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Bad Students Can Turn Out To Be Bad Doctors

Irresponsible behavior in medical school could serve as a red flag, study suggests

WEDNESDAY, Dec. 21, 2005 (HealthDay News) -- Doctors who misbehave in medical school are more likely to have disciplinary action taken against them by medical boards when they become practicing physicians, a new study has found.

In particular, students who were described as irresponsible or not able to improve their behavior were most likely to run into trouble later on, according to research in the Dec. 22 issue of the New England Journal of Medicine.

The study is a first step toward being able to identify and incorporate subjective concepts -- such as personal behavior or professionalism -- into medical education, said 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.

"This gives us much more specific information," she said. "If we see people with certain behaviors in the third year of medical school, we do everything we know how to help them improve. If we continue to see problems, we have to ask if this is somebody we want to graduate."

Study author Dr. Maxine Papadakis, associate dean for student affairs at University of California, San Francisco, said: "We want to identify people in their formative medical education stage who may have problems down the pike so we can remediate them. The big goal is to increase the quality of patient care."

Only a small number of physicians in the United States are disciplined: 0.3 percent of a total of about 725,000 physicians, the researchers said.

The data on professionalism in medical students and doctors is lacking, the study authors said.

The same group of researchers behind the new study had previously done a study of medical school graduates from UCSF. The researchers found that disciplinary action taken against working physicians was associated with prior unprofessional behavior when the physicians were still students.

The new study broadened the inquiry to three medical schools, to see if the original findings held true at other schools and other state medical boards.

The researchers looked at 235 graduates of the University of Michigan Medical School in Ann Arbor, Jefferson Medical College of Thomas Jefferson University in Philadelphia, and the UCSF School of Medicine. All doctors had graduated since 1970 and had been disciplined by a state medical board between 1990 and 2003.

These physicians were compared with 469 "control" physicians who had graduated from the same schools in the same years but had not been disciplined.

Unprofessional behavior in medical school was determined by looking at narratives describing unprofessional behavior, grades and standardized test scores, among other measures.

Doctors who had exhibited unprofessional behavior in medical school were three times more likely to be disciplined by a medical board than students who had not had such problems in medical school, the study found.

But 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.

"It was that lack of the compulsiveness which you would like a physician to have," Kirk said.

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.

This study provides empirical support for including professionalism as a core "competency" in graduate medical education, the researchers said.

"This will allow us to look closely at our evaluations and make sure that we have specific examples of these behaviors so that we really focus the evaluator, the faculty member, to specifically comment on these," Kirk explained.

"We're talking about a very small group, but something may happen in medical school or any time in our lives so that we start demonstrating these behaviors," she added. "If it's something we can fix, we would certainly want to do that."

More information

The Council on Graduate Medical Education has information on physician workforce trends and related matters.

SOURCES: Maxine A. Papadakis, M.D., associate dean, student affairs, University of California, San Francisco School of Medicine; Lynne Kirk, M.D., associate dean, graduate medical education, University of Texas Southwestern Medical Center, Dallas; Dec. 22, 2005, New England Journal of Medicine
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