As corporate scandals proliferate, practitioners and researchers alike need a cumulative, quantitative understanding of the antecedents associated with unethical decisions in organizations. In this meta-analysis, the authors draw from over 30 years of research and multiple literatures to examine individual ("bad apple"), moral issue ("bad case"), and organizational environment ("bad barrel") antecedents of unethical choice. Findings provide empirical support for several foundational theories and paint a clearer picture of relationships characterized by mixed results. Structural equation modeling revealed the complexity (multidetermined nature) of unethical choice, as well as a need for research that simultaneously examines different sets of antecedents. Moderator analyses unexpectedly uncovered better prediction of unethical behavior than of intention for several variables. This suggests a need to more strongly consider a new "ethical impulse" perspective in addition to the traditional "ethical calculus" perspective. Results serve as a data-based foundation and guide for future theoretical and empirical development in the domain of behavioral ethics.

Bad Apples, Bad Cases, and Bad Barrels: Meta-Analytic Evidence About Sources of Unethical Decisions at Work

Anatomy has historically been a cornerstone in medical education regardless of nation or specialty. Until recently, dissection and didactic lectures were its sole pedagogy. Teaching methodology has been revolutionized with more reliance on models, imaging, simulation, and the Internet to further consolidate and enhance the learning experience. Moreover, modern medical curricula are giving less importance to anatomy education and to the acknowledged value of dissection. Universities have even abandoned dissection completely in favor of user-friendly multimedia, alternative teaching approaches, and newly defined priorities in clinical practice. Anatomy curriculum is undergoing international reformation but the current framework lacks uniformity among institutions. Optimal learning content can be categorized into the following modalities: (1) dissection/prosection, (2) interactive multimedia, (3) procedural anatomy, (4) surface and clinical anatomy, and (5) imaging. The importance of multimodal teaching, with examples suggested in this article, has been widely recognized and assessed. Nevertheless, there are still ongoing limitations in anatomy teaching. Substantial problems consist of diminished allotted dissection time and the number of qualified anatomy instructors, which will eventually deteriorate the quality of education. Alternative resources and strategies are discussed in an attempt to tackle these genuine concerns. The challenges are to reinstate more effective teaching and learning tools while maintaining the beneficial values of orthodox dissection. The UK has a reputable medical education but its quality could be improved by observing international frameworks. The heavy penalty of not concentrating on sufficient anatomy education will inevitably lead to incompetent anatomists and healthcare professionals, leaving patients to face dire repercussions. Anat Sci Educ 3: 83–93, 2010. © 2010 American Association of Anatomists.

The anatomy of anatomy: A review for its modernization

Context The relationship between professionalism and distress among medical students is unknown. Objective To determine the relationship between measures of professionalism and burnout among US medical students. Design, Setting, and Participants Cross-sectional survey of all medical students attending 7 US medical schools (overall response rate, 2682/4400 [61%]) in the spring of 2009. The survey included the Maslach Burnout Inventory (MBI), the PRIME–MD depression screening instrument, and the SF-8 quality of life (QOL) assessment tool, as well as items exploring students' personal engagement in unprofessional conduct, understanding of appropriate relationships with industry, and attitudes regarding physicians' responsibility to society. Main Outcome Measures Frequency of self-reported cheating/dishonest behaviors, understanding of appropriate relationships with industry as defined by American Medical Association policy, attitudes about physicians' responsibility to society, and the relationship of these dimensions of professionalism to burnout, symptoms of depression, and QOL. Results Of the students who responded to all the MBI items, 1354 of 2566 (52.8%) had burnout. Cheating/dishonest academic behaviors were rare (endorsed by Conclusion Burnout was associated with self-reported unprofessional conduct and less altruistic professional values among medical students at 7 US schools.

https://jamanetwork.com/journals/jama/articlepdf/186582/joc05089_1173_1180.pdf

Relationship between burnout and professional conduct and attitudes among US medical students.

Context Web 2.0 applications, such as social networking sites, are creating new challenges for medical professionalism. The scope of this problem in undergraduate medical education is not well-defined. Objective To assess the experience of US medical schools with online posting of unprofessional content by students and existing medical school policies to address online posting. Design, Setting, and Participants An anonymous electronic survey was sent to deans of student affairs, their representatives, or counterparts from each institution in the Association of American Medical Colleges. Data were collected in March and April 2009. Main Outcome Measures Percentage of schools reporting incidents of students posting unprofessional content online, type of professionalism infraction, disciplinary actions taken, existence of institution policies, and plans for policy development. Results Sixty percent of US medical schools responded (78/130). Of these schools, 60% (47/78) reported incidents of students posting unprofessional online content. Violations of patient confidentiality were reported by 13% (6/46). Student use of profanity (52%; 22/42), frankly discriminatory language (48%; 19/40), depiction of intoxication (39%; 17/44), and sexually suggestive material (38%; 16/42) were commonly reported. Of 45 schools that reported an incident and responded to the question about disciplinary actions, 30 gave informal warning (67%) and 3 reported student dismissal (7%). Policies that cover student-posted online content were reported by 38% (28/73) of deans. Of schools without such policies, 11% (5/46) were actively developing new policies to cover online content. Deans reporting incidents were significantly more likely to report having such a policy (51% vs 18%; P = .006), believing these issues could be effectively addressed (91% vs 63%; P = .003), and having higher levels of concern (P = .02). Conclusion Many responding schools had incidents of unprofessional student online postings, but they may not have adequate policy in place.

