role in ensuring the integrity of manuscripts produced by their students, as responsibility for suspected RM is shared between senior researchers and young scientists. 71 Our results in term of low-level of KoRM are expected since some previous Tunisian studies including UHDs from different specialties including dentistry, reported a low-level of awareness regarding RM. 6 , 7 These results reinforce the notion that academics who themselves lack knowledge 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 KoRM may be attributed to the lack of RM detection software tools in medical faculties. 72 The implementation of RM, such as plagiarism, detection tools has the potential to reduce its prevalence within institutions. 6 , 73 , 74 However, it is important to consider different perspectives on the effectiveness of these tools. While Stappenbelt and Rowles. 75 identified that allowing students to check their own work can be beneficial and improve their skills, Youmans 76 reported that the availability of such software for students does not necessarily reduce RM in their own work. Additionally, Rodafinos 77 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 RM 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 RM and provide training to prevent their occurrence. Ford and Hughes 23 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. 23 However, it is important to note that existing RM 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. 6 , 71 , 78 , 79

Study limitations

This study has some limitations that need to be addressed. First, our quiz is widely used within the Laval University as an educational tool to raise awareness about RM among students. 45 However, there is no publicly available documentation indicating that it has undergone formal validation processes, such as reliability testing or item analysis, typically associated with psychometric evaluations. 80 This potentially affects score reliability and construct validity. Although it demonstrates adequate face/content validity and consistency with prior literature on student RM knowledge gaps, future studies should employ fully validated instruments or develop culturally adapted, psychometrically robust KoRM measures for PGDSs. In addition, the cut-off thresholds used to classify quiz scores as ‘low,’ ‘acceptable,’ or ‘excellent’ were not formally justified by the quiz developers. This lack of explanation may limit the interpretability and comparability of the results. 80 Second, as with any questionnaire-based study, the questionnaire utilization 45 introduces subjectivity into the responses, and there is a possibility that some questions may have been answered randomly. 6 This introduces the potential for measurement bias, which should be considered when interpreting the results. Third, 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, 45 the questions can be considered “far away” from the realities of KoRM. Fourth, 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. 81 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. 28 Consequently, it is important to note that our findings solely pertain to the included PGDSs. 82 Caution must be exercised when interpreting the results as this sample may not be representative of all PGDSs in North Africa, though the 72.1% response rate strengthens representativeness. Fifth, it would have been beneficial to include an additional validated questionnaire, such as the “Attitude toward Plagiarism” questionnaire, 52 as utilized in a previous study. 28 This would have enhanced the scientific rigor of our research by providing a more comprehensive assessment of students’ attitudes towards RM. By incorporating established measurement tools, we could have gained valuable insights and comparisons that would contribute to the validity and generalizability of our findings. Sixth, 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. 83 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. 83 Seventh, the cross-sectional design precludes causality assessment. Finally, it was better to complete the study by an interventional program in order to objectively measure the effectiveness of the intervention. 84 This method is particularly useful in situations where students start with a low-level of KoRM, as it allows for a clear demonstration of progress and the effectiveness of educational strategies aimed at improving awareness and KoRM. 84 Assessing students’ KoRM before the program (pre-test) and after its completion (post-test), allow determining the extent of learning and the impact of the intervention on students’ KoRM. Despite these constraints, our findings reliably document substantial KoRM deficits warranting educational intervention.

Recommendations for future studies

Misunderstanding RM is a common occurrence, and the lack of clarity surrounding the concept makes KoRM essential to prevent it. However, it should be noted that KoRM alone is not sufficient. As highlighted by Iloh et al. 40 despite the awareness of RM among Nigerian students, instances of violations were still detected. Therefore, it is crucial to focus on enhancing researchers’ knowledge and attitudes towards RM, particularly among junior researchers. According to Poorolajal et al. 85 there is a significant association between the prevalence of RM and an increase in scores of knowledge and attitude towards RM, 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 RM. Achieving the following three goals, as proposed by Muthanna, 86 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 RM. 29 , 86 Interactive seminars have shown effectiveness in addressing this issue, as suggested by Marshal et al. 87 Dedicated modules on medical research ethics and writing, and learning outcomes for educational courses on RM should be integrated into undergraduate medical curricula in North-Africa to proactively prevent RM. 6 A more sustainable strategy goes beyond one-time training and incorporates research integrity education into the curriculum over time. 88 This could involve formative, non-punitive exercises utilizing plagiarism detection software in conjunction with microlearning modules on certain subjects like citation and paraphrase. 88 Research suggests that these curriculum-based, integrated interventions work better than stand-alone lectures in creating a long-lasting culture of integrity. 89 Students' perceptions and understandings of academic honesty can be changed by enabling them to use resources like Turnitin as a learning tool for their drafts rather than just as a way to check final submissions. 89 Combatting RM is a shared responsibility, and each medical school should establish its own institutional policies to effectively address this growing phenomenon. 86

