Unprofessional; do you still have right to MD? Judge: yes

[sazerac]

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http://www.cleveland.com/metro/index.ssf/2014/06/medical_student_not_allowed_to.html

Cliff notes:

4th year med student with behavior the university considers unprofessional (disciplined for trying to cover three late attendances; rude behavior in 2012 at a dance where he had likely been drunk; trying to skirt a cab fare by jumping out of the moving car; complaints from a patient's family; giving patient case summaries where he might not have personally examined the patient; driving while impaired, etc).

Student is denied MD degree, sues the university.

Judge concludes that the student paid tuition, passed classes, and didn't directly violate items in the student handbook, and this whole professionalism thingy is overblown, therefore the student has a right to MD degree.


This must have been an interesting case, with so much riding on the outcome. Is a med student who follows the letter of the student handbook entitled to a medical degree, against the university's wishes? Can a university protect the quality of its graduating class for "soft" reasons like behavior? Why do we even have these professionalism clauses if they are so weak?

 

[DermViser]

What makes you believe the university is in the right here? Did you read the article? A student handbook is there for good reason. There are many ways which the school could have dealt with acts of "unprofessionalism" if they were actually concerned about it. They talk about the last episode where the judgement came after the match was already over.

 

[AlmostAnMD]

1) if he follows the letter of the student handbook and is denied the degree, then the student handbook is worthless. Seems they they should update their handbook if they wish to prevent this.

2) Getting out of paying cab fair by jumping from a moving vehicle is awesome.

EDIT: the article mentions him going to a derm residency at riverside methodist hospital but there is no derm residency there, at least on the web page. I have literally zero interest in derm myself but knowing that hospital I was surprised to see they had a derm residency. But then I went to google it and I can't find any reference to them having one, just these residencies:

Family Medicine
Internal Medicine
Preliminary Medicine
Transitional Year
Obstetrics and Gynecology
Preliminary Surgery
General Surgery

 

[DermViser]

1) if he follows the letter of the student handbook and is denied the degree, then the student handbook is worthless. Seems they they should update their handbook if they wish to prevent this.

2) Getting out of paying cab fair by jumping from a moving vehicle is awesome.

EDIT: the article mentions him going to a derm residency at riverside methodist hospital but there is no derm residency there, at least on the web page. I have literally zero interest in derm myself but knowing that hospital I was surprised to see they had a derm residency. But then I went to google it and I can't find any reference to them having one, just these residencies:

Family Medicine
Internal Medicine
Preliminary Medicine
Transitional Year
Obstetrics and Gynecology
Preliminary Surgery
General Surgery

He's obviously going there for internship. I definitely don't expect them to get actual nitty-gritty facts correct.

 

[username456789]

2) Getting out of paying cab fair by jumping from a moving vehicle is awesome.

If you're, like, 14 years old.

 

[Winged Scapula]

Since it appears that at least two and possibly three of the events in question involved substance-abuse, is there any obligation of the medical school to address these?

After all substance related problems are amongst the most frequent reasons for licensure and medical Board sanctions.

 

[sazerac]

Well the handbook does say you can't get a degree unless you satisfy the Committee on Students, who are tasked with evaluating your "total performance".

And yes the final unprofessional act did occur after the match, but it occurred before graduation. It doesn't seem right to start collecting DUI's after the match because you are somehow in the safe zone.

I'm not saying the university is in the right here, but I can certainly see their point of view. That's what makes it such an interesting case.

 

[DermViser]

Since it appears that at least two and possibly three of the events in question involved substance-abuse, is there any obligation of the medical school to address these?

After all substance related problems are amongst the most frequent reasons for licensure and medical Board sanctions.

Apparently not as both sides "agree he does not have an alcohol problem, the judge wrote."

 

[alpinism]

If he didn't violate any of the student handbook regulations, then legally he shouldn't be denied an MD degree.

As others have said, if Case considered his behavior to be unprofessional then why wasn't it addressed in their code of conduct?

While the cab incident is unique, problems with substance abuse and late attendance are common issues affecting medical students.

 

[DermViser]

Well the handbook does say you can't get a degree unless you satisfy the Committee on Students, who are tasked with evaluating your "total performance".

And yes the final unprofessional act did occur after the match, but it occurred before graduation. It doesn't seem right to start collecting DUI's after the match because you are somehow in the safe zone.

I'm not saying the university is in the right here, but I can certainly see their point of view. That's what makes it such an interesting case.

