Unprofessional Physicians Grow from Unprofessional Medical Students

Students are accepted into medical school, taught and then sent out. But do we really know what happens to each student years later? Not really. Unless a study is done which has statistical power, we can’t really be sure the followup will provide us with any help in establishing cause and effect relationships needed for improving the medical education system. With numbers of physicians being subjected to disciplinary action by state medical boards for unprofessional behavior, it is important to look for relationships of medical student misbehavior to later problems that could give early warning and hopefully lead to corrective measures.

Such a statistical study regarding the disciplinary action by medical boards and prior behavior in medical school was published in the December 22, 2005 issue of the New England Journal of Medicine by Maxine A. Papadakis, M.D.,et al. (p.2673). The following is an abstract of the article.
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Background

Evidence supporting professionalism as a critical measure of competence in medical
education is limited. In this case-control study, we investigated the association
of disciplinary action against practicing physicians with prior unprofessional behavior
in medical school. We also examined the specific types of behavior that are
most predictive of disciplinary action against practicing physicians with unprofessional
behavior in medical school.

Methods

The study included 235 graduates of three medical schools who were disciplined by
one of 40 state medical boards between 1990 and 2003 (case physicians). The 469
control physicians were matched with the case physicians according to medical
school and graduation year. Predictor variables from medical school included the
presence or absence of narratives describing unprofessional behavior, grades, standardized-
test scores, and demographic characteristics. Narratives were assigned an
overall rating for unprofessional behavior. Those that met the threshold for unprofessional
behavior were further classified among eight types of behavior and assigned
a severity rating (moderate to severe).

Results

Disciplinary action by a medical board was strongly associated with prior unprofessional
behavior in medical school (odds ratio, 3.0; 95 percent confidence interval,
1.9 to 4.8), for a population attributable risk of disciplinary action of 26 percent.
The types of unprofessional behavior most strongly linked with disciplinary action
were severe irresponsibility (odds ratio, 8.5; 95 percent confidence interval, 1.8 to
40.1) and severely diminished capacity for self-improvement (odds ratio, 3.1; 95 percent
confidence interval, 1.2 to 8.2). Disciplinary action by a medical board was also
associated with low scores on the Medical College Admission Test and poor grades
in the first two years of medical school (1 percent and 7 percent population attributable
risk, respectively), but the association with these variables was less strong
than that with unprofessional behavior.

Conclusions

In this case-control study, disciplinary action among practicing physicians by medical
boards was strongly associated with unprofessional behavior in medical school.
Students with the strongest association were those who were described as irresponsible
or as having diminished ability to improve their behavior. Professionalism should
have a central role in medical academics and throughout one’s medical career.
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As medical school teachers and as supervisors in internships and residencies, we should not look casually at unprofessional behaviors in those we are supervising but based on studies such as this and hopefully others to come, consider the behaviors as warnings of future behavior and establish systems to act on them at the time. ..Maurice.

ADDENDUM 12-28-2005:
One of the excuses a medical school may give on being shy to remove an unprofessional student from the medical school is their concern about being sued by the student for their action. No one, not even a medical school enjoys a legal suit. However,with statistically significant studies like this one in the current NEJM, suits from students will be "no prob..llem". It is going to be the law suits from injured patients later on who, with this documentation in the literature, coming back to the medical schools with their suits that then will be a problem! ..Maurice.