For future similar studies, some precautions are needed. First, the use of questionnaire, such as the French quiz, 45 derived from a Western academic culture within a sample representing an Eastern culture needs to be considered when interpreting the results. For example, despite the Tunisian PGDSs’ fluency in the French language, their understanding of quizzes derived from Western academic culture may differ. 90 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. 90 This variation could partially explain the low-level of KoRM among Tunisian PGDSs. Research has shown that educational practices related to honesty and quality in teaching and learning differ across cultures. 90 , 91 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. 90 Second, future studies should consider collecting data regarding the number of publications and/or communications in medical congresses among the students. 6 Including this information will provide a more comprehensive understanding of the students’ characteristics, will allow for a more nuanced analysis by categorizing them based on their publication and communication activity, and will enhance the interpretation of findings and provide a more detailed characterization of the participants. 6 Third, in countries where English is the not the first language, it is recommended 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. 92 Some authors reported statistically significant differences in the English language abilities of students who have previously committed RM offences, compared to students who have not. 92

Conclusion

The KoRM’ 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 RM. Our study serves as an urgent call to raise awareness among North-African officials in dental faculties regarding the prevalence of RM in the medical dental field. It is imperative that institutions make dedicated efforts to investigate instances of RM, 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. 93

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]. 93

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. 48

Zenodo: Questionnaire (English version). Knowledge of research misconduct amid Tunisian post-graduate dental students. DOI: https://zenodo.org/records/10992137. 49

The project contains the following extended data:

[ Appendix A: Copy of the French questionnaire] (Applied questionnaire). 48

[ Appendix B: Copy of the translated English questionnaire]. 49

Reporting guidelines

Zenodo: STROBE checklist for “Knowledge of research misconduct amid North-African post-graduate dental students: A cross sectional study”. Doi: https://zenodo.org/records/10692067. 94

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

 Acknowledgments

The authors disclose that two artificial intelligence tools—ChatGPT (ephemeral version) and QuillBot—were utilized to improve the clarity and coherence of the manuscript. These tools were used exclusively for language refinement, without modifying the scientific content or generating original material. 95 Authors wish to express their sincere gratitude to all students for their cooperation. Authors also wish to express their sincere gratitude to the reviewers for their excellent feedback, which has substantially improved the quality of this work. Their insightful comments and constructive suggestions were invaluable in refining our manuscript. 96

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Epub 2016/08/04. eng. 27652208 10.5492/wjccm.v5.i3.171 PMC4986546 Mahapatra I Nagarajappa R Satyarup D : Considerations in questionnaire development: A review. Indian. J. Med. Forensic. Med. Toxicol. 2020;14(4):8612–7. Ganguli M Lytle ME Reynolds MD : Random versus volunteer selection for a community-based study. J. Gerontol. A Biol. Sci. Med. Sci. 1998 ;53(1):M39–46. 9467432 10.1093/gerona/53A.1.M39 Lucas SR : An inconvenient dataset: bias and inappropriate inference with the multilevel model. Qual. Quant. 2014;48(3):1619–49. 24683276 10.1007/s11135-013-9865-x PMC3965847 Field A : Discovering statistics using IBM SPSS. Statistics: SAGE Publications;2017. Kirkpatrick DL : The four levels of evaluation.In: Brown SM Seidner CJ , editors. Evaluating corporate training: Models and issues. Dordrecht: Springer Netherlands;1998; pp.95–112. Poorolajal J Cheraghi P Irani AD : Construction of knowledge, attitude and practice questionnaire for assessing plagiarism. Iran. J. 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A case study investigating the cultural context of plagiarism. J. Pract. Teach. Learn. 2005;2(3):74–95. PMID: WOS:000213530300008. English. 10.53761/1.2.3.8 McInnis C : Researching the first year experience: Where to from here? Routledge;20102001/07/01; vol.20: pp.105–14. 10.1080/07294360120064376 Perkins M Gezgin UB Roe J : Understanding the relationship between language ability and plagiarism in non-native English speaking business students. J. Acad. Ethics. 2018;16(4):317–28. 2018/12/01. 10.1007/s10805-018-9311-8 Ben Saad H : Excel data of the 106 Tunisian post-graduate dental students. Zenodo. 2024. (Last visit: January 6, 2026). 10.5281/zenodo.13212820 Ben Saad H : STROBE checklist for “Knowledge of research misconduct amid North-African post-graduate dental students: A cross sectional study”. Zenodo. 2024. (Last visit: April 8, 2026). Reference Source Dergaa I Ben SH : Artificial intelligence and promoting open access in academic publishing. Tunis. Med. 2023;101(6):533–6. Epub 2023/06/05. 38372545 Hidouri S Kamoun H Salah S : Key guidelines for responding to reviewers. F1000Res. 2024;13:921. Epub 20240920. 39246824 10.12688/f1000research.154614.3 PMC11377928 10.5256/f1000research.198637.r476412 Reviewer response for version 6 Bik Elisabeth M. 1 Referee https://orcid.org/0000-0001-5477-0324 Harbers Bik LLC, Sunnyvale, CA, USA

Competing interests: I am an independent consultant who has received payments from scientific publishers and research institutions to investigate particular cases of research misconduct. I have also received payments from publishers, professional societies, and research institutions to give talks and workshops about research integrity and misconduct. In addition, I receive donations to support my work through Patreon.com. I receive free access to ImageTwin and Proofig, two software tools that can find duplications within images, between figures, and between papers, and to iThenticate, a plagiarism detection tool. Because of a sponsored affiliate membership with Stanford's METRICS Institute, I have access to the Stanford University Library. I am an author on four patent applications in the field of microbiome analysis.

