0a486c79-ffe0-47b5-becc-d7e5850b35d2_148694_-_helmi_ben

Abbreviations list

BDSc: Bachelor of Dental Science
BOralH: Bachelor of Oral Health
FDMM: Faculty of Dental Medicine of Monastir
PGDSs: Post-graduate Dental Students
SD: Standard Deviation
SDG4: Sustainable Development Goal number 4
UHDs: University Hospital Doctors
UP: Understanding of Plagiarism

Introduction

Plagiarism, a form of research misconduct,

derives from the Latin term

“

plagiarius

”

, which means

“

kidnapper

”

“

abductor

”

This longstanding issue,

which involves the act of stealing ideas without proper attribution or crediting the

original source,

can apply to textual content, articles, or words.

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

”

Plagiarism is prevalent across various fields such as arts, literature, medicine,

dentistry, and engineering,

and its consequences can lead to article retractions.

Despite the widespread occurrence of

plagiarism between 2000 and 2023,

studies focusing on plagiarism remain scarce. As of December 16, 2023, a search in

PubMed using the MeSH term

“

plagiarism

”

yielded only 933 papers, with 12 % (n=111) of them published in the last five

years (2018-2023). Several factors contribute to researchers resorting to plagiarism, including the easy availability of
data

and the increased accessibility to information on the Internet.

The pressure to publish can also drive individuals to

engage in plagiarism.

Memon

et al.

compared plagiarism awareness among medical and non-medical students, finding

statistically significant differences between them, with medical students being more susceptible to these behaviors. The
literature reports a high prevalence of plagiarism among medical students.

The lack of education about plagiarism in

educational institutions is a major factor contributing to its proliferation.

In 2023, plagiarism is widely considered one of

the most persistent matters faced by higher education establishments.

A systematic review conducted in 2020, focusing on plagiarism in the dental field, concluded that this phenomenon is
inevitable but varies in terms of intent, ranging from deliberate misconduct to unintentional repetition of previous ideas.

Teaching students to avoid plagiarism is crucial for promoting academic integrity and ensuring the production of
acceptable academic work.

Consequently, assessing the

“

understanding of plagiarism

”

(UP) among students, especially

those in dental education, holds significant importance. However, studies investigating UP among dental students are
limited and present discrepancies.

–

For instance, while a Brazilian study reported that 100% of students enrolled in a

dentistry course at a university acknowledged that plagiarism constitutes a crime,

an Australian study reported that 44%

of post-graduate dental students did not consider plagiarism to be a problem.

These disparities can be attributed to

methodological differences in the questionnaires used to assess UP and variations in student populations.

–

Although

there are studies evaluating UP among North African dental academics,

to the best of the authors

’

knowledge, no

research has been conducted in this area among North African dental students.

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

Methods

This study is a component of a broader research project led by a dentist affiliated with a university hospital (

in the

authors

’

list). The project encompasses two distinct studies. The first focused on evaluating the UP among 96 North

African university hospital doctors (UHDs, 22% were dentists).

The findings of this study revealed a lack of awareness

regarding plagiarism among North African UHDs, with 74% of UHDs demonstrating a low level of UP.

Building upon

these results, the present study aims to investigate UP among a different group of participants, such as PGDSs.

Study design

The study was conducted following the guidelines established by the STROBE statement.

This cross-sectional pilot

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

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F1000Research 2024, 13:415 Last updated: 29 APR 2024

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 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.
For the specific year under investigation (

; 2022), the total number of PGDSs was 147, distributed as follows: 38 in the

year, 33 in the 2

year, 38 in the 3

year, and 38 in the 4

year. These PGDSs are residents who have completed their

medical studies and passed the Tunisian national exam to obtain a specialist diploma.

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:

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 a medical congress or were acquainted with individuals involved in the study. During steps 1 to 3, which
involved the electronic recruitment method, a total of 59 PGDSs were recruited. In steps 4 and 5, which involved the
paper-based recruitment method, an additional 47 PGDSs were recruited.

Sample size calculation

The sample size for this study was estimated using the following formula

: n = [(Z

)

(1 - P)

D]/E

; where «

represents the proportion of the main event of interest (

; low UP), «

» is the margin of error, «

» is the normal deviate

for a two-tailed alternative hypothesis at the desired level of significance, and «

» represents the design, which is equal to

1 for simple random sampling.

