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Journal of Bioethical Inquiry

, Volume 9, Issue 2, pp 135–147 | Cite as

Competing Duties

Medical Educators, Underperforming Students, and Social Accountability
  • Thalia Arawi
  • Philip M. RosoffEmail author
Original Research

Abstract

Over the last 80 years, a major goal of medical educators has been to improve the quality of applicants to medical school and, hence, the resulting doctors. To do this, academic standards have been progressively strengthened. The Medical College Admission Test (MCAT) in the United States and the undergraduate science grade point average (GPA) have long been correlated with success in medical school, and graduation rates have been close to 100 percent for many years. Recent studies have noted that some doctors having difficulties in practice were found to have had similar problems while in school. In this essay, we present a brief historical account of attitudes and approaches to admissions requirements, then discuss basic broad areas of accomplishment in clinical practice: academic mastery, clinical acumen, and professionalism. We then review data that suggest that lack of competency can often be detected very early in a student’s career and may or may not be immune to remediation efforts. We end with a recommendation for a course of action that upholds and fulfills the profession’s social responsibility. This will be a moral argument, defending an aggressive but equitable approach to maintaining both public accountability and trust.

Keywords

Medical education Professionalism Professional competency 

Notes

Competing Interests

The authors have no competing interests with reference to this manuscript.

Funding Support

No external funding was used for this manuscript.

