Unprofessional Behaviors Among Tomorrow's Physicians: Review of the Literature With a Focus on Risk Factors, Temporal Trends, and Future Directions

Purpose: Recent reports have identified concerning patterns of unprofessional and dishonest behavior by physician trainees. Despite this publicity, the prevalence and impact of these behaviors is not well described; thus, the authors aimed to review and analyze the various studies on unprofessional behavior among U.S. medical trainees.

Method: The authors performed a literature review. They sought all reports on unprofessional and dishonest behavior among U.S. medical school students or resident physicians published in English and indexed in PubMed between January 1980 and May 2014.

Results: A total of 51 publications met criteria for inclusion in the study. The data in these reports suggest that plagiarism, cheating on examinations, and listing fraudulent publications on residency/fellowship applications were reported in 5% to 15% of the student and resident populations that were studied. Other behaviors, such as inaccurately reporting that a medical examination was performed on a patient or falsifying duty hours, appear to be even more common (reportedly occurring among 40% to 50% of students and residents).

Conclusions: "Unprofessional behavior" lacks a unified definition. The data on the prevalence of unprofessional behavior in medical students and residents are limited. Unprofessional behaviors are common and appear to be occurring in various demographic groups within the medical trainee population. The relationship between unprofessional behaviors in training and future disciplinary action is poorly understood. Going forward, defining "unprofessional behavior"; developing validated instruments to evaluate such behaviors scientifically; and studying their incidence, motivations, and consequences are critical.