According to a study conducted in Saudi Arabia,

it was found that 17.9% of dental students (

= 0.179) were unaware of

the meaning of the term

“

plagiarism

”

among a sample of 246 participants. Assuming a confidence interval of 99.9%

(

= 3.29) and a «

» of 0.065, the calculated sample size (

) was determined to be 376 participants [376 = [(3.29)

0.179

–

0.179)

1]/0.065

]. However, since our descriptive study involves a finite population (

; a population with

a limited number of participants), a correction was applied to the sample size.

The number of students to be included

after correction is given by the formula n

’

= (N x n)/(N + n), where

“

’”

represents the corrected sample size,

“

”

is the

size of the finite population (

which is

147 in our study), and

“

”

is the sample size calculated from the standard formula

(n=376). Therefore, the corrected minimum sample size (n

’

) is equal to 106 participants [106 = (147 x 376)/(147+376)].

Figure 1.

Study flowchart. TAOM

: Tunisian Association of Oral Medicine.

PGDSs

: Post-Graduated Dental Students.

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Applied questionnaire

The study employed a questionnaire written in French (See extended data

Appendix A

for the French version and

Appendix B

for the English version), and participants were not given a time limit for completing it. The questionnaire

was divided into two sections. The first section focused on gathering general characteristics of the students, including age
(in years), sex (

; 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 (

; differentiating between basic sciences and

clinical sciences), post-graduate level (

; 1

year, 2

year, 3

year, 4

year), experience level (

; non-experienced for

and 2

years, experienced for 3

and 4

years), response modality (

; electronic or paper), and dental doctor

graduation (

; yes, not yet).

The second section of the questionnaire focused on the French survey, which comprised 11 questions related to UP.

The

survey was an online quiz accessible on the Laval University website.

Each question provided three answer choices (

;

yes, no, may be), with one point awarded for each correct answer.

A total score was calculated for each participant, and

based on this score, three levels of UP were identified:

i) 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.

ii) Acceptable level (score of 7 or 8): Participants at this level need to pay attention to certain points, and

consulting literature about plagiarism may be beneficial.

iii) Low level (score

≤

6): Participants at this level are required to be vigilant when writing papers about

plagiarism and consulting literature books on the topic is imperative.

For statistical purposes, two objective levels of UP were considered:

“

excellent or acceptable

”

and

“

low

”

An additional question regarding self-assessment of UP by the PGDSs was added at the beginning of the questionnaire

how do you evaluate your UP? Is it

“

low

”

“

acceptable

”

“

excellent

”

? Two subjective levels of understanding of

plagiarism were retained:

“

excellent or acceptable

”

and

“

low

”

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 a 95% confidence

interval and range [minimum-maximum]. Categorical data were presented as relative frequencies. The two-sided Chi-2
test was used to compare the percentages of PGDSs based on subjective (self-assessment) and objective (survey)
assessments of UP. 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 survey was
completed by 59 students (55.1%) through electronic mails and by 47 students (41.9%) through paper-based question-
naires (

Figure 1

The characteristics of the 106 PGDSs are presented in

Table 1

. The majority of the sample consisted of female participants

(76.42%), and most of the PGDSs belonged to the clinical sciences (87.74%).

Table 2

displays the results of the assessment of UP. The mean UP score was 4.7

2.2, indicating a low level of

understanding. A high percentage of PGDSs (81.13%) demonstrated a low level of UP. A comparison between subjective
and objective assessments revealed that a significant proportion of PGDSs underestimated their low level of UP.

Table 3

provides the characteristics of the PGDSs categorized based on their objective level of UP (

i.e.

; low vs acceptable/

excellent). The two groups exhibited comparable ages and comparable percentages of PGDSs in terms of sex, discipline,
post-graduate level, experience level, graduation status, and response modality.

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F1000Research 2024, 13:415 Last updated: 29 APR 2024

Table 1.

Characteristic of the 106 post-graduate dental students.

Variable

Unit/Category

Values

Age

Year

2 (27 to 28)

Sex

Female

81 (76.42)

Departments

Biomaterials

1 (0.94)

Dental anatomy

3 (2.83)

General anatomy

3 (2.83)

Microbiology

1 (0.94)

Oral physiology

3 (2.83)

Oral radiology

2 (1.89)

Dental surgery

23 (21.70)

Endodontics

20 (18.87)

Fixed prosthodontics

18 (16.98)

Maxillofacial prosthesis

1 (0.94)

Orthodontics

8 (7.55)

Pedodontics

6 (5.66)

Periodontology

5 (4.72)

Removable prosthodontics

12 (11.32)

Discipline

Basic sciences

13 (12.26)

Clinical sciences

93 (87.74)

Post-graduate level

First year

32 (30.19)

Second year

19 (17.92)

Third year

30 (28.30)

Fourth year

25 (23.58)

Experience level

Experienced

55 (51.89)

Not-experienced

51 (48.11)

Response modality

Electronic

59 (55.66)

Paper

47 (44.34)

Graduation

Yes

62 (58.49)

Not yet

44 (41.51)

Age was mean

standard deviation (95% confidence interval). The remaining data were number (%).