References

  1. Aagaard, E.M., and K.E. Hauer. 2003. A cross-sectional descriptive study of mentoring relationships formed by medical students. Journal of General Internal Medicine 18(4): 298–302.PubMedCrossRefGoogle Scholar
  2. Accreditation Council for Graduate Medical Education (ACGME). 2009. ACGME data resource book: Academic year 2008–2009. Chicago: ACGME Department of Applications and Data Analysis. http://www.acgme.org/acWebsite/dataBook/2008-2009_ACGME_Data_Resource_Book.pdf. Accessed March 6, 2010.
  3. Anderson, R.E., and S.S. Obenshain. 1994. Cheating by students: Findings, reflections, and remedies. Academic Medicine 69(5): 323–332.PubMedCrossRefGoogle Scholar
  4. Aristotle. 1999. Nicomachean ethics, 2nd edition. Trans. T. Irwin. Indianapolis: HackettGoogle Scholar
  5. Arulampalam, W., R.A. Naylor, and J.P. Smith. 2007. Dropping out of medical school in the UK: Explaining the changes over ten years. Medical Education 41(4): 385–394.PubMedCrossRefGoogle Scholar
  6. Association of American Medical Colleges (AAMC). 2012. Facts: Applicants, matriculants, enrollment, graduates, MD/PhD, and residency applicants data. https://www.aamc.org/data/facts/. Accessed October 28, 2011.
  7. Baldwin Jr., D.C., T.E. Adamson, D.J. Self, T.J. Sheehan, and A.A. Oppenberg. 1996. Moral reasoning and malpractice. A pilot study of orthopedic surgeons. American Journal of Orthopaedics (Belle Mead NJ) 25(7): 481–484.Google Scholar
  8. Baldwin Jr., D.C., S.R. Daugherty, B.D. Rowley, and M.D. Schwarz. 1996. Cheating in medical school: A survey of second-year students at 31 schools. Academic Medicine 71(3): 267–273.PubMedCrossRefGoogle Scholar
  9. Basco, W., C. Lancaster, G. Gilbert, M. Carey, and A. Blue. 2008. Medical school application interview score has limited predictive validity for performance on a fourth year clinical practice examination. Advances in Health Sciences Education 13(2): 151–162.PubMedCrossRefGoogle Scholar
  10. Bilic-Zulle, L., J. Azman, V. Frkovic, and M. Petrovecki. 2008. Is there an effective approach to deterring students from plagiarizing? Science and Engineering Ethics 14(1): 139–147.PubMedCrossRefGoogle Scholar
  11. Boon, K., and J. Turner. 2004. Ethical and professional conduct of medical students: Review of current assessment measures and controversies. Journal of Medical Ethics 30(2): 221–226.PubMedCrossRefGoogle Scholar
  12. Bore, M., D. Munro, I. Kerridge, and D. Powis. 2005. Selection of medical students according to their moral orientation. Medical Education 39(3): 266–275.PubMedCrossRefGoogle Scholar
  13. Brainard, A.H., and H.C. Brislen. 2007. Viewpoint: Learning professionalism: A view from the trenches. Academic Medicine 82(11): 1010–1014.PubMedCrossRefGoogle Scholar
  14. Branch Jr., W.T. 1998. Professional and moral development in medical students: The ethics of caring for patients. Transactions of the American Clinical and Climatological Association 109: 218–229, discussion 229–230.PubMedGoogle Scholar
  15. Branch Jr., W.T., R.J. Pels, and J.P. Hafler. 1998. Medical students’ empathic understanding of their patients. Academic Medicine 73(4): 360–362.PubMedCrossRefGoogle Scholar
  16. Brewer, L., and D. Grbic. 2010. Medical students’ socioeconomic background and their completion of the first two years of medical school. Analysis in Brief (AAMC) 9(11): 1–2.Google Scholar
  17. Bryden, P., S. Ginsburg, B. Kurabi, and N. Ahmed. 2010. Professing professionalism: Are we our own worst enemy? Faculty members’ experiences of teaching and evaluating professionalism in medical education at one school. Academic Medicine 85(6): 1025–1034.PubMedCrossRefGoogle Scholar
  18. Burack, J.H., D.M. Irby, J.D. Carline, R.K. Root, and E.B. Larson. 1999. Teaching compassion and respect. Attending physicians’ responses to problematic behaviors. Journal of General Internal Medicine 14(1): 49–55.PubMedCrossRefGoogle Scholar
  19. Callahan, C.A., M. Hojat, J. Veloski, J.B. Erdmann, and J.S. Gonnella. 2010. The predictive validity of three versions of the MCAT in relation to performance in medical school, residency, and licensing examinations: A longitudinal study of 36 classes of Jefferson Medical College. Academic Medicine 85(6): 980–987.PubMedCrossRefGoogle Scholar