 14 5 2026 Copyright: © 2026 Bik EM 2026 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 thank the authors for revising the manuscript with some of the reviewers' comments. Unfortunately, it appears that the authors did not reply to my review of version 1. We are now at version 6, and none of my main concerns have been addressed.

1. The manuscript still confuses academic and research misconduct. 

The manuscript still frames the study as an assessment of the knowledge of “research misconduct” (KoRM). However, the questionnaire used (the Laval University plagiarism quiz) primarily evaluates understanding of academic integrity and classroom-related plagiarism scenarios rather than research misconduct. The questions focus largely on academic misconduct, such as citation practices, paraphrasing, teamwork, homework collaboration, and plagiarism in student assignments, with examples involving course work, teachers, and grading. In contrast, research misconduct generally refers to fabrication, falsification, and plagiarism in the conduct, reporting, or publication of research. As a specific example, writing an essay about the Olympic Games is very different from studying the formation of dental biofilms, conducting clinical research on oral disease, or analyzing patient-derived data in a laboratory setting. The quiz used, therefore, does not adequately assess knowledge of research misconduct, and the title, aims, and conclusions of the manuscript should be revised accordingly to reflect that the study evaluates knowledge of academic plagiarism/integrity rather than research misconduct. 

2. The Laval University quiz is ambiguous. 

As mentioned in my review of version 1, the Laval University quiz used to test the students' knowledge is not very clear. Several items in the questionnaire appear insufficiently precise and may not have a single unambiguous correct answer. Some questions assess familiarity with local editorial or classroom practices rather than misconduct concepts, making interpretation of the resulting scores difficult. Consequently, the validity of using this instrument as a measure of “knowledge of research misconduct” is questionable. I am a research integrity specialist and I would not score very high on this quiz. This quiz is not a good tool to use.

3. None of my specific comments, including pointing out a typo, have been addressed. Did anyone even read my review?

4. I did not raise this in my initial review on version 1, but it was raised by another reviewer. I see that the Ethics Committee found the research to be exempt, but there are still concerns about potential coercion - were any of the authors also teachers of these students? Could students be assuming they might get a lower grade if they declined to participate? These are questions that should be carefully addressed.

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

No

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?

No

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

Yes

Reviewer Expertise:

Research Misconduct, Plagiarism, Image Forensics, Microbiology, Molecular Biology, Scientific Publishing

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

 10.5256/f1000research.198637.r476414 Reviewer response for version 6 Satyarup Dharmashree 1 Referee https://orcid.org/0000-0002-4969-5830 Department of Public Health Dentistry, Institute of Dental Sciences, Siksha ‘O’ Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India

Competing interests: No competing interests were disclosed.

 13 5 2026 Copyright: © 2026 Satyarup D 2026 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

The authors are commended for the clarifications provided regarding the questionnaire. However, the recruitment process appears potentially coercive and raises several ethical concerns that require further clarification and justification:

Ethical clearance was reportedly waived; however, the rationale and approving authority for this waiver have not been adequately detailed.

There is no clear mention of obtaining informed consent from participants prior to survey administration.

The statement that “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” raises concerns regarding voluntariness and the possibility of response bias. Recruitment conducted directly by investigators known to the participants may inadvertently influence participation decisions due to existing hierarchical or personal relationships.

 While convenience sampling may be ethically permissible, such author-linked recruitment approaches require explicit safeguards to ensure voluntary participation and absence of coercion. Further clarification on these ethical safeguards is warranted.

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?

Yes

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?

Yes

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

Partly

Reviewer Expertise:

Oral health promotion, cross-sectional questionnaire-based studies, dental education

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

 10.5256/f1000research.194764.r453798 Reviewer response for version 5 Bik Elisabeth M. 1 Referee https://orcid.org/0000-0001-5477-0324 Harbers Bik LLC, Sunnyvale, CA, USA

Competing interests: I am an independent consultant who has received payments from scientific publishers and research institutions to investigate particular cases of research misconduct. I have also received payments from publishers, professional societies, and research institutions to give talks and workshops about research integrity and misconduct. In addition, I receive donations to support my work through Patreon.com. I receive free access to ImageTwin and Proofig, two software tools that can find duplications within images, between figures, and between papers, and to iThenticate, a plagiarism detection tool. Because of a sponsored affiliate membership with Stanford's METRICS Institute, I have access to the Stanford University Library. I am an author on four patent applications in the field of microbiome analysis.

 25 2 2026 Copyright: © 2026 Bik EM 2026 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

This study addresses an important topic: knowledge of research misconduct among dental postgraduate students in North Africa. The topic is timely, and the authors have clearly invested effort in data collection and revisions across multiple versions.

Despite the topic's relevance and several revisions, the manuscript still suffers from conceptual, methodological, and interpretive weaknesses that substantially limit the strength and generalizability of its conclusions. Many of these problems are already visible in the opening sections, and they persist throughout the manuscript. Most importantly, the questionnaire used tests plagiarism in classroom assignments, instead of testing knowledge of research misconduct. Therefore the method used is a mismatch with the title and topic of the study. 

