Professionalism starts in med school

Medical students who behave unprofessionally are likely to display similar behavior as physicians, a new study has found.

Researchers said the findings in the March Academic Medicine show that medical students display warning signs of future disciplinary action by state medical boards. They urged better evaluation tools and other efforts to keep students out of trouble.

"Far and away, physicians do an outstanding job when one looks at the percentages. But there are occasionally problems that are identified in medical school that need higher levels of action and attention," said lead study author Maxine Papadakis, MD, professor of clinical medicine at University of California, San Francisco, School of Medicine, and associate dean of student affairs.

The study examined UCSF graduates who were disciplined by the Medical Board of California from 1990 to 2000. Alumni in the study graduated between 1943 and 1989. The 68 disciplined doctors reviewed by researchers were found through a search of the medical board's database.

Researchers analyzed data including grade point average, comments on unprofessional behavior from course evaluation forms, deans' letters of recommendation for residencies and other correspondence. The UCSF medical school has a professionalism evaluation system that monitors students' behavior during their years in school. Researchers said the American Board of Internal Medicine defines professionalism as requiring "the physician to serve the interests of the patient above his or her self-interest."

The study said 1% of UCSF graduates had been disciplined by the medical board between 1990 and 2000. The main reason for discipline in 65 of the 68 studied physicians was violation of professionalism, with negligence being the leading violation.

Students who received comments about unprofessional behavior were more than twice as likely to be disciplined by the medical board when they became practicing physicians, the study said.

Traditional measures such as grades and scores on national standardized tests did not identify students who would experience problems as physicians.

Physicians support study's findings

Educators and medical board leaders said the study's results likely are echoed in other states.

"In my 4½ years on the [medical] board, I would support [the study's] conclusion, based on what I've seen," said David Garza, DO, a member of the Texas State Board of Medical Examiners and family physician in Laredo, Texas.

"Sometimes, they've got personality traits that just aren't going to change [after med school]."

Educator Tee Guidotti, MD, MPH, agrees.

"If they try to get away with something in medical school, then later on when there's much less supervision, they're going to try to get away with more," said Dr. Guidotti, professor of occupational and environmental medicine at George Washington University Medical Center in Washington, D.C.

The study's authors said early identification of problems could help turn around a student's behavior. They said professionalism is a competency that must be demonstrated for a student to graduate from medical school.

"When the student does not attain these skills, then the student should not finish medical school," Dr. Papadakis said

Teaching professionalism

An official at the Assn. of American Medical Colleges said schools are doing a better job of teaching professionalism. "All schools are including content related to professionalism in the earliest stage of their curriculum," said Michael Whitcomb, MD, AAMC senior vice president for medical education.

Some medical boards encourage greater cooperation with medical schools as a way to keep students out of trouble. In North Carolina, for example, educators have met with the North Carolina Medical Board to discuss issues such as licensing and discipline, said James Thompson, MD, CEO of the Federation of State Medical Boards.

"In some states, the medical school deans are invited to participate in medical board activities," he said. "[Nationwide] some deans attend [board meetings] regularly, and others don't know where the board offices are."

Physician counselor Wayne Sotile, PhD, said there are no fail-safe predictors of which students will have unprofessional behavior as physicians. But when problems arise, schools should provide students with the appropriate help early enough to change behavioral patterns -- or risk sending troubled doctors into the profession.

"Problem medical students can grow up to be problem physicians," said Dr. Sotile, co-director of Sotile Psychological Associates in Winston-Salem, N.C. "You either learn [professionalism] in medical school or you're going to be forced to learn it later."