Newswise — Physicians disciplined by state medical boards during their professional medical careers were three times more likely than their colleagues to have exhibited unprofessional behavior while in medical school, according to a new study. Study findings are reported in the Dec. 22 issue of the New England Journal of Medicine.

The researchers looked for early warning signs during medical school that were associated with a higher risk for disciplinary action when the students became practicing physicians.

Behavior for which physicians were disciplined included use of drugs or alcohol, unprofessional conduct, conviction for a crime, and negligence. Unprofessional behavior in medical school was the strongest risk factor for later disciplinary action by a state medical board. In contrast, more traditional measures of academic success, such as performance on the Medical College Admission Test and early medical school grades, were much weaker risk factors for later disciplinary action, according to the study.

"When medical schools increase their attentiveness to the measurement of professional behavior, it helps to assure the competency of graduates. It also helps fulfill a commitment to our patients, who are increasingly insisting that physicians have not only intellectual and technical competency, but interpersonal and professional competency as well," says co-author David Stern, M.D., Ph.D., who is an associate professor of internal medicine and medical education at the University of Michigan Medical School.

This is the first national study that links performance during medical school with later disciplinary action.

"Likely, there will be many more studies that identify behaviors in medical school and link them to behaviors among practicing physicians. It helps to demonstrate the value of working with students to make sure we graduate physicians who won't be likely to lose their licenses down the line," Stern says.

The study included 235 graduates since 1970 of three geographically diverse medical schools representing both public and private institutions " University of Michigan Medical School in Ann Arbor, University of California, San Francisco School of Medicine, and Jefferson Medical College of Thomas Jefferson University in Philadelphia " who were disciplined by one of 40 state medical boards between 1990 and 2003. They were matched with 469 control physicians according to medical school and graduation year.

The study looked at a broad range of unprofessional behaviors among medical students. The strongest association with disciplinary action was seen in students who were irresponsible in attendance or patient care. These students were nearly nine times more likely than their colleagues to be disciplined when they became practicing physicians.

"Professionalism can and must be taught in medical school," notes the study authors. As part of this, the study recommends that medical school admissions and graduation standards should be reviewed to make sure they contain explicit language about professional behavior and that professionalism should be an important part of the curriculum. It also recommends that standardized methods should be implemented for both assessing the personal qualities of medical school applicants and predicting their performance.

Stern notes that the study results are not necessarily predictive of future doctors' behavior, although it can help identify those medical students who are at risk and offer remediation while still in school.

"Since this is a retrospective study, it looks back as long ago as 30 years. In the last 10 years or so, many schools " especially Michigan " have taken a serious look at professional behavior and work to ensure that graduates are professionally competent," he says.

Maxine A. Papadakis, M.D., professor of clinical medicine at the University of California, San Francisco and associate dean of student affairs at UCSF School of Medicine, led the research team. In addition to Stern, other co-authors included Timothy R. Knettler, MBA, of the Federation of State Medical Boards, Arianne Teherani, Ph.D., and Mary A. Banach, Ph.D., MPH, of UCSF; Susan L. Rattner, M.D., of Jefferson Medical College; Jon Veloski, MS, of JMC; and Carol S. Hodgson, Ph.D., of the University of Colorado at Denver and Denver Health Sciences Center.

This study was supported in part by a grant from the Edward J. Stemmler, M.D. Medical Education Research Fund of the National Board of Medical Examiners.

Stern, who is also a Senior Research Scientist at the Center for Human Growth and Development and Staff Physician at the Veterans Affairs Ann Arbor Healthcare System, is the editor of Measuring Medical Professionalism, Oxford University Press, 2005, a theory-to-practice text focused on ways to evaluate professional behavior in physicians.

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