General comments

The Introduction begins with incorrect or imprecise definitions of research misconduct (RM). Paraphrasing, classroom cheating, and “publishing ethics” are not forms of research misconduct. Classroom cheating is academic misconduct, publication ethics refers to standards that guide proper conduct rather than misconduct, and paraphrasing is acceptable when appropriately cited. Most national and international frameworks define research misconduct primarily as plagiarism, fabrication, and falsification, although additional practices (e.g., gift authorship, peer review manipulation, paper mills) may also be considered misconduct. The opening section and related passages should therefore be revised to provide accurate definitions and consistent terminology.

The Introduction appears to focus heavily on plagiarism, despite the study claiming to examine knowledge of research misconduct (KoRM) more broadly. The literature search described by the authors focuses largely on plagiarism rather than research misconduct as a whole, and many cited papers concern academic misconduct, plagiarism, or attitudes and behaviors rather than KoRM. The literature review would benefit from narrowing its focus to KoRM specifically, reducing the number of citations, and clearly articulating the research gap—namely, the lack of data on KoRM among Tunisian or North-African postgraduate dental students.

Methods: A formal sample size calculation is presented, even though the entire eligible population consisted of only 147 students, and all were invited to participate. The practical relevance of this calculation is unclear and should be simplified or better justified.

More importantly, the questionnaire given to the dental students in this study does not actually measure KoRM. All questions are about plagiarism or cheating in coursework assignments, not about misconduct in research. Core domains of research misconduct, such as fabrication, falsification, authorship abuse, data manipulation, image manipulation, or peer review misconduct, are not assessed. As a result, conclusions about knowledge of research misconduct in this study population are not well supported by the survey used.

In addition, the questionnaire scenario involving Olympic Games marketing has little relevance to dental postgraduate training or biomedical research practice. It would have been preferable to use or develop scenarios relevant to the respondents’ academic and research context. The instrument also functions more as a knowledge test than as a survey, despite being described as a questionnaire.

It is not always clear what the correct answers to these questions would be. The correct answers to some of these questions would depend on institutional rules or conventions (e.g., collaboration on homework, responsibility in group work). Even experienced researchers could reasonably disagree about correct answers without knowing institutional policies, which raises concerns about measurement reliability.

The results are over-interpreted and over-generalized. The data comes from a single institution and a narrow population (dental students) answering vague scenarios focused on plagiarism in coursework rather than research practice. These findings therefore cannot support conclusions about knowledge of research misconduct among North-African dental students more broadly. Differences in curricula or research ethics training across institutions are also not examined. Statements extending conclusions to the wider region or to research misconduct in general can not be made.

Despite all fancy statistics mentioned in the Methods, and the detailed demographics in Table 1, the results analysis remains limited to reporting percentages of correct answers. No analyses explore associations between knowledge scores and variables such as training year or experience level, which could provide more informative insights.

The very low rates of correct answers in some domains, including categories with 0% correct responses, may reflect limitations or ambiguities in the questionnaire rather than true lack of knowledge. This possibility should be considered more critically, especially given that the instrument largely tests plagiarism scenarios in coursework contexts. Even experienced researchers might perform poorly on such items.

The Discussion is overly long and repetitive: Large portions reiterate literature comparisons or general statements about misconduct without advancing the interpretation of the study’s findings. Streamlining would improve focus and readability.

Overall, the Conclusion that "The KoRM’ level among Tunisian PGDSs is alarmingly low" seems unsupported, given that the questionnaire primarily measures plagiarism knowledge in academic assignments rather than research misconduct knowledge itself. 

Specific comments

Introduction: What is "Sustainable Development Goal number 4" - this is not general knowledge and should be clarified. 

Introduction, typo: "Chines study"

Introduction: "However, as of January 2, 2026, only one Chines study was found by searching PubMed with the following query:“(“Research Misconduct”[Mesh]) AND“Students, Dental”[Mesh]”. If I use the search term: "(Research Misconduct)[Mesh] AND (Students, Dental)[Mesh]", I get 18 results (February 2026). How did the authors only get 1 study?

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

No

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?

No

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

Yes

Reviewer Expertise:

Research Misconduct, Plagiarism, Image Forensics, Microbiology, Molecular Biology, Scientific Publishing

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

 10.5256/f1000research.194764.r449888 Reviewer response for version 5 Okonta Patrick 1 Referee https://orcid.org/0000-0001-6209-7336 Obstetrics and Gynaecology, Delta State University, Abraka, Delta, P.O.Box 1031, Nigeria

Competing interests: No competing interests were disclosed.

 6 2 2026 Copyright: © 2026 Okonta P 2026 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

Thank you for your revised manuscript.

I am satisfied with the revisions made in response to my review comments

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?

Yes

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?

Yes

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:

Research Ethics/ Bioethics/Maternal health/Public Health

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

 10.5256/f1000research.194764.r449885 Reviewer response for version 5 Satyarup Dharmashree 1 Referee https://orcid.org/0000-0002-4969-5830 Department of Public Health Dentistry, Institute of Dental Sciences, Siksha ‘O’ Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India

Competing interests: No competing interests were disclosed.

