Performance and Professionalism of Medical

Students Responsibilities and Consequences

Today

Should and could universities be found liable for the

negligent acts of their graduates

Is future unprofessional conduct of medical students reliably

predictable during undergraduate studies

What mechanisms exist within the University and current

regulatory system to respond to concerns about poor

professionalism in medical students

What is the potential impact on Medical Education and

assessment of lsquoprofessionalismrsquoSchool of Medicine

Should and could universities be found liable

for the negligent acts of their graduates

School of Medicine

Peter Hamilton BScEd LLB(Hons) GDLP

Lecturer in Medical Law

School of Medicine

Are universities acting negligently ldquoThe university professor who stood up against dumbing down of degreesrdquo 1

raquo ldquohellip internal documents revealed that the university had lsquoupgradedrsquo a number of first and second year

pharmacy students ndash effectively lowering the pass mark on one course to 26 per cent ndash after half of

them failed their examsrdquo

raquo ldquoStaff who taught and marked the papers said that some students were simply lsquonot up to the rigors of

the programmersquo and in many cases lsquohad a poor attitude to workrsquo

ldquoUnderperforming nursing students lsquocould endanger public safetyrsquo says university

academicsrdquo 2

raquo ldquoAcademics come under pressure to turn a blind eye to problems caused by poor academic capabilities

and actively play a part in allowing students to pass who should failrdquo

raquo ldquohellip exam questions were being leaked to ensure students passed subjects and provide lecturers with

the positive feedback now essential to a renewed teaching contractrdquo

ldquoNSW universities taking students with ATARs as low as 30rdquo 3

raquo ldquoOne student hellip scored an ATAR in the 30s and was admitted to a combined Bachelor of Secondary

Education and Arts hellip with a cut off of 75rdquo

raquo ldquohellip students with ATARs as low as 46 have been offered a place in the Medical Science degreerdquo

School of Medicine

1 Henry J ldquoThe university professor who stood up against dumbing down of degreesrdquo Telegraph 28 February 2010

lthttpwwwtelegraphcoukeducationnewsgt

2 Besser L Cronau P amp Cohen H ldquoUnderperforming nursing students lsquocould endanger public safetyrsquo says university academicsrdquo ABC News 20

April 2015 httpwwwabcenetaunews Also reported on ldquoDegrees of deceptionrdquo Four Corners ABC 20 April 2015

3 Bagshaw E amp Ting I ldquoNSW universities taking students with ATARs as low as 30rdquo The Sydney Morning Herald 27 January 2016

httpwwwsmhcomau

Should and could universities be found liable

for the negligent acts of their graduates

School of Medicine

Peter Hamilton BScEd LLB(Hons) GDLP

Lecturer in Medical Law

School of Medicine

Are universities acting negligently ldquoThe university professor who stood up against dumbing down of degreesrdquo 1

raquo ldquohellip internal documents revealed that the university had lsquoupgradedrsquo a number of first and second year

pharmacy students ndash effectively lowering the pass mark on one course to 26 per cent ndash after half of

them failed their examsrdquo

raquo ldquoStaff who taught and marked the papers said that some students were simply lsquonot up to the rigors of

the programmersquo and in many cases lsquohad a poor attitude to workrsquo

ldquoUnderperforming nursing students lsquocould endanger public safetyrsquo says university

academicsrdquo 2

raquo ldquoAcademics come under pressure to turn a blind eye to problems caused by poor academic capabilities

and actively play a part in allowing students to pass who should failrdquo

raquo ldquohellip exam questions were being leaked to ensure students passed subjects and provide lecturers with

the positive feedback now essential to a renewed teaching contractrdquo

ldquoNSW universities taking students with ATARs as low as 30rdquo 3

raquo ldquoOne student hellip scored an ATAR in the 30s and was admitted to a combined Bachelor of Secondary

Education and Arts hellip with a cut off of 75rdquo

raquo ldquohellip students with ATARs as low as 46 have been offered a place in the Medical Science degreerdquo

School of Medicine

1 Henry J ldquoThe university professor who stood up against dumbing down of degreesrdquo Telegraph 28 February 2010

lthttpwwwtelegraphcoukeducationnewsgt

2 Besser L Cronau P amp Cohen H ldquoUnderperforming nursing students lsquocould endanger public safetyrsquo says university academicsrdquo ABC News 20

April 2015 httpwwwabcenetaunews Also reported on ldquoDegrees of deceptionrdquo Four Corners ABC 20 April 2015

3 Bagshaw E amp Ting I ldquoNSW universities taking students with ATARs as low as 30rdquo The Sydney Morning Herald 27 January 2016

httpwwwsmhcomau

Are universities acting negligently ldquoThe university professor who stood up against dumbing down of degreesrdquo 1

raquo ldquohellip internal documents revealed that the university had lsquoupgradedrsquo a number of first and second year

pharmacy students ndash effectively lowering the pass mark on one course to 26 per cent ndash after half of

them failed their examsrdquo

raquo ldquoStaff who taught and marked the papers said that some students were simply lsquonot up to the rigors of

the programmersquo and in many cases lsquohad a poor attitude to workrsquo

ldquoUnderperforming nursing students lsquocould endanger public safetyrsquo says university

academicsrdquo 2

raquo ldquoAcademics come under pressure to turn a blind eye to problems caused by poor academic capabilities

and actively play a part in allowing students to pass who should failrdquo

raquo ldquohellip exam questions were being leaked to ensure students passed subjects and provide lecturers with

the positive feedback now essential to a renewed teaching contractrdquo

ldquoNSW universities taking students with ATARs as low as 30rdquo 3

raquo ldquoOne student hellip scored an ATAR in the 30s and was admitted to a combined Bachelor of Secondary

Education and Arts hellip with a cut off of 75rdquo

raquo ldquohellip students with ATARs as low as 46 have been offered a place in the Medical Science degreerdquo

School of Medicine

1 Henry J ldquoThe university professor who stood up against dumbing down of degreesrdquo Telegraph 28 February 2010

lthttpwwwtelegraphcoukeducationnewsgt

2 Besser L Cronau P amp Cohen H ldquoUnderperforming nursing students lsquocould endanger public safetyrsquo says university academicsrdquo ABC News 20

April 2015 httpwwwabcenetaunews Also reported on ldquoDegrees of deceptionrdquo Four Corners ABC 20 April 2015

3 Bagshaw E amp Ting I ldquoNSW universities taking students with ATARs as low as 30rdquo The Sydney Morning Herald 27 January 2016

httpwwwsmhcomau

Scenario

A medical student is passed by a university The student however

fails to meet the standard of the ldquosafe internrdquo as indicated by the

Australian Medical Council guidelines4 Within three weeks of the

studentrsquos guaranteed internship they are called to see a patient with

worsening breathlessness hypotension and hypoxia They fail to

recognise the clinical deterioration5 of the patient who has acute

pulmonary oedema and the patient consequently dies Can the

university be held liable for graduating a student who did not have a

basic skill expected of them upon graduation

School of Medicine

4 Medical School Accreditation Committee December 2012 Standards for Assessment and Accreditation of

Primary Medical Programs by the Australian Medical Council 2012 Australian Medical Council Limited

5 Medical School Accreditation Committee December 2012 Standards for Assessment and Accreditation of

Primary Medical Programs by the Australian Medical Council 2012 ndash Domain 2 clause 212 Australian Medical

Council Limited

Negligence

In order for the university to be held liable for negligence the

following questions need to be answered in the affirmative

1 Did the university (defendant) owe a duty of care to

the patient (plaintiff)

2 Did the university breach their duty of care by falling

below the standard of care expected

3 Did the patient suffer damages that were foreseeable

and quantifiable

4 Did the breach of duty cause the damages

School of Medicine

Duty of CareA duty of care is an obligation imposed on a personinstitution to

take reasonable care to ensure that they do not through their

conduct cause another person to suffer harm6

In the case of Donoghue v Stevenson Lord Atkin proposed a

general approach that should be taken in deciding whether a person

owes a duty of care to another 7

You must take reasonable care to avoid acts and omissions which you can

reasonably foresee would be likely to injure your neighbour Who then in

law is my neighbour The answer seems to be ndash persons who are so closely

and directly affected by my act that I ought reasonably to have them in

contemplation as being so affected when I am directing my mind to the acts

and omissions which are called in question

School of Medicine

6 Withnall Sarah Greg Walsh and Patrick Rooney Torts Chatswood Australia LexisNexis Butterworths 2008

p 11

7 Donoghue v Stevenson [1932] AC 562 per Lord Atkin page 580

Breach of the duty of careA university will have breached their duty of care by falling below

the standard of care expected

The standard of care expected in this instance is that of the ldquosafe

internrdquo as determined by the Standards for Assessment and

Accreditation of Primary Medical Programs by the Australian Medical

Council 2012 which states8

ldquoRecognise and assess deteriorating and critically unwell patients who require immediate care Perform common emergency and life support procedures including caring for the unconscious patient and performing CPRrdquo

School of Medicine

8 Medical School Accreditation Committee December 2012 Standards for Assessment and Accreditation of

Primary Medical Programs by the Australian Medical Council 2012 ndash Domain 2 clause 212 Australian Medical

Council Limited

DamagesIn our scenario the patient has died If a patient has died as result of negligent

treatment or failure to treat relatives such as the patientrsquos widow or children may be

able to sue if they have suffered financial loss as a result of the patientrsquos death9

In relation to a patient that has not died damages can also be awarded in regard to10

raquo General damages for pain suffering and loss of enjoyment of life

raquo Specific damages for actual financial losses and expenses (loss of income

and superannuation medical and hospital expenses)

raquo Future losses and expenses arising from the negligence (including care

medical expenses home modification and maintenance and therapeutic and

physical aids)

School of Medicine

9 Skene Leone Law and Medical Practice Rights Duties Claims and Defences 3rd ed Chatswood NSW

LexisNexis Butterworths 2008 at pp 81-82

10 Breen Kerry J Stephen M Cordner Colin J H Thomson amp Vernon D Plueckhahn Good Medical Practice

Professionalism Ethics and Law First Edition Port Melbourne VIC Cambridge University Press 2010

Chapter 7 pp 114-115

CausationThe doctorrsquos breach of duty must cause the damages alleged by the

patient

The courts have modified the lsquobut forrsquo test for causation to be

determined by a value judgment involving ordinary notions of

language and common sense11

If an injury can be attributed to a number of possible causes one of

which is the negligence of the university then the court may determine

if the universityrsquos negligence was a lsquomaterial contributionrsquo to the

patientrsquos condition If the universityrsquos actions are a material contribution

to the patientrsquos condition the university could be held liable to the

extent of that contribution11

School of Medicine

11 Skene Leone Law and Medical Practice Rights Duties Claims and Defences 3rd ed Chatswood NSW

LexisNexis Butterworths 2008 at pp 231-235

Precedent Nothing along the lines that have been suggested here

In the USA there are a number of pending claims from students who are bringing

actions against universities for intentionally misleading students exaggerating

post graduation employment figures and future salary expectations1213 14 15

Students have brought negligence claims against schoolsuniversities for failing to

adequately educate them1617 These claims have had some limited success in

the United Kingdom where it was said that ldquoa school which accepts a pupil

assumes responsibility not only for his physical well being but also for his

educational needsrdquo18

Students have brought claims against universities claiming they ought to have

received a higher grade These to my knowledge have been unsuccessful1219

School of Medicine

12 Black D ldquoDisgruntled university students can sue their school for breach of contractrdquo Toronto Star 23 April 2012 httpwwwthestarcomnewscanada

13 Kerr JC ldquoAnother large for-profit college is under government scrutiny-this time DeVry Universityrdquo US News 27 January 2016

httpwwwusnescomnewsbusinessarticles

14 ldquoEducation graduates sue University of Minnesota Duluth over accreditationrdquo Star Tribune 16 October 2015 httpwwwstartribunecom

15 Whigham N ldquoHapless graduates sue their former universities in shockingly high numbersrdquo 25 December 2015 httpwwwnewscomaufinancework

16 Newman J ldquoEdukashonal negligencerdquo (2008) 82(1amp2) Law Institute Journal p34

17 Underwood J K ldquoLiability of School Districts and School Personnel for Negligence ndash Duty Breach of Duty Injury Causation Defences Malpracticerdquo

httpeducationstateuniversitycom

18 X (Minors) v Bedfordshire CC [1995] UKHL 9

19 Maughan v the University of British Columbia (2009) BCCA 447

Negligence

In order for the university to be held liable for negligence the

following questions need to be answered in the affirmative

1 Did the university (defendant) owe a duty of care to

the patient (plaintiff)

2 Did the university breach their duty of care by falling

below the standard of care expected

3 Did the patient suffer damages that were foreseeable

and quantifiable

4 Did the breach of duty cause the damages

School of Medicine

Duty of CareA duty of care is an obligation imposed on a personinstitution to

take reasonable care to ensure that they do not through their

conduct cause another person to suffer harm6

In the case of Donoghue v Stevenson Lord Atkin proposed a

general approach that should be taken in deciding whether a person

owes a duty of care to another 7

You must take reasonable care to avoid acts and omissions which you can

reasonably foresee would be likely to injure your neighbour Who then in

law is my neighbour The answer seems to be ndash persons who are so closely

and directly affected by my act that I ought reasonably to have them in

contemplation as being so affected when I am directing my mind to the acts

and omissions which are called in question

School of Medicine

6 Withnall Sarah Greg Walsh and Patrick Rooney Torts Chatswood Australia LexisNexis Butterworths 2008

p 11

7 Donoghue v Stevenson [1932] AC 562 per Lord Atkin page 580

Breach of the duty of careA university will have breached their duty of care by falling below

the standard of care expected

The standard of care expected in this instance is that of the ldquosafe

internrdquo as determined by the Standards for Assessment and

Accreditation of Primary Medical Programs by the Australian Medical

Council 2012 which states8

ldquoRecognise and assess deteriorating and critically unwell patients who require immediate care Perform common emergency and life support procedures including caring for the unconscious patient and performing CPRrdquo

School of Medicine

8 Medical School Accreditation Committee December 2012 Standards for Assessment and Accreditation of

Primary Medical Programs by the Australian Medical Council 2012 ndash Domain 2 clause 212 Australian Medical

