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.
The professional behavior of physicians and trainees has received increasing attention from medical school educators, the broader community of medicine, and society at large.1-4 The University of California, San Francisco (UCSF), School of Medicine has a professionalism evaluation system that monitors students' professional behavior longitudinally across their four years of medical school.5,6 Begun in 1995, the goals of this system are to identify medical students who demonstrate unprofessional behavior, provide a uniform evaluation and response to unprofessional behavior, and to remediate that deficiency. If a student receives a less-than-satisfactory rating on professional skills at the end of any course or clerkship, a Professionalism Evaluation Form is submitted. The student and the school then work to remediate the student's deficiencies. Deficiencies in professional skills identified in two or more clerkships (or two courses in the first two years and then a clerkship) are considered to reflect a pattern of deficiencies in professional behavior. At minimum, the dean's letter for application to residency programs will document these areas of concern or deficiencies. In addition, the student is placed on academic probation and, if the professional violations are severe, may be dismissed despite attaining passing grades in all courses and clerkships.
There are other professionalism assessment tools for medical students, but the adequacy of existing assessment tools is uncertain.7,8 For example, we do not know whether professionalism inadequacies in students affect their subsequent professional performance as physicians. We hypothesized that unprofessional behavior in medical school, rather than more traditional measures such as demographic characteristics and undergraduate and medical school measures of academic performance, predicts subsequent state board disciplinary action. To test this, we conducted a case-control study of UCSF School of Medicine graduates disciplined by the Medical Board of California.