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Nancy LC
Wed, Dec-21-05, 20:43
Your doctor was a cut-up in school? He might still be... literally! :lol:

http://www.forbes.com/lifestyle/health/feeds/hscout/2005/12/21/hscout529812.html

Health
Bad Students Can Turn Out To Be Bad Doctors


WEDNESDAY, Dec. 21 (HealthDay News) -- Doctors who misbehave in medical school are more likely to have disciplinary action taken against them by medical boards when they become practicing physicians, a new study has found.

In particular, students who were described as irresponsible or not able to improve their behavior were most likely to run into trouble later on, according to research in the Dec. 22 issue of the New England Journal of Medicine.

The study is a first step toward being able to identify and incorporate subjective concepts -- such as personal behavior or professionalism -- into medical education, said Dr. Lynne Kirk, associate dean for graduate medical education at the University of Texas Southwestern Medical Center in Dallas, and author of an accompanying editorial in the journal.

"This gives us much more specific information," she said. "If we see people with certain behaviors in the third year of medical school, we do everything we know how to help them improve. If we continue to see problems, we have to ask if this is somebody we want to graduate."

Study author Dr. Maxine Papadakis, associate dean for student affairs at University of California, San Francisco, said: "We want to identify people in their formative medical education stage who may have problems down the pike so we can remediate them. The big goal is to increase the quality of patient care."

Only a small number of physicians in the United States are disciplined: 0.3 percent of a total of about 725,000 physicians, the researchers said.

The data on professionalism in medical students and doctors is lacking, the study authors said.

The same group of researchers behind the new study had previously done a study of medical school graduates from UCSF. The researchers found that disciplinary action taken against working physicians was associated with prior unprofessional behavior when the physicians were still students.

The new study broadened the inquiry to three medical schools, to see if the original findings held true at other schools and other state medical boards.

The researchers looked at 235 graduates of the University of Michigan Medical School in Ann Arbor, Jefferson Medical College of Thomas Jefferson University in Philadelphia, and the UCSF School of Medicine. All doctors had graduated since 1970 and had been disciplined by a state medical board between 1990 and 2003.

These physicians were compared with 469 "control" physicians who had graduated from the same schools in the same years but had not been disciplined.

Unprofessional behavior in medical school was determined by looking at narratives describing unprofessional behavior, grades and standardized test scores, among other measures.

Doctors who had exhibited unprofessional behavior in medical school were three times more likely to be disciplined by a medical board than students who had not had such problems in medical school, the study found.

But doctors who had exhibited certain types of behavior in medical school were even more likely to be cited by a medical board: Those who behaved unprofessionally in school were 8.5 times more likely to be disciplined while those with a diminished capacity for self-improvement were 3.1 times more likely to be disciplined, according to the study.

The students were deemed irresponsible if they were late for rounds, didn't show up for the clinics they were assigned to, or didn't finish taking care of a patient.

"It was that lack of the compulsiveness which you would like a physician to have," Kirk said.

Also, doctors who had been disciplined had lower scores on the Medical College Admission Test and poor grades in the first two years of medical school, although these associations were weaker, the study authors said.

The violations among the 235 physicians that led to disciplinary actions included use of drugs or alcohol, negligence, sexual misconduct, fraud and failure to meet continuing medical education requirements. Many of these physicians were repeat offenders, the study authors said.

This study provides empirical support for including professionalism as a core "competency" in graduate medical education, the researchers said.

"This will allow us to look closely at our evaluations and make sure that we have specific examples of these behaviors so that we really focus the evaluator, the faculty member, to specifically comment on these," Kirk explained.

"We're talking about a very small group, but something may happen in medical school or any time in our lives so that we start demonstrating these behaviors," she added. "If it's something we can fix, we would certainly want to do that."

Duparc
Thu, Dec-22-05, 09:14
I am not happy with the premise of this article. It is tantamount to saying either you fall into alignment with the prevailing culture (whether it is negative or position) or you are out! It is akin to saying I know better and if I do not like you then you will be black-balled. Its leanings are towards encouraging discrimination and the abuse of power.

Colleges tend to have a laisser-faire approach toward student discipline and this might be the problem area that needs resolving. Read the delightful book by Rosa Ehrenreich, "A Garden of Paper Flowers" to learn what takes place behind the cloisters of academe. Students should be compelled to attend lectures, seminars, and work place experience, and to be prompt. Failure to do so on a regular basis should invoke the penalty of dismissal. Allowing discretion under training could foster arrogance which could equally become indelible but, is this the fault of the student who is testing the boundaries of authority and control in his/her new found freedom, or is it the fault of the college's ethos?

Problems of an organisation do not start at the bottom and percolate upwards but rather reflect the absence of effective leadership by its chief executive. Too often those problems are blamed on subordinates, or the lack of resources, or finances, or the need for additional training, but, those are excuses designed to protect the chosen one, maintain the status quo, or to 'feed bananas to the monkeys'.

Compulsion fosters self-discipline and self-awareness; freedom creates anarchy.

LC FP
Thu, Dec-22-05, 10:35
Compulsion fosters self-discipline and self-awareness; freedom creates anarchy.

Duparc, will you talk to my daughter?

Angeline
Thu, Dec-22-05, 12:02
I don't know Duparc. If they were talking about conformism and adhering to the party line as it were, I'd tend to agree with you. But things like "The students were deemed irresponsible if they were late for rounds, didn't show up for the clinics they were assigned to, or didn't finish taking care of a patient." That seems like a reasonable expectation that a doctor should be dependable and care about his job and therefore his patient.

I find that professionalism is something you have or you don't. It will be sometimes be negatively influenced by job conditions such as how much you like your job, or how you are treated. But overall it's an attitude you develop early. So yes, medical students who act like they don't care should be weeded out early. The profession being lucrative does attract people who are only in it for the money. However being a doctor ideally should be a calling, not a meal ticket.

Angeline
Thu, Dec-22-05, 12:11
Duparc, will you talk to my daughter?
That's one of those unfortunate things that come with wisdom. Looking back you wish your parents had been more insistent about self-discipline but that's the power of hindsight. Rare is the teen that will gladly accept being denied. It's all about what they want right here and right now and damn the consequences. Parents don't understand anything anyway. I think that's a universal trait of adolescence. Might even have an evolutionary purpose who knows.

Duparc
Thu, Dec-22-05, 13:43
LC FP: Having brought-up three daughters myself you have my sincerest commiserations! If you invite your boss and his wife to your home for dinner you invariably find you have to apologise for brassiers, knickers, and stockings, hanging across the backs of chairs!

Seeking to balance the concepts of care, concern, and the freedom of imposition needed to develop into well adjusted adults (and without a text-book either) is one of the burdens of parenthood.

Slightly off-topic but still on the theme of management and influence as related by the article; you will probably have noticed from your calling that in the case of children being of the same gender in a family that the parent of the opposite sex is the dominant partner and, in the situation of mixed sexes, then the parents continue to battle over supremacy. Just a small point of personal observation. Having said this I have probably put my head above the parapet!

Incidentally, on a more sober topic, my middle daughter became chronically obese during her adult years. My late wife and I tried different styles of counselling and cajoling her to lose weight but she resisted. At the age of 45 she succumbed to BC. I have no doubt that it was diet related.

LC FP
Thu, Dec-22-05, 16:17
Thank you, Duparc, for your wisdom and experience. I am sorry for your loss. I hope your holiday season is cheerful nonetheless.

I only have the one child. This is tougher on her than it is on me, I'm sure. There are a lot of expectations for her to deal with, probably more than any one person can meet.