Council Limited

DamagesIn our scenario the patient has died If a patient has died as result of negligent

treatment or failure to treat relatives such as the patientrsquos widow or children may be

able to sue if they have suffered financial loss as a result of the patientrsquos death9

In relation to a patient that has not died damages can also be awarded in regard to10

raquo General damages for pain suffering and loss of enjoyment of life

raquo Specific damages for actual financial losses and expenses (loss of income

and superannuation medical and hospital expenses)

raquo Future losses and expenses arising from the negligence (including care

medical expenses home modification and maintenance and therapeutic and

physical aids)

School of Medicine

9 Skene Leone Law and Medical Practice Rights Duties Claims and Defences 3rd ed Chatswood NSW

LexisNexis Butterworths 2008 at pp 81-82

10 Breen Kerry J Stephen M Cordner Colin J H Thomson amp Vernon D Plueckhahn Good Medical Practice

Professionalism Ethics and Law First Edition Port Melbourne VIC Cambridge University Press 2010

Chapter 7 pp 114-115

CausationThe doctorrsquos breach of duty must cause the damages alleged by the

patient

The courts have modified the lsquobut forrsquo test for causation to be

determined by a value judgment involving ordinary notions of

language and common sense11

If an injury can be attributed to a number of possible causes one of

which is the negligence of the university then the court may determine

if the universityrsquos negligence was a lsquomaterial contributionrsquo to the

patientrsquos condition If the universityrsquos actions are a material contribution

to the patientrsquos condition the university could be held liable to the

extent of that contribution11

School of Medicine

11 Skene Leone Law and Medical Practice Rights Duties Claims and Defences 3rd ed Chatswood NSW

LexisNexis Butterworths 2008 at pp 231-235

Precedent Nothing along the lines that have been suggested here

In the USA there are a number of pending claims from students who are bringing

actions against universities for intentionally misleading students exaggerating

post graduation employment figures and future salary expectations1213 14 15

Students have brought negligence claims against schoolsuniversities for failing to

adequately educate them1617 These claims have had some limited success in

the United Kingdom where it was said that ldquoa school which accepts a pupil

assumes responsibility not only for his physical well being but also for his

educational needsrdquo18

Students have brought claims against universities claiming they ought to have

received a higher grade These to my knowledge have been unsuccessful1219

School of Medicine

12 Black D ldquoDisgruntled university students can sue their school for breach of contractrdquo Toronto Star 23 April 2012 httpwwwthestarcomnewscanada

13 Kerr JC ldquoAnother large for-profit college is under government scrutiny-this time DeVry Universityrdquo US News 27 January 2016

httpwwwusnescomnewsbusinessarticles

14 ldquoEducation graduates sue University of Minnesota Duluth over accreditationrdquo Star Tribune 16 October 2015 httpwwwstartribunecom

15 Whigham N ldquoHapless graduates sue their former universities in shockingly high numbersrdquo 25 December 2015 httpwwwnewscomaufinancework

16 Newman J ldquoEdukashonal negligencerdquo (2008) 82(1amp2) Law Institute Journal p34

17 Underwood J K ldquoLiability of School Districts and School Personnel for Negligence ndash Duty Breach of Duty Injury Causation Defences Malpracticerdquo

httpeducationstateuniversitycom

18 X (Minors) v Bedfordshire CC [1995] UKHL 9

19 Maughan v the University of British Columbia (2009) BCCA 447

Duty of CareA duty of care is an obligation imposed on a personinstitution to

take reasonable care to ensure that they do not through their

conduct cause another person to suffer harm6

In the case of Donoghue v Stevenson Lord Atkin proposed a

general approach that should be taken in deciding whether a person

owes a duty of care to another 7

You must take reasonable care to avoid acts and omissions which you can

reasonably foresee would be likely to injure your neighbour Who then in

law is my neighbour The answer seems to be ndash persons who are so closely

and directly affected by my act that I ought reasonably to have them in

contemplation as being so affected when I am directing my mind to the acts

and omissions which are called in question

School of Medicine

6 Withnall Sarah Greg Walsh and Patrick Rooney Torts Chatswood Australia LexisNexis Butterworths 2008

p 11

7 Donoghue v Stevenson [1932] AC 562 per Lord Atkin page 580

Breach of the duty of careA university will have breached their duty of care by falling below

the standard of care expected

The standard of care expected in this instance is that of the ldquosafe

internrdquo as determined by the Standards for Assessment and

Accreditation of Primary Medical Programs by the Australian Medical

Council 2012 which states8

ldquoRecognise and assess deteriorating and critically unwell patients who require immediate care Perform common emergency and life support procedures including caring for the unconscious patient and performing CPRrdquo

School of Medicine

8 Medical School Accreditation Committee December 2012 Standards for Assessment and Accreditation of

Primary Medical Programs by the Australian Medical Council 2012 ndash Domain 2 clause 212 Australian Medical

Council Limited

DamagesIn our scenario the patient has died If a patient has died as result of negligent

treatment or failure to treat relatives such as the patientrsquos widow or children may be

able to sue if they have suffered financial loss as a result of the patientrsquos death9

In relation to a patient that has not died damages can also be awarded in regard to10

raquo General damages for pain suffering and loss of enjoyment of life

raquo Specific damages for actual financial losses and expenses (loss of income

and superannuation medical and hospital expenses)

raquo Future losses and expenses arising from the negligence (including care

medical expenses home modification and maintenance and therapeutic and

physical aids)

School of Medicine

9 Skene Leone Law and Medical Practice Rights Duties Claims and Defences 3rd ed Chatswood NSW

LexisNexis Butterworths 2008 at pp 81-82

10 Breen Kerry J Stephen M Cordner Colin J H Thomson amp Vernon D Plueckhahn Good Medical Practice

Professionalism Ethics and Law First Edition Port Melbourne VIC Cambridge University Press 2010

Chapter 7 pp 114-115

CausationThe doctorrsquos breach of duty must cause the damages alleged by the

patient

The courts have modified the lsquobut forrsquo test for causation to be

determined by a value judgment involving ordinary notions of

language and common sense11

If an injury can be attributed to a number of possible causes one of

which is the negligence of the university then the court may determine

if the universityrsquos negligence was a lsquomaterial contributionrsquo to the

patientrsquos condition If the universityrsquos actions are a material contribution

to the patientrsquos condition the university could be held liable to the

extent of that contribution11

School of Medicine

11 Skene Leone Law and Medical Practice Rights Duties Claims and Defences 3rd ed Chatswood NSW

LexisNexis Butterworths 2008 at pp 231-235

Precedent Nothing along the lines that have been suggested here

In the USA there are a number of pending claims from students who are bringing

actions against universities for intentionally misleading students exaggerating

post graduation employment figures and future salary expectations1213 14 15

Students have brought negligence claims against schoolsuniversities for failing to

adequately educate them1617 These claims have had some limited success in

the United Kingdom where it was said that ldquoa school which accepts a pupil

assumes responsibility not only for his physical well being but also for his

educational needsrdquo18

Students have brought claims against universities claiming they ought to have

received a higher grade These to my knowledge have been unsuccessful1219

School of Medicine

12 Black D ldquoDisgruntled university students can sue their school for breach of contractrdquo Toronto Star 23 April 2012 httpwwwthestarcomnewscanada

13 Kerr JC ldquoAnother large for-profit college is under government scrutiny-this time DeVry Universityrdquo US News 27 January 2016

httpwwwusnescomnewsbusinessarticles

14 ldquoEducation graduates sue University of Minnesota Duluth over accreditationrdquo Star Tribune 16 October 2015 httpwwwstartribunecom

15 Whigham N ldquoHapless graduates sue their former universities in shockingly high numbersrdquo 25 December 2015 httpwwwnewscomaufinancework

16 Newman J ldquoEdukashonal negligencerdquo (2008) 82(1amp2) Law Institute Journal p34

17 Underwood J K ldquoLiability of School Districts and School Personnel for Negligence ndash Duty Breach of Duty Injury Causation Defences Malpracticerdquo

httpeducationstateuniversitycom

18 X (Minors) v Bedfordshire CC [1995] UKHL 9

19 Maughan v the University of British Columbia (2009) BCCA 447

Breach of the duty of careA university will have breached their duty of care by falling below

the standard of care expected

The standard of care expected in this instance is that of the ldquosafe

internrdquo as determined by the Standards for Assessment and

Accreditation of Primary Medical Programs by the Australian Medical

Council 2012 which states8

ldquoRecognise and assess deteriorating and critically unwell patients who require immediate care Perform common emergency and life support procedures including caring for the unconscious patient and performing CPRrdquo

School of Medicine

8 Medical School Accreditation Committee December 2012 Standards for Assessment and Accreditation of

Primary Medical Programs by the Australian Medical Council 2012 ndash Domain 2 clause 212 Australian Medical

Council Limited

DamagesIn our scenario the patient has died If a patient has died as result of negligent

treatment or failure to treat relatives such as the patientrsquos widow or children may be

able to sue if they have suffered financial loss as a result of the patientrsquos death9

In relation to a patient that has not died damages can also be awarded in regard to10

raquo General damages for pain suffering and loss of enjoyment of life

raquo Specific damages for actual financial losses and expenses (loss of income

and superannuation medical and hospital expenses)

raquo Future losses and expenses arising from the negligence (including care

medical expenses home modification and maintenance and therapeutic and

physical aids)

School of Medicine

9 Skene Leone Law and Medical Practice Rights Duties Claims and Defences 3rd ed Chatswood NSW

LexisNexis Butterworths 2008 at pp 81-82

10 Breen Kerry J Stephen M Cordner Colin J H Thomson amp Vernon D Plueckhahn Good Medical Practice

Professionalism Ethics and Law First Edition Port Melbourne VIC Cambridge University Press 2010

Chapter 7 pp 114-115

CausationThe doctorrsquos breach of duty must cause the damages alleged by the

patient

The courts have modified the lsquobut forrsquo test for causation to be

determined by a value judgment involving ordinary notions of

language and common sense11

If an injury can be attributed to a number of possible causes one of

which is the negligence of the university then the court may determine

if the universityrsquos negligence was a lsquomaterial contributionrsquo to the

patientrsquos condition If the universityrsquos actions are a material contribution

to the patientrsquos condition the university could be held liable to the

extent of that contribution11

School of Medicine

11 Skene Leone Law and Medical Practice Rights Duties Claims and Defences 3rd ed Chatswood NSW

LexisNexis Butterworths 2008 at pp 231-235

Precedent Nothing along the lines that have been suggested here

In the USA there are a number of pending claims from students who are bringing

actions against universities for intentionally misleading students exaggerating

post graduation employment figures and future salary expectations1213 14 15

Students have brought negligence claims against schoolsuniversities for failing to

adequately educate them1617 These claims have had some limited success in

the United Kingdom where it was said that ldquoa school which accepts a pupil

assumes responsibility not only for his physical well being but also for his

educational needsrdquo18

Students have brought claims against universities claiming they ought to have

received a higher grade These to my knowledge have been unsuccessful1219

School of Medicine

12 Black D ldquoDisgruntled university students can sue their school for breach of contractrdquo Toronto Star 23 April 2012 httpwwwthestarcomnewscanada

13 Kerr JC ldquoAnother large for-profit college is under government scrutiny-this time DeVry Universityrdquo US News 27 January 2016

httpwwwusnescomnewsbusinessarticles

14 ldquoEducation graduates sue University of Minnesota Duluth over accreditationrdquo Star Tribune 16 October 2015 httpwwwstartribunecom

15 Whigham N ldquoHapless graduates sue their former universities in shockingly high numbersrdquo 25 December 2015 httpwwwnewscomaufinancework

16 Newman J ldquoEdukashonal negligencerdquo (2008) 82(1amp2) Law Institute Journal p34

17 Underwood J K ldquoLiability of School Districts and School Personnel for Negligence ndash Duty Breach of Duty Injury Causation Defences Malpracticerdquo

httpeducationstateuniversitycom

18 X (Minors) v Bedfordshire CC [1995] UKHL 9

19 Maughan v the University of British Columbia (2009) BCCA 447

DamagesIn our scenario the patient has died If a patient has died as result of negligent

treatment or failure to treat relatives such as the patientrsquos widow or children may be

able to sue if they have suffered financial loss as a result of the patientrsquos death9

In relation to a patient that has not died damages can also be awarded in regard to10

raquo General damages for pain suffering and loss of enjoyment of life

raquo Specific damages for actual financial losses and expenses (loss of income

and superannuation medical and hospital expenses)

raquo Future losses and expenses arising from the negligence (including care

medical expenses home modification and maintenance and therapeutic and

physical aids)

School of Medicine

9 Skene Leone Law and Medical Practice Rights Duties Claims and Defences 3rd ed Chatswood NSW

LexisNexis Butterworths 2008 at pp 81-82

10 Breen Kerry J Stephen M Cordner Colin J H Thomson amp Vernon D Plueckhahn Good Medical Practice

Professionalism Ethics and Law First Edition Port Melbourne VIC Cambridge University Press 2010

Chapter 7 pp 114-115

CausationThe doctorrsquos breach of duty must cause the damages alleged by the

patient

The courts have modified the lsquobut forrsquo test for causation to be

determined by a value judgment involving ordinary notions of

language and common sense11

If an injury can be attributed to a number of possible causes one of

which is the negligence of the university then the court may determine

if the universityrsquos negligence was a lsquomaterial contributionrsquo to the

patientrsquos condition If the universityrsquos actions are a material contribution

to the patientrsquos condition the university could be held liable to the

extent of that contribution11

School of Medicine

11 Skene Leone Law and Medical Practice Rights Duties Claims and Defences 3rd ed Chatswood NSW

LexisNexis Butterworths 2008 at pp 231-235

Precedent Nothing along the lines that have been suggested here

In the USA there are a number of pending claims from students who are bringing

actions against universities for intentionally misleading students exaggerating

post graduation employment figures and future salary expectations1213 14 15

Students have brought negligence claims against schoolsuniversities for failing to

adequately educate them1617 These claims have had some limited success in

the United Kingdom where it was said that ldquoa school which accepts a pupil

assumes responsibility not only for his physical well being but also for his

educational needsrdquo18

Students have brought claims against universities claiming they ought to have

received a higher grade These to my knowledge have been unsuccessful1219

School of Medicine

12 Black D ldquoDisgruntled university students can sue their school for breach of contractrdquo Toronto Star 23 April 2012 httpwwwthestarcomnewscanada