Table 2.

Understanding of plagiarism amid post-graduate dental students (n=106).

Evaluation

Level of understanding of plagiarism

Number (%)

Subjective: Self-assessment

Low level

66 (62.26)

Acceptable/Excellent level

41 (38.68)

Objective: Using the questionnaire

Low level

86 (81.13)

Acceptable/Excellent level

20 (18.87)

P-value

0.0023

Understanding of plagiarism score

4.7

2.2 (4.3 to 5.1) [1-11]

Data were:
P-value (2-sided Chi-2 test): subjective vs. objective evaluation of understanding of plagiarism.

Number (%).

Mean

standard deviation (95% confidence interval) [minimum-maximum].

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F1000Research 2024, 13:415 Last updated: 29 APR 2024

Discussion

This study was conducted among a sample of North-African PGDSs, as they represent future academic doctors and are
required to write scientific papers. The main concerning finding of this pilot study was that 80.4% of Tunisian PGDSs
demonstrated a low level of UP. 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 UP issue among PGDSs in
North Africa.

In recent years, the phenomenon of plagiarism has emerged as a significant ethical problem, especially among medical
students, as evidenced by various studies.

–

This misconduct in research writing has become widespread

worldwide, with high prevalence reported among students from different continents, including America,

Europe,

Asia,

and Africa.

Regarding the African continent, Rohwer et al.

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.

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).

Achieving the targets of SDG4 in higher education institutions requires

addressing the issue of plagiarism.

There is a scarcity of studies specifically assessing UP among dental students.

–

Table 4

provides a detailed overview

of seven related studies. Nevertheless, to the finest of the authors

’

knowledge, this is the first Tunisian and North African

study to examine the issue of UP among PGDSs.

Discussion of results

UP level

The mean score for UP was low at 4.7

2.2, with 80.4% of PGDSs showing a low level of UP. Of concern was the finding

that a significant percentage of PGDSs underestimated their level of UP (

Table 2

). These alarming results closely

resemble those reported in a previous study conducted among Tunisian UHDs.

Using the same French survey,

Khemiss et al.

reported that UHDs had a low mean score of UP (5.4

1.9), with 74% of them demonstrating low levels.

Our findings suggest that Tunisian PGDSs have not received adequate guidance regarding plagiarism, a growing issue

Table 3.

Characteristics of the 106 post-graduate dental students divided according to the objective level of

plagiarism understanding.

Variable

Unit/Category

“

Low

”

level

(n=86, 81.13)

“

Acceptable/Excellent

”

level (n=20, 18.87)

P-value

Understanding of
plagiarism score

3.9

1.3 (3.6 to 4.1)

[1.0-6.0]

8.3

1.5 (7.6 to 9.0)

[7.0-11.0]

0.001

Age

Year

2 (27 to 28)

[24-31]

2 (27 to 28)

[25-35]

0.551

Sex

Female

65 (75.58)

16 (80.00)

0.675

Male

21 (24.42)

4 (20.00)

Discipline

Basic sciences

9 (10.47)

4 (20.00)

0.242

Clinical sciences

77 (89.53)

16 (80.00)

Post-graduate
level

First year

28 (32.56)

4 (20.00)

0.2704

Second year

15 (17.44)

4 (20.00)

0.788

Third year

22 (25.58)

8 (40.00)

0.197

Fourth year

21 (24.42)

4 (20.00)

0.675

Experience level

Experienced

43 (50.00)

8 (40.00)

0.420

Not-experienced

43 (50.00)

12 (60.00)

Response modality

Electronic

47 (54.65)

12 (60.00)

0.664

Paper

39 (45.35)

8 (40.00)

Graduation

Yes

49 (56.98)

13 (65.00)

0.512

Not yet

37 (43.02)

7 (35.00)

Understanding of plagiarism score and age were mean

standard deviation (95% confidence interval). The remaining data were

number (%).
P-value (Student test or 2-sided Chi-2 test):

“

low level

”

vs.