  20. Carr, D. 2003. Character and moral choice in the cultivation of virtue. Philosophy 78: 219–232.CrossRefGoogle Scholar
  21. Carufel-Wert, D.A., S. Younkin, J. Foertsch, T. Eisenberg, C.L. Haq, B.J. Crouse, and J.J. Frey III. 2007. LOCUS: Immunizing medical students against the loss of professional values. Family Medicine 39(5): 320–325.PubMedGoogle Scholar
  22. Center for Academic Integrity. 2010. http://www.academicintegrity.org/. Accessed October 4, 2010.
  23. Cleland, J.A., L.V. Knight, C.E. Rees, S. Tracey, and C.M. Bond. 2008. Is it me or is it them? Factors that influence the passing of underperforming students. Medical Education 42(8): 800–809.PubMedCrossRefGoogle Scholar
  24. Cohen, J. 2008. Students whose behaviour causes concern: Role of universities. British Medical Journal 337: a2884.PubMedCrossRefGoogle Scholar
  25. Cohen, J.J. 2006. Professionalism in medical education, an American perspective: From evidence to accountability. Medical Education 40(7): 607–617.PubMedCrossRefGoogle Scholar
  26. Colliver, J.A., S.J. Markwell, S.J. Verhulst, and R.S. Robbs. 2007. The prognostic value of documented unprofessional behavior in medical school records for predicting and preventing subsequent medical board disciplinary action: The Papadakis studies revisited. Teaching and Learning in Medicine 19(3): 213–215.PubMedCrossRefGoogle Scholar
  27. Conger, J.J., and R.H. Fitz. 1963. Prediction of success in medical school. Academic Medicine 38(11): 943–948.Google Scholar
  28. Coulehan, J. 2005. Viewpoint: Today’s professionalism: Engaging the mind but not the heart. Academic Medicine 80(10): 892–898.PubMedCrossRefGoogle Scholar
  29. Dent v. West Virginia, 129 U.S. 114 (1889).Google Scholar
  30. Donnon, T., E. Oddone Paolucci, and C. Violato. 2009. A predictive validity study of medical judgment vignettes to assess students’ noncognitive attributes: A 3-year prospective longitudinal study. Medical Teacher 31(4): e148–e155.PubMedCrossRefGoogle Scholar
  31. Dubovsky, S.L., M. Gendel, A.N. Dubovsky, J. Rosse, R. Levin, and R. House. 2005. Do data obtained from admissions interviews and resident evaluations predict later personal and practice problems? Academic Psychiatry 29(5): 443–447.PubMedCrossRefGoogle Scholar
  32. Edwards, J.C., E.K. Johnson, and J.B. Molidor. 1990. The interview in the admission process. Academic Medicine 65(3): 167–177.PubMedCrossRefGoogle Scholar
  33. Flexner, A. 1910. Medical education in the United States and Canada. Boston: D.B. Updike.Google Scholar
  34. Frellsen, S.L., E.A. Baker, K.K. Papp, and S.J. Durning. 2008. Medical school policies regarding struggling medical students during the internal medicine clerkships: Results of a national survey. Academic Medicine 83(9): 876–881.PubMedCrossRefGoogle Scholar
  35. Garrison, G., C. Mikesell, and D. Matthew. 2007. Medical school graduation and attrition rates. Association of American Medical Colleges Analysis in Brief 7(2): 1–2.Google Scholar
  36. Glick, S.M. 2001. Cheating at medical school. British Medical Journal 322(7281): 250–251.PubMedCrossRefGoogle Scholar
  37. Gough, H.G., and W.B. Hall. 1975. An attempt to predict graduation from medical school. Academic Medicine 50(10): 940–950.CrossRefGoogle Scholar
  38. Hafferty, F.W., and R. Franks. 1994. The hidden curriculum, ethics teaching, and the structure of medical education. Academic Medicine 69(11): 861–871.PubMedCrossRefGoogle Scholar
  39. Haidet, P., and H.F. Stein. 2006. The role of the student–teacher relationship in the formation of physicians. The hidden curriculum as process. Journal of General Internal Medicine 21(Supplement 1): S16–S20.PubMedCrossRefGoogle Scholar
  40. Happel, S.K., and M.M. Jennings. 2008. An economic analysis of academic dishonesty and its deterrence in higher education. Journal of Legal Studies Education 25(2): 183–214.CrossRefGoogle Scholar