13 Kerr JC ldquoAnother large for-profit college is under government scrutiny-this time DeVry Universityrdquo US News 27 January 2016

httpwwwusnescomnewsbusinessarticles

14 ldquoEducation graduates sue University of Minnesota Duluth over accreditationrdquo Star Tribune 16 October 2015 httpwwwstartribunecom

15 Whigham N ldquoHapless graduates sue their former universities in shockingly high numbersrdquo 25 December 2015 httpwwwnewscomaufinancework

16 Newman J ldquoEdukashonal negligencerdquo (2008) 82(1amp2) Law Institute Journal p34

17 Underwood J K ldquoLiability of School Districts and School Personnel for Negligence ndash Duty Breach of Duty Injury Causation Defences Malpracticerdquo

httpeducationstateuniversitycom

18 X (Minors) v Bedfordshire CC [1995] UKHL 9

19 Maughan v the University of British Columbia (2009) BCCA 447

CausationThe doctorrsquos breach of duty must cause the damages alleged by the

patient

The courts have modified the lsquobut forrsquo test for causation to be

determined by a value judgment involving ordinary notions of

language and common sense11

If an injury can be attributed to a number of possible causes one of

which is the negligence of the university then the court may determine

if the universityrsquos negligence was a lsquomaterial contributionrsquo to the

patientrsquos condition If the universityrsquos actions are a material contribution

to the patientrsquos condition the university could be held liable to the

extent of that contribution11

School of Medicine

11 Skene Leone Law and Medical Practice Rights Duties Claims and Defences 3rd ed Chatswood NSW

LexisNexis Butterworths 2008 at pp 231-235

Precedent Nothing along the lines that have been suggested here

In the USA there are a number of pending claims from students who are bringing

actions against universities for intentionally misleading students exaggerating

post graduation employment figures and future salary expectations1213 14 15

Students have brought negligence claims against schoolsuniversities for failing to

adequately educate them1617 These claims have had some limited success in

the United Kingdom where it was said that ldquoa school which accepts a pupil

assumes responsibility not only for his physical well being but also for his

educational needsrdquo18

Students have brought claims against universities claiming they ought to have

received a higher grade These to my knowledge have been unsuccessful1219

School of Medicine

12 Black D ldquoDisgruntled university students can sue their school for breach of contractrdquo Toronto Star 23 April 2012 httpwwwthestarcomnewscanada

13 Kerr JC ldquoAnother large for-profit college is under government scrutiny-this time DeVry Universityrdquo US News 27 January 2016

httpwwwusnescomnewsbusinessarticles

14 ldquoEducation graduates sue University of Minnesota Duluth over accreditationrdquo Star Tribune 16 October 2015 httpwwwstartribunecom

15 Whigham N ldquoHapless graduates sue their former universities in shockingly high numbersrdquo 25 December 2015 httpwwwnewscomaufinancework

16 Newman J ldquoEdukashonal negligencerdquo (2008) 82(1amp2) Law Institute Journal p34

17 Underwood J K ldquoLiability of School Districts and School Personnel for Negligence ndash Duty Breach of Duty Injury Causation Defences Malpracticerdquo

httpeducationstateuniversitycom

18 X (Minors) v Bedfordshire CC [1995] UKHL 9

19 Maughan v the University of British Columbia (2009) BCCA 447

Precedent Nothing along the lines that have been suggested here

In the USA there are a number of pending claims from students who are bringing

actions against universities for intentionally misleading students exaggerating

post graduation employment figures and future salary expectations1213 14 15

Students have brought negligence claims against schoolsuniversities for failing to

adequately educate them1617 These claims have had some limited success in

the United Kingdom where it was said that ldquoa school which accepts a pupil

assumes responsibility not only for his physical well being but also for his

educational needsrdquo18

Students have brought claims against universities claiming they ought to have

received a higher grade These to my knowledge have been unsuccessful1219

School of Medicine

12 Black D ldquoDisgruntled university students can sue their school for breach of contractrdquo Toronto Star 23 April 2012 httpwwwthestarcomnewscanada

13 Kerr JC ldquoAnother large for-profit college is under government scrutiny-this time DeVry Universityrdquo US News 27 January 2016

httpwwwusnescomnewsbusinessarticles

14 ldquoEducation graduates sue University of Minnesota Duluth over accreditationrdquo Star Tribune 16 October 2015 httpwwwstartribunecom

15 Whigham N ldquoHapless graduates sue their former universities in shockingly high numbersrdquo 25 December 2015 httpwwwnewscomaufinancework

16 Newman J ldquoEdukashonal negligencerdquo (2008) 82(1amp2) Law Institute Journal p34

17 Underwood J K ldquoLiability of School Districts and School Personnel for Negligence ndash Duty Breach of Duty Injury Causation Defences Malpracticerdquo

httpeducationstateuniversitycom

18 X (Minors) v Bedfordshire CC [1995] UKHL 9

19 Maughan v the University of British Columbia (2009) BCCA 447

Why the lack of precedent In 2010 the Labour government removed the capped funding and enrolment targets that had

previously controlled the number of students enrolling in Bachelor degrees From 2012

universities were able to enrol as many qualified students as they could attract

raquo Universities now have a corporate feel advertising and selling a product1234

raquo University rankings attract students and are influenced by student satisfaction rates (students appear

satisfied if they receive a high grade)56

raquo Students can be persuaded to attend institutions which have a reputation for passing students and

providing employment opportunities (which is assisted by a transcript that contains all distinctions

whether genuine or not)25

raquo Academic promotion is often based on student satisfaction rates creating a pressure to pass students

that would not ordinarily pass for fear of negative often anonymous feedback36

As a matter of public policy there is a general reluctance of the courts to interfere with the

decision making process of universities78

No precedent from the USA where lsquocreative litigationrsquo would usually arise first because the

United States has a licensing exam for medical graduates

School of Medicine

1 Henry J ldquoThe university professor who stood up against dumbing down of degreesrdquo Telegraph 28 February 2010 lthttpwwwtelegraphcoukeducationnewsgt

2 ldquoNatfhersquos anger at pressure to pass studentsrdquo Times Higher Education 6 August 2004 httpwwwtimeshighereducationcomnews

3 Besser L Cronau P amp Cohen H ldquoUnderperforming nursing students lsquocould endanger public safetyrsquo says university academicsrdquo ABC News 20 April 2015

httpwwwabcenetaunews Also reported on ldquoDegrees of deceptionrdquo Four Corners ABC 20 April 2015

4 Bagshaw E amp Ting I ldquoNSW universities taking students with ATARs as low as 30rdquo The Sydney Morning Herald 27 January 2016 httpwwwsmhcomau

5 Lancaster A ldquoAustralian University Rankings 2016rdquo Last updated 8 October 2015 httpsuniversityreviewscomauaustralian-rankings

6 Poropatat A ldquoStudents donrsquot know what is best for their own learningrdquo The Conversation 19 November 2014 httptheconversationcom

7 Newman J ldquoEdukashonal negligencerdquo (2008) 82(1amp2) Law Institute Journal p34

8 Parrott J ldquoAre advisors risking lawsuits for misadvising studentsrdquo The Mentor 9 July 2001 httpduspsuedumentot

Points to consider It may be argued that employment procedures such as interviews constitute a break in the

chain of causation

raquo What if two students have received the same standard in a subject However

University A gives all its students 80 (making employment opportunities more

attractive) and University B gives the same standard 55 and the

employerhospital chooses students from University A over students from

University B who received 75

Should employers act and proceed on the basis that a university passing grade means that

the student has met the relevant standard of care as set out in the Standards for Assessment

and Accreditation of Primary Medical Programs by the Australian Medical Council 2012 Is it

reasonable for employers to conduct lsquorigorousrsquo interviews (with OSCE stations) in order to

detect a student who has not genuinely met the required standard

When does the liability shift from the University to the employer This is clearly time

dependent The earlier the incident in time the more the University could be held to have

lsquomaterially contributedrsquo to the negligent act of the graduate Whilst clearly at some point in

time the employer will become completely vicariously liable for its employer

School of Medicine

Points to consider Until 2016 most students were assured an internship upon graduation

This lsquoguaranteersquo can effectively remove the employerrsquos ability to remove

the weaker students from the employment sector

Market Forces Is it a defence that a poor performing student would

have been employed in any event because there is a shortage of

doctors at that time

In the case of BKY v The University of Newcastle [2014] NSWCATAD

39 a student was successful in appealing her exclusion from the

Bachelor of Medicine

raquo This was a clear case of discrimination and sends a message to

universities to be consistent in the application of their exclusion

policies and possibly to make these policies more stringent

School of Medicine

Can universities

reliably predict

future

unprofessional

conduct

Points to consider Until 2016 most students were assured an internship upon graduation

This lsquoguaranteersquo can effectively remove the employerrsquos ability to remove

the weaker students from the employment sector

Market Forces Is it a defence that a poor performing student would

have been employed in any event because there is a shortage of

doctors at that time

In the case of BKY v The University of Newcastle [2014] NSWCATAD

39 a student was successful in appealing her exclusion from the

Bachelor of Medicine

raquo This was a clear case of discrimination and sends a message to

universities to be consistent in the application of their exclusion

policies and possibly to make these policies more stringent

School of Medicine

Can universities

reliably predict

future

unprofessional

conduct

Can universities

reliably predict

future

unprofessional

conduct

1991 Graduates RPAH Yearbook

A prediction from the 1991 yearbookhellip

Disciplinary action and prior behaviour in medical schools

Papadakis et al (2005 2008)

raquoPoor interpersonalcommunication skills

raquoPoor personal responsibility

raquoLack of initiative

raquoPoor attendance

raquoInability to accept criticism

raquoArgumentative

raquoPassivity

raquoDiminished capacity for self improvement (multiple instances)

raquoSeverely Irresponsible (multiple instancesgt3)

raquo3to 8 times more likely to be involved in professional disciplinary measures

raquoLow admission scores(but still met the cut off)

raquoPoor academic performance in early years of program (but still met the minimum standard)

Overall Disciplined

Physicians

Control Physicians (no

referral to regulator)

Displayed lsquounprofessionalrsquo

behaviour in medical school 391 192

But

Papadakis et al (2005) Table 3

~40 of target physicians (disciplined) displayed unprofessional

behaviour in medical school ( ie 60 didnrsquot)

~20 of control physicians (not disciplined) displayed unprofessional

behaviour in medical schoolndash with no further problems raised

Further research by Santen (20) ndash 2000 students140 poor professionalism

in med school 29 sanctions ( ~20 - 80 false positive)

-Lots of false positives and false negatives ndash this is a poor diagnostic test

Furthermorehellip (Norman 2015)

Poor professionalism (however defined and lsquomeasuredrsquo) is a low

prevalence problem (~1)

Situation rather than personality may actually be a greater determinant

of problem

Personality may not be as stable as believed ndash impact for young

adults

ldquoIt is folly to presume that we will ever be able to create an adequate

diagnostic test to the ultimately rare disease of unprofessionalismrdquo

CONCLUSION Medical school is not a great place to reliably

predict future poor conduct

The lsquoVividness HypothesisrsquoNisbett R E amp Ross L (1980)

lsquoA single vivid instance can influence social

attitudes when pallid statistics of far greater

evidential value do notrsquo (p 57)

Prediction and prevention is desirable

raquo Current model waits until harm has arisen

Prediction provides the opportunity to intervene

before harm occurs

raquo Current model waits until behaviours are

entrenched before addressing them

raquo Prediction enables monitoring from an earlier

point = less patient harm

The Promise (Why we want to believe in prediction)

Influenced by hindsight bias

raquo Being wise after the event

Reinforced by The Vividness Hypothesis - creates un-

evidenced future Bias

Can create injustice

raquo Doesnrsquot account for developmental considerations for

students

raquo May deny natural justice as many would be unfairly caught

in the lsquopredictiversquo net

raquo Too many false positives and false negatives ndash with a

disproportionate consequence

Draws educators into the role of lsquoprospectiversquo regulators

The Peril(Why we should be cautious about prediction)

Its just the vibe of the thing

Professor X considered that BKY would not be safe to practise even if

she was ultimately capable of completing her degree

It is not the task of this Tribunal to determine if the applicant would be fit

to practice as a medical practitioner if she were to complete her medical

degree Professor X was very concerned about the applicants ability to

practise due to her psychiatric conditions The completion of the medical

degree does not mean that she can automatically practise as a medical

practitioner Her psychiatric conditions are already registered with the

NSW Medical Council The Tribunal notes thathellipfitness to practise as a

medical practitioner is governed by the NSW Medical Council and if the

Medical Council deems that the applicant is not fit to practise then she

will not be able to do so

School of Medicine

What mechanisms exist within the University and current

regulatory system to respond to concerns about poor

professionalism in medical students

Universities

Robust academic standards

Misconduct policies ( transparency)

Inability to complete policies

Regulatory

Mandatory and Voluntary reporting (National Law)

The bar for regulatory intervention is high for students ndash

and reasonably so ndash the core principle is protection of the

publicSchool of Medicine

What is the potential impact on Medical Education

and assessment

For clinical knowledge and competence - ensure a common

and adequate minimum national standard

raquo AMC standards

raquo National exam ( eg USACanada)

For assessment of professionalism

raquo Longitudinal and multi source feedback is best

raquo Peer assessments are good - Mini PAT360 feedback ndash but

time and resource intensive - Are they worth it

raquo In Training Assessment (ITA)

raquo Need to make this an assessable part of the curriculum ndash but

set a minimum standardSchool of Medicinoe

Focus on actual stage approprate conduct and skill (here and now)

raquo Resist the lsquovividness hypothesisrsquo and hindsight bias

raquo Promote and expect honesty in assessment

Proportionality in response

raquo High Risk = High Scrutiny = High Consequence= High Accountability

(and vice versa)

raquo Challenge the disproportionate use of resources lsquopolicingrsquo minor

concerns ndash Donrsquot create an lsquoalbatrossrsquo

Accept that students pose very low risk of harm to the public ndash and

regulatory intervention should be ( and is) rare

The Practicalitieswhat can Universities actually do

Finallyhellip

Each progression to a new stage raises the

bar - apply an appropriate (higher) standard to

each step

Educators are not prospective regulators- but

they do have a duty to train to a standard

School of Medicine

Ainsworth M and Szauter KM (2006) Medical student professionalism Are we measuring the right behaviours A comparison of lapses by students and physicians Acad Med 81s83-s86