If the school was that concerned about unprofessionalism they have clear avenues to address that - mainly in the student's MSPE. They apparently did not do this bc there is no way the person would have gotten a dermatology residency with a lapse in professionalism on an MSPE. If he followed the rules according to the Student Handbook something both the student follows and is likely put out by the Committee on Students, then I don't see that the school has a leg to stand on.

 

[Psai]

I'm against the university for trying to even use the word "unprofessional" to justify anything. He's not entitled to a degree but he definitely earned it. And they must have thought he was a good student since they wrote him a dean's letter that was good enough to get him into derm. 4 years of hard work and a 6 digit debt without a degree? No thank you.

 

[SouthernSurgeon]

Apparently not as both sides "agree he does not have an alcohol problem, the judge wrote."

Even so, these etoh related incidents can come back and bite you at any point in the future.

One of our interns a year or so ago had his license delayed because of a DUI in college...and had to attend substance abuse counseling before the state would give him a license. He was unable to start residency on time.

 

[DermViser]

Even so, these etoh related incidents can come back and bite you at any point in the future.

One of our interns a year or so ago had his license delayed because of a DUI in college...and had to attend substance abuse counseling before the state would give him a license. He was unable to start residency on time.

I agree as state medical boards want to err on the side of caution (and no liability). I was addressing bc WS had mentioned substance abuse.

 

[Winged Scapula]

I agree as state medical boards want to err on the side of caution (and no liability). I was addressing bc WS had mentioned substance abuse.

Which is why I asked who's responsible for addressing it? The court in the system must have a pretty lenient definition of a problem because as far as I can see he uses substances inappropriately. As noted above that can be long-lasting effects.

 

[DermViser]

Which is why I asked who's responsible for addressing it? The court in the system must have a pretty lenient definition of a problem because as far as I can see he uses substances inappropriately. As noted above that can be long-lasting effects.

The incidence prior to the car accident (an actual incident) was, "rude behavior in 2012 at a dance where he had likely been drunk".

 

[DermViser]

Which is why I asked who's responsible for addressing it? The court in the system must have a pretty lenient definition of a problem because as far as I can see he uses substances inappropriately. As noted above that can be long-lasting effects.

http://chronicle.com/blogs/ticker/j...ern-to-grant-diploma-to-medical-student/79167

I thought this was quite interesting:
“Although courts should give almost complete deference to university judgments regarding academic issues, the same deference does not follow university character judgments, especially on character judgments only distantly related to medical education,” Judge Gwin wrote. He found that Case Western had “arbitrarily and capriciously” denied Mr. Al-Dabagh his diploma, and ordered the university to grant it to him.

 

[Kaputt]

Here's the actual court summary: http://docs.justia.com/cases/federal/district-courts/ohio/ohndce/1:2014cv01046/209292/18

One of the big issues: all his professionalism issues that were in his file before the school was aware of his DUI were left off of his MSPE, and it was an overall positive recommendation to residency programs. No mention of his late attendances, no mention of him groping ladies at the med school dance, no mention of him jumping out of a moving cab to avoid paying a fare, etc. So when they decide to expel/ask him to withdraw after the DUI, his lawyers were easily able to down-play the importance of those earlier incidents because the MSPE didn't think it was important to mention those events. The fine print in the handbook made him get off on a technicality regarding the circumstances of his DUI...the school argued he should have told them about the arrest, but the handbook said only convictions needed reporting. Once the kid was convicted of his DUI, he called his residency program director first, who apparently called the Case deans before the student was able to.

So, basically the take-home message here is that Case white-washed the kid's MSPE to give him the best chance of matching at his desired residency (and the guy matched derm!) despite multiple professionalism issues. He got a DUI and the school freaked out, realizing they didn't want this guy being a doctor. They should have done more earlier in this kid's case.

 

[DermViser]

Here's the actual court summary: http://docs.justia.com/cases/federal/district-courts/ohio/ohndce/1:2014cv01046/209292/18

One of the big issues: all his professionalism issues that were in his file before the school was aware of his DUI were left off of his MSPE, and it was an overall positive recommendation to residency programs. No mention of his late attendances, no mention of him groping ladies at the med school dance, no mention of him jumping out of a moving cab to avoid paying a fare, etc. So when they decide to expel/ask him to withdraw after the DUI, his lawyers were easily able to down-play the importance of those earlier incidents because the MSPE didn't think it was important to mention those events. The fine print in the handbook made him get off on a technicality regarding the circumstances of his DUI...the school argued he should have told them about the arrest, but the handbook said only convictions needed reporting. Once the kid was convicted of his DUI, he called his residency program director first, who apparently called the Case deans before the student was able to.

