Medical School Professionalism Concerns

Professionalism in Medical School: How Lapses Can Lead to Disciplinary Action and Other Consequences

Medical schools across the United States have implemented professionalism into institutions' curriculum in an effort allow medical students and doctors live up to their ideals.  Upholding professional behaviors in medical school is vastly important to ensure students adequately perform academically and in real life encounters, such as in clinicals. As a medical school student, it is your responsibility to uphold the school's expectations of professionalism and expectations of academic integrity. 

A student's professionalism can cause concerns when that student is not adapting to what is expected of him or her. For example, a teacher may provide feedback to a student on how to proceed in the future with a patient's injury/ailment; if that feedback is ignored or misapplied, this may lead to a concern about a student's professionalism. Further, concerns regarding a student's professionalism can potentially lead to academic probation, records of unprofessionalism in a student's MPSE, or even dismissal from an institution.

If a concern about a student's professionalism is raised during his or her period of enrollment, it is vital to have the proper guidance on your side. Failure to comply with expectations can result in medical school issues such as remedial and disciplinary actions, and in more serious cases. the possibility of dismissal.  An experienced attorney can help you navigate the process, advise you how to handle the situation, and avoid potential disciplinary action. It is a difficult time for medical students to juggle the burdens of academics and life. A skilled and professional attorney can help you avoid unnecessary burdens and potential consequences so that you can achieve your goal of becoming a licensed doctor.

3 Pillars of Medical School Professionalism

There are three pillars that United States medical schools follow in creating their curriculum.

1. The Primacy of Patient Welfare: This principle focuses on altruism, trust, and patient interest that must not be compromised by “market forces, societal pressures, and administrative exigencies”.
2. Patient Autonomy: This principle incorporates honesty with patients and the need to educate and empower them to make appropriate medical decisions.
3. Social Justice: This principle addresses physicians' societal contract and distributive justice, that is, considering the available resources and the needs of all patients while taking care of an individual patient.

Professional competence is the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community being served. — Epstein and Hundert

How Professionalism Concerns Can Lead to Disciplinary Actions for Medical Students

Medical School curriculum have tailored methods in teaching professionalism to its students. The following steps provide the foundation that medical schools typically use in order to address and discipline students:

• Setting the expectations.
• Performing assessments
• Remediating inappropriate behaviors
• Preventing inappropriate behaviors
• Implementing a cultural change

Professionalism - Setting Expectations and Student Responsibilities

It is vital for a medical school to clearly define the expected behaviors of the institution's students and teachers. In setting a list of expected behavior, the institution details what it sees as inappropriate or unacceptable behaviors. It is also imperative that the school's policies are defined and explained, including its due processes such as: reporting channels, and absence of retaliation for those who report behavior, remediation processes and follow-ups with the student or teacher in question, and so forth.

All parties entering an institution, including students, residents and staff, should be given a list of these expected behaviors that they will be evaluated on, and held accountable. There should be an understanding of what is expected of that person. Additionally, the consequences for deviating from this expected behavior must also be explained.

Consequences of inappropriate acts that persistently violate the expectations could lead to disciplinary action which can result in academic probation or even dismissal of that party from the institution. However, there are processes in place that an institution must follow in order to accomplish the proper result for each party involved. Institutions have begun to treat problems with medical student (and physician) professionalism similar to physician impairment issues and will be investigated if there are concerns brought forth. 

PERFORMING ASSESSMENTS

A teacher/educator should try to incorporate expected behavior into formative and summative evaluations. Simply put, a formative evaluation is feedback to the medical student. How a student takes in that feedback and applies it will be given a grade. That grade is the summative evaluation. For example, if a student has trouble but improves after given formative evaluation (feedback), the final evaluation (summative) should be represent what that student has been able to achieve. On the other hand, if there is no improvement (of the inappropriate behavior), a “follow-up” is necessary. Accordingly, it is improper for a teacher to comment on a student's issue or inappropriate behavior one time and fail the student for the issue. At the same time of giving students feedback on issues, teachers should be simultaneously explaining the consequences of that action.

EVALUATIONS

Proving evaluations to medical students is an important step in addressing professionalism concerns. Evaluations should consist of a network of peers, nurses, patients and colleagues, in addition to direct supervisors. Typically, an attending physician may be able to judge and evaluate a student's knowledge and decision-making ability, but that is too small of a sample size. A student should be evaluated 360 degrees, not by just one angle of a supervisor.