“

Acceptable/Excellent level

”

Page 7 of 18

F1000Research 2024, 13:415 Last updated: 29 APR 2024

Table

Designs

and

characteristics

some

studies

aiming

assess

plagiarism

knowledge

(PK)

practice

(PP)

attitudes

(PA)

among

dental

students.

author(s)

Andrews

Ford

Hughes

Guedes

Gomes

Filho

Naveen

Manjiri

Zakirulla

Lingam

Sai

Reference

publication

.2007

.2012

.2015

.2017

.2020

the

study

.2005

.NR

.2013

.2015

.NR

Country

.USA/Canada

.Australia

.Brazil

.India

.Saudi

Arabia

.India

Main

aims:

assess

the

.Degree

which

academic

integrity

issues

currently

exist

the

dental

schools

.Perceptions

and

experience

plagiarism

and

the

usefulness

the

workshops

.PK

dental

students

.PK

and

among

post

graduate

students

.PK,

PA,

and

Master

degree

students

.PK

and

plagiarism

awareness

.Perception

plagiarism

among

the

dental

students

Study

design

.Descriptive

.Cross-sectional

Recruitment

method

.Exhaustive

sample

.Exhaustive

sample

.Exhaustive

sample

.Exhaustive

sample

.Exhaustive

sample

.Convenience

sample

.Random

sample

Population

.Dental

students

.Undergraduate

students

.Students

enrolled

dentistry

course

university

.Dental

post-

graduate

students

.Dental

and

Master

degree

students

.Dental

students

.Dental

students

and

interns)

Target

population

.Dental

students

dental

schools

(n=NR)

.n=188

.110:

the

BOralH

and

BDSc

program

.69:

the

BDSc

program

.9:

Postgraduate

students

.n=199

.n=600

.n=412

.NR

Total

number

participants

.1153

.154

.103:

the

BOralH

and

BDSc

program

.43:

the

BDSc

program

.9:

Postgraduate

students

.186

.452

.248

.246

.102

Page 8 of 18

F1000Research 2024, 13:415 Last updated: 29 APR 2024

Table

Continued

author(s)

Andrews

Ford

Hughes

Guedes

Gomes

Filho

Naveen

Manjiri

Zakirulla

Lingam

Sai

Sex

(M/F)

.569/491

.NR

.66/120

.156/296

.138/110

.179/67

.NR

Age

(Yrs)

.NR

.23

[18-39]

.NR

.[20-25]

:202

.[26-30]

:24

.[31-35]

:20

.NR

Plagiarism

training

.NR

.129

.NR

Sample

size

.Not

calculated

.Not

calculated

.Not

calculated

.Not

calculated

.Not

calculated

.Calculated

.Not

calculated

Questionnaires

.Non-standardized

.Self-administered

.70

Likert-type

items

requested

responses

open-

ended

questions

.No

reference

.Non-

standardized

.Self-

administered

.No

reference

.Non-

standardized

.Self-

administered

.13

multiple-

choice

questions

discursive

questions

.Reference:

.Non-

standardized

.Self-

administered

.31

multiple-

choice

questions

.25

regarding

.10

regarding

.No

reference

.Non-standardized

.Self-administered

.18

multiple-choice

questions

regarding

.No

reference

.Standardized:

References:

.Valid/reliable

.15

questions

regarding

.Non-standardized

.Self-administered

.10

multiple-choice

questions

.No

reference

Way

answer

.Sent

via

mail

.Distributed

directly

.Direct

answer

.Distributed

directly

.Web

links

mailed

.NR

.Sent

via

mail

Explored

items

.Plagiarism

perception

.Cheating

perception

.Plagiarism

understanding

.Academic

integrity

.PK

.Attitude

about

laws

.PK

(scores

from

15)

.PA

.PK

.PA

.PP

.PK

.PA

.PK

Mains

results

.47

:students

should

held

responsible

for

monitoring

the

academic

integrity

other

students

.31

cheating

serious

problem

the

university

Plagiarism

not

problem

.44

Post-

graduate

students

.37

students

.17

students

School

has

clear

guidelines

place

for

.100

plagiarism

constitutes

crime

.78

not

respect

image

copyrights

.56

author

must

correctly

referenced

.52

knew

PK:

.Total

score:

6.9

3.3

.Good

knowledge:40.5

.Very

good

knowledge:41.2

.Excellent

knowledge:18.4

.PK

increases

the

age

increases

and

the

participants

.88

knew

the

meaning

the

term

“

plagiarism

”

.84

plagiarism

act

academic

malpractice

.74

aware

mandatory

dental

council

India

point

system

for

scientific

publications

academics

.51

knew

that

.PK

scores:

10.4

1.1

10.5

1.2

.PA

scores:

13.6

1.6

13.8

1.3

.77

justified

use

descriptions

method

.56

self-plagiarism

not

punishable

because

not

harmful

.53

plagiarized

parts

paper

maybe

ignored

great

scientific

value

.48

justified

use

one

’

own

previously

Page 9 of 18

F1000Research 2024, 13:415 Last updated: 29 APR 2024

Table

Continued

author(s)

Andrews

Ford

Hughes

Guedes

Gomes

Filho

Naveen

Manjiri

Zakirulla

Lingam

Sai

dealing

with

plagiarism

.90

students

.56

Post-

graduate

students

.44

students

the

types

plagiarism

.31

knew

the

meaning

paraphrase

.26

knew

the

meaning

direct

quote

progressed

academic

year

plagiarism

has

adverse

effect

the

health

the

community

.51

knew

that

software

are

available

check

plagiarism

.49

plagiarism

punishable

offence

published

work

without

providing

citation

.45

not

doing

anything

bad

colleague

mine

allows

copy

because

have

his/her

permission

BDSc

Bachelor

Dental

Science.

BOralH

Bachelor

Oral

Health.

Female.

Male.

Max

Maximum.

Min

Minimum.

Not-Reported.

Standard

Deviation.

Year.Data

were:

Mean

[Minimum-Maximum].

Mean

standard

deviation.

Page 10 of 18

F1000Research 2024, 13:415 Last updated: 29 APR 2024

with the widespread availability of internet resources and artificial intelligence.

This lack of understanding may be a

primary reason for the prevalence of plagiarism in North African states, such as Tunisia.

The findings also confirm a lack

of awareness about plagiarism among both academics and students in Tunisian universities.

The observed low average score of UP (4.7

2.2 out of 11 questions) was intermediate compared to studies conducted

among postgraduate and undergraduate dental students (

Table 4

). On one hand, this score was consistent with an Iranian

study involving 452 PGDSs, where the mean number of correct answers to 25 plagiarism knowledge questions was low at
6.9

3.3

(

Table 4

). On the other hand, the local score contradicted findings from a Saudi Arabian study involving

246 dental students, where the mean plagiarism knowledge scores, assessed through 15 questions,

were high at

10.4

1.1 for males and 10.5

1.2 for females

(

Table 4

The high percentage of PGDSs displaying a low level of UP (80.4%) was also intermediate compared to percentages
reported in the literature (

Table 4

). On one hand, our percentage aligned with findings from some studies

(

Table 4

). 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.

In a Brazilian study involving 186 dental students, 78%, 74%, 69%, 48%, and 44% of

students reported a lack of respect for image copyrights, a lack of understanding of direct quotes and paraphrasing,
ignorance about the different types of plagiarism, and the belief that authors can be wrongly referenced, respectively.

An Indian study of 248 dental master

’

s degree students revealed that 51%, 49%, and 49% of students did not recognize

plagiarism as a punishable offense, were unaware of its adverse effects on the community

’

s health, and did not know that

software is available for plagiarism checking, respectively.

Similarly, an Iranian study involving 102 dental students,

found that 77%, 56%, 53%, 48%, and 45% of students believed using previous method descriptions was justified, self-
plagiarism was not punishable, plagiarized parts of a paper could be ignored if they had scientific value, using one

’

s own

Table 5.

Ten recommendations aimed at preventing plagiarism among dental medical students.

Issue

Details

Raise awareness

Conduct workshops, seminars, and orientation programs to educate
dental medical students about plagiarism, its consequences, and ethical
writing practices.

Incorporate academic
integrity policies

Establish clear and comprehensive academic integrity policies that
explicitly address plagiarism and its consequences. Communicate these
policies to students and faculty.

Provide writing support

Offer writing support services, such as writing centers or writing tutors, to
help students develop proper academic writing skills and avoid
unintentional plagiarism.

Teach citation and
referencing

Include training sessions on citation and referencing styles commonly
used in dental research, ensuring students understand how to properly
cite and reference sources to give credit to the original authors.

Offer research ethics
courses

Integrate research ethics courses into the dental curriculum to educate
students about responsible conduct in research and scholarly writing,
including the importance of originality and intellectual integrity.

Encourage critical thinking

Foster critical thinking skills among dental medical students, enabling
them to develop their own ideas and interpretations, reducing the
likelihood of relying heavily on direct copying from sources.

Provide plagiarism
detection tools

Make plagiarism detection software available to students, allowing them
to self-check their work before submission and encouraging the
cultivation of originality.

Emphasize paraphrasing
and summarizing

Teach effective paraphrasing and summarizing techniques to students,
enabling them to express ideas in their own words while appropriately
acknowledging the original source.