So, basically the take-home message here is that Case white-washed the kid's MSPE to give him the best chance of matching at his desired residency (and the guy matched derm!) despite multiple professionalism issues. He got a DUI and the school freaked out, realizing they didn't want this guy being a doctor. They should have done more earlier in this kid's case.

Exactly. The MSPE was the time to bring this up. That time passed long ago. The only thing that sucks is bc of this ****head, future students will have to take the fall for him.

 

[Pathvisor - AVOID PATH]

Exactly. The MSPE was the time to bring this up. That time passed long ago. The only thing that sucks is bc of this ****head, future students will have to take the fall for him.

The decision is not a surprise to me.

While schools are given wide latitude over education, the decisions have to be consistent and there has to be fair notice. That doesn't seemed to have happened here and Case Western got nailed. Overall, for medical education, this a good thing.

What truly screwed Case Western's decision was their MSPE. I read over 200 MSPEs a year and they vary in usefulness. Some only include the glowing stuff while others are a fairly objective evaluation of a medical students performance. Some medical schools will leave out some pretty major stuff if it doesn't lead to formal probation. For example, I know of a student that was actually barred from a clinical rotation site for serious professionalism issues. The MSPE for that student said nothing about this fairly major issue. Medical schools do it because they want their graduates to match and to match in prestigious specialties. Damaging information obviously makes matching more difficult and may make a medical school's match numbers look worse and thus less attractive. Medical Education is a huge business, even though we pretend it isn't.

 

[Pathvisor - AVOID PATH]

I'm against the university for trying to even use the word "unprofessional" to justify anything. He's not entitled to a degree but he definitely earned it. And they must have thought he was a good student since they wrote him a dean's letter that was good enough to get him into derm. 4 years of hard work and a 6 digit debt without a degree? No thank you.

They basically puffed up his formal recommendation from the medical school and then tried to say he was too unprofessional to be a doctor for not doing something their policy didn't say he had to do. It is no surprise, with the huge "penalty" associated with not completed medical school, that things fell apart when it went to court. Case Western was a victim of themselves. If they had issued him formal letters putting him on probation for professionalism issue and had set out an improvement plan and formal expectation and then mentioned it on his MSPE, this may have gone completely differently.

Personally, I hope this cleans ups MSPEs and makes them useful. I suspect it won't but I can hope. There is move for accuracy and transparency and some schools are moving for complete truth. Second, this shows the need for good documentation of all issues. If a medical student/resident has issues, it is best to document it before there are problems. For most, it will be a one or two off event. But when the problems start to mount, you don't want to start the trail then.

 

[KinasePro]

More evidence that the MSPE is completely and utterly useless these days. Everyone walks on water in their MSPEs, hence why I've heard PD's say they hardly read them-- instead they just skim for rank, AOA, and clerkship comments.

 

[Kaputt]

More evidence that the MSPE is completely and utterly useless these days. Everyone walks on water in their MSPEs, hence why I've heard PD's say they hardly read them-- instead they just skim for rank, AOA, and clerkship comments.

Agreed. Even the clerkship comments are heavily filtered. Instead of an MSPE they should just make schools fill out some standardized form with the raw data residencies need...AOA, rank, scores, issues, etc. As is, MSPEs are massive fluff pieces that must be a headache to actually wade through.

 

[DermViser]

More evidence that the MSPE is completely and utterly useless these days. Everyone walks on water in their MSPEs, hence why I've heard PD's say they hardly read them-- instead they just skim for rank, AOA, and clerkship comments.

Depends on the school. I think in some cases the MSPE is rightfully edited, as there are some ****head residents that are unnecessarily vindictive in their summative comments. The important stuff in the MSPE is rank (which includes clerkships grades), AOA, etc. anyways. Some of those professionalism accusations are quite dubious.

 

[Goro]

This definitely happens at my school. Every year Faculty are invited to write things about our students for their our equivalents of the MSPE. We use a specific term for this, so let's just call it a "folder". I am honest about my opinions about good bad and indifferent students, but my comments on the bad ones routinely get filtered, if not actually censored from the "folder".

My Clinical Dean gave me almost word for word the explanation given here by my learned colleague.