  41. Harding, T.S., D.D. Carpenter, C.J. Finelli, and H.J. Passow. 2004. Does academic dishonesty relate to unethical behavior in professional practice? An exploratory study. Science and Engineering Ethics 10(2): 311–324.PubMedCrossRefGoogle Scholar
  42. Hauer, K.E., A. Teherani, K.M. Kerr, D.M. Irby, and P.S. O’Sullivan. 2009. Consequences within medical schools for students with poor performance on a medical school standardized patient comprehensive assessment. Academic Medicine 84(5): 663–668.PubMedCrossRefGoogle Scholar
  43. Hawker v. People of State of New York, 170 U.S. 189 (1898).Google Scholar
  44. Hiltzik, M. 2011. Curing the state’s medical regulation system. May: Los Angeles Times, 4.Google Scholar
  45. Hodges, B. 2006. Medical education and the maintenance of incompetence. Medical Teacher 28(8): 690–696.PubMedCrossRefGoogle Scholar
  46. Hodgson, C.S., A. Teherani, H.G. Gough, P. Bradley, and M.A. Papadakis. 2007. The relationship between measures of unprofessional behavior during medical school and indices on the California Psychological Inventory. Academic Medicine 82(Supplement 10): S4–S7.PubMedCrossRefGoogle Scholar
  47. Horton, R. 2001. The real lessons from Harold Frederick Shipman. The Lancet 357(9250): 82–83.CrossRefGoogle Scholar
  48. Huckle, P., and P. McGuffin. 1991. Familial factors in going to medical school. Medical Education 25(1): 13–15.PubMedCrossRefGoogle Scholar
  49. Huddle, T.S. 2005. Viewpoint: Teaching professionalism: Is medical morality a competency? Academic Medicine 80(10): 885–891.PubMedCrossRefGoogle Scholar
  50. Ingelfinger, F.J. 1980. Arrogance. The New England Journal of Medicine 303(26): 1507–1511.PubMedCrossRefGoogle Scholar
  51. James, D., E. Ferguson, D. Powis, M. Bore, D. Munro, I. Symonds, and J. Yates. 2009. Graduate entry to medicine: Widening psychological diversity. BioMed Central Medical Education 9(1): 67.PubMedGoogle Scholar
  52. Johnson, D.G., and E.B. Hutchins. 1966. Doctor or dropout? A study of medical student attrition. Journal of Medical Education 41(12): 1099–1274.PubMedGoogle Scholar
  53. Johnson, M., C. Elam, J. Edwards, D. Taylor, C. Heldberg, R. Hinkley, and R. Comeau. 1998. Medical school admission committee members’ evaluations of and impressions from recommendation letters. Academic Medicine 73(Supplement 10): S41–S43.PubMedCrossRefGoogle Scholar
  54. Julian, E.R. 2005. Validity of the Medical College Admission Test for predicting medical school performance. Academic Medicine 80(10): 910–917.PubMedCrossRefGoogle Scholar
  55. Karnieli-Miller, O., T.R. Vu, M.C. Holtman, S.G. Clyman, and T.S. Inui. 2010. Medical students’ professionalism narratives: A window on the informal and hidden curriculum. Academic Medicine 85(1): 124–133.PubMedCrossRefGoogle Scholar
  56. Kaufman, D., C. Dowhan, and A. Dowhan. 2009. Essays that will get you into medical school. Hauppage, NY: Barrons.Google Scholar
  57. Kenny, D. 2007. Student plagiarism and professional practice. Nurse Education Today 27(1): 14–18.PubMedCrossRefGoogle Scholar
  58. Kenny, N.P., K.V. Mann, and H. MacLeod. 2003. Role modeling in physicians’ professional formation: Reconsidering an essential but untapped educational strategy. Academic Medicine 78(12): 1203–1210.PubMedCrossRefGoogle Scholar
  59. Kohatsu, N.D., D. Gould, L.K. Ross, and P.J. Fox. 2004. Characteristics associated with physician discipline: A case–control study. Archives of Internal Medicine 164(6): 653–658.PubMedCrossRefGoogle Scholar
  60. Kohn, L.T., J.M. Corrigan, and M.S. Donaldson (eds.). 2000. To err is human: Building a safer health system. Washington, DC: National Academy Press.Google Scholar
  61. Larkham, P.J., and S. Manns. 2002. Plagiarism and its treatment in higher education. Journal of Further and Higher Education 26(4): 339–349.CrossRefGoogle Scholar
  62. Leape, L.L., and J.A. Fromson. 2006. Problem doctors: Is there a system-level solution? Annals of Internal Medicine 144(2): 107–115.PubMedGoogle Scholar
  63. Levine, A., R. Oshel, and S. Wolfe. 2011. State medical boards fail to discipline doctors with hospital actions against them. Washington, DC: Public Citizen.Google Scholar