Bismark M Spittal M and Studdert D (2011) Prevalence and characteristic s of complaint prone doctors in Australia Med J Aust 195436-440Bismark M et al (2013) Identification of doctors at risk of recurrent complaints a national study of healthcare complaints in AustraliaBMJ Qual

Saf doi101136bmjqs-2012-001691Elkin K Spittal MJ Studdert DM (2012) Risks of complaints and adverse disciplinary findings against international medical graduates in Victoria and

Western Australia Med J Aust 197(8) 448-452Elkin KJ1 Spittal MJ Elkin DJ Studdert DM (2011) Doctors disciplined for professional misconduct in Australia and New Zealand 2000-2009 Med J Aust

194 (9) 452-456Colliver J A Markwell S J Verhulst S J amp Robbs R S (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 213ndash215

Giedd JN (2008) The teen brain Insights from neuroimaging J Adolesc Health 42335ndash43Johnson S Blum R Giedd J (2009) Adolescent Maturity and the Brain The Promise and Pitfalls of Neuroscience Research in Adolescent Health Policy J

Adolesc Health 2009 Sep 45(3) 216ndash221Medicare Statistics (2013-2014) httpmedicarestatisticshumanservicesgovaustatisticsmbs_groupjsp Accessed 4th march 2015Norman G Identifying the bad apples Advances in Health Sciences EducationTheory and Practice copy Springer Science+Business Media Dordrecht

2015101007s10459-015-9598-9Papadakis et al ( 2005) Unprofessional behaviour in medical School is associated with subsequent disciplinary action by state medical board Acad Med

79 244-249Papadakis et al (2008) Performance during internal medicine residency training and subsequent disciplinary action by state licensing boards Ann Int

Med 148 (11) 869-876Parker M Turner J and McGurgan P (2010) The difficult problem of assessing medical studentsrsquo professional attitudes and behaviour Med J Aust Parker M Luke T Zhang J Wilkinson Ozolins L (2008) The ldquoPyramid of Professionalismrdquo Seven Years of Experience With an Integrated Program of

Teaching Developing and Assessing Professionalism Among Medical Students ADDPatterson R (2013) Not so random patient complaints and frequent flier doctors BMJ Qual Saf 01-3Santen S A Petrusa E amp Gruppen L D (2014) The relationship between promotions committeesrsquo identification of problem medical students and

subsequent state medical board actions Advances in Health Sciences Education doi101007s10459-014-9536-2Stern DT Frohna AZ Gruppen LD (2005) The prediction of professional behaviour Med Ed 3975-82

References

A prediction from the 1991 yearbookhellip

Disciplinary action and prior behaviour in medical schools

Papadakis et al (2005 2008)

raquoPoor interpersonalcommunication skills

raquoPoor personal responsibility

raquoLack of initiative

raquoPoor attendance

raquoInability to accept criticism

raquoArgumentative

raquoPassivity

raquoDiminished capacity for self improvement (multiple instances)

raquoSeverely Irresponsible (multiple instancesgt3)

raquo3to 8 times more likely to be involved in professional disciplinary measures

raquoLow admission scores(but still met the cut off)

raquoPoor academic performance in early years of program (but still met the minimum standard)

Overall Disciplined

Physicians

Control Physicians (no

referral to regulator)

Displayed lsquounprofessionalrsquo

behaviour in medical school 391 192

But

Papadakis et al (2005) Table 3

~40 of target physicians (disciplined) displayed unprofessional

behaviour in medical school ( ie 60 didnrsquot)

~20 of control physicians (not disciplined) displayed unprofessional

behaviour in medical schoolndash with no further problems raised

Further research by Santen (20) ndash 2000 students140 poor professionalism

in med school 29 sanctions ( ~20 - 80 false positive)

-Lots of false positives and false negatives ndash this is a poor diagnostic test

Furthermorehellip (Norman 2015)

Poor professionalism (however defined and lsquomeasuredrsquo) is a low

prevalence problem (~1)

Situation rather than personality may actually be a greater determinant

of problem

Personality may not be as stable as believed ndash impact for young

adults

ldquoIt is folly to presume that we will ever be able to create an adequate

diagnostic test to the ultimately rare disease of unprofessionalismrdquo

CONCLUSION Medical school is not a great place to reliably

predict future poor conduct

The lsquoVividness HypothesisrsquoNisbett R E amp Ross L (1980)

lsquoA single vivid instance can influence social

attitudes when pallid statistics of far greater

evidential value do notrsquo (p 57)

Prediction and prevention is desirable

raquo Current model waits until harm has arisen

Prediction provides the opportunity to intervene

before harm occurs

raquo Current model waits until behaviours are

entrenched before addressing them

raquo Prediction enables monitoring from an earlier

point = less patient harm

The Promise (Why we want to believe in prediction)

Influenced by hindsight bias

raquo Being wise after the event

Reinforced by The Vividness Hypothesis - creates un-

evidenced future Bias

Can create injustice

raquo Doesnrsquot account for developmental considerations for

students

raquo May deny natural justice as many would be unfairly caught

in the lsquopredictiversquo net

raquo Too many false positives and false negatives ndash with a

disproportionate consequence

Draws educators into the role of lsquoprospectiversquo regulators

The Peril(Why we should be cautious about prediction)

Its just the vibe of the thing

Professor X considered that BKY would not be safe to practise even if

she was ultimately capable of completing her degree

It is not the task of this Tribunal to determine if the applicant would be fit

to practice as a medical practitioner if she were to complete her medical

degree Professor X was very concerned about the applicants ability to

practise due to her psychiatric conditions The completion of the medical

degree does not mean that she can automatically practise as a medical

practitioner Her psychiatric conditions are already registered with the

NSW Medical Council The Tribunal notes thathellipfitness to practise as a

medical practitioner is governed by the NSW Medical Council and if the

Medical Council deems that the applicant is not fit to practise then she

will not be able to do so

School of Medicine

What mechanisms exist within the University and current

regulatory system to respond to concerns about poor

professionalism in medical students

Universities

Robust academic standards

Misconduct policies ( transparency)

Inability to complete policies

Regulatory

Mandatory and Voluntary reporting (National Law)

The bar for regulatory intervention is high for students ndash

and reasonably so ndash the core principle is protection of the

publicSchool of Medicine

What is the potential impact on Medical Education

and assessment

For clinical knowledge and competence - ensure a common

and adequate minimum national standard

raquo AMC standards

raquo National exam ( eg USACanada)

For assessment of professionalism

raquo Longitudinal and multi source feedback is best

raquo Peer assessments are good - Mini PAT360 feedback ndash but

time and resource intensive - Are they worth it

raquo In Training Assessment (ITA)

raquo Need to make this an assessable part of the curriculum ndash but

set a minimum standardSchool of Medicinoe

Focus on actual stage approprate conduct and skill (here and now)

raquo Resist the lsquovividness hypothesisrsquo and hindsight bias

raquo Promote and expect honesty in assessment

Proportionality in response

raquo High Risk = High Scrutiny = High Consequence= High Accountability

(and vice versa)

raquo Challenge the disproportionate use of resources lsquopolicingrsquo minor

concerns ndash Donrsquot create an lsquoalbatrossrsquo

Accept that students pose very low risk of harm to the public ndash and

regulatory intervention should be ( and is) rare

The Practicalitieswhat can Universities actually do

Finallyhellip

Each progression to a new stage raises the

bar - apply an appropriate (higher) standard to

each step

Educators are not prospective regulators- but

they do have a duty to train to a standard

School of Medicine

Ainsworth M and Szauter KM (2006) Medical student professionalism Are we measuring the right behaviours A comparison of lapses by students and physicians Acad Med 81s83-s86

Bismark M Spittal M and Studdert D (2011) Prevalence and characteristic s of complaint prone doctors in Australia Med J Aust 195436-440Bismark M et al (2013) Identification of doctors at risk of recurrent complaints a national study of healthcare complaints in AustraliaBMJ Qual

Saf doi101136bmjqs-2012-001691Elkin K Spittal MJ Studdert DM (2012) Risks of complaints and adverse disciplinary findings against international medical graduates in Victoria and

Western Australia Med J Aust 197(8) 448-452Elkin KJ1 Spittal MJ Elkin DJ Studdert DM (2011) Doctors disciplined for professional misconduct in Australia and New Zealand 2000-2009 Med J Aust

194 (9) 452-456Colliver J A Markwell S J Verhulst S J amp Robbs R S (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 213ndash215

Giedd JN (2008) The teen brain Insights from neuroimaging J Adolesc Health 42335ndash43Johnson S Blum R Giedd J (2009) Adolescent Maturity and the Brain The Promise and Pitfalls of Neuroscience Research in Adolescent Health Policy J

Adolesc Health 2009 Sep 45(3) 216ndash221Medicare Statistics (2013-2014) httpmedicarestatisticshumanservicesgovaustatisticsmbs_groupjsp Accessed 4th march 2015Norman G Identifying the bad apples Advances in Health Sciences EducationTheory and Practice copy Springer Science+Business Media Dordrecht

2015101007s10459-015-9598-9Papadakis et al ( 2005) Unprofessional behaviour in medical School is associated with subsequent disciplinary action by state medical board Acad Med

79 244-249Papadakis et al (2008) Performance during internal medicine residency training and subsequent disciplinary action by state licensing boards Ann Int

Med 148 (11) 869-876Parker M Turner J and McGurgan P (2010) The difficult problem of assessing medical studentsrsquo professional attitudes and behaviour Med J Aust Parker M Luke T Zhang J Wilkinson Ozolins L (2008) The ldquoPyramid of Professionalismrdquo Seven Years of Experience With an Integrated Program of

Teaching Developing and Assessing Professionalism Among Medical Students ADDPatterson R (2013) Not so random patient complaints and frequent flier doctors BMJ Qual Saf 01-3Santen S A Petrusa E amp Gruppen L D (2014) The relationship between promotions committeesrsquo identification of problem medical students and

subsequent state medical board actions Advances in Health Sciences Education doi101007s10459-014-9536-2Stern DT Frohna AZ Gruppen LD (2005) The prediction of professional behaviour Med Ed 3975-82

References

Disciplinary action and prior behaviour in medical schools

Papadakis et al (2005 2008)

raquoPoor interpersonalcommunication skills

raquoPoor personal responsibility

raquoLack of initiative

raquoPoor attendance

raquoInability to accept criticism

raquoArgumentative

raquoPassivity

raquoDiminished capacity for self improvement (multiple instances)

raquoSeverely Irresponsible (multiple instancesgt3)

raquo3to 8 times more likely to be involved in professional disciplinary measures

raquoLow admission scores(but still met the cut off)

raquoPoor academic performance in early years of program (but still met the minimum standard)

Overall Disciplined

Physicians

Control Physicians (no

referral to regulator)

Displayed lsquounprofessionalrsquo

behaviour in medical school 391 192

But

Papadakis et al (2005) Table 3

~40 of target physicians (disciplined) displayed unprofessional

behaviour in medical school ( ie 60 didnrsquot)

~20 of control physicians (not disciplined) displayed unprofessional

behaviour in medical schoolndash with no further problems raised

Further research by Santen (20) ndash 2000 students140 poor professionalism

in med school 29 sanctions ( ~20 - 80 false positive)

-Lots of false positives and false negatives ndash this is a poor diagnostic test

Furthermorehellip (Norman 2015)

Poor professionalism (however defined and lsquomeasuredrsquo) is a low

prevalence problem (~1)

Situation rather than personality may actually be a greater determinant

of problem

Personality may not be as stable as believed ndash impact for young

adults

ldquoIt is folly to presume that we will ever be able to create an adequate

diagnostic test to the ultimately rare disease of unprofessionalismrdquo

CONCLUSION Medical school is not a great place to reliably

predict future poor conduct

The lsquoVividness HypothesisrsquoNisbett R E amp Ross L (1980)

lsquoA single vivid instance can influence social

attitudes when pallid statistics of far greater

evidential value do notrsquo (p 57)

Prediction and prevention is desirable

raquo Current model waits until harm has arisen

Prediction provides the opportunity to intervene

before harm occurs

raquo Current model waits until behaviours are

entrenched before addressing them

raquo Prediction enables monitoring from an earlier

point = less patient harm

The Promise (Why we want to believe in prediction)

Influenced by hindsight bias

raquo Being wise after the event

Reinforced by The Vividness Hypothesis - creates un-

evidenced future Bias

Can create injustice

raquo Doesnrsquot account for developmental considerations for

students

raquo May deny natural justice as many would be unfairly caught

in the lsquopredictiversquo net

raquo Too many false positives and false negatives ndash with a

disproportionate consequence

Draws educators into the role of lsquoprospectiversquo regulators

The Peril(Why we should be cautious about prediction)

Its just the vibe of the thing

Professor X considered that BKY would not be safe to practise even if

she was ultimately capable of completing her degree

It is not the task of this Tribunal to determine if the applicant would be fit

to practice as a medical practitioner if she were to complete her medical

degree Professor X was very concerned about the applicants ability to

practise due to her psychiatric conditions The completion of the medical

degree does not mean that she can automatically practise as a medical

practitioner Her psychiatric conditions are already registered with the

NSW Medical Council The Tribunal notes thathellipfitness to practise as a

medical practitioner is governed by the NSW Medical Council and if the

Medical Council deems that the applicant is not fit to practise then she

will not be able to do so

School of Medicine

What mechanisms exist within the University and current

regulatory system to respond to concerns about poor

professionalism in medical students

Universities

Robust academic standards

Misconduct policies ( transparency)

Inability to complete policies

Regulatory

Mandatory and Voluntary reporting (National Law)