 30 1 2026 Copyright: © 2026 Satyarup D 2026 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

Thank you for the clarification regarding the origin and intended purpose of the instrument. While the explanation helps contextualize the questionnaire as an educational resource developed and hosted by Université Laval, the concerns raised regarding its scientific robustness remain largely unresolved. Although the questionnaire may be appropriate as a pedagogical tool to raise awareness of plagiarism and academic integrity among students, this educational function does not substitute for methodological rigor required in empirical research. Without validation, it is unclear whether the instrument consistently and accurately measures the constructs it purports to assess, though authors have acknowledged this under limitations.

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?

Yes

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?

Yes

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

Partly

Reviewer Expertise:

Oral health promotion, cross-sectional questionnaire-based studies, dental education

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

BEN SAAD Helmi Université de Sousse, Tunisia

Competing interests: no competing interests

 8 4 2026

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 our responses to your questions and suggestions: Sincerely yours.

COMMENT N° 1. Thank you for the clarification regarding the origin and intended purpose of the instrument.

While the explanation helps contextualize the questionnaire as an educational resource developed and hosted by Université Laval, the concerns raised regarding its scientific robustness remain largely unresolved. Although the questionnaire may be appropriate as a pedagogical tool to raise awareness of plagiarism and academic integrity among students, this educational function does not substitute for methodological rigor required in empirical research. Without validation, it is unclear whether the instrument consistently and accurately measures the constructs it purports to assess, though authors have acknowledged this under limitations.

RESPONSE.

We sincerely thank the reviewer for this thoughtful feedback, which underscores the importance of instrument validation in empirical research. We fully acknowledge that the Laval University quiz functions primarily as an educational resource rather than a formally validated psychometric tool, and we have strengthened this acknowledgment in the revised manuscript (see Methods - Applied questionnaire section and Limitations in Discussion). Specifically, we have:

1. Added explicit language clarifying that while the quiz demonstrated face/content validity through expert review and prior use in a comparable population [previous UHD study], it lacks formal psychometric validation (reliability coefficients, factor analysis).

2. Emphasized its selection rationale: French-language availability (critical for Tunisian PGDSs), brevity (15 minutes), prior local use, and focus on practical KoRM assessment despite validation limitations.

3. Expanded the Limitations section to discuss potential impacts on score reliability/validity and generalizability, while noting the study's descriptive aims align with the instrument's educational strengths.

These revisions enhance transparency without altering our key findings. We believe this cross-sectional assessment provides valuable preliminary data on KoRM gaps among North-African PGDSs, supporting calls for targeted interventions. Revised text is highlighted inside the paper.

 10.5256/f1000research.190463.r429394 Reviewer response for version 4 Okonta Patrick 1 Referee https://orcid.org/0000-0001-6209-7336 Obstetrics and Gynaecology, Delta State University, Abraka, Delta, P.O.Box 1031, Nigeria

Competing interests: No competing interests were disclosed.

 30 12 2025 Copyright: © 2025 Okonta P 2025 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

Thank you very much for asking me to review this 4th version of this manuscript. The revisions done has greatly improved the quality of the manuscript when compared to the first version.

However, I wish to make the following few comments.

1. TITLE: The misconduct in the title should be qualified to make it more specific. Adding the word 'research' before misconduct would make the title more informative and appropriate to the contents of the study.

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

2. There is a misalignment between the title and scope of the study on one hand and the introduction on the other hand. The introduction focused specifically on plagiarism to the exclusion of other forms of misconduct reported in this study. Just reading the introduction readers would imagine that this study focused exclusively only on plagiarism. I suggest the authors revise the introduction to include other forms of research misconducts especially the other three domains also investigated in this study.

3. There are 2 headings - Discussion and Discussion of Results. I wonder why the authors decided to make these two headings. The heading 'Discussion' in a research paper automatically assumes the discussion of the results of the study 

4. I would suggest that the authors reduce or limit the comparisons with other studies. While it is allowed to situate the results of one's study in the context of other previous studies by comparing results, it is important to compare with similar studies. As already admitted by the authors in stating their limitations in this study, it is important to highlight the flaws of comparison since the population. instruments used and definition and scope of misconduct vary highly between studies. Therefore I would suggest that the authors focus more on discussing and explaining their findings rather that making long narratives of describing other peoples study.

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?

Yes

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?

Yes

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:

Research Ethics/ Bioethics/Maternal health/Public Health

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

BEN SAAD Helmi Université de Sousse, Tunisia

Competing interests: None.

 2 1 2026

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 our responses to your questions and suggestions: Sincerely yours.

COMMENT N° 1.

Thank you very much for asking me to review this 4th version of this manuscript. The revisions done has greatly improved the quality of the manuscript when compared to the first version. However, I wish to make the following few comments.

RESPONSE.

Thank you very much for your thoughtful review of this fourth version of the manuscript and for your positive feedback on the improvements made since the first version. We greatly appreciate your time and expertise. All your remarks have been carefully considered and addressed in the revised manuscript. We look forward to your further comments if any.

COMMENT N° 2.

TITLE: The misconduct in the title should be qualified to make it more specific. Adding the word 'research' before misconduct would make the title more informative and appropriate to the contents of the study. Knowledge of research misconduct amid North-African post-graduate dental students: A cross sectional study.

RESPONSE.

