In one of the more interesting cases I’ve read about recently, a judge in the Northern District of Ohio granted an injunction against Case Western Reserve University, forbidding Case from expelling a medical student (a former classmate of mine) for his failures in professionalism. As a brief summary of the case, a medical student just weeks from graduating from Case was convicted of driving while impaired. He reported the conviction to the residency program he had matched at, and the program then notified Case before the student reported it to the school himself. Case took the position that failing to alert the medical school of the arrest merited expulsion and withholding the medical degree that the student was to receive with distinction the very next month. Although reporting such arrests was not a requirement of graduation, the school believed that he should have reported the arrest and prosecution, particularly in light of the fact that the student had a history of other infractions throughout his time as a medical student.
While the facts of the case are worth a read, especially as recounted in the opinion, the court’s analysis of a medical school’s role in making “character judgments” was rather striking. In ultimately disagreeing with the school’s decision, the court noted that, “[w]hile Case should receive great discretion in judging academic standards, the determination of ‘professionalism’ goes well beyond academic or patient related matters.” The court continued by reiterating that Case here had made “character judgments only distantly related to medical education” in its dismissal of the medical student (emphasis added).
Without discussing whether I agree with the overall outcome of this case, I can’t help but be surprised at how the court seems to completely separate a medical student’s personal character from his ability to practice as a physician. In this survey that I have cited before, people reported that the most important characteristics of a physician were empathy, being a good listener, and being compassionate/caring/kind. These characteristics came far ahead of intelligence and even ahead of competence. So, if this is (theoretically) what is important to patients and what makes someone a good doctor, shouldn’t medical schools be able to fail or dismiss students when they step out of line?
Of course, those medical schools would probably have to provide explicit provisions in their student handbooks for what infractions would merit dismissal, as was elaborated on in detail in the court’s opinion. But, at the end of the day, “professionalism” would be just as much a part of the curriculum as anatomy and biochemistry – and could not be brushed aside as “only distantly related to medical education.” There would doubtless be objections to too closely policing medical students’ personal lives or to potentially dismissing great minds because of poor communication skills, but the bar could be kept rather low and flexible to both accommodate these concerns and also produce good doctors.