Bad professional behavior dates back to medical school

Doctors with questionable professional lives often had the same kind of trouble in medical school, according to US researchers.

Physicians disciplined by state medical boards were three times more likely to have had a history of unprofessional behavior while in medical school than those with no discipline records, says a study in New England Journal of Medicine.

The study is a first step towards identifying and incorporating subjective concepts such as personal behavior or professionalism into medical education, says Dr. Lynne Kirk, associate dean for graduate medical education at the University of Texas Southwestern Medical Center in Dallas, and author of an accompanying editorial in the journal.

Maxine Papadakis, lead author on the study and the dean for student affairs at the University of California-San Francisco medical school, says, "We found that for physicians disciplined by licensing boards, the strongest association in medical school was unprofessional behavior," The study is the first to link doctor's professionalism in medical school to later bad outcomes when they practice; it gives professors criteria that can serve as early warning signs of trouble, Papadakis says.

The research found that doctors who had exhibited certain types of behavior in medical school were even more likely to be cited by a medical board: Those who behaved unprofessionally in school were 8.5 times more likely to be disciplined while those with a diminished capacity for self-improvement were 3.1 times more likely to be disciplined, according to the study.

The students were deemed irresponsible if they were late for rounds, didn't show up for the clinics they were assigned to, or didn't finish taking care of a patient.

Also, doctors who had been disciplined had lower scores on the Medical College Admission Test and poor grades in the first two years of medical school, although these associations were weaker, the study authors said.

The violations among the 235 physicians that led to disciplinary actions included use of drugs or alcohol, negligence, sexual misconduct, fraud and failure to meet continuing medical education requirements. Many of these physicians were repeat offenders, the study authors said.

The research supports a growing movement to make professionalism a requirement for graduation from medical residency programs. In 1999, the Accreditation Council for Graduate Medical Education in the US included professionalism as one of six "core competencies" being phased in by 2006 as a requirement for graduation.

Researchers looked at such things as how responsibly medical students followed up on patient care and their attitudes when taking constructive criticism.

The study examined the medical school history of graduates who were later disciplined by a state medical board from 1990 to 2003, and compared them with similar students with no history of problems in medical school. The schools studied were UCSF, the University of Michigan Medical School in Ann Arbor and Jefferson Medical College in Philadelphia.

Together, these traits turned out to be a much stronger predictor of future disciplinary action than more traditional measures such as test scores and grades.

The study is part of a larger movement within the field of medicine to retool itself for a world where "I don't know" is an acceptable phrase from a doctor. This is in contrast to the all-knowing, paternalistic doctor whom medical schools educated prior to the 1970s. The change began in the 1980s and 1990s. Today there's a great deal more emphasis being placed on professionalism, humanistic behavior and ethical issues.

Disciplinary action by a state medical board is rare. Of the 725,000 practicing physicians in the USA, only 0.3% is disciplined each year. Failing to graduate from medical school is more likely; one in 20 students wash out for a host of reasons.