The bar for regulatory intervention is high for students ndash

and reasonably so ndash the core principle is protection of the

publicSchool of Medicine

What is the potential impact on Medical Education

and assessment

For clinical knowledge and competence - ensure a common

and adequate minimum national standard

raquo AMC standards

raquo National exam ( eg USACanada)

For assessment of professionalism

raquo Longitudinal and multi source feedback is best

raquo Peer assessments are good - Mini PAT360 feedback ndash but

time and resource intensive - Are they worth it

raquo In Training Assessment (ITA)

raquo Need to make this an assessable part of the curriculum ndash but

set a minimum standardSchool of Medicinoe

Focus on actual stage approprate conduct and skill (here and now)

raquo Resist the lsquovividness hypothesisrsquo and hindsight bias

raquo Promote and expect honesty in assessment

Proportionality in response

raquo High Risk = High Scrutiny = High Consequence= High Accountability

(and vice versa)

raquo Challenge the disproportionate use of resources lsquopolicingrsquo minor

concerns ndash Donrsquot create an lsquoalbatrossrsquo

Accept that students pose very low risk of harm to the public ndash and

regulatory intervention should be ( and is) rare

The Practicalitieswhat can Universities actually do

Finallyhellip

Each progression to a new stage raises the

bar - apply an appropriate (higher) standard to

each step

Educators are not prospective regulators- but

they do have a duty to train to a standard

School of Medicine

Ainsworth M and Szauter KM (2006) Medical student professionalism Are we measuring the right behaviours A comparison of lapses by students and physicians Acad Med 81s83-s86

Bismark M Spittal M and Studdert D (2011) Prevalence and characteristic s of complaint prone doctors in Australia Med J Aust 195436-440Bismark M et al (2013) Identification of doctors at risk of recurrent complaints a national study of healthcare complaints in AustraliaBMJ Qual

Saf doi101136bmjqs-2012-001691Elkin K Spittal MJ Studdert DM (2012) Risks of complaints and adverse disciplinary findings against international medical graduates in Victoria and

Western Australia Med J Aust 197(8) 448-452Elkin KJ1 Spittal MJ Elkin DJ Studdert DM (2011) Doctors disciplined for professional misconduct in Australia and New Zealand 2000-2009 Med J Aust

194 (9) 452-456Colliver J A Markwell S J Verhulst S J amp Robbs R S (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 213ndash215

Giedd JN (2008) The teen brain Insights from neuroimaging J Adolesc Health 42335ndash43Johnson S Blum R Giedd J (2009) Adolescent Maturity and the Brain The Promise and Pitfalls of Neuroscience Research in Adolescent Health Policy J

Adolesc Health 2009 Sep 45(3) 216ndash221Medicare Statistics (2013-2014) httpmedicarestatisticshumanservicesgovaustatisticsmbs_groupjsp Accessed 4th march 2015Norman G Identifying the bad apples Advances in Health Sciences EducationTheory and Practice copy Springer Science+Business Media Dordrecht

2015101007s10459-015-9598-9Papadakis et al ( 2005) Unprofessional behaviour in medical School is associated with subsequent disciplinary action by state medical board Acad Med

79 244-249Papadakis et al (2008) Performance during internal medicine residency training and subsequent disciplinary action by state licensing boards Ann Int

Med 148 (11) 869-876Parker M Turner J and McGurgan P (2010) The difficult problem of assessing medical studentsrsquo professional attitudes and behaviour Med J Aust Parker M Luke T Zhang J Wilkinson Ozolins L (2008) The ldquoPyramid of Professionalismrdquo Seven Years of Experience With an Integrated Program of

Teaching Developing and Assessing Professionalism Among Medical Students ADDPatterson R (2013) Not so random patient complaints and frequent flier doctors BMJ Qual Saf 01-3Santen S A Petrusa E amp Gruppen L D (2014) The relationship between promotions committeesrsquo identification of problem medical students and

subsequent state medical board actions Advances in Health Sciences Education doi101007s10459-014-9536-2Stern DT Frohna AZ Gruppen LD (2005) The prediction of professional behaviour Med Ed 3975-82

References

Overall Disciplined

Physicians

Control Physicians (no

referral to regulator)

Displayed lsquounprofessionalrsquo

behaviour in medical school 391 192

But

Papadakis et al (2005) Table 3

~40 of target physicians (disciplined) displayed unprofessional

behaviour in medical school ( ie 60 didnrsquot)

~20 of control physicians (not disciplined) displayed unprofessional

behaviour in medical schoolndash with no further problems raised

Further research by Santen (20) ndash 2000 students140 poor professionalism

in med school 29 sanctions ( ~20 - 80 false positive)

-Lots of false positives and false negatives ndash this is a poor diagnostic test

Furthermorehellip (Norman 2015)

Poor professionalism (however defined and lsquomeasuredrsquo) is a low

prevalence problem (~1)

Situation rather than personality may actually be a greater determinant

of problem

Personality may not be as stable as believed ndash impact for young

adults

ldquoIt is folly to presume that we will ever be able to create an adequate

diagnostic test to the ultimately rare disease of unprofessionalismrdquo

CONCLUSION Medical school is not a great place to reliably

predict future poor conduct

The lsquoVividness HypothesisrsquoNisbett R E amp Ross L (1980)

lsquoA single vivid instance can influence social

attitudes when pallid statistics of far greater

evidential value do notrsquo (p 57)

Prediction and prevention is desirable

raquo Current model waits until harm has arisen

Prediction provides the opportunity to intervene

before harm occurs

raquo Current model waits until behaviours are

entrenched before addressing them

raquo Prediction enables monitoring from an earlier

point = less patient harm

The Promise (Why we want to believe in prediction)

Influenced by hindsight bias

raquo Being wise after the event

Reinforced by The Vividness Hypothesis - creates un-

evidenced future Bias

Can create injustice

raquo Doesnrsquot account for developmental considerations for

students

raquo May deny natural justice as many would be unfairly caught

in the lsquopredictiversquo net

raquo Too many false positives and false negatives ndash with a

disproportionate consequence

Draws educators into the role of lsquoprospectiversquo regulators

The Peril(Why we should be cautious about prediction)

Its just the vibe of the thing

Professor X considered that BKY would not be safe to practise even if

she was ultimately capable of completing her degree

It is not the task of this Tribunal to determine if the applicant would be fit

to practice as a medical practitioner if she were to complete her medical

degree Professor X was very concerned about the applicants ability to

practise due to her psychiatric conditions The completion of the medical

degree does not mean that she can automatically practise as a medical

practitioner Her psychiatric conditions are already registered with the

NSW Medical Council The Tribunal notes thathellipfitness to practise as a

medical practitioner is governed by the NSW Medical Council and if the

Medical Council deems that the applicant is not fit to practise then she

will not be able to do so

School of Medicine

What mechanisms exist within the University and current

regulatory system to respond to concerns about poor

professionalism in medical students

Universities

Robust academic standards

Misconduct policies ( transparency)

Inability to complete policies

Regulatory

Mandatory and Voluntary reporting (National Law)

The bar for regulatory intervention is high for students ndash

and reasonably so ndash the core principle is protection of the

publicSchool of Medicine

What is the potential impact on Medical Education

and assessment

For clinical knowledge and competence - ensure a common

and adequate minimum national standard

raquo AMC standards

raquo National exam ( eg USACanada)

For assessment of professionalism

raquo Longitudinal and multi source feedback is best

raquo Peer assessments are good - Mini PAT360 feedback ndash but

time and resource intensive - Are they worth it

raquo In Training Assessment (ITA)

raquo Need to make this an assessable part of the curriculum ndash but

set a minimum standardSchool of Medicinoe

Focus on actual stage approprate conduct and skill (here and now)

raquo Resist the lsquovividness hypothesisrsquo and hindsight bias

raquo Promote and expect honesty in assessment

Proportionality in response

raquo High Risk = High Scrutiny = High Consequence= High Accountability

(and vice versa)

raquo Challenge the disproportionate use of resources lsquopolicingrsquo minor

concerns ndash Donrsquot create an lsquoalbatrossrsquo

Accept that students pose very low risk of harm to the public ndash and

regulatory intervention should be ( and is) rare

The Practicalitieswhat can Universities actually do

Finallyhellip

Each progression to a new stage raises the

bar - apply an appropriate (higher) standard to

each step

Educators are not prospective regulators- but

they do have a duty to train to a standard

School of Medicine

Ainsworth M and Szauter KM (2006) Medical student professionalism Are we measuring the right behaviours A comparison of lapses by students and physicians Acad Med 81s83-s86

Bismark M Spittal M and Studdert D (2011) Prevalence and characteristic s of complaint prone doctors in Australia Med J Aust 195436-440Bismark M et al (2013) Identification of doctors at risk of recurrent complaints a national study of healthcare complaints in AustraliaBMJ Qual

Saf doi101136bmjqs-2012-001691Elkin K Spittal MJ Studdert DM (2012) Risks of complaints and adverse disciplinary findings against international medical graduates in Victoria and

Western Australia Med J Aust 197(8) 448-452Elkin KJ1 Spittal MJ Elkin DJ Studdert DM (2011) Doctors disciplined for professional misconduct in Australia and New Zealand 2000-2009 Med J Aust

194 (9) 452-456Colliver J A Markwell S J Verhulst S J amp Robbs R S (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 213ndash215

Giedd JN (2008) The teen brain Insights from neuroimaging J Adolesc Health 42335ndash43Johnson S Blum R Giedd J (2009) Adolescent Maturity and the Brain The Promise and Pitfalls of Neuroscience Research in Adolescent Health Policy J

Adolesc Health 2009 Sep 45(3) 216ndash221Medicare Statistics (2013-2014) httpmedicarestatisticshumanservicesgovaustatisticsmbs_groupjsp Accessed 4th march 2015Norman G Identifying the bad apples Advances in Health Sciences EducationTheory and Practice copy Springer Science+Business Media Dordrecht

2015101007s10459-015-9598-9Papadakis et al ( 2005) Unprofessional behaviour in medical School is associated with subsequent disciplinary action by state medical board Acad Med

79 244-249Papadakis et al (2008) Performance during internal medicine residency training and subsequent disciplinary action by state licensing boards Ann Int

Med 148 (11) 869-876Parker M Turner J and McGurgan P (2010) The difficult problem of assessing medical studentsrsquo professional attitudes and behaviour Med J Aust Parker M Luke T Zhang J Wilkinson Ozolins L (2008) The ldquoPyramid of Professionalismrdquo Seven Years of Experience With an Integrated Program of

Teaching Developing and Assessing Professionalism Among Medical Students ADDPatterson R (2013) Not so random patient complaints and frequent flier doctors BMJ Qual Saf 01-3Santen S A Petrusa E amp Gruppen L D (2014) The relationship between promotions committeesrsquo identification of problem medical students and

subsequent state medical board actions Advances in Health Sciences Education doi101007s10459-014-9536-2Stern DT Frohna AZ Gruppen LD (2005) The prediction of professional behaviour Med Ed 3975-82

References

Furthermorehellip (Norman 2015)

Poor professionalism (however defined and lsquomeasuredrsquo) is a low

prevalence problem (~1)

Situation rather than personality may actually be a greater determinant

of problem

Personality may not be as stable as believed ndash impact for young

adults

ldquoIt is folly to presume that we will ever be able to create an adequate

diagnostic test to the ultimately rare disease of unprofessionalismrdquo

CONCLUSION Medical school is not a great place to reliably

predict future poor conduct

The lsquoVividness HypothesisrsquoNisbett R E amp Ross L (1980)

lsquoA single vivid instance can influence social

attitudes when pallid statistics of far greater

evidential value do notrsquo (p 57)

Prediction and prevention is desirable

raquo Current model waits until harm has arisen

Prediction provides the opportunity to intervene

before harm occurs

raquo Current model waits until behaviours are

entrenched before addressing them

raquo Prediction enables monitoring from an earlier

point = less patient harm

The Promise (Why we want to believe in prediction)

Influenced by hindsight bias

raquo Being wise after the event

Reinforced by The Vividness Hypothesis - creates un-

evidenced future Bias

Can create injustice

raquo Doesnrsquot account for developmental considerations for

students

raquo May deny natural justice as many would be unfairly caught

in the lsquopredictiversquo net

raquo Too many false positives and false negatives ndash with a

disproportionate consequence

Draws educators into the role of lsquoprospectiversquo regulators

The Peril(Why we should be cautious about prediction)

Its just the vibe of the thing

Professor X considered that BKY would not be safe to practise even if

she was ultimately capable of completing her degree

It is not the task of this Tribunal to determine if the applicant would be fit

to practice as a medical practitioner if she were to complete her medical

degree Professor X was very concerned about the applicants ability to

practise due to her psychiatric conditions The completion of the medical

degree does not mean that she can automatically practise as a medical

practitioner Her psychiatric conditions are already registered with the

NSW Medical Council The Tribunal notes thathellipfitness to practise as a

medical practitioner is governed by the NSW Medical Council and if the

Medical Council deems that the applicant is not fit to practise then she

will not be able to do so

School of Medicine

What mechanisms exist within the University and current

regulatory system to respond to concerns about poor

professionalism in medical students

Universities

Robust academic standards

Misconduct policies ( transparency)

Inability to complete policies

Regulatory

Mandatory and Voluntary reporting (National Law)

The bar for regulatory intervention is high for students ndash

and reasonably so ndash the core principle is protection of the

publicSchool of Medicine

What is the potential impact on Medical Education

and assessment

For clinical knowledge and competence - ensure a common

and adequate minimum national standard

raquo AMC standards

raquo National exam ( eg USACanada)

For assessment of professionalism

raquo Longitudinal and multi source feedback is best

raquo Peer assessments are good - Mini PAT360 feedback ndash but

time and resource intensive - Are they worth it

raquo In Training Assessment (ITA)

raquo Need to make this an assessable part of the curriculum ndash but

set a minimum standardSchool of Medicinoe

Focus on actual stage approprate conduct and skill (here and now)

raquo Resist the lsquovividness hypothesisrsquo and hindsight bias

raquo Promote and expect honesty in assessment

Proportionality in response

raquo High Risk = High Scrutiny = High Consequence= High Accountability

(and vice versa)

raquo Challenge the disproportionate use of resources lsquopolicingrsquo minor

concerns ndash Donrsquot create an lsquoalbatrossrsquo

Accept that students pose very low risk of harm to the public ndash and

regulatory intervention should be ( and is) rare

The Practicalitieswhat can Universities actually do

Finallyhellip

Each progression to a new stage raises the

bar - apply an appropriate (higher) standard to

each step

Educators are not prospective regulators- but

they do have a duty to train to a standard

School of Medicine

Ainsworth M and Szauter KM (2006) Medical student professionalism Are we measuring the right behaviours A comparison of lapses by students and physicians Acad Med 81s83-s86

