The Science Smith

Unprofessional Behavior in Medical School Predicts Misconduct in Clinical Practice

Medical SchoolNicholas Smith

Papadakis et al. found a significant correlation between unprofessional behavior in medical school and future disciplinary action by medical licensing boards (Papdakis 2005). They found that physicians cited by state medical boards were three times as likely to have displayed unprofessional behavior during medical school compared to their cohorts. It is important that we focus on better understanding what drives this relationship, so that we may reduce professional misconduct among doctors and improve the future of healthcare. The processes involved are complex, but some researchers have already begun to unpack them. Lack of standard definitions, assessments, and training procedures are some reasons allowing unprofessional medical students become at-risk for misconduct in their medical careers.

Currently, there are no unified definitions for what classifies as professional and unprofessional within medical settings. Professionalism is complex. What might be acceptable behavior in one setting may be inappropriate in another. Due to the subjective and transient nature of professional behavior, medical student perceptions of what is and what is not professional have shown to be inconsistent (Jamalabadi 2018). After performing a survey, Jamalabadi et al. found that for students who passed the same professionalism course still had significantly different perceptions surrounding what constitutes as unprofessional behavior. Despite receiving the same curriculum, discrepancies exist between these students when they must apply what they have learned to situations. If these misperceptions as students go unaddressed, they could lead to professional missteps as medical providers.

Differences in understanding professional behavior among medical students necessitate standardization of assessments. Fargen et al. noted that developing validated instruments to evaluate behaviors scientifically will be an important step forward in improving behavior in residents and physicians (Fargen 2016). According to the Liaison Committee on Medical Education (LCME), medical schools must develop

“effective written policies that address violations of the code, has effective mechanisms in place for a prompt response to any complaints, and supports educational activities aimed at preventing inappropriate behavior” (LCME 2016).

The current LCME policy allows individual medical schools to develop their own evaluation practices regarding professionalism. While this liberty is justified given the geographical diversity of American medical schools, new policies could be implemented to standardize measurements of medical students across all schools. By unifying how we measure medical student’s professional competence, red flags may be discovered sooner while they are still training rather than while practicing as licensed physicians.

As soon as these red flags are discovered through evaluations having an appropriate and standard course of action for students is necessary. Once medical students are cited for unprofessional behavior, there may not be consistent feedback for them (Papadkis 2001). This observation prompted administrators at the University of California San Francisco School of Medicine to change their curriculum to increase evaluations of their students and include “intensive remediation” for students failing to meet certain benchmarks of their professionalism standards. Students who receive inadequate or inconsistent training after signs of professional misconduct could develop issues as physicians. More robust professional remediation programs in medical schools could improve these outcomes, especially after certain program standards have not been met by specific individuals.


1. Fargen, K. M., Drolet, B. C. & Philibert, I. Unprofessional Behaviors Among Tomorrow’s Physicians: Review of the Literature With a Focus on Risk Factors, Temporal Trends, and Future Directions. Acad Med 91, 858–864 (2016).

2. Jamalabadi, Z. & Ebrahimi, S. Medical students’ experiences and perspective on unprofessional behavior in clinical practice. J Adv Med Educ Prof 6, 31–36 (2018).

3. Liaison Committee on Medical Education. Functions and Structure of a Medical School: Standards for Accreditation of Medical Education Programs Leading to the MD Degree. (2017).  

4. Papadakis, M. A., Loeser, H. & Healy, K. Early Detection and Evaluation of Professionalism Deficiencies in Medical Students: One School’s Approach. Academic Medicine 76, 1100–1106 (2001).

5. Papadakis, M. A. et al. Disciplinary action by medical boards and prior behavior in medical school. N. Engl. J. Med. 353, 2673–2682 (2005).

Study Hack: Book Binding

SuccessNicholas SmithComment

Hi all! Today I wanted to share a useful and simple study hack – book binding. This is helpful for those of you who have multiple review books for your classes or one large go-to text (like FirstAid).  Binding has allowed me to stay organized and to streamline my studying. I often have multiple books open, a notepad, planner, and computer on my desk at once. Spiral binding allows you to fold-over your books, freeing up space on your desk. By the way this can help you when studying in coffee shops or places with limited table space. Decluttering your space improves your focus and efficiency. Additionally, I find that the spiral binding facilitates flipping through the pages. This is nice especially when I am reviewing answers to practice questions at the end of a chapter or appendix. Here I will show you how to have your materials bound and things to consider before doing so. 

Just a few examples of what spiral binding looks like! 

Just a few examples of what spiral binding looks like! 

1. Decide which books to bind

This should be easy, but there are some considerations you should make especially if you are in medical school or a science graduate program as you likely have many books. You might need to narrow it down because binding can get expensive. For those of you in medicine, prioritize FirstAid and your go-to review question books (like Pre-Test, BRS, or Case Files). Lay out your books and choose the materials you use most when studying. Also, consider if it is worth to bind them. This generally comes down to a book’s weight and thickness. For example, I decided not to bind my Pathoma book because it is lightweight. Additionally, there are no questions with answers in the back that I need to quickly reference so I ruled out having Pathoma bound. I also only had my paper back books bound, but you can still spiral bind your hardback books. I just decided against it since hardbacks are typically more expensive books to begin with and I like having them on my shelves just for reference. For those books that you decide against binding you can always bind them later or bind them yourself if you are ambitious enough. See the section on DIY spiral binding.

2. Compare locations that offer spiral binding services for the best price

I had my books bound at FedEx Office, which as of this writing offers the service for about $5 per book. If you are currently a member of a university, you should see if the library or information technology departments offer binding services. Most universities do, but they get busy around mid-terms and finals so be sure to be proactive as you don’t want to be without your study materials for a long period of time! I have found that whether you go through the commercial-route or university-route the prices are comparable. You can possibly get them bound for free! Some public libraries might offer free (or reduced rate) book binding services so definitely check your local libraries to potentially save some money. Here are other places that have spiral binding services to consider: Office Depot, Staples, and UPS stores, local stationary/office supply stores.  

3. Have more time than money? Do it yourself to cut down on costs.  

Maybe its Summer or Winter break and you enjoy working with your hands! Stores and Universities have fancy machines that quickly punch holes in your books, but these are too expensive and unnecessary to purchase. There are tutorials online that show you how to bind books without a machine, but just a warning they are labor intensive, which is why I decided to just do it at a store. Those of you who are up for a challenge, need a creative outlet, or really do just enjoy working with your hands this could be a rewarding process for you. I know that if I had personally bound my books I might have a deeper level of appreciation for them. Here are some tutorials that you should check out if you are interested in going this route: 

Whether you decide to get them bound professionally or to DIY, you will thank yourself for doing so. It really has changed the way I study. I can go on walks with my dog and bring a review book with me since now I can fold over the pages, holding the book in one hand and the leash in the other. Imagine trying to walk a dog with an unbound version of FirstAid! 

Please comment below if you have your own experiences with book binding or if you have any additional questions about the process.