The prognostic value of documented unprofessional behavior in medical school records for predicting and preventing subsequent medical board disciplinary action: The papadakis studies revisited

The extended findings presented here reveal little or no benefit and a major cost associated with using documented unprofessional behavior in medical school to detect later board disciplinary action. The link between unprofessional behavior in medical school and board action is too weak to be of any prognostic value. And detection is not prevention; even if detected, the problem remains as to how to successfully remediate and prevent board action. The alternative is to dismiss students with documented unprofessional behavior, but this would involve the dismissal of many documented students who in fact would not incur board action (about 3,200 false positive students out of 16,000 graduates annually nationwide). We do not mean to imply that unprofessional behavior in medical school is not a serious problem, nor that medical school faculty and administrators should turn a blind eye to such behavior. But unprofessional behavior in medical school is not a good predictor of board disciplinary action-or conversely, and maybe more to the point, board action is not a good criterion for validating unprofessional behavior in medical school as an indicator of later problems in practice. The former is a risk factor for the latter, but the prognostic value of the relationship is very limited. The reporting of research results is part of the broader question of the quality of research reporting in medical education, which was examined in two recent related reviews of published articles in medical education journals. One review focused on titles and abstracts; the other on the texts of the articles. The reviews concluded that "The quality of reporting was generally poor" and that "More informative reporting is needed." We concur, but emphasize that we think the most serious problem is the reporting of research results, which all too often are reported in a way that does not provide an informative picture of the meaning of the results in terms of the strength of the findings in the context of practice, as in the Papadakis' studies. And examples of studies like these are not unusual. We have expressed similar concerns and presented other examples in numerous papers over the last 10 years. Our recommendation is that researchers in medical education need to be more focused, more reflective, and more critical in thinking about and reporting research results in terms of their implications for practice.