Bismark M Spittal M and Studdert D (2011) Prevalence and characteristic s of complaint prone doctors in Australia Med J Aust 195436-440Bismark M et al (2013) Identification of doctors at risk of recurrent complaints a national study of healthcare complaints in AustraliaBMJ Qual

Saf doi101136bmjqs-2012-001691Elkin K Spittal MJ Studdert DM (2012) Risks of complaints and adverse disciplinary findings against international medical graduates in Victoria and

Western Australia Med J Aust 197(8) 448-452Elkin KJ1 Spittal MJ Elkin DJ Studdert DM (2011) Doctors disciplined for professional misconduct in Australia and New Zealand 2000-2009 Med J Aust

194 (9) 452-456Colliver J A Markwell S J Verhulst S J amp Robbs R S (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 213ndash215

Giedd JN (2008) The teen brain Insights from neuroimaging J Adolesc Health 42335ndash43Johnson S Blum R Giedd J (2009) Adolescent Maturity and the Brain The Promise and Pitfalls of Neuroscience Research in Adolescent Health Policy J

Adolesc Health 2009 Sep 45(3) 216ndash221Medicare Statistics (2013-2014) httpmedicarestatisticshumanservicesgovaustatisticsmbs_groupjsp Accessed 4th march 2015Norman G Identifying the bad apples Advances in Health Sciences EducationTheory and Practice copy Springer Science+Business Media Dordrecht

2015101007s10459-015-9598-9Papadakis et al ( 2005) Unprofessional behaviour in medical School is associated with subsequent disciplinary action by state medical board Acad Med

79 244-249Papadakis et al (2008) Performance during internal medicine residency training and subsequent disciplinary action by state licensing boards Ann Int

Med 148 (11) 869-876Parker M Turner J and McGurgan P (2010) The difficult problem of assessing medical studentsrsquo professional attitudes and behaviour Med J Aust Parker M Luke T Zhang J Wilkinson Ozolins L (2008) The ldquoPyramid of Professionalismrdquo Seven Years of Experience With an Integrated Program of

Teaching Developing and Assessing Professionalism Among Medical Students ADDPatterson R (2013) Not so random patient complaints and frequent flier doctors BMJ Qual Saf 01-3Santen S A Petrusa E amp Gruppen L D (2014) The relationship between promotions committeesrsquo identification of problem medical students and

subsequent state medical board actions Advances in Health Sciences Education doi101007s10459-014-9536-2Stern DT Frohna AZ Gruppen LD (2005) The prediction of professional behaviour Med Ed 3975-82

References

The lsquoVividness HypothesisrsquoNisbett R E amp Ross L (1980)

lsquoA single vivid instance can influence social

attitudes when pallid statistics of far greater

evidential value do notrsquo (p 57)

Prediction and prevention is desirable

raquo Current model waits until harm has arisen

Prediction provides the opportunity to intervene

before harm occurs

raquo Current model waits until behaviours are

entrenched before addressing them

raquo Prediction enables monitoring from an earlier

point = less patient harm

The Promise (Why we want to believe in prediction)

Influenced by hindsight bias

raquo Being wise after the event

Reinforced by The Vividness Hypothesis - creates un-

evidenced future Bias

Can create injustice

raquo Doesnrsquot account for developmental considerations for

students

raquo May deny natural justice as many would be unfairly caught

in the lsquopredictiversquo net

raquo Too many false positives and false negatives ndash with a

disproportionate consequence

Draws educators into the role of lsquoprospectiversquo regulators

The Peril(Why we should be cautious about prediction)

Its just the vibe of the thing

Professor X considered that BKY would not be safe to practise even if

she was ultimately capable of completing her degree

It is not the task of this Tribunal to determine if the applicant would be fit

to practice as a medical practitioner if she were to complete her medical

degree Professor X was very concerned about the applicants ability to

practise due to her psychiatric conditions The completion of the medical

degree does not mean that she can automatically practise as a medical

practitioner Her psychiatric conditions are already registered with the

NSW Medical Council The Tribunal notes thathellipfitness to practise as a

medical practitioner is governed by the NSW Medical Council and if the

Medical Council deems that the applicant is not fit to practise then she

will not be able to do so

School of Medicine

What mechanisms exist within the University and current

regulatory system to respond to concerns about poor

professionalism in medical students

Universities

Robust academic standards

Misconduct policies ( transparency)

Inability to complete policies

Regulatory

Mandatory and Voluntary reporting (National Law)

The bar for regulatory intervention is high for students ndash

and reasonably so ndash the core principle is protection of the

publicSchool of Medicine

What is the potential impact on Medical Education

and assessment

For clinical knowledge and competence - ensure a common

and adequate minimum national standard

raquo AMC standards

raquo National exam ( eg USACanada)

For assessment of professionalism

raquo Longitudinal and multi source feedback is best

raquo Peer assessments are good - Mini PAT360 feedback ndash but

time and resource intensive - Are they worth it

raquo In Training Assessment (ITA)

raquo Need to make this an assessable part of the curriculum ndash but

set a minimum standardSchool of Medicinoe

Focus on actual stage approprate conduct and skill (here and now)

raquo Resist the lsquovividness hypothesisrsquo and hindsight bias

raquo Promote and expect honesty in assessment

Proportionality in response

raquo High Risk = High Scrutiny = High Consequence= High Accountability

(and vice versa)

raquo Challenge the disproportionate use of resources lsquopolicingrsquo minor

concerns ndash Donrsquot create an lsquoalbatrossrsquo

Accept that students pose very low risk of harm to the public ndash and

regulatory intervention should be ( and is) rare

The Practicalitieswhat can Universities actually do

Finallyhellip

Each progression to a new stage raises the

bar - apply an appropriate (higher) standard to

each step

Educators are not prospective regulators- but

they do have a duty to train to a standard

School of Medicine

Ainsworth M and Szauter KM (2006) Medical student professionalism Are we measuring the right behaviours A comparison of lapses by students and physicians Acad Med 81s83-s86

Bismark M Spittal M and Studdert D (2011) Prevalence and characteristic s of complaint prone doctors in Australia Med J Aust 195436-440Bismark M et al (2013) Identification of doctors at risk of recurrent complaints a national study of healthcare complaints in AustraliaBMJ Qual

Saf doi101136bmjqs-2012-001691Elkin K Spittal MJ Studdert DM (2012) Risks of complaints and adverse disciplinary findings against international medical graduates in Victoria and

Western Australia Med J Aust 197(8) 448-452Elkin KJ1 Spittal MJ Elkin DJ Studdert DM (2011) Doctors disciplined for professional misconduct in Australia and New Zealand 2000-2009 Med J Aust

194 (9) 452-456Colliver J A Markwell S J Verhulst S J amp Robbs R S (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 213ndash215

Giedd JN (2008) The teen brain Insights from neuroimaging J Adolesc Health 42335ndash43Johnson S Blum R Giedd J (2009) Adolescent Maturity and the Brain The Promise and Pitfalls of Neuroscience Research in Adolescent Health Policy J

Adolesc Health 2009 Sep 45(3) 216ndash221Medicare Statistics (2013-2014) httpmedicarestatisticshumanservicesgovaustatisticsmbs_groupjsp Accessed 4th march 2015Norman G Identifying the bad apples Advances in Health Sciences EducationTheory and Practice copy Springer Science+Business Media Dordrecht

2015101007s10459-015-9598-9Papadakis et al ( 2005) Unprofessional behaviour in medical School is associated with subsequent disciplinary action by state medical board Acad Med

79 244-249Papadakis et al (2008) Performance during internal medicine residency training and subsequent disciplinary action by state licensing boards Ann Int

Med 148 (11) 869-876Parker M Turner J and McGurgan P (2010) The difficult problem of assessing medical studentsrsquo professional attitudes and behaviour Med J Aust Parker M Luke T Zhang J Wilkinson Ozolins L (2008) The ldquoPyramid of Professionalismrdquo Seven Years of Experience With an Integrated Program of

Teaching Developing and Assessing Professionalism Among Medical Students ADDPatterson R (2013) Not so random patient complaints and frequent flier doctors BMJ Qual Saf 01-3Santen S A Petrusa E amp Gruppen L D (2014) The relationship between promotions committeesrsquo identification of problem medical students and

subsequent state medical board actions Advances in Health Sciences Education doi101007s10459-014-9536-2Stern DT Frohna AZ Gruppen LD (2005) The prediction of professional behaviour Med Ed 3975-82

References

Prediction and prevention is desirable

raquo Current model waits until harm has arisen

Prediction provides the opportunity to intervene

before harm occurs

raquo Current model waits until behaviours are

entrenched before addressing them

raquo Prediction enables monitoring from an earlier

point = less patient harm

The Promise (Why we want to believe in prediction)

Influenced by hindsight bias

raquo Being wise after the event

Reinforced by The Vividness Hypothesis - creates un-

evidenced future Bias

Can create injustice

raquo Doesnrsquot account for developmental considerations for

students

raquo May deny natural justice as many would be unfairly caught

in the lsquopredictiversquo net

raquo Too many false positives and false negatives ndash with a

disproportionate consequence

Draws educators into the role of lsquoprospectiversquo regulators

The Peril(Why we should be cautious about prediction)

Its just the vibe of the thing

Professor X considered that BKY would not be safe to practise even if

she was ultimately capable of completing her degree

It is not the task of this Tribunal to determine if the applicant would be fit

to practice as a medical practitioner if she were to complete her medical

degree Professor X was very concerned about the applicants ability to

practise due to her psychiatric conditions The completion of the medical

degree does not mean that she can automatically practise as a medical

practitioner Her psychiatric conditions are already registered with the

NSW Medical Council The Tribunal notes thathellipfitness to practise as a

medical practitioner is governed by the NSW Medical Council and if the

Medical Council deems that the applicant is not fit to practise then she

will not be able to do so

School of Medicine

What mechanisms exist within the University and current

regulatory system to respond to concerns about poor

professionalism in medical students

Universities

Robust academic standards

Misconduct policies ( transparency)

Inability to complete policies

Regulatory

Mandatory and Voluntary reporting (National Law)

The bar for regulatory intervention is high for students ndash

and reasonably so ndash the core principle is protection of the

publicSchool of Medicine

What is the potential impact on Medical Education

and assessment

For clinical knowledge and competence - ensure a common

and adequate minimum national standard

raquo AMC standards

raquo National exam ( eg USACanada)

For assessment of professionalism

raquo Longitudinal and multi source feedback is best

raquo Peer assessments are good - Mini PAT360 feedback ndash but

time and resource intensive - Are they worth it

raquo In Training Assessment (ITA)

raquo Need to make this an assessable part of the curriculum ndash but

set a minimum standardSchool of Medicinoe

Focus on actual stage approprate conduct and skill (here and now)

raquo Resist the lsquovividness hypothesisrsquo and hindsight bias

raquo Promote and expect honesty in assessment

Proportionality in response

raquo High Risk = High Scrutiny = High Consequence= High Accountability

(and vice versa)

raquo Challenge the disproportionate use of resources lsquopolicingrsquo minor

concerns ndash Donrsquot create an lsquoalbatrossrsquo

Accept that students pose very low risk of harm to the public ndash and

regulatory intervention should be ( and is) rare

The Practicalitieswhat can Universities actually do

Finallyhellip

Each progression to a new stage raises the

bar - apply an appropriate (higher) standard to

each step

Educators are not prospective regulators- but

they do have a duty to train to a standard

School of Medicine

Ainsworth M and Szauter KM (2006) Medical student professionalism Are we measuring the right behaviours A comparison of lapses by students and physicians Acad Med 81s83-s86

Bismark M Spittal M and Studdert D (2011) Prevalence and characteristic s of complaint prone doctors in Australia Med J Aust 195436-440Bismark M et al (2013) Identification of doctors at risk of recurrent complaints a national study of healthcare complaints in AustraliaBMJ Qual

Saf doi101136bmjqs-2012-001691Elkin K Spittal MJ Studdert DM (2012) Risks of complaints and adverse disciplinary findings against international medical graduates in Victoria and

Western Australia Med J Aust 197(8) 448-452Elkin KJ1 Spittal MJ Elkin DJ Studdert DM (2011) Doctors disciplined for professional misconduct in Australia and New Zealand 2000-2009 Med J Aust

194 (9) 452-456Colliver J A Markwell S J Verhulst S J amp Robbs R S (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 213ndash215

Giedd JN (2008) The teen brain Insights from neuroimaging J Adolesc Health 42335ndash43Johnson S Blum R Giedd J (2009) Adolescent Maturity and the Brain The Promise and Pitfalls of Neuroscience Research in Adolescent Health Policy J

Adolesc Health 2009 Sep 45(3) 216ndash221Medicare Statistics (2013-2014) httpmedicarestatisticshumanservicesgovaustatisticsmbs_groupjsp Accessed 4th march 2015Norman G Identifying the bad apples Advances in Health Sciences EducationTheory and Practice copy Springer Science+Business Media Dordrecht

2015101007s10459-015-9598-9Papadakis et al ( 2005) Unprofessional behaviour in medical School is associated with subsequent disciplinary action by state medical board Acad Med

79 244-249Papadakis et al (2008) Performance during internal medicine residency training and subsequent disciplinary action by state licensing boards Ann Int

Med 148 (11) 869-876Parker M Turner J and McGurgan P (2010) The difficult problem of assessing medical studentsrsquo professional attitudes and behaviour Med J Aust Parker M Luke T Zhang J Wilkinson Ozolins L (2008) The ldquoPyramid of Professionalismrdquo Seven Years of Experience With an Integrated Program of