What truly screwed Case Western's decision was their MSPE. I read over 200 MSPEs a year and they vary in usefulness. Some only include the glowing stuff while others are a fairly objective evaluation of a medical students performance. Some medical schools will leave out some pretty major stuff if it doesn't lead to formal probation. For example, I know of a student that was actually barred from a clinical rotation site for serious professionalism issues. The MSPE for that student said nothing about this fairly major issue. Medical schools do it because they want their graduates to match and to match in prestigious specialties. Damaging information obviously makes matching more difficult and may make a medical school's match numbers look worse and thus less attractive. Medical Education is a huge business, even though we pretend it isn't.[/QUOTE]

 

[NotAProgDirector]

This case brings up some really important questions. Most importantly, what do we do with a student (or resident) who has a professionalism violation? In general, you'd want to counsel that person, make sure they understand the issue, make amends to those injured, and help ensure that it never happens again. If you force schools / residency programs to report all violations in the MSPE / referral letters, then there's no chance for the student/resident to "improve" -- since we all know that if these issues were raised in the MSPE, the student would have had great difficulty getting derm, or maybe anything else. So on the one hand we want to be able to remove such comments from the MSPE if they represent a single event, but report them if there is a pattern.

From the court document link, Case did a miserable job of documenting his performance, and also appears to not have explained the situation well to the court. Specifically:

1. When he had his first problems, the entire incident should have been documented clearly. They would have determined that his major issue was honesty (the lateness issue, and then asking the prof to lie about it). They should have documented a remediation plan, and also stated that because the event was a single incident, that it would not be reported in his MSPE. However, should he have further events, it then would be reported in his MSPE.

2. The court seems to gloss over the fact that he received a "Satisfactory with Concerns" in his Sub-I, TWICE. Although I can't be certain without reviewing Case's MSPE, I expect that grade will be <5% of the class, and probably <1%. The court document makes it seem that it's a minor thing. His performance in his AI sounds like there were many problems, again not documented well.

The second issue raised is what impact behavior outside the educational program should have on evaluations. The dance was a social event. His behavior (if correctly described) is horrific. But was the dance part of his education? If we say it is (and if the dance is on school property, that would more likely be true) then they should have done something about the incident, and documented it. Same with the DUI. I had a resident who had a DUI during residency. His performance was otherwise fine. We basically told him it was his responsibility to get to work on time every day -- his inability to drive for 6 months was his problem. Otherwise, it was none of our business. As mentioned in the court documents, the handbook was clear that he only needed to report convictions. What's not clear is whether he ever reported the conviction -- what Case should have done is received the call from his PD, and then waited to see if he would report the conviction to them (not clear in the documents).

 

[StIGMA]

There are a few instances of poor judgment and no felonies or other serious crimes. Unprofessional? Yes. Egregious? No. The school severely overstepped. They would expel half their class by this standard if they monitored everyone 24/7 for every accumulated, inconceivably minor offense.

 

[Winged Scapula]

There are a few instances of poor judgment and no felonies or other serious crimes. Unprofessional? Yes. Egregious? No. The school severely overstepped. They would expel half their class by this standard if they monitored everyone 24/7 for every accumulated, inconceivably minor offense.

You consider his behavior a "minor offense"?

 

[StIGMA]

You consider his behavior a "minor offense"?

Compared to rape, stalking, intoxication during clerkships, verbal altercations/insubordination, weapons charges, theft of narcotics, intentionally harming a patient, etc., yes they are in comparison minor. His violations are certainly in between 'inconceivably minor' and major offenses. The point is that even inconceivably minor offenses are professionalism violations, for which the school cited as the sole basis for his expulsion. In your opinion, what is one egregious thing that he did that deserves expulsion in let's say the majority of cases?

The school panel decided that nothing that he did deserved mention to residencies. So I feel that I am in good company with the school panel and the judge in considering his actions as not egregious.

The judge notes that both the residency program and the licensing board will decide if he is fit to practice medicine in the future. Case could have fixed his behavior but chose instead to let his issues persist and later renege on their commitment to their student at the worst possible time.

 

[StIGMA]

On the dance issue, I think the appropriate punishment is to be taken out back by a few of the guys in the class for a proper 'talking to'. Case should have monitored him more closely and considered courses of action if he were to escalate (eg: told him if he had more alcohol or professionalism issues, he would not graduate). They can't be punitive to him based on their failure/dissatisfaction, which is basically what the judge concluded.

"While saying that candor is essential, Case Western Medical School gave a most important
evaluation that Case now says did not truly reflect its opinion. Against such a backdrop, the
University’s argument that Al-Dabagh’s lack of complete c[a]ndor on the arrest for driving while impaired disqualifies him from practicing medicine is not persuasive.