  64. Mazar, N., O. Amir, and D. Ariely. 2008. The dishonesty of honest people: A theory of self-concept maintenance. Journal of Marketing Research 45(6): 633–644.CrossRefGoogle Scholar
  65. McCabe, D.L., and L.K. Trevino. 1993. Academic dishonesty. Honor codes and other contextual influences. Journal of Higher Education 64(5): 522–538.CrossRefGoogle Scholar
  66. McCabe, D.L., L.K. Trevino, and K.D. Butterfield. 2002. Honor codes and other contextual influences on academic integrity: A replication and extension to modified honor code settings. Research in Higher Education 43(3): 357–378.CrossRefGoogle Scholar
  67. McCarthy, M. 2000. US doctor pleads guilty to murdering patients. The Lancet 356(9234): 1010.CrossRefGoogle Scholar
  68. McGaghie, W.C. 2002. Assessing readiness for medical education: Evolution of the Medical College Admission Test. Journal of the American Medical Association 288(9): 1085–1090.PubMedCrossRefGoogle Scholar
  69. McLachlan, J.C., G. Finn, and J. Macnaughton. 2009. The conscientiousness index: A novel tool to explore students’ professionalism. Academic Medicine 84(5): 559–565. doi: 10.1097/ACM.0b013e31819fb7ff.PubMedCrossRefGoogle Scholar
  70. Moberg, D.J. 2000. Role models and moral exemplars: How do employees acquire virtues by observing others? Business Ethics Quarterly 10(3): 675–696.CrossRefGoogle Scholar
  71. Moss, F.A. 1930. Scholastic aptitude tests for medical students. Journal of the Association of American Medical Colleges 5(2): 90–110.CrossRefGoogle Scholar
  72. Murden, R.A., D.P. Way, A. Hudson, and J.A. Westman. 2004. Professionalism deficiencies in a first-quarter doctor–patient relationship course predict poor clinical performance in medical school. Academic Medicine 79(Supplement 10): S46–S48.PubMedCrossRefGoogle Scholar
  73. National Board of Medical Examiners. 2009. 2008 USMLE performance data [as published in the 2008 NBME Annual Report]. http://www.usmle.org/Scores_Transcripts/performance/2008.htm. Accessed October 16, 2010.
  74. Osborn, E. 2000. Punishment: A story for medical educators. Academic Medicine 75(3): 241–244.PubMedCrossRefGoogle Scholar
  75. Paice, E., S. Heard, and F. Moss. 2002. How important are role models in making good doctors? British Medical Journal 325(7366): 707–710.PubMedCrossRefGoogle Scholar
  76. Papadakis, M.A. 2004. The step 2 clinical-skills examination. The New England Journal of Medicine 350(17): 1703–1705.PubMedCrossRefGoogle Scholar
  77. Papadakis, M.A., G.K. Arnold, L.L. Blank, E.S. Holmboe, and R.S. Lipner. 2008. Performance during internal medicine residency training and subsequent disciplinary action by state licensing boards. Annals of Internal Medicine 148(11): 869–876.PubMedGoogle Scholar
  78. Papadakis, M.A., C.S. Hodgson, A. Teherani, and N.D. Kohatsu. 2004. Unprofessional behavior in medical school is associated with subsequent disciplinary action by a state medical board. Academic Medicine 79(3): 244–249.PubMedCrossRefGoogle Scholar
  79. Papadakis, M.A., H. Loeser, and K. Healy. 2001. Early detection and evaluation of professionalism deficiencies in medical students: One school’s approach. Academic Medicine 76(11): 1100–1106.PubMedCrossRefGoogle Scholar
  80. Papadakis, M.A., A. Teherani, M.A. Banach, T.R. Knettler, S.L. Rattner, D.T. Stern, J.J. Veloski, and C.S. Hodgson. 2005. Disciplinary action by medical boards and prior behavior in medical school. The New England Journal of Medicine 353(25): 2673–2682.PubMedCrossRefGoogle Scholar
  81. Papadakis, M.A., and D. Wofsy. 2010. Plagiarism on personal statements: A disturbing symptom of a broader trend. Annals of Internal Medicine 153(2): 128–129.PubMedGoogle Scholar
  82. Park, C. 2003. In other (people’s) words: Plagiarism by university students—literature and lessons. Assessment and Evaluation in Higher Education 28(5): 471–488.CrossRefGoogle Scholar
  83. Patenaude, J., T. Niyonsenga, and D. Fafard. 2003. Changes in students’ moral development during medical school: A cohort study. Canadian Medical Association Journal 168(7): 840–844.PubMedGoogle Scholar
