Aim To provide insights into the students' attitude towards academic integrity and their perspective of academic honesty at Croatian medical schools.Methods A cross-sectional study using an anonymous questionnaire containing 29 questions on frequency of cheating, perceived seriousness of cheating, perceptions on integrity atmosphere, cheating behaviour of peers and on willingness to report misconduct. Participants were third-year and fifth-year students from all four Croatian Schools of Medicine. Outcome measures were descriptive statistical correlates and differences in students' self-reported educational dishonesty, perceptions of (...) cheating behaviour and medical school integrity atmosphere.Results Of the 1074 students enrolled in the third and fifth year, 662 completed the questionnaire. A large proportion of the students admitted using some method of cheating and 78% admitted engaging in at least one form of misconduct. About 50% had a lenient attitude towards six acts of academic dishonesty. Only 2% reported another student for cheating. Risk factors for cheating were strongly correlated with students' perceptions of peer cheating behaviour, peer approval of cheating, low perception of seriousness of cheating and inappropriate severity level of exams and teaching materials.Conclusions Cheating is prevalent in Croatian medical schools and academic dishonesty is seen as acceptable behaviour among numerous future Croatian doctors. (shrink)