Foster mentorship

Encourage faculty members to act as mentors, guiding students in the
research and writing process, emphasizing good academic practices, and
serving as role models of integrity.

10.

Regularly assess and
evaluate

Continuously assess and evaluate the effectiveness of plagiarism
prevention measures, seeking feedback from students and faculty, and
making necessary adjustments to improve educational strategies and
support systems.

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F1000Research 2024, 13:415 Last updated: 29 APR 2024

previously published work without citation was allowed, and copying with a colleague

’

s permission was not wrong,

respectively.

On the other hand, the percentage in our study differed from that in some reported studies

–

(

Table 4

For instance, among Australian undergraduate students, 56% of nine postgraduate students considered plagiarism a
problem, and 90% of 103 first-year students in the Bachelor of Oral Health (BOralH) and Bachelor of Dental Science
(BDSc) program reported that their school had clear guidelines for dealing with plagiarism.

In addition, 88%, 84%, and

74% of Indian dental master

’

s degree students were familiar with the term

“

plagiarism

”

, recognized it as an act of

academic malpractice, and were aware of the mandatory dental council of India point system for scientific publications in
academics.

Some authors also reported that 100% of Brazilian students enrolled in a dentistry course were aware that

plagiarism constitutes a crime.

A significant percentage of PGDSs underestimated their low level of UP. While 62.26% of PGDSs considered their UP to
be low, objective evaluation increased this percentage to 81.13% (

Table 2

). No previous study has evaluated this issue in

dental students. Our result was similar to that reported for Tunisian UHDs, where 44.8% of them perceived their UP as
low, but objective evaluation raised this percentage to 74.0%.

Our finding was partially aligned with another study

comprising doctoral candidates at the Faculty of Medicine and comparing attitudes towards scientific misconduct and
self-reported behavior (

, plagiarized publication).

This discrepancy between subjective and objective evaluations can

be explained by the Kruger-Dunning effect,

a cognitive bias in which individuals with low ability or knowledge in a

particular domain tend to overestimate their competence in that domain.

The overestimation of knowledge 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.

–

What is the profile of a Tunisian PGDS with a low level of UP?

The two groups of PGDSs with

“

low

”

and

“

acceptable/excellent

”

UP levels showed comparable characteristics,

including age, sex, discipline, post-graduate level, experience level, graduation, and response modalities (

Table 3

). To

the best of the authors

’

knowledge, no previous specific study has aimed to identify the profile of a PGDS with a low level

of UP. 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.

The study examined patterns of

plagiarism among professional academic writers and found 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.

However, it appears that the

post-graduate level, academic year, and students

’

age influence the UP level of dental students

(

Table 4

). First, one

study

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,

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

identified that UP increased as the age and academic year of dental post-graduate

students progressed. In contrast to our study, some authors

reported that first-year medical dental students exhibited the

highest negative attitude towards plagiarism, followed by second-year and then third-year students.

How to explain the low level of UP among Tunisian PGDSs?

Four factors may contribute to the observed low level of UP amid Tunisian PGDSs. First, there appears to be a perception
of permissiveness towards plagiarism within dental medical faculties, with institution leaders exhibiting tolerance
towards plagiarists, despite Tunisia implementing initiatives to combat this issue.

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.

The absence of comprehensive policies may explain the low level of UP

among PGDSs. Fifteen years after the decree

’

s publication,

it is crucial to evaluate whether policies against plagiarism

in the medical field are being effectively implemented in Tunisia. Second, a significant reason for the prevalence of
plagiarism is the inadequate emphasis by institutions on addressing the problem.

The absence of mandatory training

modules on research and medical writing within medical curricula may account for the observed low level of UP.

Writing a thesis or article or dissertation is a complex task for medical students, requiring training and practice similar to
any other academic skill.

PGDSs require support from qualified supervisors to improve the quality of their

academic and scientific work.

Qualified supervisors play a vital role in ensuring the integrity of manuscripts

produced by their students, as responsibility for suspected plagiarism is shared between senior researchers and young
scientists.

Our results are expected since some previous Tunisian studies including UHDs from different specialties

including dentistry, reported a low level of awareness regarding plagiarism.

These results reinforce the notion that

academics who themselves lack knowledge or understanding in a particular subject (

; UP) are less likely to effectively

teach or transmit that knowledge to their students. The adage

“

One who lacks something cannot give it

”

aptly applies.

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F1000Research 2024, 13:415 Last updated: 29 APR 2024

Third, the low level of UP may be attributed to the lack of plagiarism detection software tools in medical faculties.

