Thursday, December 22, 2005

Garbage In = Garbage Out....
From USA Today and the NEJM:Bad med students, bad docs:
Physicians disciplined by state medical boards were three times more likely to have shown unprofessional behavior while in medical school than those with no discipline records, a study in today's New England Journal of Medicine finds.
"We found that for physicians disciplined by licensing boards, the strongest association in medical school was unprofessional behavior," says Maxine Papadakis, lead author on the study and the dean for student affairs at the University of California-San Francisco medical school.

Score another for evidence-based medicine:
Thompson, the former dean of Wake Forest University School of Medicine in Winston-Salem, N.C., says medical educators have always known intuitively that there was a connection between unprofessional behavior in medical school and later problems. But Papadakis' work "adds science at a time when we're demanding an evidence base for our judgments," Thompson says.
From the abstract of the article:Disciplinary Action by Medical Boards and Prior Behavior in Medical School
Results Disciplinary action by a medical board was strongly associated with prior unprofessional behavior in medical school (odds ratio, 3.0; 95 percent confidence interval, 1.9 to 4.8), for a population attributable risk of disciplinary action of 26 percent. The types of unprofessional behavior most strongly linked with disciplinary action were severe irresponsibility (odds ratio, 8.5; 95 percent confidence interval, 1.8 to 40.1) and severely diminished capacity for self-improvement (odds ratio, 3.1; 95 percent confidence interval, 1.2 to 8.2). Disciplinary action by a medical board was also associated with low scores on the Medical College Admission Test and poor grades in the first two years of medical school (1 percent and 7 percent population attributable risk, respectively), but the association with these variables was less strong than that with unprofessional behavior.
Interestingly failure of courses the first two years of school had a higher association that did failures the third or fourth years. Also academic honesty issues were not examined. How were they selected? Let us see:
The physicians who had been disciplined were graduates of three medical schools since 1970: the University of Michigan Medical School in Ann Arbor, Jefferson Medical College of Thomas Jefferson University in Philadelphia, and UCSF School of Medicine. These schools were chosen for reasons of geographic diversity and to provide representation of both public and private institutions. In addition, complete records for their graduates were available. The physicians from the University of Michigan and Jefferson Medical College included all graduates disciplined by any state medical board in the United States between 1990 and 2003. The physicians from UCSF included all graduates disciplined by any state board other than the Medical Board of California during the same period. UCSF graduates disciplined by the Medical Board of California were excluded from this study, because they had been described previously.

All physicians were identified through a search of public records maintained in databases by the Federation of State Medical Boards. The disciplinary actions taken against physicians are available to the public according to individual state laws. The disciplinary actions range from public reprimand to revocation of the medical license. According to the Federation of State Medical Boards, even behavior that results in the least severe disciplinary action — public reprimand — may adversely affect patients. Three persons, two of whom were staff members at the Federation of State Medical Boards, classified the disciplinary actions of the state boards into three categories: unprofessional behavior, incompetence, and violation with the category not determined.
While the disciplinary records of physicians are rightly public, aren't there some regulations about the privacy of academic records? Mind you, this isn't raw data removed of names and SSN's, these researchers had the names of disciplined physicians, and obtained their medical school transcripts. In addition, they obtained twice as many records of "non-disciplined" physicians:
In the analysis, each physician who was disciplined was paired with two control physicians who had graduated within one year of the disciplined physician and for whom no disciplinary actions were recorded in the database of the Federation of State Medical Boards

If consent was obtained from these physicians, the paper fails to mention it. Why stop at medical school? Why not examine undergraduate or high school records? I blame Bush and the NSA for this.
My program director always told us that a residency program can't purge someone of their personality disorders. Goes along with the conventional wisdom of being unable to change someone after you marry them. This has been my anecdotal experience as well. In Georgia the quarterly report from the medical board has the names of physicians placed on the naughty list during that time period. Occasionally I will recognize a classmate's name and recall what a buffoon/screwball/jackass he/she was. Could have saved the board a lot of time.
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