Call for medical student screening

Efforts should be made to screen out unethical doctors

Medical school applicants should be screened for personality disorders to avoid future cases like the Shipman murders, according to research.

A study carried out at the University of Newcastle in Australia suggests that screening at this early stage is the only way to weed out potentially rogue doctors.

Credible attempts should be made to at least minimise the chances of unethical behaviour occurring. Not to do so would seem to be ethically inappropriate in itself

Dr Ian Kerridge

However, the authors of the study, which is published in the Journal of Medical Ethics, admit that many screening methods would not produce accurate results.

For example, contrived scenarios where students were asked, for example, to provide a list of ethical issues they might encounter and action they could take, would not work.

Personality traits

The researchers concluded that intelligent students would be able to approach such a task like an exercise or a game and provide reasonable answers without having to refer to their own ethics.

Ethical beliefs, such as whether female circumcision or animal testing is acceptable, were also discounted as such ideas can and do change and develop during training.

However the author's study did reveal that unethical behaviour among doctors was often linked to certain personality traits.

It must be recognised that some students may not be suited to a career in medicine even though they may attain the academic standards necessary for admission to medical school

CHMS

Interviews were conducted with 32 academics, general staff and clinicians from the University of Newcastle during which each respondent was asked to describe an experience they may have had with an unethical doctor.

Many of the participants chose similar words to describe personality traits rather than the behaviour itself - such as arrogant, brash, condescending, power-seeking, devious, self-centred and patronising.

'Narcissistic egotists'

Unethical doctors were portrayed generally as "narcissistic egotists unconcerned with anyone's interests but their own".

The authors admit in their report that screening out narcissists, people who possess a morbid self-love or self-admiration, may deprive medicine of future leaders and innovators.

But they believe there are ways to separate doctors who are merely egocentric and unpleasant and those whose narcissism could lead to unethical behaviour.

Dr Ian Kerridge, of the Royal Free Hospital in London and co-author of the report, said: "The Shipmans of our profession may prove to be identifiable only after evidence of their inappropriate behaviour becomes apparent.

"It is our conclusion, however, that credible attempts should be made to at least minimise the chances of unethical behaviour occurring.

"Not to do so would seem to be ethically inappropriate in itself."

A spokesperson for the General Medical Council said: "The selection and development of selection criteria are the responsibility of the medical schools.

"However as they act as gatekeepers to the profession they must ensure that any individual who starts and completes the medical course has demonstrated their fitness to practise as a pre-registration house officer."

The Council for the Heads of Medical Schools (CHMS) has produced a "guiding principals for the admission of medical students".

One of those principals states: "The practice of medicine requires the highest standards of personal and professional conduct."

It adds: "It must be recognised that some students may not be suited to a career in medicine even though they may attain the academic standards necessary for admission to medical school."