So, Case Western Reserve Medical School failed to disclose concerns to residency programs.
This leads to two alternative explanations. If the earlier incidents were actually no big deal, then the earlier incidents do not warrant expulsion even when followed by Al-Dabagh’s failure to report the North Carolina arrest. Alternatively, if the earlier incidents were important, then Case cannot rely on any lack of candor because Case demonstrated worse in giving glowing recommendations without mention of Al-Dabagh’s supposed character flaws. That Case did not to explain any concerns to potential residency programs shows these incidents were more innocuous than the University now argues."

And "Given the way Case treated the previous incidents together with the nature of those incidents, the University acted arbitrarily and capriciously in finding Al-Dabagh did not satisfy the core competency of “professionalism.”"
http://docs.justia.com/cases/federal/district-courts/ohio/ohndce/1:2014cv01046/209292/18

So the judge interprets that Case is more unprofessional in this aspect than the student (and therefore has limited basis to charge him with unprofessionalism).

 

[FutureInternist]

This is exactly why I have a list of doctors (b/w medical school, residency & fellowship) that I will never refer patients to

 

[SouthernSurgeon]

Compared to rape, stalking, intoxication during clerkships, verbal altercations/insubordination, weapons charges, theft of narcotics, intentionally harming a patient, etc., yes they are in comparison minor.

That's kind of like saying, "hey come on, he didn't KILL anyone"...

 

[StIGMA]

That's kind of like saying, "hey come on, he didn't KILL anyone"...

So what did he do that warranted dismissal immediately after the school wrote him a letter saying he was all clear to graduate? A DWI? There are offenses that can be remediated (IMO, his should have been if the school had acted appropriately early on) and others that warrant immediate dismissal. I'm sure we agree more than we disagree on this point.

I'm stating the opposite of what you claim; there are obvious reasons for expulsion, including murder. I am in no way trying to excuse his disgraceful conduct- something about his conduct issues should have been in his Dean's letter. I just happen to agree with the Judge's ruling. If getting drunk and doing stupid **** is grounds for dismissal, I would have a very small graduating class. How much better are you than this kid in concealing your faults?

 

[NickNaylor]

Which is why I asked who's responsible for addressing it? The court in the system must have a pretty lenient definition of a problem because as far as I can see he uses substances inappropriately. As noted above that can be long-lasting effects.

I think this is an important question that is failing to be addressed in the thread on this topic in the pre-allo forum. I'm very uncomfortable with the prospect of medical schools withholding degrees for "professionalism" issues, simply because "professionalism" tends to be a term whose definition is fluid at best and simply used as a tool for persecution at worst. By the school's own admission he successfully completed all aspects of the education curriculum. In my mind (ignoring, of course, the behavioral concerns), that alone makes me lean in his favor despite these problems.

At the end of the day, an MD grants you the ability to do very little in the absence of further training. If his residency program(s) are concerned about this, they may very well be in their right to remove him from their program. I've never seen a residency contract so I'm not sure what all is involved there. But the point is that there are many other "checks" in place by which this issue is to be addressed. If there are serious concerns about this guy's behavior - with respect to substances or otherwise - then I find it hard to believe he will every practice medicine as one of the many hurdles to that end goal will trip him up. If he makes it through residency, then this will surely become an issue if he attempts to find a job or apply for his license, prescribing rights, etc..

I also subscribe to the philosophy that we are more than the worst thing we have ever done. This guy didn't kill a patient or perform patient care while wasted. This could be a wake-up call for him and a signal to get his ass in line. Maybe he'll seize it, maybe he won't - time will tell. But I think it's a bit premature and just a tad judgmental to try and revoke this guy's degree for what is, at the present moment, a first-time offense.

 

[Smurf Account]

They apparently did not do that bc there is no way the person would have gotten a dermatology residency with a lapse in professionalism on an MSPE.

Exactly why it likely wasn't listed on his MSPE. Exactly why NOTHING negative is EVER listed on the MSPE if a candidate wants to match. I believed this to be standard practice, and while certainly it isn't optimal to any extent, I don't think Case deans are in the wrong for doing such.

 

[DermViser]

Exactly why it likely wasn't listed on his MSPE. Exactly why NOTHING negative is EVER listed on the MSPE if a candidate wants to match. I believed this to be standard practice, and while certainly it isn't optimal to any extent, I don't think Case deans are in the wrong for doing such.

