Do students falsify information in clinical notes?

If students report information in a post-encounter note that was allegedly not obtained from the patient, they may be suspected of serious professional misconduct, ie, deliberate falsification of patient data. Over-reporting during a clinical assessment may result in accusations of cheating and even lead to failure of a high-stakes examination. Despite these serious implications, the prevalence and reasons for over-reporting are not clear. We investigated every detected incident of false reporting during our high-stakes clinical skills assessment (CSA) at the end of the third year. Of 73 alleged incidents, 69 were attributed to errors in standardized patient (SP) performance, note scoring, data management, or the design of cases or scoring instruments. The four instances of over-reporting by students were more compatible with mistakes and lack of specificity than deliberate falsification. We conclude that all potential sources of error must be excluded before over-reporting incidents are attributed to deliberate falsification of data by students.