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    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov

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    Friday, December 23, 2005

    Attendance Counts: Can irresponsible behavior in medical school predict who will become bad doctors? Some academic specialists think so. And they say attendance is one of the indicators:

    The study looked at a broad range of unprofessional behaviors in medical students. The strongest association with disciplinary action was seen in students who were irresponsible in attendance or patient care. These students were nearly nine times more likely than their colleagues to be disciplined when they became practicing physicians.

    The study is in yesterday's New England Journal of Medicine, and the data aren't as impressive as the press release makes it sound.
    Thirty-nine percent of physicians who were disciplined at some point in their careers by state medical boards had, in retrospect, some form of unprofessional behavior identified in their medical school records, compared to only 19% of the doctors who had never been disciplined. But, when the authors broke the bad behavior down into specifics, the differences weren't all that remarkable - the two groups only differ by about 6-7 percentage points in any one category. The widest disparity was in "capacity for self improvement" and "irresponsibility." The small absolute differences mean that it's still hard to predict who will be a bad doctor - although chances are if someone's a jerk in medical school, they'll be a jerk in the real world, too.

    The authors published more detailed information on rating medical school behavior in this earlier paper, which includes this evaluation of "physicianship skills".

    They are somewhat subjective, and could potentially be used punatively by a professor to punish a student. Although some students are very good at fighting back:

    Student B, a second-year student, received a Physicianship Evaluation Form because s/he missed several preceptorship sessions, was not sensitive to the needs of patients, and did not respond to feedback and make appropriate changes in behavior. A community-based preceptor, who is an experienced faculty member who had precepted many students, initiated these comments. The course director was convinced of the merits of the observations after discussions with the preceptor, who was considered to have excellent judgment and insight. The student felt that it was inappropriate that s/he receive a Physicianship Evaluation Form. This resulted in extensive communications over a three-month period between the student and the preceptor, course director, ombudsperson, and administration. An informal resolution session was held between the student, the ombudsperson, the course director, and the associate dean for student affairs. The student supplied documentation that demonstrated his/her appropriate attendance at the preceptorship. The course director retracted that aspect of the negative evaluation that had to do with attendance, but not the other remaining deficiencies in professional development. The student received extensive feedback during the multiple interactions, but it is uncertain whether the student was able to incorporate the feedback constructively. The preceptor was so annoyed with the frequency and intensity of the interactions that he is no longer willing to precept our students.

    And this:

    Student C, a second-year student, received a Physicianship Evaluation Form under the category of "relating well to faculty in a learning environment" for making an inappropriate comment about the quality of a written examination to fellow classmates while the examination was in session. At the meeting with the associate dean for student affairs, the student explained that the course director had established a casual environment with friendly interchanges between faculty members and students. The student readily acknowledged his/her behavior, but felt that submission of the form was punitive rather than educational. The student also did not know of the existence of this new professionalism-evaluation system, materials for which had been distributed at the orientation at the beginning of the academic year. S/he made constructive, insightful comments about the process. This interaction highlighted that there are many ways to help a student with professional development. In this instance, one-on-one feedback may have sufficed, which would have lessened the pain that the student felt because s/he received a form.

    Maybe medical schools should treat medical students the way an employer does an employee - make attendance count, and have quarterly evaluations of behavior in addition to grades. But do it for everyone, not just for the problem students.

    P.S. Wouldn't "professionalism" be a better word than "physicianship skills"? Or, even "form" - as in "good form" vs. "bad form"?

    posted by sydney on 12/23/2005 08:43:00 AM 1 comments


    "Maybe medical schools should treat medical students the way an employer does an employee - make attendance count, and have quarterly evaluations of behavior in addition to grades."

    Maybe we should shelve this idea until medical schools are also able to pay me like an employee.

    You can't undo twenty years in four. I mean, if you don't know right from wrong coming in, you're not going to know it going out.

    Certainly, there's something to be said for training in professionalism, such as being taught to handle critiques, for example, but reading some of these examples you see evidence of much worse - lack of empathy for patients, disrespect for authority, etc.

    So, if you truly feel this is a major problem, then the focus needs to be on becoming better at deciphering applicant's attitudes and making such a much bigger part of the selection criteria. I don't know if the focus can be on trying to browbeat students once they're here.

    By Blogger TXMed, at 11:38 AM  

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