Unprofessional Behavior in Medical School Is Associated... : Academic Medicine (original) (raw)

Research Report

Unprofessional Behavior in Medical School Is Associated with Subsequent Disciplinary Action by a State Medical Board

Papadakis, Maxine A. MD; Hodgson, Carol S. PhD; Teherani, Arianne PhD; Kohatsu, Neal D. MD, MPH

Dr. Papadakisis professor of clinical medicine, Department of Medicine and associate dean of student affairs; Dr. Hodgsonis associate professor, Department of Medicine and director, Office of Educational Research; and Dr. Teheraniis assistant professor, Department of Medicine. All are at the University of California, San Francisco, School of Medicine, San Francisco, California. Dr. Kohatsuwas medical director of the Medical Board of California, California Department of Consumer Affairs when this study was conducted. He is now associate professor, Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa.

Correspondence should be addressed to Dr. Maxine Papadakis, University of California, San Francisco, S-245, Box 0454, San Francisco, CA 94143; e-mail: 〈[email protected]〉.

For an article on a related topic, see pp. 265–271.

Abstract

Purpose

To determine if medical students who demonstrate unprofessional behavior in medical school are more likely to have subsequent state board disciplinary action.

Method

A case–control study was conducted of all University of California, San Francisco, School of Medicine graduates disciplined by the Medical Board of California from 1990–2000 (68). Control graduates (196) were matched by medical school graduation year and specialty choice. Predictor variables were male gender, undergraduate grade point average, Medical College Admission Test scores, medical school grades, National Board of Medical Examiner Part 1 scores, and negative excerpts describing unprofessional behavior from course evaluation forms, dean's letter of recommendation for residencies, and administrative correspondence. Negative excerpts were scored for severity (Good/Trace versus Concern/Problem/Extreme). The outcome variable was state board disciplinary action.

Results

The alumni graduated between 1943 and 1989. Ninety-five percent of the disciplinary actions were for deficiencies in professionalism. The prevalence of Concern/Problem/Extreme excerpts in the cases was 38% and 19% in controls. Logistic regression analysis showed that disciplined physicians were more likely to have Concern/Problem/Extreme excerpts in their medical school file (odds ratio, 2.15; 95% confidence interval, 1.15–4.02; p = .02). The remaining variables were not associated with disciplinary action.

Conclusion

Problematic behavior in medical school is associated with subsequent disciplinary action by a state medical board. Professionalism is an essential competency that must be demonstrated for a student to graduate from medical school.