I don't know about Case, but when it comes to professionalism issues, schools list them. under the remediation or adverse actions questions:
https://www.aamc.org/download/139542/data/mspe.pdf

They may filter comments (rightfully so in some cases), but not professionalism issues.

 

[DermViser]

I think this is an important question that is failing to be addressed in the thread on this topic in the pre-allo forum. I'm very uncomfortable with the prospect of medical schools withholding degrees for "professionalism" issues, simply because "professionalism" tends to be a term whose definition is fluid at best and simply used as a tool for persecution at worst. By the school's own admission he successfully completed all aspects of the education curriculum. In my mind (ignoring, of course, the behavioral concerns), that alone makes me lean in his favor despite these problems.

At the end of the day, an MD grants you the ability to do very little in the absence of further training. If his residency program(s) are concerned about this, they may very well be in their right to remove him from their program. I've never seen a residency contract so I'm not sure what all is involved there. But the point is that there are many other "checks" in place by which this issue is to be addressed. If there are serious concerns about this guy's behavior - with respect to substances or otherwise - then I find it hard to believe he will every practice medicine as one of the many hurdles to that end goal will trip him up. If he makes it through residency, then this will surely become an issue if he attempts to find a job or apply for his license, prescribing rights, etc..

I also subscribe to the philosophy that we are more than the worst thing we have ever done. This guy didn't kill a patient or perform patient care while wasted. This could be a wake-up call for him and a signal to get his ass in line. Maybe he'll seize it, maybe he won't - time will tell. But I think it's a bit premature and just a tad judgmental to try and revoke this guy's degree for what is, at the present moment, a first-time offense.

You would make a pitiful academic dean in a medical school. I say that as a compliment.

 

[Smurf Account]

The only thing that sucks is bc of this ****head, future students will have to take the fall for him.

I totally agree, and feel terrible for the next graduating class. Information such as this spreads like wildfire among program directors, right? How much of an impact do you suspect this will have on invites and rank lists for Case students?

I don't know about Case, but when it comes to professionalism issues, schools list them. under the remediation or adverse actions questions:
https://www.aamc.org/download/139542/data/mspe.pdf

They may filter comments (rightfully so in some cases), but not professionalism issues.

Good to know, thanks.

 

[croak]

Here's the actual court summary: http://docs.justia.com/cases/federal/district-courts/ohio/ohndce/1:2014cv01046/209292/18

One of the big issues: all his professionalism issues that were in his file before the school was aware of his DUI were left off of his MSPE, and it was an overall positive recommendation to residency programs. No mention of his late attendances, no mention of him groping ladies at the med school dance, no mention of him jumping out of a moving cab to avoid paying a fare, etc. So when they decide to expel/ask him to withdraw after the DUI, his lawyers were easily able to down-play the importance of those earlier incidents because the MSPE didn't think it was important to mention those events. The fine print in the handbook made him get off on a technicality regarding the circumstances of his DUI...the school argued he should have told them about the arrest, but the handbook said only convictions needed reporting. Once the kid was convicted of his DUI, he called his residency program director first, who apparently called the Case deans before the student was able to.

So, basically the take-home message here is that Case white-washed the kid's MSPE to give him the best chance of matching at his desired residency (and the guy matched derm!) despite multiple professionalism issues. He got a DUI and the school freaked out, realizing they didn't want this guy being a doctor. They should have done more earlier in this kid's case.

 

[croak]

The most salient aspect of this remains in the phrase: "Always have good legal talent on speed dial." The "grad" may very well be an immature tool, and undeserving—in an emotional sense—of graduating, the realities of life remain intact. The guy managed to drink, and party his way through CWRU med school—not an easy feat. However he did it—socially inept, chemically altered, obnoxious and grab-ass douche-baggery—he paid tuition, passed classes, and rotations, and with the bang of the gavel, he's absolved of his sins. Drumroll at the oasis, this kid's going to be your colleague. This is how things will play out if he stays in the US: People he does business with will be "on to him," soon enough, and nobody's immune from being impossible to work with in any capacity. I'm surprised he was accepted to CWRU, or wasn't "dealt with" throughout school, but the end result based on "good lawyering" suggests he's got the support of some of Ohio's finest legal skill money can buy.

 

[croak]

Here's something else to consider: Look up the law firm. Motions, hearings, depositions, bad press—restricted to Northeast Ohio—shows CWRU wisely used their own "damage control," to minimize this imbroglio. The University consistently attracts talented, high quality students, and has a long list of folks who've gone on to make remarkable contributions to society as well as a number of Nobel Prize winners, academicians, artists, authors, inventors, musicians etc., and believe wholly they've got a good grasp of "idiocy" control.

