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.

Sources: 

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. http://lcme.org/publications/ (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).