  84. Pellegrino, E.D., and D.C. Thomasma. 1981. A philosophical basis of medical practice. New York: Oxford University Press.Google Scholar
  85. Pellegrino, E.D., and D.C. Thomasma. 1993. The virtues of medical practice. New York: Oxford University Press.Google Scholar
  86. Petersdorf, R.G. 1989. A matter of integrity. Academic Medicine 64(3): 119–123.PubMedCrossRefGoogle Scholar
  87. Prideaux, D., C. Roberts, K. Eva, A. Centeno, P. McCrorie, C. McManus, F. Patterson, D. Powis, A. Tekian, and D. Wilkinson. 2011. Assessment for selection for the health care professions and specialty training: Consensus statement and recommendations from the Ottawa 2010 Conference. Medical Teacher 33(3): 215–223.PubMedCrossRefGoogle Scholar
  88. Ramsay, S. 2001. Audit further exposes UK’s worst serial killer. The Lancet 357(9250): 123–124.CrossRefGoogle Scholar
  89. Reed, D.A., and S.M. Wright. 2010. Role models in medicine. In Mentoring in academic medicine, ed. H.J. Humphrey, 67–81. Philadelphia: American College of Physicians.Google Scholar
  90. Reid, A. 2010. Identifying medical students at risk of subsequent misconduct. British Medical Journal 340: c2169.PubMedCrossRefGoogle Scholar
  91. Rennie, S.C., and J.R. Crosby. 2001. Are “tomorrow’s doctors” honest? Questionnaire study exploring medical students’ attitudes and reported behaviour on academic misconduct. British Medical Journal 322(7281): 274–275.PubMedCrossRefGoogle Scholar
  92. Roberts, C., M. Walton, I. Rothnie, J. Crossley, P. Lyon, K. Kumar, and D. Tiller. 2008. Factors affecting the utility of the multiple mini-interview in selecting candidates for graduate-entry medical school. Medical Education 42(4): 396–404.PubMedCrossRefGoogle Scholar
  93. Roland, M., S.R. Rao, B. Sibbald, M. Hann, S. Harrison, A. Walter, B. Guthrie, C. Desroches, T.G. Ferris, and E.G. Campbell. 2011. Professional values and reported behaviours of doctors in the USA and UK: Quantitative survey. BMJ Quality & Safety. doi: 10.1136/bmjqs.2010.048173.
  94. Sanazaro, P.J., and E.B. Hutchins. 1963. The origin and rationale of the medical college admission test. Journal of Medical Education 38(12): 1044–1050.PubMedGoogle Scholar
  95. Satterwhite, R.C., W.M. Satterwhite III, and C. Enarson. 2000. An ethical paradox: The effect of unethical conduct on medical students’ values. Journal of Medical Ethics 26(6): 462–465.PubMedCrossRefGoogle Scholar
  96. Segal, S., B.J. Gelfand, S. Hurwitz, L. Berkowitz, S.W. Ashley, E.S. Nadel, and J.T. Katz. 2010. Plagiarism in residency application essays. Annals of Internal Medicine 153(2): 112–120.PubMedGoogle Scholar
  97. Self, D.J., and D.C. Baldwin. 1998. Does medical education inhibit the development of moral reasoning in medical students? A cross-sectional study. Academic Medicine 73(Supplement 10): S91–S93.PubMedCrossRefGoogle Scholar
  98. Self, D.J., D.E. Schrader, D.C. Baldwin, and F.D. Wolinsky. 1993. The moral development of medical students: A pilot study of the possible influence of medical education. Medical Education 27(1): 26–34.PubMedCrossRefGoogle Scholar
  99. Self, D.J., F.D. Wolinsky, and C. Baldwin. 1989. The effect of teaching medical ethics on medical students’ moral reasoning. Academic Medicine 64(12): 755–759.PubMedCrossRefGoogle Scholar
  100. Sierles, F.S., B.D. Kushner, and P.B. Krause. 1988. A controlled experiment with a medical student honor system. Academic Medicine 63(9): 705–712.CrossRefGoogle Scholar
  101. Simpson, D.E., K.J. Yindra, J.B. Towne, and P.S. Rosenfeld. 1989. Medical students’ perceptions of cheating. Academic Medicine 64(4): 221–222.PubMedCrossRefGoogle Scholar
  102. Smith, R. 2000. Cheating at medical school. British Medical Journal 321(7258): 398.PubMedCrossRefGoogle Scholar
  103. Starr, P. 1982. The social transformation of American medicine. New York: Basic Books.Google Scholar
  104. Sternberg, R.J. 2008. Assessing students for medical school admissions: Is it time for a new approach? Academic Medicine 83(10): S105–S110. doi: 10.1097/ACM.0b013e318183e586.PubMedCrossRefGoogle Scholar
