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

Abstract

Supplemental Digital Content is available in the text. 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 for 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 with 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 vs 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.