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Acad Med. 2019 Dec 31. doi: 10.1097/ACM.0000000000003145. [Epub ahead of print]

Do Professionalism Lapses in Medical School Predict Problems in Residency and Clinical Practice?

Author information

1
E. Krupat is associate professor of medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. J.L. Dienstag is interim dean for faculty affairs and professor of medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. S.L. Padrino is assistant dean for clinical sciences, and assistant professor, Departments of Medicine and Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio; ORCID ID: http://orcid.org/0000-0001-5637-5870. J.E. Mayer Jr. is professor of surgery, Boston Children's Hospital, Boston, Massachusetts. M.F. Shore, deceased, was professor emeritus, Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Massachusetts. A. Young is assistant vice president, Research and Data Integration, Federation of State Medical Boards, Euless, Texas; ORCID ID: http://orcid.org/0000-0002-5517-5874. H.J. Chaudhry is president and chief executive officer, Federation of State Medical Boards, Euless, Texas; ORCID ID: http://orcid.org/0000-0003-3356-1106 S.R. Pelletier is senior project manager, Office of Educational Quality Improvement, Harvard Medical School, Boston, Massachusetts. B.Y. Reis is director, Predictive Medicine Group, Harvard Medical School and Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts.

Abstract

PURPOSE:

Recognizing that physicians must exhibit high levels of professionalism, researchers have attempted to identify the precursors of clinicians' professionalism difficulties, typically using retrospective designs that trace sanctioned physicians back to medical school. To better establish relative risk for professionalism lapses in practice, however, this relationship must also be studied prospectively. Therefore, this study investigated the sequelae of medical school professionalism lapses by following students with medical school professionalism problems into residency and practice.

METHOD:

Beginning in 2014, 108 graduates from Harvard Medical School and Case Western Reserve University School of Medicine who appeared before their schools' review boards between 1993 and 2007 for professionalism-related reasons were identified, as well as 216 controls matched by sex, minority status, and graduation year. Prematriculation information and medical school performance data were collected on both groups. Outcomes for the groups were studied at 2 points in time: ratings by residency directors; and state medical board sanctions and malpractice suits during clinical practice.

RESULTS:

Compared to controls, students who appeared before their schools' review boards were over 5 times more likely to undergo disciplinary review during residency (16% vs. 3%, respectively) and almost 4 times more likely to require remediation or counseling (35% vs. 9%, respectively). During clinical practice, 10% of those who had made review board appearances were sued or sanctioned versus 5% of controls. Logistic regression for these outcomes indicated, however, that professional lapses in medical school were not the only, or even the most important, predictor of problems in practice.

CONCLUSIONS:

Students with professionalism lapses in medical school are significantly more likely to experience professionalism-related problems during residency and practice, although other factors may also play an important predictive role.

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