Do Professionalism Lapses In Medical School Predict The Future? 

Professionalism — Probably to some extent, according to the 20+ year case-control study of graduated medical students from Harvard and Case Western medical schools.  Case were 108 students appearing before a review board for professionalism concerns; these were compared to 215 controls matched for gender, under-represented minority status, and year of graduation.  Comparisons were made at several time points based on information available to the researchers:  academic and demographic items at matriculation; academic achievements during medical school; professionalism surveys completed retrospectively by residency program directors; and state board information about board sanctions and malpractice suits.  Cases and controls looked very similar at matriculation, with similar undergraduate institutions, college majors, MCAT scores, and family educational attainment (50% of the students’ fathers had doctorate degrees).  During medical school the academic performance of case students coming to professionalism review was substantially worse than that of their peers as measured by licensing exam scores (Step 1 and Step 2 CK) and clerkship grades. which is interesting given the very similar MCAT scores.  Despite a 50% survey response rate from residency program directors, unsurprising given the passage of time, case students were rated far lower than their peers (with p <0.05) for a wide variety of behaviors during residency: treating colleagues with respect; incorporating feedback; honesty; team functioning; taking responsibility for shortcomings; and trustworthiness.  They were much more likely to “require remediation or counseling” (35% vs. 9%) and the residency director was much less likely to feel “strongly enthusiastic” about the resident possibly applying to be a faculty member (29% vs. 56%).  After residency, there was a small, non-significant trend for increased sanctions by state boards in the cases, 4% vs. 1%, and increased malpractice claims, but these were small trends and not corrected for specialty.  These data suggest that the rare student coming to a review board for professionalism reasons is much more likely to have academic difficulty and to display continuing professionalism misbehaviors during residency than their peers.  The post-residency outcomes measured here are probably somewhat  insensitive for professionalism difficulties, with a small number of outcomes impairing the ability of this study to find a difference (which have been found in some other studies). — Laura Willett, MD

Krupat E, Dienstag JL, Padrino SL, Mayer JE Jr, Shore MF, Young A, Chaudhry HJ, Pelletier SR, Reis BY Do Professionalism Lapses in Medical School Predict Problems in Residency and Clinical Practice? Acad Med. 2019
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