REMEDIATION

Professionalism can be always be taught from a student's experiences, good or bad. If unacceptable or inappropriate behavior is identified early in a student's career, a follow-up meeting is needed. This follow-up meeting should consist of the educator explaining what is acceptable in the situation the student was observed in and how he/she could improve. A remediation plan should be developed between the teacher and the student. The teacher would explain the potential consequences to the student for not improving on that inappropriate behavior. Accordingly, the consequences of discipline should be conspicuous. For example, an action of discipline a student could face may be probation and dismissal.

In cases where a remediation plan has been developed, it is important to have frequent follow-ups with the student. In order to execute a remediation plan and help the student, teachers should check on a student's progress, give positive reinforcement if improved and discuss the ways a student can continue to improve.

Medical School Professionalism FAQS

Understanding the fundamentals of professionalism is critical to succeeding in medical school (and as a doctor), but regrettably, the best laid plans can at times go awry, and the following topics provide additional information for what to expect if a medical student is faced with the unfortunate reality of his/her professionalism being called into question, and also the potential consequences both at medical school and also beyond.

What is professionalism based on in medical schools?

Professionalism in medical schools stems from the three principles: the primacy of patient welfare, patient autonomy, and social justice. These three ideals represent that a physician will focus on trust and altruism with a patient, not to be disturbed by outside societal pressures and market forces. Patient autonomy educates the patient with the knowledge of what is happening and empowers them to make the appropriate decision. Social justice addresses the physician's available resources and the needs of all patients while taking care of an individual patient. In other words, doing what is best for the patient, using that patient's values and preferences and is consistent with a physician's own clinical judgment.

What kinds of professionalism concerns can lead to disciplinary action in medical school?

There are examples of linking professionalism values to specific behavior which, if egregious or inappropriate, could lead to disciplinary action. For example, medical students are expected to maintain the following professional standards involving:

• Responsibility:
  • Following through on tasks assigned.
  • Arriving on time.
  • Accepts blame for a failure.
• Maturity:
  • Does not make inappropriate demands.
  • Is not abusive and critical in times of stress.
  • Listens well.
• Communication skills:
  • Is not hostile, derogatory or sarcastic.
  • Is not loud or disruptive/loud.
  • Maintains patient confidentiality.
  • Is patient.
• Respect:
  • Is sensitive to physical/emotional needs.
  • Is not biased/discriminatory.

Demonstrating inappropriate behavior in these categories may potentially lead to disciplinary action in medical school.

How do medical schools handle disciplinary action involving professionalism concerns?

Once a professor or instructor identifies an issue, or an inappropriate behavior that deviates from the institution's expectations, the teacher must address the issue/inappropriate behavior with the student. This would put the student on notice of what the inappropriate behavior is. Follow-up meetings should take place to instill the appropriate action. If that student repeats the inappropriate behavior, that student can face disciplinary action such as being placed on academic probation or even dismissal from that institute. However, a teacher cannot give a failing grade to a student if the issue merely mentioned once to the student and does not follow-up.

Typical behavior observed in studies that resulted in disciplinary action were severe irresponsibility, and severely diminished capacity for self-improvement.

Independent, but also at times related to professionalism concerns in medical school, disciplinary action by state medical boards have been associated with low scores on the Medical College Admission test and poor grades in the first two years of medical school.

Will I be offered remediation if professionalism concerns arise in medical school?

It depends on the severity of the lapse in professionalism, but from a fundamental perspective, it is an institution's duty to address a student's unprofessionalism or inappropriate behavior.  Once an issue is identified and made aware to the student, remediation is the crux of how to fix that behavior. Feedback from an observation of the student is key. For example, a teacher tells a student how to take certain approaches, that student needs to apply that feedback the next time around. Ignoring such feedback will negatively affect the remediation process. Students who show an inability to accept responsibility are at risk of failing the remediation.

What type of disciplinary action can occur if I accumulate patterns of unprofessionalism?

