The Roots of Disciplinary Action by Medical Boards
The Roots of Disciplinary Action by Medical Boards
Abstract & Commentary
By Frank W. Ling, MD, Clinical Professor, Dept. of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, is Associate Editor for OB/GYN Clinical Alert.
Dr. Ling reports no financial relationship to this field of study.
Synopsis: Disciplinary action by medical boards is strongly associated with unprofessional behavior in medical school.
Source: Papadakis MA, et al. Disciplinary action by medical boards and prior behavior in medical school. N Engl J Med. 2005;353:2673-2682.
In this case-control study, the authors matched 235 graduates of 3 medical schools who were disciplined by their respective medical boards between 1990 and 2003 with 469 control physicians who were matched based on graduation year and medical school. The schools studied were Jefferson Medical College of Thomas Jefferson University in Philadelphia, the University of California, San Francisco School of Medicine, and the University of Michigan Medical School in Ann Arbor. The authors state that these schools were chosen for the purposes of geographic diversity and to represent private and public institutions.
Disciplinary action was found to be strongly associated with unprofessional behavior in medical school (OR, 3.0; 95% CI, 1.9-4.8). Most strongly linked were severe irresponsibility (OR, 8.5; 95% CI, 1.8-40.1) and severely diminished capacity for self-improvement (OR, 3.1; 95% CI, 1.2-8.2). Weaker associations were found with low MCAT scores and poor grades in the first 2 years of medical school.
Commentary
Like it or not, we are all in this practice of medicine together. Part of the responsibility of being part of this system is to maintain standards of behavior, both for ourselves and others. Call it role-modeling; call it self-policing. Just as we are to act professionally, so are we to hold others to similar standards. These data ring out loudly as an endorsement for the teaching of Professionalism as a core competency, both at the medical school and residency level. Admittedly, the rate of disciplinary action is thankfully low, 0.3%. It should be noted, however, that disciplinary actions likely represent only the most extreme cases.
Each of us, as individuals, have little, if any, ability to alter the system of student (and resident) behavior. Fortunately, administrators have begun the difficult task of institutionalizing measures of professional behavior. Systems of evaluation are being developed and/or implemented. Feedback to the learner, both formal and informal, is critical to develop the next generation of physicians. We cannot, however, remove ourselves from the equation, because it is on each of our respective shoulders to be the eyes and ears of the system.
Without realizing it, each of us role models the professional behavior of a physician every day that we function in practice. We may not be teaching as part of the curriculum of a medical school, but we are behaving in a public arena, observed by patients, their families, and other professionals. Each physician probably has a story that demonstrates how the “ripple effect” of something you said or did with a patient affected someone's perception of what a doctor is or is not. Similarly, many of us are involved with clinical instruction of students and residents as volunteer faculty at one or more medical schools. Again, we serve as role models as we not only teach, but act professionally for all the learners to watch and internalize.
Within the formal curriculum, we are given the opportunity to evaluate the learner, and it is here that I urge everyone to take on this responsibility with all due respect. As the data here demonstrate, some behaviors cannot and should not be acceptable. If you are concerned, that concern should be documented. This is for the benefit of not only patients, but also the learner. Who knows what other incidents might fall into the same pattern either before or after the episode that you observe? Is it “tattling” or “ratting out” a student/resident? Putting it in perspective, I would submit that it is our duty to report unprofessional behavior.
Certainly the bars are set differently for the student, the resident, and the practitioner. Each must be met on a continuous basis. Getting to the point of disciplinary action by a state medical board is bad stuff, but what leads up to it is merely a series of events that have gone unchecked. Hopefully each of us has the inner strength to speak up for what is right, regardless of whether the individual is a student, a resident, or even another practicing physician. We should all recall that we are called to a profession that has standards that cry out for enforcement. “Physician, heal thyself.” Words to live by.
In this case-control study, the authors matched 235 graduates of 3 medical schools who were disciplined by their respective medical boards between 1990 and 2003 with 469 control physicians who were matched based on graduation year and medical school.Subscribe Now for Access
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