The

implementation of plagiarism detection tools has the potential to reduce the prevalence of plagiarism within institu-
tions.

However, it is important to consider different perspectives on the effectiveness of these tools. While

Stappenbelt and Rowles.

found that allowing students to check their own work can be beneficial and improve their

skills, Youmans

reported that the availability of such software for students does not necessarily reduce plagiarism in

their own work. Additionally, Rodafinos

concluded that expecting students to self-check their work may inadvertently

encourage them to

“

cheat

”

by avoiding matches with the original sources. Since 2022, the FDMM has implemented

plagiarism checker software (Turnitin), providing all teachers with access to this tool. This initiative aims to effectively
raise awareness about plagiarism among students, encouraging them to use the software to check their theses and articles
prior to submission. The faculty authorities are committed to promoting awareness of plagiarism and provide training to
prevent its occurrence. Ford and Hughes

found 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.

However, it is important to note that existing plagiarism 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.

Discussion of the methodology and study limitations

The sample size calculation for this study (n=106) appears to be acceptable. It was slightly higher than the sample size of a
previous Indian study, which included 102 dental students.

However, it was significantly lower compared to the sample

sizes of other relevant studies, such as 154 Australian undergraduate students,

186 Brazilian students enrolled in a

dentistry course at a university,

246 Saudi Arabian dental students,

248 Indian dental Master

’

s degree students

;

452 Indian dental post-graduate students,

and 1153 American/Canadian dental students.

Among these seven studies,

only one

reported the sample size calculation. Calculating the sample size is crucial as it ensures the study has a

sufficient number of participants to generate statistically significant results, increases the study

’

s power to detect

meaningful effects, enhances the reliability of findings, and improves the generalizability of the results to the target
population.

Following a similar approach to a previous North African study involving university hospital doctors,

we combined the

PGDSs with acceptable and excellent UP levels. We made this decision for two reasons. First, the number of students with
an excellent UP level was low (n=8). Second, including three separate groups in a single study raises concerns about the
comparability of sex distribution and postgraduate levels among the groups.

While various tools have been established and recommended to assess plagiarism, particularly in terms of attitudes,
acceptance, and practice,

–

evaluating UP is also important, especially among PGDSs. Assessing UP helps

promote academic integrity, ensures ethical research practices, cultivates critical thinking skills, and enhances the quality
and originality of scholarly work. This study appears to be the first to apply a virtual quiz to assess UP in students.

chose to use the University of Laval quiz

to evaluate UP among Tunisian PGDSs for several reasons. First, the quiz had

previously been used in a local study involving university hospital doctors.

Second, all available surveys used to assess

understanding, attitudes, practices, and knowledge related to plagiarism were in English and lacked a certified French
version.

–

Since French is the second language in Tunisia, the French Laval quiz appeared to be more suitable

for Tunisian PGDSs without the need for translation or validation. Third, the Laval quiz

is not time-consuming,

requiring thoughtful responses, with an average of 15 minutes needed to answer the 11 questions.

Questionnaires have proven to be advantageous and consistent tools for evaluating attitudes, practices, and knowledge
related to plagiarism.

Some previous studies that aimed to assess UP among students in the medical or

engineering fields chose to use quizzes.

–

In other related studies (

Table 4

), non-standardized questionnaires were

predominantly used,

–

with the exception of one study from Saudi Arabia.

Moreover, only two studies

provided

references for the questionnaires used.

Similar to a previous Indian study,

our study exclusively focused on PGDSs. However, in other related studies

(

Table 4

), authors included dental students without providing further specifics,

or both undergraduate and

postgraduate students.

We decided to concentrate on PGDSs in our study due to their requirement to complete a medical

thesis as part of their graduation process. This decision was made with the intention of creating a more homogeneous
sample, as PGDSs undergo a distinct academic milestone that has the potential to impact their attitudes and behaviors
within our research context. This study has some limitations that need to be addressed. Firstly, as with any questionnaire-
based study, the utilization of a questionnaire

introduces subjectivity into the responses, and there is a possibility that

some questions may have been answered randomly.

This introduces the potential for measurement bias, which should be

considered when interpreting the results. Secondly, the use of a French quiz,

derived from a Western academic culture

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F1000Research 2024, 13:415 Last updated: 29 APR 2024

within a sample representing an Eastern culture should be acknowledged. Despite the Tunisian PGDSs

’

fluency in the

French language, their understanding of quizzes derived from Western academic culture may differ.

This aspect needs

to be considered when interpreting the results. Additionally, the undergraduate experience and educational practices of
Tunisian PGDSs occur within a culturally distinct context compared to the Canadian university system. While integrity is
universally valued, its manifestations and practices may vary across different countries and cultures.