Generally, after a student exhibits an instance of troubling behavior, and especially if there is an egregious act by a student, a staff member from the medical institution will meet directly with the student. Accumulating multiple instances of arguably lesser concerns will also lead to action by the school.  From that point, the student may be directed to meet with a committee of the school (i.e.: Committee on Professionalism, Committee on Academic Promotions, etc.). This committee may recommend different actions; such as, remediation, placement on monitored academic status, or placed on academic probation. Essentially, if the student does not improve or adapt as per the remedial plan, a note concerning the student's professionalism may be placed in the Medical Student Performance Evaluation (MSPE). This recommendation comes from the applicable committee and made to the applicable dean who will ultimately decide whether the professionalism concerns will be included in the student's MSPE.

The medical school has the ability to terminate a student from school for academic reasons, which includes the inability to exhibit ethical or professional behavior.

Because of what is at stake both in the short and long, it is critical that a medical student who finds himself/herself in such a scenario should retain an experienced attorney. By doing so, you are protecting yourself and the investment in yourself. With the proper guidance, disciplinary actions or notations may be resolved.

Can professionalism concerns in medical school affect my ability to obtain residencies?

YES, if a student is made aware of a concern or issue that a teacher has identified regarding the student's professionalism, and it is not remedied over time. A student who displays the inability to adapt to behavioral expectations or refuses to accept responsibility of unprofessional behavior is at high risk for a negative summative report. In other words, a school may keep record of observations of a student, which would allow future hiring boards to see a report of unprofessionalism in medical school and its remedial plan. The specificity of unprofessionalism must be brought to the student's attention.

Will professionalism concerns be reported on a Medical Student Performance Evaluation / Dean's Letter? And will those concerns be reported to residency programs?

YES.  The Medical Student Performance Evaluation (MPSE) is attached to the medical student's residency application. This evaluation consists of achievements, grades (good or bad), leaves of absences, and observations of the student and including, but not limited to professionalism throughout medical school. The MPSE summarizes the student's work during their tenure. Notations of unprofessionalism, or inappropriate behavior can be included in the MPSE, which is ultimately sent to residency programs.

Can I be dismissed from medical school because of professionalism concerns?

YES.  A medical school has the authority to dismiss a student due repeated concerns of unprofessionalism. Failure to adhere to a remedial plan or constant disregard of a feedback can lead to a student's dismissal due to professionalism concerns. This can be a combination of poor grades, inappropriate behaviors, lack of effort or motivation and inability to adapt. If faced with this level of discipline, an attorney can help advocate on your behalf.

Can professionalism disciplinary actions in medical school affect my ability to become a licensed doctor?

YES. Disciplinary actions against a licensed physician can range from a simple public reprimand to revocation of the medical license. This depends on the inappropriate act that occurred and the individual state's medical board. Hence the reason why teaching professionalism in medical school has become paramount. Studies have shown that unprofessional behavior as a medical student is a strong predictor of disciplinary action.

Should I have an attorney help me address professionalism concerns in medical school?  How can an attorney help?

YES. A skilled attorney can help you navigate and prepare you for the most effective responses. If facing disciplinary action or dismissal, they can potentially engage with the necessary parties at the school such as the Dean, the school's office of general counsel (the school's attorneys), other applicable administrators, to potentially help negotiate alternative and favorable resolutions.

Remember: this is your livelihood. You have too much at stake to go it alone without experienced professional assistance. As a student, too many years of hard work and money invested are at risk if the necessary steps are not taken. Obtaining an experienced attorney can help protect you in troubling times. You want to ensure a blemish free record in order to succeed in future opportunities with residencies and employment as a doctor.  Having a skilled attorney can allow a fair process and favorable outcome, and because of what is at stake, having the right person in your corner to fight for your best interest is essential!

Attorney to Help Medical Students Nationwide Address Professionalism and Dismissal Concerns

Attorney Joseph D. Lento and the Lento Law Firm have helped countless clients through their most difficult times in life at medical schools across the nation.  He has represented countless students at colleges and universities across all corners of the United States - in Alaska, California, Florida, Hawaii, Maine, Texas, and so forth - and he has also represented many clients who are studying or teaching abroad - for example, students at Caribbean medical schools, and students involved with overseas programs - in Asia, Europe, the Mideast, and so forth. 

Medical students have invested substantial years of their lives and have made tremendous sacrifices to pursue their goal of graduating from medical school, becoming doctors, and contributing to the greater good.  Too much is at stake for there to be any potential missteps in navigating a medical school's disciplinary processes.  Contact attorney Joseph D. Lento today at 888-535-3686 for help!