Thank you very much for your valuable feedback on the title of our manuscript. We have changed the title as you recommended to make it more specific and informative: "Knowledge of research misconduct amid North-African post-graduate dental students: A cross-sectional study." We greatly appreciate your time and expertise in reviewing our work

COMMENT N° 3. There is a misalignment between the title and scope of the study on one hand and the introduction on the other hand. The introduction focused specifically on plagiarism to the exclusion of other forms of misconduct reported in this study. Just reading the introduction readers would imagine that this study focused exclusively only on plagiarism. I suggest the authors revise the introduction to include other forms of research misconducts especially the other three domains also investigated in this study.

RESPONSE.

Thank you very much for your insightful comment regarding the alignment between the title, scope, and introduction of our manuscript. We greatly appreciate your expertise and the time you have invested in this review. We have revised the introduction accordingly to better reflect the full scope of the study, including explicit mentions of the other forms of misconduct investigated: verbatim plagiarism, paraphrasing, publication ethics, and cheating in classrooms. Please see the revised version.

COMMENT N° 4. There are 2 headings - Discussion and Discussion of Results. I wonder why the authors decided to make these two headings. The heading 'Discussion' in a research paper automatically assumes the discussion of the results of the study.

RESPONSE.

We thank the reviewer for this helpful observation. The redundant heading “Discussion of Results” has been deleted, and only the main heading “Discussion” is now retained for clarity and consistency with standard manuscript structure. Please see the revised version.

COMMENT N° 5. I would suggest that the authors reduce or limit the comparisons with other studies. While it is allowed to situate the results of one's study in the context of other previous studies by comparing results, it is important to compare with similar studies. As already admitted by the authors in stating their limitations in this study, it is important to highlight the flaws of comparison since the population. instruments used and definition and scope of misconduct vary highly between studies. Therefore I would suggest that the authors focus more on discussing and explaining their findings rather that making long narratives of describing other peoples study.

RESPONSE.

We thank the reviewer for this valuable and constructive comment. All the points raised have been carefully considered. The discussion has been revised to reduce extensive comparisons with other studies and to emphasize the interpretation and explanation of our own findings, while maintaining concise contextual references to relevant literature. Please see the revised version.

COMMENT N° 5.

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?

Yes

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

Yes

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

Yes

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.

We sincerely thank the reviewer for the positive evaluation and for the six affirmative responses. We appreciate the reviewer’s recognition of the clarity, methodological soundness, and reproducibility of our work, as well as the appropriateness of the analyses and conclusions

 10.5256/f1000research.174309.r418006 Reviewer response for version 3 Satyarup Dharmashree 1 Referee https://orcid.org/0000-0002-4969-5830 Department of Public Health Dentistry, Institute of Dental Sciences, Siksha ‘O’ Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India

Competing interests: No competing interests were disclosed.

 9 10 2025 Copyright: © 2025 Satyarup D 2025 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

The authors deserve commendation for selecting a research area that is rarely investigated and for developing a novel questionnaire aimed at gathering data on research misconduct. This innovative approach contributes valuable insight to an underexplored domain. However, several methodological limitations significantly affect the robustness and interpretability of the study’s findings.

1. Participant selection process: raises ethical and methodological concerns. The recruitment approach appears to verge on coercion, potentially compromising the voluntariness of participation and the authenticity of responses. Furthermore, the sample size estimation lacks sufficient methodological transparency. Critical parameters—including the rationale for choosing an unusually high confidence level (99.9%) and a narrowly defined margin of error (0.065)—are not adequately justified. Importantly, the sampling procedure appears to have been structured after the sample size determination, rather than derived from it, which contradicts standard statistical practice.

2. Instrument-related concerns: Although the questionnaire is comprehensive and explores multiple dimensions of research behavior, it suffers from several shortcomings. The instrument has not undergone validation to ensure reliability or construct validity, and the criteria used to categorize responses as “low,” “acceptable,” or “excellent” are not explicitly defined. Additionally, the rationale for naming it the “Laval University Questionnaire” is not clarified. The novelty of the instrument, while commendable, also contributes to interpretive challenges by the respondents, as acknowledged by the authors themselves under the limitations section.

Overall, while the study demonstrates originality and addresses an important topic, its methodological shortcomings—particularly regarding sampling design, statistical justification, and questionnaire validation—limit the reliability and generalizability of its conclusions.

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?

Yes

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?

Yes

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

Partly

Reviewer Expertise:

Dental education, validity and reliability of questionnaires, oral health promotion

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

BEN SAAD Helmi Université de Sousse, Tunisia

Competing interests: None

 28 10 2025

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 our responses to your questions and suggestions: Sincerely yours.

COMMENT No 1.

The authors deserve commendation for selecting a research area that is rarely investigated and for developing a novel questionnaire aimed at gathering data on research misconduct. This innovative approach contributes valuable insight to an underexplored domain. However, several methodological limitations significantly affect the robustness and interpretability of the study’s findings.

RESPONSE.

We sincerely thank the reviewer for this encouraging comment.

We greatly appreciate the recognition of the novelty of our research topic and the development of a new questionnaire to assess research misconduct. This positive feedback reinforces our commitment to advancing knowledge in this underexplored area.

We have considered all your remarks related to methodological limitations that affect the robustness and interpretability of our findings.

COMMENT No 2.