Teaching Developing and Assessing Professionalism Among Medical Students ADDPatterson R (2013) Not so random patient complaints and frequent flier doctors BMJ Qual Saf 01-3Santen S A Petrusa E amp Gruppen L D (2014) The relationship between promotions committeesrsquo identification of problem medical students and

subsequent state medical board actions Advances in Health Sciences Education doi101007s10459-014-9536-2Stern DT Frohna AZ Gruppen LD (2005) The prediction of professional behaviour Med Ed 3975-82

References

Influenced by hindsight bias

raquo Being wise after the event

Reinforced by The Vividness Hypothesis - creates un-

evidenced future Bias

Can create injustice

raquo Doesnrsquot account for developmental considerations for

students

raquo May deny natural justice as many would be unfairly caught

in the lsquopredictiversquo net

raquo Too many false positives and false negatives ndash with a

disproportionate consequence

Draws educators into the role of lsquoprospectiversquo regulators

The Peril(Why we should be cautious about prediction)

Its just the vibe of the thing

Professor X considered that BKY would not be safe to practise even if

she was ultimately capable of completing her degree

It is not the task of this Tribunal to determine if the applicant would be fit

to practice as a medical practitioner if she were to complete her medical

degree Professor X was very concerned about the applicants ability to

practise due to her psychiatric conditions The completion of the medical

degree does not mean that she can automatically practise as a medical

practitioner Her psychiatric conditions are already registered with the

NSW Medical Council The Tribunal notes thathellipfitness to practise as a

medical practitioner is governed by the NSW Medical Council and if the

Medical Council deems that the applicant is not fit to practise then she

will not be able to do so

School of Medicine

What mechanisms exist within the University and current

regulatory system to respond to concerns about poor

professionalism in medical students

Universities

Robust academic standards

Misconduct policies ( transparency)

Inability to complete policies

Regulatory

Mandatory and Voluntary reporting (National Law)

The bar for regulatory intervention is high for students ndash

and reasonably so ndash the core principle is protection of the

publicSchool of Medicine

What is the potential impact on Medical Education

and assessment

For clinical knowledge and competence - ensure a common

and adequate minimum national standard

raquo AMC standards

raquo National exam ( eg USACanada)

For assessment of professionalism

raquo Longitudinal and multi source feedback is best

raquo Peer assessments are good - Mini PAT360 feedback ndash but

time and resource intensive - Are they worth it

raquo In Training Assessment (ITA)

raquo Need to make this an assessable part of the curriculum ndash but

set a minimum standardSchool of Medicinoe

Focus on actual stage approprate conduct and skill (here and now)

raquo Resist the lsquovividness hypothesisrsquo and hindsight bias

raquo Promote and expect honesty in assessment

Proportionality in response

raquo High Risk = High Scrutiny = High Consequence= High Accountability

(and vice versa)

raquo Challenge the disproportionate use of resources lsquopolicingrsquo minor

concerns ndash Donrsquot create an lsquoalbatrossrsquo

Accept that students pose very low risk of harm to the public ndash and

regulatory intervention should be ( and is) rare

The Practicalitieswhat can Universities actually do

Finallyhellip

Each progression to a new stage raises the

bar - apply an appropriate (higher) standard to

each step

Educators are not prospective regulators- but

they do have a duty to train to a standard

School of Medicine

Ainsworth M and Szauter KM (2006) Medical student professionalism Are we measuring the right behaviours A comparison of lapses by students and physicians Acad Med 81s83-s86

Bismark M Spittal M and Studdert D (2011) Prevalence and characteristic s of complaint prone doctors in Australia Med J Aust 195436-440Bismark M et al (2013) Identification of doctors at risk of recurrent complaints a national study of healthcare complaints in AustraliaBMJ Qual

Saf doi101136bmjqs-2012-001691Elkin K Spittal MJ Studdert DM (2012) Risks of complaints and adverse disciplinary findings against international medical graduates in Victoria and

Western Australia Med J Aust 197(8) 448-452Elkin KJ1 Spittal MJ Elkin DJ Studdert DM (2011) Doctors disciplined for professional misconduct in Australia and New Zealand 2000-2009 Med J Aust

194 (9) 452-456Colliver J A Markwell S J Verhulst S J amp Robbs R S (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 213ndash215

Giedd JN (2008) The teen brain Insights from neuroimaging J Adolesc Health 42335ndash43Johnson S Blum R Giedd J (2009) Adolescent Maturity and the Brain The Promise and Pitfalls of Neuroscience Research in Adolescent Health Policy J

Adolesc Health 2009 Sep 45(3) 216ndash221Medicare Statistics (2013-2014) httpmedicarestatisticshumanservicesgovaustatisticsmbs_groupjsp Accessed 4th march 2015Norman G Identifying the bad apples Advances in Health Sciences EducationTheory and Practice copy Springer Science+Business Media Dordrecht

2015101007s10459-015-9598-9Papadakis et al ( 2005) Unprofessional behaviour in medical School is associated with subsequent disciplinary action by state medical board Acad Med

79 244-249Papadakis et al (2008) Performance during internal medicine residency training and subsequent disciplinary action by state licensing boards Ann Int

Med 148 (11) 869-876Parker M Turner J and McGurgan P (2010) The difficult problem of assessing medical studentsrsquo professional attitudes and behaviour Med J Aust Parker M Luke T Zhang J Wilkinson Ozolins L (2008) The ldquoPyramid of Professionalismrdquo Seven Years of Experience With an Integrated Program of

Teaching Developing and Assessing Professionalism Among Medical Students ADDPatterson R (2013) Not so random patient complaints and frequent flier doctors BMJ Qual Saf 01-3Santen S A Petrusa E amp Gruppen L D (2014) The relationship between promotions committeesrsquo identification of problem medical students and

subsequent state medical board actions Advances in Health Sciences Education doi101007s10459-014-9536-2Stern DT Frohna AZ Gruppen LD (2005) The prediction of professional behaviour Med Ed 3975-82

References

Its just the vibe of the thing

Professor X considered that BKY would not be safe to practise even if

she was ultimately capable of completing her degree

It is not the task of this Tribunal to determine if the applicant would be fit

to practice as a medical practitioner if she were to complete her medical

degree Professor X was very concerned about the applicants ability to

practise due to her psychiatric conditions The completion of the medical

degree does not mean that she can automatically practise as a medical

practitioner Her psychiatric conditions are already registered with the

NSW Medical Council The Tribunal notes thathellipfitness to practise as a

medical practitioner is governed by the NSW Medical Council and if the

Medical Council deems that the applicant is not fit to practise then she

will not be able to do so

School of Medicine

What mechanisms exist within the University and current

regulatory system to respond to concerns about poor

professionalism in medical students

Universities

Robust academic standards

Misconduct policies ( transparency)

Inability to complete policies

Regulatory

Mandatory and Voluntary reporting (National Law)

The bar for regulatory intervention is high for students ndash

and reasonably so ndash the core principle is protection of the

publicSchool of Medicine

What is the potential impact on Medical Education

and assessment

For clinical knowledge and competence - ensure a common

and adequate minimum national standard

raquo AMC standards

raquo National exam ( eg USACanada)

For assessment of professionalism

raquo Longitudinal and multi source feedback is best

raquo Peer assessments are good - Mini PAT360 feedback ndash but

time and resource intensive - Are they worth it

raquo In Training Assessment (ITA)

raquo Need to make this an assessable part of the curriculum ndash but

set a minimum standardSchool of Medicinoe

Focus on actual stage approprate conduct and skill (here and now)

raquo Resist the lsquovividness hypothesisrsquo and hindsight bias

raquo Promote and expect honesty in assessment

Proportionality in response

raquo High Risk = High Scrutiny = High Consequence= High Accountability

(and vice versa)

raquo Challenge the disproportionate use of resources lsquopolicingrsquo minor

concerns ndash Donrsquot create an lsquoalbatrossrsquo

Accept that students pose very low risk of harm to the public ndash and

regulatory intervention should be ( and is) rare

The Practicalitieswhat can Universities actually do

Finallyhellip

Each progression to a new stage raises the

bar - apply an appropriate (higher) standard to

each step

Educators are not prospective regulators- but

they do have a duty to train to a standard

School of Medicine

Ainsworth M and Szauter KM (2006) Medical student professionalism Are we measuring the right behaviours A comparison of lapses by students and physicians Acad Med 81s83-s86

Bismark M Spittal M and Studdert D (2011) Prevalence and characteristic s of complaint prone doctors in Australia Med J Aust 195436-440Bismark M et al (2013) Identification of doctors at risk of recurrent complaints a national study of healthcare complaints in AustraliaBMJ Qual

Saf doi101136bmjqs-2012-001691Elkin K Spittal MJ Studdert DM (2012) Risks of complaints and adverse disciplinary findings against international medical graduates in Victoria and

Western Australia Med J Aust 197(8) 448-452Elkin KJ1 Spittal MJ Elkin DJ Studdert DM (2011) Doctors disciplined for professional misconduct in Australia and New Zealand 2000-2009 Med J Aust

194 (9) 452-456Colliver J A Markwell S J Verhulst S J amp Robbs R S (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 213ndash215

Giedd JN (2008) The teen brain Insights from neuroimaging J Adolesc Health 42335ndash43Johnson S Blum R Giedd J (2009) Adolescent Maturity and the Brain The Promise and Pitfalls of Neuroscience Research in Adolescent Health Policy J

Adolesc Health 2009 Sep 45(3) 216ndash221Medicare Statistics (2013-2014) httpmedicarestatisticshumanservicesgovaustatisticsmbs_groupjsp Accessed 4th march 2015Norman G Identifying the bad apples Advances in Health Sciences EducationTheory and Practice copy Springer Science+Business Media Dordrecht

2015101007s10459-015-9598-9Papadakis et al ( 2005) Unprofessional behaviour in medical School is associated with subsequent disciplinary action by state medical board Acad Med

79 244-249Papadakis et al (2008) Performance during internal medicine residency training and subsequent disciplinary action by state licensing boards Ann Int

Med 148 (11) 869-876Parker M Turner J and McGurgan P (2010) The difficult problem of assessing medical studentsrsquo professional attitudes and behaviour Med J Aust Parker M Luke T Zhang J Wilkinson Ozolins L (2008) The ldquoPyramid of Professionalismrdquo Seven Years of Experience With an Integrated Program of

Teaching Developing and Assessing Professionalism Among Medical Students ADDPatterson R (2013) Not so random patient complaints and frequent flier doctors BMJ Qual Saf 01-3Santen S A Petrusa E amp Gruppen L D (2014) The relationship between promotions committeesrsquo identification of problem medical students and

subsequent state medical board actions Advances in Health Sciences Education doi101007s10459-014-9536-2Stern DT Frohna AZ Gruppen LD (2005) The prediction of professional behaviour Med Ed 3975-82

References

What mechanisms exist within the University and current

regulatory system to respond to concerns about poor

professionalism in medical students

Universities

Robust academic standards

Misconduct policies ( transparency)

Inability to complete policies

Regulatory

Mandatory and Voluntary reporting (National Law)

The bar for regulatory intervention is high for students ndash

and reasonably so ndash the core principle is protection of the

publicSchool of Medicine

What is the potential impact on Medical Education

and assessment

For clinical knowledge and competence - ensure a common

and adequate minimum national standard

raquo AMC standards

raquo National exam ( eg USACanada)

For assessment of professionalism

raquo Longitudinal and multi source feedback is best

raquo Peer assessments are good - Mini PAT360 feedback ndash but

time and resource intensive - Are they worth it

raquo In Training Assessment (ITA)

raquo Need to make this an assessable part of the curriculum ndash but

set a minimum standardSchool of Medicinoe

Focus on actual stage approprate conduct and skill (here and now)

raquo Resist the lsquovividness hypothesisrsquo and hindsight bias

raquo Promote and expect honesty in assessment

Proportionality in response

raquo High Risk = High Scrutiny = High Consequence= High Accountability

(and vice versa)

raquo Challenge the disproportionate use of resources lsquopolicingrsquo minor

concerns ndash Donrsquot create an lsquoalbatrossrsquo

Accept that students pose very low risk of harm to the public ndash and

regulatory intervention should be ( and is) rare

The Practicalitieswhat can Universities actually do

Finallyhellip

Each progression to a new stage raises the

bar - apply an appropriate (higher) standard to

each step

Educators are not prospective regulators- but

they do have a duty to train to a standard

School of Medicine

Ainsworth M and Szauter KM (2006) Medical student professionalism Are we measuring the right behaviours A comparison of lapses by students and physicians Acad Med 81s83-s86

Bismark M Spittal M and Studdert D (2011) Prevalence and characteristic s of complaint prone doctors in Australia Med J Aust 195436-440Bismark M et al (2013) Identification of doctors at risk of recurrent complaints a national study of healthcare complaints in AustraliaBMJ Qual

Saf doi101136bmjqs-2012-001691Elkin K Spittal MJ Studdert DM (2012) Risks of complaints and adverse disciplinary findings against international medical graduates in Victoria and

Western Australia Med J Aust 197(8) 448-452Elkin KJ1 Spittal MJ Elkin DJ Studdert DM (2011) Doctors disciplined for professional misconduct in Australia and New Zealand 2000-2009 Med J Aust

194 (9) 452-456Colliver J A Markwell S J Verhulst S J amp Robbs R S (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 213ndash215

Giedd JN (2008) The teen brain Insights from neuroimaging J Adolesc Health 42335ndash43Johnson S Blum R Giedd J (2009) Adolescent Maturity and the Brain The Promise and Pitfalls of Neuroscience Research in Adolescent Health Policy J

Adolesc Health 2009 Sep 45(3) 216ndash221Medicare Statistics (2013-2014) httpmedicarestatisticshumanservicesgovaustatisticsmbs_groupjsp Accessed 4th march 2015Norman G Identifying the bad apples Advances in Health Sciences EducationTheory and Practice copy Springer Science+Business Media Dordrecht

2015101007s10459-015-9598-9Papadakis et al ( 2005) Unprofessional behaviour in medical School is associated with subsequent disciplinary action by state medical board Acad Med

79 244-249Papadakis et al (2008) Performance during internal medicine residency training and subsequent disciplinary action by state licensing boards Ann Int

