A three-judge panel of the US Court of Appeals for the Sixth Circuit reversed a federal district court decision and said that Case Western Reserve University could withhold an MD degree from a student who they said exhibited unprofessional behavior.

I have written about this situation on two previous occasions—here and here. Briefly, a medical student who had performed well academically had committed a few transgressions outside the classroom. These included: sexually harassing some female students at a dance; attempting to avoid payment of a taxi fare; having problems interacting with staff, patients, and families, resulting in a failing grade and requirement to repeat a [sub?]internship; and asking faculty members not to mark him late for teaching sessions, which occurred 30% of the time.

The issue that prompted the school to expel the student just prior to graduation was a conviction in another state for driving while intoxicated. He denied or had excuses for most of the incidents.

The original court decision pointed out that his earlier problems had apparently not been considered serious because the school had given him positive letters of recommendation. The lower court also opined that professionalism was distinct from academic matters.

The appeals court disagreed and said, “professionalism is part of what [medical] students must learn and practice.” It added that the school’s definition of professionalism in moral judgment terms was appropriate and should not be separated from academic performance.

Here are some of the ways the school defined professionalism in its curriculum: ethical, honest, responsible and reliable behavior; respectful dialogue with peers, faculty, and patients, to enhance learning and resolve differences; recognize personal limitations and biases and find ways to overcome them.

The ruling states, “Because that lack-of-professionalism finding amounts to an academic judgment to which courts owe considerable deference, we must reverse.”

If you have a few minutes, you should read the appeals court ruling, which is only 8 pages long and refreshingly written in plain English.

The student had matched to a residency in the highly competitive field of dermatology. The hospital where he was training has suspended him pending the inevitable appeal.

In one of my earlier posts, I said that I disagreed with the district court’s ruling and felt that character judgments are strongly related to medical education, but wondered how medical schools and residency programs can teach professionalism and assess whether their trainees possess it if it is so ill-defined?

I guess we now have some answers.

“To educate a man in mind and not in morals is to educate a menace to society.” Theodore Roosevelt as quoted by Henry Doss in Forbes.

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and critical care and has re-certified in both several times. He blogs at SkepticalScalpel.blogspot.com and tweets as @SkepticScalpel.