Instrument-related concerns: Although the questionnaire is comprehensive and explores multiple dimensions of research behavior, it suffers from several shortcomings. The instrument has not undergone validation to ensure reliability or construct validity, and the criteria used to categorize responses as “low,” “acceptable,” or “excellent” are not explicitly defined. Additionally, the rationale for naming it the “Laval University Questionnaire” is not clarified. The novelty of the instrument, while commendable, also contributes to interpretive challenges by the respondents, as acknowledged by the authors themselves under the limitations section.

RESPONSE.

Thank you for your interesting concerns related to the used instrument (an online quiz accessible on the Laval University website: https://applications.fsa.ulaval.ca/plagiat/)

First, the instrument has not been formally validated (in the psychometric sense: reliability, validity, item-analysis, etc). The Laval university has disciplinary regulations and policies regarding plagiarism in place; the quiz is part of that broader context. The quiz is listed on the Faculty of Business Administration website (“Quiz du plagiat” under the policies & regulations section). It is intended as a student-resource to test understanding of plagiarism and academic integrity. Because the quiz appears to serve as an educational tool rather than a high-stakes assessment, formal “validation” may not have been undertaken or publicly reported. However, it may still be a useful tool for awareness and student (and teacher) learning about plagiarism.

Second, the criteria used to categorize responses as “low,” “acceptable,” or “excellent” are reported, but not defined. The publicly available information regarding the online quiz shows the following criteria were used to categorize responses into “low”, “acceptable”, or “excellent” levels:

* The quiz comprised 11 questions, each offering three answer-choices (yes/no/maybe).

* One point was awarded for each correct answer.

* The total score ( i.e. , sum of correct answers) was used to classify participants into levels:

Excellent: Score between 9 and 11.

Acceptable: Score of 7 or 8.

Low: Score of 6 or below

The “cut-off rationales” (why these thresholds) are not explained in detail, which is a methodological limitation. In formal research reporting, the rationale for score thresholds (cut-offs) is important because transparency, reproducibility, interpretation of findings, and validity concerns.

Third, the questionnaire is called the “Laval University Questionnaire” because it was developed and hosted by Université Laval (Faculty of Business Administration) as part of their educational resources on plagiarism and academic integrity. The name reflects its institutional origin rather than implying a formal, externally validated research instrument. Therefore, the “Laval University Questionnaire” essentially means it is a quiz from Laval University rather than a generic or externally validated questionnaire.

Fourth, we appreciate the acknowledgment of the novelty of our instrument and agree that it may present interpretive challenges for respondents. We have highlighted this issue appropriately in the limitations section to ensure transparency and guide interpretation of the findings.

The following sentences were added inside the manuscript:

Why we have chosen the Laval University quiz 35 ?

First, the questionnaire is called the “Laval University quiz” because it was developed and hosted by Université Laval (Faculty of Business Administration) as part of their educational resources on plagiarism and academic integrity. 35 The name reflects its institutional origin rather than implying a formal, externally validated research instrument. 35 Therefore, the “Laval University quiz” essentially means it is a quiz from Laval University rather than a generic or externally validated questionnaire.

Study limitation

First, the quiz is widely used within the Laval University as an educational tool to raise awareness about plagiarism among students. However, there is no publicly available documentation indicating that it has undergone formal validation processes, such as reliability testing or item analysis, typically associated with psychometric evaluations. In addition, the cut-off thresholds used to classify quiz scores as ‘low,’ ‘acceptable,’ or ‘excellent’ were not formally justified by the quiz developers. This lack of explanation may limit the interpretability and comparability of the results

COMMENT No 3.

Overall, while the study demonstrates originality and addresses an important topic, its methodological shortcomings—particularly regarding sampling design, statistical justification, and questionnaire validation—limit the reliability and generalizability of its conclusions.

RESPONSE.

We sincerely thank the reviewer for this thorough and constructive feedback.

We greatly appreciate the recognition of the originality of our study and the importance of the topic. We acknowledge the methodological limitations highlighted, including aspects of sampling design, statistical justification, and questionnaire validation, and we have carefully considered all your remarks in revising our manuscript to improve clarity and transparency.

COMMENT No 4.

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?

Yes

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.

We sincerely thank the reviewer for the careful evaluation and constructive feedback. We have noted that three of the items were marked “Yes” and three as “Partly.” For the items marked “Partly,” we have taken the following steps in revising the manuscript:

*Clarity and literature citation: We have reviewed the text to ensure that the work is clearly and accurately presented and have updated references to include recent and relevant literature.

For example, the following 10 references were added :

Mahapatra I, et al. Considerations in Questionnaire Development: A Review. Indian Journal of Forensic Medicine & Toxicology. 2020;14(4):8612-7.

Wu X, et al. Status of scientific research integrity knowledge in dental undergraduates from 34 universities in China. BMC Med Ethics. 2025;26(1):29.

Chen Z, et al. Research integrity in the era of artificial intelligence: Challenges and responses. Medicine (Baltimore). 2024;103(27):e38811.

Boud D and Tennant M. Putting doctoral education to work: challenges to academic practice. Higher Education Research & Development. 2007;25(3):293-306.

Hosseini M and Resnik DB. Guidance needed for using artificial intelligence to screen journal submissions for misconduct. Res Ethics. 2025;21(1):1-8.

Luscombe C and Montgomery J. Exploring medical student learning in the large group teaching environment: examining current practice to inform curricular development. BMC Med Educ. 2016;16:184.