 

[DermViser]

I totally agree, and feel terrible for the next graduating class. Information such as this spreads like wildfire among program directors, right? How much of an impact do you suspect this will have on invites and rank lists for Case students?

I was actually more referring to the medical school bringing down the professionalism hammer on their students much earlier in the process for much less egregious offenses, and destroying them on their MSPE unnecessarily.

 

[Kaputt]

The most salient aspect of this remains in the phrase: "Always have good legal talent on speed dial." The "grad" may very well be an immature tool, and undeserving—in an emotional sense—of graduating, the realities of life remain intact. The guy managed to drink, and party his way through CWRU med school—not an easy feat. However he did it—socially inept, chemically altered, obnoxious and grab-ass douche-baggery—he paid tuition, passed classes, and rotations, and with the bang of the gavel, he's absolved of his sins. Drumroll at the oasis, this kid's going to be your colleague. This is how things will play out if he stays in the US: People he does business with will be "on to him," soon enough, and nobody's immune from being impossible to work with in any capacity. I'm surprised he was accepted to CWRU, or wasn't "dealt with" throughout school, but the end result based on "good lawyering" suggests he's got the support of some of Ohio's finest legal skill money can buy.

You could argue that this guy is why he was accepted:

http://profiles.ucsf.edu/bishr.aldabagh

His older brother graduated CWRU med in 2009, had a full-ride merit scholarship, graduated AOA, and matched dermatology at Duke. Currently a fellow at UCSF. CWRU loved his brother. They must've had no idea the story would end up like this when they accepted this all-star's younger brother.

Apparently their whole family is very high-achieving.
http://www.mlive.com/news/flint/index.ssf/2010/05/biology_student_becomes_fifth.html

 

[Psai]

Oh it's that guy? I remember reading that article when it came out. It's not like he's not an all-star either though, matching derm is no joke.

 

[DermViser]

You could argue that this guy is why he was accepted:

http://profiles.ucsf.edu/bishr.aldabagh

His older brother graduated CWRU med in 2009, had a full-ride merit scholarship, graduated AOA, and matched dermatology at Duke. Currently a fellow at UCSF. CWRU loved his brother. They must've had no idea the story would end up like this when they accepted this all-star's younger brother.

Apparently their whole family is very high-achieving.
http://www.mlive.com/news/flint/index.ssf/2010/05/biology_student_becomes_fifth.html

Yes, but the younger brother was also a high achieving all-star in medical school as well. To have about 10 publications in Derm in a year is fantastic: http://www.ncbi.nlm.nih.gov/pubmed/?term=Al-Dabagh A[Author]

 

[DermViser]

Compared to rape, stalking, intoxication during clerkships, verbal altercations/insubordination, weapons charges, theft of narcotics, intentionally harming a patient, etc., yes they are in comparison minor. His violations are certainly in between 'inconceivably minor' and major offenses. The point is that even inconceivably minor offenses are professionalism violations, for which the school cited as the sole basis for his expulsion. In your opinion, what is one egregious thing that he did that deserves expulsion in let's say the majority of cases?

The school panel decided that nothing that he did deserved mention to residencies. So I feel that I am in good company with the school panel and the judge in considering his actions as not egregious.

The judge notes that both the residency program and the licensing board will decide if he is fit to practice medicine in the future. Case could have fixed his behavior but chose instead to let his issues persist and later renege on their commitment to their student at the worst possible time.

The thing is the issue of "professionalism" in medical education is not at all related to the legal standard or breaking the law. It's PURPOSEFULLY supposed to be a "higher" standard.

 

[StIGMA]

The thing is the issue of "professionalism" in medical education is not at all related to the legal standard or breaking the law. It's PURPOSEFULLY supposed to be a "higher" standard.

I agree. "Professional" itself represents a higher standard. Expectations for professionalism then must be very clearly defined so that the implementation of disciplinary measures regarding professionalism are not "arbitrary and capricious," as the judge found in this case.

This student, now doctor, did not do anything so egregious until the DWI that the school believed to be deserving of removal from the degree program or mention to residencies. This is my point- he was unprofessional (which can mean basically anything, so it must be clearly defined along with consequences for breaches) but not egregiously unprofessional. So where is the line? It must be well defined. He should have been told early on that future unprofessional acts would lead to dismissal or something to this extent should have been in the student handbook.

