Prior to 1995, the faculty at one of America's most highly regarded medical schools, the University of California, San Francisco (UCSF), were aware that every year one or more students graduated because of passing grades despite notable deficiencies in professional conduct during medical clerkships. During 1995-98 UCSF decided to address this problem by developing forms for reporting observed lack of professionalism. Although the primary purpose was remediation, a pattern of unprofessional conduct could lead to academic probation and even dismissal, despite passing grades.
In 2004 the UCSF Dean for Student Affairs, Dr. Maxine Papadakis, published a study showing that UCSF students who had received comments regarding unprofessional behavior in one or more courses were twice as likely to be disciplined than a control group of otherwise similar graduates. Of nine identified "domains" of unprofessional behavior, three in particular were strongly associated with later disciplinary action: (1) poor reliability and responsibility, (2) lack of self-improvement and adaptability, and (3) poor initiative and motivation. In contrast, standardized test scores and medical school grades did not identify who would have disciplinary problems. Subsequent research including two additional medical schools indicated that disciplined physicians were three times more likely to have displayed unprofessional behavior in medical school than a control group. Among the categories of unprofessional behavior, students who displayed irresponsibility were eight times more likely to be disciplined. This research has resulted in much greater emphasis on learning and assessing professional conduct throughout US medical education.
Part of the “new normal” for legal education is an increasing concern about the formation of a moral professional identity and greater expectations from the profession and licensing authorities that law school graduates will be prepared for practice not only in terms of substantive knowledge but able and willing to apply that knowledge with skill and professional responsibility. Clinic teachers are in a critical position to play a central role in accomplishing these goals. Like the directors of medical school rotations, clinic teachers are uniquely situated to observe and assess professional conduct, but to date nothing like the UCSF approach has been developed in legal education even though probably most clinic teachers have supervised students who have given them concern about the risk of future unprofessional conduct. Development of well designed and tested forms and procedures for reporting on unprofessional conduct will make the wealth of information gained by clinic teachers of considerable potential benefit both to the law school as an institution and ultimately the profession.