Smedley A, et al. An Evaluation of an Extended Intervention to Reduce Plagiarism in Bachelor of Nursing Students. Nurs Educ Perspect. 2020;41(2):106-8.

Hidouri S, et al. Key Guidelines for Responding to Reviewers. F1000Res. 2024;13:921.

Dergaa I, et al. A thorough examination of ChatGPT-3.5 potential applications in medical writing: A preliminary study. Medicine (Baltimore). 2024;103(40):e39757.

Dergaa I, et al. Enhancing scholarly discourse in the age of artificial intelligence: A guided approach to effective peer review process. Tunis Med. 2023;101(10):721-6.

*Study design and technical soundness: We have provided additional explanation and justification for the study design to clarify its appropriateness and technical rigor.

For example, we have added the following sentences :

Introduction: Furthermore, upholding academic integrity is made more difficult by the changing digital landscape, which is marked by the ease of access to online information and the rise of advanced artificial intelligence (AI) tools. According to recent research, AI has the potential to both enable new types of misconduct and be an effective tool for identifying it. This change to digital technology may make accidental plagiarism more likely and calls for a modern definition of misconduct that goes beyond conventional guidelines. Thus, it is crucial to evaluate the underlying KoM in this new era.

Discussion:

As of October 28, 2025, one Chines study published on February 22, 2025, was found by searching PubMed with the following query: "("Scientific Misconduct"[Mesh]) AND "Students, Dental"[Mesh]". According to the authors, of the 1514 dental undergraduates, almost 70% learn about scientific integrity through coursework and political and ideological instruction, while the remaining students learn about scientific integrity through other sources like books and conferences, and 80–90% of students are against scientific misconduct.

Students are required to change from being knowledge consumers to knowledge creators at the crucial point of transitioning from undergraduate to graduate school. This change necessitates the concurrent growth of writing and ethical research skills. The observed low-level KoM shows a large gap in this transition, indicating that the current educational framework may not effectively equip PGDSs with the required abilities for ethical scholarship. Instead of thinking that research integrity will be learned implicitly, educational theories suggest that explicit, integrated training is essential for this developmental leap.

A more sustainable strategy goes beyond one-time training and incorporates research integrity education into the curriculum over time. This could involve formative, non-punitive exercises utilizing plagiarism detection software in conjunction with microlearning modules on certain subjects like citation and paraphrase. Research suggests that these curriculum-based, integrated interventions work better than stand-alone lectures in creating a long-lasting culture of integrity. Students' perceptions and understandings of academic honesty can be changed by enabling them to use resources like Turnitin as a learning tool for their drafts rather than just as a way to check final submissions.

*Details of methods and analysis: We have expanded the Methods section with more detailed descriptions to allow replication and improve transparency.

We appreciate these observations and have carefully considered them in revising the manuscript to improve clarity, methodological transparency, and the presentation of results.

 10.5256/f1000research.174309.r341943 Reviewer response for version 3 Başar Gezgin Ulaş 1 Referee https://orcid.org/0000-0002-6075-3501 Dinçşahin Şakir 1 Co-referee Istanbul Gedik University, Istanbul, Turkey

Competing interests: No competing interests were disclosed.

 12 12 2024 Copyright: © 2024 Dinçşahin Ş and Başar Gezgin U 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

The newest version did not respond to my criticisms which essentially requires reformulation of the research problem. So I am not satisfied about it.

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: None

 12 12 2024

Dear Reviewer ,

      Thank you for taking the time to review our manuscript. 

      First, we have revised our paper to address the constructive comments provided by the first reviewer during this third round of revision. 

      Second, we would like to reiterate that our study is quantitative in nature, which limits the applicability of the qualitative suggestions you proposed. To clarify, the primary distinctions between qualitative and quantitative studies lie in the following 4 areas: 

- Purpose: Qualitative studies explore ideas, perceptions, and meanings to gain an in-depth understanding of phenomena, whereas quantitative studies focus on measuring and analyzing numerical data to test hypotheses or identify patterns. 

- Data: Qualitative studies utilize non-numerical data, such as interviews, observations, and open-ended responses, while quantitative studies rely on numerical data, such as statistics, surveys with closed questions, and experimental results. 

- Analysis: Qualitative studies employ interpretive, thematic, or narrative analysis, whereas quantitative studies use statistical or computational analysis. 

- Outcome: Qualitative studies provide detailed insights and understanding, whereas quantitative studies yield measurable and generalizable results. 

      Lastly, while we deeply value your insightful comments during the first review round, incorporating those suggestions into our methodology would not align with the design and objectives of our study. Nonetheless, we have addressed your observations by acknowledging them in the limitations section of our paper. 

        Thank you once again for your thoughtful review and feedback.

 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.

TEXT INSERTION (IF APPLICABLE)/ PAGE/ LINE NUMBER OF CHANGE

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.

TEXT INSERTION (IF APPLICABLE)/ PAGE/ LINE NUMBER OF CHANGE

.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

TEXT INSERTION (IF APPLICABLE)/ PAGE/ LINE NUMBER OF CHANGE

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

TEXT INSERTION (IF APPLICABLE)/ PAGE/ LINE NUMBER OF CHANGE

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.