 

[croak]

There are things that happen behind the scenes nobody will ever make public. As you proceed through your career, business, life-in general, things that don't seem like they should add up, just do. As JFK said: "Whoever said that life is fair had some seriously poor advisors." This sort of stuff happens, and maybe looking at this "less than stellar" scene, use it as an example of what not to be, do, or have any part of. From what I've read the whole thing looks fishy, and wouldn't want any part of it. Professionalism is something to reflect on, and sometimes seeing what it's not helps the process as you evolve into physisciandom. Is it old-fashioned to consider the "rights, privileges, responsibilities and obligations," that it says on your degree? Even if you never see a patient, or do anything with your M.D., those words are on it mean something. What you do with it, is up to you.

 

[DermViser]

I agree. Expectations for professionalism then must be very clearly defined so that the implementation of disciplinary measures regarding professionalism are not "arbitrary and capricious," as the judge found in this case.

I agree and I think this is where the discussion of professionalism is an issue. Research has shown that millenials want clearly defined expectations on what they're supposed to do and what is allowed and isn't allowed. As you can imagine the physician faculty whose research is in this area of medical education and faculty who implement this across medical schools aren't millenials.

So the frustration (IMHO a valid one) is that medical school faculty throw around this word "professionalism" and don't clearly define it. And millenial medical students are supposed to intuitively "know" if something is unprofessional or not. Not to mention, all too often, it gets used as a weapon against medical students to get them to shut up or to squelch any real criticism of the school. The judge in his ruling made it clear that medical schools have absolutely no business with factoring in character judgments when it comes to granting a degree.

 

[DermViser]

There are things that happen behind the scenes nobody will ever make public. As you proceed through your career, business, life-in general, things that don't seem like they should add up, just do. As JFK said: "Whoever said that life is fair had some seriously poor advisors." This sort of stuff happens, and maybe looking at this "less than stellar" scene, use it as an example of what not to be, do, or have any part of. From what I've read the whole thing looks fishy, and wouldn't want any part of it. Professionalism is something to reflect on, and sometimes seeing what it's not helps the process as you evolve into physisciandom. Is it old-fashioned to consider the "rights, privileges, responsibilities and obligations," that it says on your degree? Even if you never see a patient, or do anything with your M.D., those words are on it mean something. What you do with it, is up to you.

I'm curious during your time, that this wasn't as big of an issue back then, bc the term "professionalism" as it relates to medical education fit in well with the traits of your generation. Not to mention medical school tuition wasn't as high, medical doctors were quite revered and respected, reimbursements were not being cut, doctors had a lot of autonomy, etc. Now that all these things are disappearing, midlevels are encroaching, autonomy is disappearing, reimbursements are being cut, medicine has been taken over by third party payers/Pharma/Med Equipment companies, etc. and so now the area of "professionalism" is being saddled on millenial doctors to try to capture the nostalgic idea of what doctors should be, without any of the benefits you had in your career.

 

[croak]

Only YOU know what you know. These are murky times, and a confluence of factors, events, and emerging areas—extender autonomy, cost-cuttting, corporate commoditization of medicine—none singularly "defining" the reality, that which remains constant, and unchangeable—which is your individual skill set. I can't comment on tuition other than I didn't have student loans, however there are escalating costs that remain relative: DEA registration was under two hundred dollars in the late 70s, and now? So the value of money becomes relative. What can you buy with 1970s dollars in todays marketplace? For instance 100,000 dollars bought much more home in 1980 than it does today, right? The Affordable Care Act does seem to devalue doctors, and the burgeoning "check the box"-EBM, EHRs, MOC, etc., certainly is vexing in the US. We're in the midst of an experiment that remains unpredictable regarding the few years. The high deductible policies, and out of pocket expenses for medical care may give some insight down the road as to who, or what "provider" the public values. Will Joe or Jane doe favor the convenience of an NP, PA, RN, LVN, LPN, Health Coach? Will smoldering, pre-cliinal anomalies go undiagnosed until they reach a point where hospitalization and Emergency Departments are overwhelmed? Bringing this back to a personal level, the answers regarding "on being a physician," resides with the individual. If you conduct yourself with dignity, and practice to the best of your abilities, the greater truth—your education, training, and experience—will shine through. I'm optimistic. Then again, cheap, easily accessible care might reduce the US to one sick nation. Eh, I truly don't know the answer, but keep an eye on it nonetheless. All you can do is the best you can do.