Med 148 (11) 869-876Parker M Turner J and McGurgan P (2010) The difficult problem of assessing medical studentsrsquo professional attitudes and behaviour Med J Aust Parker M Luke T Zhang J Wilkinson Ozolins L (2008) The ldquoPyramid of Professionalismrdquo Seven Years of Experience With an Integrated Program of

Teaching Developing and Assessing Professionalism Among Medical Students ADDPatterson R (2013) Not so random patient complaints and frequent flier doctors BMJ Qual Saf 01-3Santen S A Petrusa E amp Gruppen L D (2014) The relationship between promotions committeesrsquo identification of problem medical students and

subsequent state medical board actions Advances in Health Sciences Education doi101007s10459-014-9536-2Stern DT Frohna AZ Gruppen LD (2005) The prediction of professional behaviour Med Ed 3975-82

References

What is the potential impact on Medical Education

and assessment

For clinical knowledge and competence - ensure a common

and adequate minimum national standard

raquo AMC standards

raquo National exam ( eg USACanada)

For assessment of professionalism

raquo Longitudinal and multi source feedback is best

raquo Peer assessments are good - Mini PAT360 feedback ndash but

time and resource intensive - Are they worth it

raquo In Training Assessment (ITA)

raquo Need to make this an assessable part of the curriculum ndash but

set a minimum standardSchool of Medicinoe

Focus on actual stage approprate conduct and skill (here and now)

raquo Resist the lsquovividness hypothesisrsquo and hindsight bias

raquo Promote and expect honesty in assessment

Proportionality in response

raquo High Risk = High Scrutiny = High Consequence= High Accountability

(and vice versa)

raquo Challenge the disproportionate use of resources lsquopolicingrsquo minor

concerns ndash Donrsquot create an lsquoalbatrossrsquo

Accept that students pose very low risk of harm to the public ndash and

regulatory intervention should be ( and is) rare

The Practicalitieswhat can Universities actually do

Finallyhellip

Each progression to a new stage raises the

bar - apply an appropriate (higher) standard to

each step

Educators are not prospective regulators- but

they do have a duty to train to a standard

School of Medicine

Ainsworth M and Szauter KM (2006) Medical student professionalism Are we measuring the right behaviours A comparison of lapses by students and physicians Acad Med 81s83-s86

Bismark M Spittal M and Studdert D (2011) Prevalence and characteristic s of complaint prone doctors in Australia Med J Aust 195436-440Bismark M et al (2013) Identification of doctors at risk of recurrent complaints a national study of healthcare complaints in AustraliaBMJ Qual

Saf doi101136bmjqs-2012-001691Elkin K Spittal MJ Studdert DM (2012) Risks of complaints and adverse disciplinary findings against international medical graduates in Victoria and

Western Australia Med J Aust 197(8) 448-452Elkin KJ1 Spittal MJ Elkin DJ Studdert DM (2011) Doctors disciplined for professional misconduct in Australia and New Zealand 2000-2009 Med J Aust

194 (9) 452-456Colliver J A Markwell S J Verhulst S J amp Robbs R S (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 213ndash215

Giedd JN (2008) The teen brain Insights from neuroimaging J Adolesc Health 42335ndash43Johnson S Blum R Giedd J (2009) Adolescent Maturity and the Brain The Promise and Pitfalls of Neuroscience Research in Adolescent Health Policy J

Adolesc Health 2009 Sep 45(3) 216ndash221Medicare Statistics (2013-2014) httpmedicarestatisticshumanservicesgovaustatisticsmbs_groupjsp Accessed 4th march 2015Norman G Identifying the bad apples Advances in Health Sciences EducationTheory and Practice copy Springer Science+Business Media Dordrecht

2015101007s10459-015-9598-9Papadakis et al ( 2005) Unprofessional behaviour in medical School is associated with subsequent disciplinary action by state medical board Acad Med

79 244-249Papadakis et al (2008) Performance during internal medicine residency training and subsequent disciplinary action by state licensing boards Ann Int

Med 148 (11) 869-876Parker M Turner J and McGurgan P (2010) The difficult problem of assessing medical studentsrsquo professional attitudes and behaviour Med J Aust Parker M Luke T Zhang J Wilkinson Ozolins L (2008) The ldquoPyramid of Professionalismrdquo Seven Years of Experience With an Integrated Program of

Teaching Developing and Assessing Professionalism Among Medical Students ADDPatterson R (2013) Not so random patient complaints and frequent flier doctors BMJ Qual Saf 01-3Santen S A Petrusa E amp Gruppen L D (2014) The relationship between promotions committeesrsquo identification of problem medical students and

subsequent state medical board actions Advances in Health Sciences Education doi101007s10459-014-9536-2Stern DT Frohna AZ Gruppen LD (2005) The prediction of professional behaviour Med Ed 3975-82

References

Focus on actual stage approprate conduct and skill (here and now)

raquo Resist the lsquovividness hypothesisrsquo and hindsight bias

raquo Promote and expect honesty in assessment

Proportionality in response

raquo High Risk = High Scrutiny = High Consequence= High Accountability

(and vice versa)

raquo Challenge the disproportionate use of resources lsquopolicingrsquo minor

concerns ndash Donrsquot create an lsquoalbatrossrsquo

Accept that students pose very low risk of harm to the public ndash and

regulatory intervention should be ( and is) rare

The Practicalitieswhat can Universities actually do

Finallyhellip

Each progression to a new stage raises the

bar - apply an appropriate (higher) standard to

each step

Educators are not prospective regulators- but

they do have a duty to train to a standard

School of Medicine

Ainsworth M and Szauter KM (2006) Medical student professionalism Are we measuring the right behaviours A comparison of lapses by students and physicians Acad Med 81s83-s86

Bismark M Spittal M and Studdert D (2011) Prevalence and characteristic s of complaint prone doctors in Australia Med J Aust 195436-440Bismark M et al (2013) Identification of doctors at risk of recurrent complaints a national study of healthcare complaints in AustraliaBMJ Qual

Saf doi101136bmjqs-2012-001691Elkin K Spittal MJ Studdert DM (2012) Risks of complaints and adverse disciplinary findings against international medical graduates in Victoria and

Western Australia Med J Aust 197(8) 448-452Elkin KJ1 Spittal MJ Elkin DJ Studdert DM (2011) Doctors disciplined for professional misconduct in Australia and New Zealand 2000-2009 Med J Aust

194 (9) 452-456Colliver J A Markwell S J Verhulst S J amp Robbs R S (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 213ndash215

Giedd JN (2008) The teen brain Insights from neuroimaging J Adolesc Health 42335ndash43Johnson S Blum R Giedd J (2009) Adolescent Maturity and the Brain The Promise and Pitfalls of Neuroscience Research in Adolescent Health Policy J

Adolesc Health 2009 Sep 45(3) 216ndash221Medicare Statistics (2013-2014) httpmedicarestatisticshumanservicesgovaustatisticsmbs_groupjsp Accessed 4th march 2015Norman G Identifying the bad apples Advances in Health Sciences EducationTheory and Practice copy Springer Science+Business Media Dordrecht

2015101007s10459-015-9598-9Papadakis et al ( 2005) Unprofessional behaviour in medical School is associated with subsequent disciplinary action by state medical board Acad Med

79 244-249Papadakis et al (2008) Performance during internal medicine residency training and subsequent disciplinary action by state licensing boards Ann Int

Med 148 (11) 869-876Parker M Turner J and McGurgan P (2010) The difficult problem of assessing medical studentsrsquo professional attitudes and behaviour Med J Aust Parker M Luke T Zhang J Wilkinson Ozolins L (2008) The ldquoPyramid of Professionalismrdquo Seven Years of Experience With an Integrated Program of

Teaching Developing and Assessing Professionalism Among Medical Students ADDPatterson R (2013) Not so random patient complaints and frequent flier doctors BMJ Qual Saf 01-3Santen S A Petrusa E amp Gruppen L D (2014) The relationship between promotions committeesrsquo identification of problem medical students and

subsequent state medical board actions Advances in Health Sciences Education doi101007s10459-014-9536-2Stern DT Frohna AZ Gruppen LD (2005) The prediction of professional behaviour Med Ed 3975-82

References

Finallyhellip

Each progression to a new stage raises the

bar - apply an appropriate (higher) standard to

each step

Educators are not prospective regulators- but

they do have a duty to train to a standard

School of Medicine

Ainsworth M and Szauter KM (2006) Medical student professionalism Are we measuring the right behaviours A comparison of lapses by students and physicians Acad Med 81s83-s86

Bismark M Spittal M and Studdert D (2011) Prevalence and characteristic s of complaint prone doctors in Australia Med J Aust 195436-440Bismark M et al (2013) Identification of doctors at risk of recurrent complaints a national study of healthcare complaints in AustraliaBMJ Qual

Saf doi101136bmjqs-2012-001691Elkin K Spittal MJ Studdert DM (2012) Risks of complaints and adverse disciplinary findings against international medical graduates in Victoria and

Western Australia Med J Aust 197(8) 448-452Elkin KJ1 Spittal MJ Elkin DJ Studdert DM (2011) Doctors disciplined for professional misconduct in Australia and New Zealand 2000-2009 Med J Aust

194 (9) 452-456Colliver J A Markwell S J Verhulst S J amp Robbs R S (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 213ndash215

Giedd JN (2008) The teen brain Insights from neuroimaging J Adolesc Health 42335ndash43Johnson S Blum R Giedd J (2009) Adolescent Maturity and the Brain The Promise and Pitfalls of Neuroscience Research in Adolescent Health Policy J

Adolesc Health 2009 Sep 45(3) 216ndash221Medicare Statistics (2013-2014) httpmedicarestatisticshumanservicesgovaustatisticsmbs_groupjsp Accessed 4th march 2015Norman G Identifying the bad apples Advances in Health Sciences EducationTheory and Practice copy Springer Science+Business Media Dordrecht

2015101007s10459-015-9598-9Papadakis et al ( 2005) Unprofessional behaviour in medical School is associated with subsequent disciplinary action by state medical board Acad Med

79 244-249Papadakis et al (2008) Performance during internal medicine residency training and subsequent disciplinary action by state licensing boards Ann Int

Med 148 (11) 869-876Parker M Turner J and McGurgan P (2010) The difficult problem of assessing medical studentsrsquo professional attitudes and behaviour Med J Aust Parker M Luke T Zhang J Wilkinson Ozolins L (2008) The ldquoPyramid of Professionalismrdquo Seven Years of Experience With an Integrated Program of

Teaching Developing and Assessing Professionalism Among Medical Students ADDPatterson R (2013) Not so random patient complaints and frequent flier doctors BMJ Qual Saf 01-3Santen S A Petrusa E amp Gruppen L D (2014) The relationship between promotions committeesrsquo identification of problem medical students and

subsequent state medical board actions Advances in Health Sciences Education doi101007s10459-014-9536-2Stern DT Frohna AZ Gruppen LD (2005) The prediction of professional behaviour Med Ed 3975-82

References

Ainsworth M and Szauter KM (2006) Medical student professionalism Are we measuring the right behaviours A comparison of lapses by students and physicians Acad Med 81s83-s86

Bismark M Spittal M and Studdert D (2011) Prevalence and characteristic s of complaint prone doctors in Australia Med J Aust 195436-440Bismark M et al (2013) Identification of doctors at risk of recurrent complaints a national study of healthcare complaints in AustraliaBMJ Qual

Saf doi101136bmjqs-2012-001691Elkin K Spittal MJ Studdert DM (2012) Risks of complaints and adverse disciplinary findings against international medical graduates in Victoria and

Western Australia Med J Aust 197(8) 448-452Elkin KJ1 Spittal MJ Elkin DJ Studdert DM (2011) Doctors disciplined for professional misconduct in Australia and New Zealand 2000-2009 Med J Aust

194 (9) 452-456Colliver J A Markwell S J Verhulst S J amp Robbs R S (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 213ndash215

Giedd JN (2008) The teen brain Insights from neuroimaging J Adolesc Health 42335ndash43Johnson S Blum R Giedd J (2009) Adolescent Maturity and the Brain The Promise and Pitfalls of Neuroscience Research in Adolescent Health Policy J

Adolesc Health 2009 Sep 45(3) 216ndash221Medicare Statistics (2013-2014) httpmedicarestatisticshumanservicesgovaustatisticsmbs_groupjsp Accessed 4th march 2015Norman G Identifying the bad apples Advances in Health Sciences EducationTheory and Practice copy Springer Science+Business Media Dordrecht

2015101007s10459-015-9598-9Papadakis et al ( 2005) Unprofessional behaviour in medical School is associated with subsequent disciplinary action by state medical board Acad Med

79 244-249Papadakis et al (2008) Performance during internal medicine residency training and subsequent disciplinary action by state licensing boards Ann Int

Med 148 (11) 869-876Parker M Turner J and McGurgan P (2010) The difficult problem of assessing medical studentsrsquo professional attitudes and behaviour Med J Aust Parker M Luke T Zhang J Wilkinson Ozolins L (2008) The ldquoPyramid of Professionalismrdquo Seven Years of Experience With an Integrated Program of

Teaching Developing and Assessing Professionalism Among Medical Students ADDPatterson R (2013) Not so random patient complaints and frequent flier doctors BMJ Qual Saf 01-3Santen S A Petrusa E amp Gruppen L D (2014) The relationship between promotions committeesrsquo identification of problem medical students and

subsequent state medical board actions Advances in Health Sciences Education doi101007s10459-014-9536-2Stern DT Frohna AZ Gruppen LD (2005) The prediction of professional behaviour Med Ed 3975-82

References

Tamblyn R Abrahamowicz M Dauphinee D Wenghofer E Jacques A Klass D et al (2007) Physician scores

on a national clinical skills examination as predictors of complaints to medical regulatory authorities JAMA 298(9)

993ndash1001CrossRef

Santen S A Petrusa E amp Gruppen L D (2014) The relationship between promotions committeesrsquo identification of

problem medical students and subsequent state medical board actions Advances in Health Sciences Education

doi101007s10459-014-9536-2

van Mook W N K A van Lujik S J Zwietering P J Southgate L Schuwirth L W T Scherpbier A J J A amp

van der Vleuten C P M (2014) The threat of the dyscompetent resident A plea to make the implicit more

explicit Advances in Health Sciences Education