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University of Otago medical students who lied about completing their overseas elective work placements are lucky to be insulated from the full effect of undermining a system that relies on integrity and trust.

They cannot be more strongly censured for their holiday making deceit: our staff-starved health system needs them - and fast - and the taxpayer has spent too much on them for the university to deny them their degrees.

Engineering, law or history students might lose points or their place on their course if caught falsifying work. For our medical students, our straightened circumstances say they simply cannot fail.

The university this week confirmed it would withhold the qualifications of 53 sixth-year students who did not meet the attendance expectations of their compulsory three-month work placements.

One-in-five of them took time off when they should have been training, and some falsified their reports to cover their tracks. The rort hit the headlines last month, and the university took action.

Those who thumbed their nose at their university and at the communities that substantially subsidised their training have been given another chance to qualify and relieve our expectant health system.

Each received a $26,756 government grant as they entered their final year of training. They will have to repay the funding for each week of holiday they took and undertake community service or research to make up for lost time.

Some cases may be referred to the Medical Council, which can impose monitoring conditions once the holiday-making student moves into work.

The university hopes the students will emerge ''more trustworthy'' - but it is clear the university must also emerge with renewed integrity and firm commitment such a rort will not happen again.

There is added pressure to do so: previous graduates say placement holidays have been the norm for many, and over many years. The university was either out of touch or turned a blind eye to what, from the outside, looked like an end-of-training culture of expectation and entitlement.

Some previous graduates - doctors - noted past students hardly hid their holiday snaps on social media. Others noted the only difference this year was that someone went public with what had happened.

Earlier this month, the Otago Daily Times asked the university whether, indeed, this sort of thing has happened before. The university is required to determine the veracity of students' work, so it really ought to know.

Of course, that request has been overtaken by events and by the university's acknowledgement this was a ''widespread situation'' and not likely to be isolated to this year's students.

It has launched an inquiry into what happened and whether it has happened before, and has already acknowledged its own systems allowed the dishonesty to occur.

To that end, the university will review the programme and ensure it has far greater checks to reduce the chances this may happen again. It has blacklisted some overseas locations and it has instituted mid-placement checks with student supervisors.

All these measures are laudable - but all ought to have been in place in the first place.

We ought to see the first results of this work next year, but the university must ensure the systems - and the people - that allowed this rort to continue are examined and censured to such an extent that the public and the Medical Council are reassured.

The university has made it very clear that its students' behaviour fell well short of what was expected of them as future health professionals. We all expect more from people we need to trust.

In the meantime, 193 final-year medical students will graduate next month. They will enter the workforce with a degree showing their honour and honesty is intact.