Firstly, there are familial, religious, and cultural values that are acquired long before medical school. For example, countries, cultures, and subcultures exist where bribes and dishonest behaviour are almost a norm, while others have much higher standards of ethical conduct. Medical schools reflect society and cannot be expected to remedy all the ills of a postmodern hedonistic society. The school's major responsibility is to focus on the young people who present themselves for admission and to nurture and enhance positive ethical behaviour. The selection process of medical students might be expected to favour candidates with integrity-if one had a reliable method for detecting such characteristics in advance.
Few data suggest that admission committees possess such prophetic qualities.
One rare piece of data is that from Ben Gurion University's interview process, which seemed to favour students with a higher score on a measure of ethical maturity 5 rather than simply those with high grades. Several Australian medical schools have adopted a screening test developed at Newcastle University with a component that evaluates ethical maturity, but data on its validity have not yet been published. Medical schools should be the major focus of attention for imbuing future doctors with integrity and ethical sensitivity. Among the factors contributing to this distressing phenomenon are the overemphasis on grades and competition, negative role models, student abuse, a hidden curriculum which delivers negative messages, a culture of student unwillingness to police them. The creation of a pervasive institutional culture of integrity is essential.