  105. Stimmel, B., and D. Yens. 1982. Cheating by medical students on examinations. American Journal of Medicine 73(2): 160–164.PubMedCrossRefGoogle Scholar
  106. Swick, H.M. 2000. Toward a normative definition of medical professionalism. Academic Medicine 75(6): 612–616.PubMedCrossRefGoogle Scholar
  107. Tamblyn, R., M. Abrahamowicz, D. Dauphinee, E. Wenghofer, A. Jacques, D. Klass, S. Smee, D. Blackmore, N. Winslade, N. Girard, R. Du Berger, I. Bartman, D.L. Buckeridge, and J.A. Hanley. 2007. Physician scores on a national clinical skills examination as predictors of complaints to medical regulatory authorities. Journal of the American Medical Association 298(9): 993–1001.PubMedCrossRefGoogle Scholar
  108. Teherani, A., C.S. Hodgson, M. Banach, and M.A. Papadakis. 2005. Domains of unprofessional behavior during medical school associated with future disciplinary action by a state medical board. Academic Medicine 80(Supplement 10): S17–S20.PubMedCrossRefGoogle Scholar
  109. van Mook, W.N., W.S. de Grave, S.J. van Luijk, H. O’Sullivan, V. Wass, L.W. Schuwirth, and C.P. van der Vleuten. 2009. Training and learning professionalism in the medical school curriculum: Current considerations. European Journal of Internal Medicine 20(4): e96–e100.PubMedCrossRefGoogle Scholar
  110. van Mook, W.N., W.S. de Grave, V. Wass, H. O’Sullivan, J.H. Zwaveling, L.W. Schuwirth, and C.P. van der Vleuten. 2009. Professionalism: Evolution of the concept. European Journal of Internal Medicine 20(4): e81–e84.PubMedCrossRefGoogle Scholar
  111. van Mook, W.N., S.J. van Luijk, H. O’Sullivan, V. Wass, J.H. Zwaveling, L.W. Schuwirth, and C.P. van der Vleuten. 2009. The concepts of professionalism and professional behaviour: Conflicts in both definition and learning outcomes. European Journal of Internal Medicine 20(4): e85–e89.PubMedCrossRefGoogle Scholar
  112. VanSusteren, T.J., E. Suter, L.J. Romrell, L. Lanier, and R.L. Hatch. 1999. Do interviews really play an important role in the medical school selection decision? Teaching and Learning in Medicine: An International Journal 11(2): 66–74.CrossRefGoogle Scholar
  113. Weissmann, P.F., W.T. Branch, C.F. Gracey, P. Haidet, and R.M. Frankel. 2006. Role modeling humanistic behavior: Learning bedside manner from the experts. Academic Medicine 81(7): 661–667. doi: 10.1097/01.ACM.0000232423.81299.fe.PubMedCrossRefGoogle Scholar
  114. Whitley Jr., B. 1998. Factors associated with cheating among college students: A review. Research in Higher Education 39(3): 235–274.CrossRefGoogle Scholar
  115. Wright, S.M., D.E. Kern, K. Kolodner, D.M. Howard, and F.L. Brancati. 1998. Attributes of excellent attending-physician role models. The New England Journal of Medicine 339(27): 1986–1993.PubMedCrossRefGoogle Scholar
  116. Yates, J., and D. James. 2006. Predicting the “strugglers”: A case–control study of students at Nottingham University Medical School. British Medical Journal 332(7548): 1009–1013.PubMedCrossRefGoogle Scholar
  117. Yates, J., and D. James. 2010. Risk factors at medical school for subsequent professional misconduct: Multicentre retrospective case–control study. British Medical Journal 340: c2040.PubMedCrossRefGoogle Scholar
  118. Yen, W., R. Hovey, K. Hodwitz, and S. Zhang. 2010. An exploration of the relationship between emotional intelligence (EI) and the multiple mini-interview (MMI). Advances in Health Sciences Education: Theory and Practice 16(1): 59–67.CrossRefGoogle Scholar
  119. Ziv, A., O. Rubin, A. Moshinsky, N. Gafni, M. Kotler, Y. Dagan, D. Lichtenberg, Y.A. Mekori, and M. Mittelman. 2008. MOR: A simulation-based assessment centre for evaluating the personal and interpersonal qualities of medical school candidates. Medical Education 42(10): 991–998.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  1. 1.Salim El-Hoss Bioethics and Professionalism Program, Faculty of MedicineAmerican University of BeirutBeirutLebanon
  2. 2.Trent Center for Bioethics, Humanities and History of Medicine, Departments of Pediatrics and MedicineDuke University Medical CenterDurhamUSA

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