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Risk factors at medical school for subsequent professional misconduct: multicentre retrospective case-control study

BMJ 2010; 340 doi: (Published 27 April 2010) Cite this as: BMJ 2010;340:c2040
  1. Janet Yates, research fellow in medical education,
  2. David James, foundation director of medical education
  1. 1Medical Education Unit, University of Nottingham Medical School, Queen’s Medical Centre, Nottingham NG7 2UH
  1. Correspondence to: J Yates janet.yates{at}
  • Accepted 9 March 2010


Objective To determine whether there are risk factors in a doctor’s time at medical school that are associated with subsequent professional misconduct.

Design Matched case-control study.

Setting Records from medical schools and the General Medical Council (GMC).

Participants 59 doctors who had graduated from any one of eight medical schools in the United Kingdom in 1958-97 and had a proved finding of serious professional misconduct in GMC proceedings in 1999-2004 (cases); 236 controls (four for each case) were selected by systematic sampling from matching graduation cohorts. Case-control status was revealed by the GMC after completion of data entry.

Main outcome measure Odds ratios for being a “case,” with multivariable conditional logistic regression of potential risk factors including pre-admission characteristics and progress during the course. These data were obtained from anonymised copies of the students’ progress files held by their original medical schools.

Results Univariate conditional logistic regression analysis found that cases were more likely to be men, to be of lower estimated social class, and to have had academic difficulties during their medical course, especially in the early years. Multivariable analysis showed that male sex (odds ratio 9.80, 95% confidence interval 2.43 to 39.44, P=0.001), lower social class (4.28, 1.52 to 12.09, P=0.006), and failure of early or preclinical examinations (5.47, 2.17 to 13.79, P<0.001) were independently associated with being a case.

Conclusions This small study suggests that male sex, a lower socioeconomic background, and early academic difficulties at medical school could be risk factors for subsequent professional misconduct. The findings are preliminary and should be interpreted with caution. Most doctors with risk factors will not come before the GMC’s disciplinary panels.


  • We are indebted to Carol Coupland, associate professor in medical statistics, Community Health Sciences, who carried out the conditional regression and data imputation, and interpreted the resulting data. We thank staff at the General Medical Council: Peter Rubin, Chris Gulik, and Nicola Costin for securing funding from the GMC’s research and development advisory board, and for coordinating support; and Adrian McAndrew and Kate Walmsley for identifying cases and controls, liaising with our partner medical schools, and extracting data from the GMC databases. We thank staff at our partner medical schools: Allan Cumming, Ruth Stewart (Edinburgh); Jill Morrison, Caroline Mallon (Glasgow); Trudie Roberts, Deborah Murdoch-Eaton (Leeds); Stewart Petersen (Leicester); Elizabeth Sheader, Tim Dornan (Manchester); Suzanne Cholerton, Dianorah Smith (Newcastle); and Nigel Bax, Denise Bee (Sheffield); and the administrative staff of all institutions. Finally, we thank our colleagues from Nottingham: Robert Wilcox, Charles Marsden, and David James for reviewing the academic statements; Eamonn Ferguson for discussions about the analysis and implications of the results; and David Yates for helping to classify parental occupations.

  • Contributors: Both authors developed the idea for the study, negotiated with the GMC, contributed to the paper and approved the final draft. JY prepared the database, conducted the initial analysis, wrote the first draft of the paper, and is guarantor. Senior staff at our partner universities were invited to comment on a late draft of the paper.

  • Funding: The external costs of the study (photocopying and anonymising student files and transporting them to Nottingham) were funded by the GMC. JY was funded by the Service Increment for Teaching (SIFT).

  • Role of the study sponsors: The GMC agreed to the design of the study and provided the names of cases and controls to participant medical schools in confidence. It had no role in the collection and analysis of data, nor the interpretation of the results. The GMC accepted a full report of the study in July 2009 and agreed to the submission this paper.

  • Competing interests: All authors have completed the Unified Competing Interest form at (available on request from the corresponding author) and declare that: (1) JY and DJ have support from the General Medical Council for the submitted work; (2) JY and DJ have had no relationships in the previous 3 years with any other Companies that might have an interest in the submitted work; (3) their spouses, partners, or children have no financial relationships that may be relevant to the submitted work; and (4) JY and DJ have no non-financial interests that may be relevant to the submitted work.

  • Ethical approval: This study was approved by the University of Nottingham research ethics committee (ref A/12/2007) and the research ethics committees of all participating universities.

  • Data sharing: Additional data (manipulation of social class and examination data, description of GMC case categories, and anonymised list of actual cases) are available in supplemental files from the authors (janet.yates{at} Raw data are not available.

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