This variation

could partially explain the low level of UP among Tunisian PGDSs. Research has shown that educational practices related
to honesty and quality in teaching and learning differ across cultures.

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.

Thirdly, 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.

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.

Conse-

quently, it is important to note that our findings solely pertain to the included PGDSs.

Caution must be exercised when

interpreting the results as this sample may not be representative of all PGDSs in North Africa. A fourth limitation of our
study is the absence of data regarding the number of publications and/or communications in medical congresses among
the PGDSs.

Including this information would have provided a more comprehensive understanding of the students

’

profile and allowed for a more nuanced analysis by categorizing them based on their publication and communication
activity. Future studies should consider collecting such data to enhance the interpretation of findings and provide a more
detailed characterization of the participants.

Finally, it would have been beneficial to include an additional validated

questionnaire, such as the

“

Attitude toward Plagiarism

”

questionnaire,

as utilized in a previous study.

This would

have enhanced the scientific rigor of our research by providing a more comprehensive assessment of students

’

attitudes

towards plagiarism. By incorporating established measurement tools, we could have gained valuable insights and
comparisons that would contribute to the validity and generalizability of our findings.

Recommendations

Misunderstanding plagiarism is a common occurrence, and the lack of clarity surrounding the concept makes UP essential
to prevent this misconduct. However, it should be noted that UP alone is not sufficient. As highlighted by Iloh et al.,

despite the awareness of plagiarism among Nigerian students, instances of violations were still detected. Therefore, it is
crucial to focus on enhancing researchers

’

knowledge and attitudes towards plagiarism, particularly among junior

researchers. According to Poorolajal et al.,

there is a significant association between the prevalence of plagiarism and an

increase in scores of knowledge and attitude towards plagiarism, with a decrease of 13% and 16% per one-unit increase,
respectively. This highlights the importance of researchers

’

awareness regarding plagiarism. Therefore, it is crucial for

scholastic programs to focus on enhancing knowledge and improving the attitude of researchers, particularly junior ones,
towards plagiarism. Achieving the following three goals, as proposed by Muthanna,

should be the target:

Develop

skills in creative, critical, and scientific thinking;

ii)

Encourage creative writing, translation, and publication across

various disciplines; and

iii)

Advance knowledge through scientific research in all fields. To address these concerns, it is

recommended to organize workshops, seminars, and scientific writing courses specifically focused on plagiarism.

Interactive seminars have shown effectiveness in addressing this issue, as suggested by Marshal et al.

Dedicated

modules on medical research ethics and writing should be integrated into undergraduate medical curricula in North Africa
to proactively prevent plagiarism.

Combatting plagiarism is a shared responsibility, and each medical school should

establish its own institutional policies to effectively address this growing phenomenon.

Table 5

presents ten recom-

mendations aimed at preventing plagiarism among dental medical students. By implementing these recommendations,
dental medical schools can promote a culture of academic integrity and equip students with the necessary skills and
knowledge to avoid plagiarism.

Conclusion

The level of UP among Tunisian PGDSs is alarmingly low, necessitating urgent action to improve it. Our study serves as
an urgent call to raise awareness among North-African officials in dental faculties regarding the prevalence of plagiarism
in the medical dental field. It is imperative that institutions make dedicated efforts to investigate instances of plagiarism,
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

Helsinki

(

https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-

medical-research-involving-human-subjects/

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F1000Research 2024, 13:415 Last updated: 29 APR 2024

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 participant 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://zenodo.org/

records/10642001

The project contains the following underlying data

Data plagiarism.xlsx

[Excel data of the 106 Tunisian post-graduate dental students].

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

The project contains the following extended data

[

Appendix A

: Copy of the French questionnaire] (Applied questionnaire).

- Zenodo: Questionnaire (English version). Knowledge attitudes regarding plagiarism: survey of dental medicine

residents. DOI:

https://zenodo.org/records/10992137

The project contains the following extended data

[

Appendix B

: Copy of the translated English questionnaire].

Reporting guidelines

Zenodo: STROBE checklist for

“

Understanding of plagiarism amid North-African post-graduate dental students: A cross

sectional pilot study

”

. Doi:

https://zenodo.org/records/10692067

Data are available under the terms of the

Creative Commons Attribution 4.0 International license

(CC-BY 4.0).

Acknowledgments

In order to correct and improve the academic writing of our paper, we have used the language model ChatGPT 3.5.

Authors wish also to express their sincere gratitude to all participants for their cooperation.

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