https://jamanetwork.com/journals/jama/articlepdf/184624/joc90101_1309_1315.pdf

Online posting of unprofessional content by medical students.

ContextPoor patient-physician communication increases the risk of patient complaints and malpractice claims. To address this problem, licensure assessment has been reformed in Canada and the United States, including a national standardized assessment of patient-physician communication and clinical history taking and examination skills.ObjectiveTo assess whether patient-physician communication examination scores in the clinical skills examination predicted future complaints in medical practice.Design, Setting, and ParticipantsCohort study of all 3424 physicians taking the Medical Council of Canada clinical skills examination between 1993 and 1996 who were licensed to practice in Ontario and/or Quebec. Participants were followed up until 2005, including the first 2 to 12 years of practice.Main Outcome MeasurePatient complaints against study physicians that were filed with medical regulatory authorities in Ontario or Quebec and retained after investigation. Multivariate Poisson regression was used to estimate the relationship between complaint rate and scores on the clinical skills examination and traditional written examination. Scores are based on a standardized mean (SD) of 500 (100).ResultsOverall, 1116 complaints were filed for 3424 physicians, and 696 complaints were retained after investigation. Of the physicians, 17.1% had at least 1 retained complaint, of which 81.9% were for communication or quality-of-care problems. Patient-physician communication scores for study physicians ranged from 31 to 723 (mean [SD], 510.9 [91.1]). A 2-SD decrease in communication score was associated with 1.17 more retained complaints per 100 physicians per year (relative risk [RR], 1.38; 95% confidence interval [CI], 1.18-1.61) and 1.20 more communication complaints per 100 practice-years (RR, 1.43; 95% CI, 1.15-1.77). After adjusting for the predictive ability of the clinical decision-making score in the traditional written examination, the patient-physician communication score in the clinical skills examination remained significantly predictive of retained complaints (likelihood ratio test, P < .001), with scores in the bottom quartile explaining an additional 9.2% (95% CI, 4.7%-13.1%) of complaints.ConclusionScores achieved in patient-physician communication and clinical decision making on a national licensing examination predicted complaints to medical regulatory authorities.

https://jamanetwork.com/journals/jama/articlepdf/208633/joc70070_993_1001.pdf

Physician scores on a national clinical skills examination as predictors of complaints to medical regulatory authorities.

Background Evidence supporting professionalism as a critical measure of competence in medical education is limited In this case–control study, we investigated the association of disciplinary action against practicing physicians with prior unprofessional behavior in medical school We also examined the specific types of behavior that are most predictive of disciplinary action against practicing physicians with unprofessional behavior in medical school Methods The study included 235 graduates of three medical schools who were disciplined by one of 40 state medical boards between 1990 and 2003 (case physicians) The 469 control physicians were matched with the case physicians according to medical school and graduation year Predictor variables from medical school included the presence or absence of narratives describing unprofessional behavior, grades, standardized-test scores, and demographic characteristics Narratives were assigned an overall rating for unprofessional behavior Those that met the thresh

https://www.nejm.org/doi/pdf/10.1056/NEJMsa052596

Disciplinary action by medical boards and prior behavior in medical school.

Background Evidence supporting professionalism as a critical measure of competence in medical education is limited. In this case–control study, we investigated the association of disciplinary action against practicing physicians with prior unprofessional behavior in medical school. We also examined the specific types of behavior that are most predictive of disciplinary action against practicing physicians with unprofessional behavior in medical school. Methods The study included 235 graduates of three medical schools who were disciplined by one of 40 state medical boards between 1990 and 2003 (case physicians). The 469 control physicians were matched with the case physicians according to medical school and graduation year. Predictor variables from medical school included the presence or absence of narratives describing unprofessional behavior, grades, standardized-test scores, and demographic characteristics. Narratives were assigned an overall rating for unprofessional behavior. Those that met the thresh...

/pdf/disciplinary-action-by-medical-boards-and-prior-behavior-in-2hn53805b2.pdf

Timothy R. Knettler

Papers

Disciplinary action by medical boards and prior behavior in medical school.

Disciplinary Action by Medical Boards and Prior Behavior in Medical School