At the beginning of this year, Fouad L. was about to receive his diploma as a medical doctor, when the Public Prosecution Service sounded the alarm at Erasmus MC. The student, the Public Prosecution Service wrote in an email to the educational institution, has come into contact with the law several times in recent years. It involved animal abuse, poaching and sadism. Is it wise to award this student a diploma?
The Erasmus MC examination committee decided that a psychological examination had to take place first. It is unclear whether that happened. On Thursday, Fouad L. was arrested after two fatal shootings in Rotterdam.
What can an educational institution do with medical students who exhibit alarming or unprofessional behavior? With students who seem unsuitable for the subject? Can they be removed from the course?
Until two months ago, radiologist Mario Maas from Amsterdam UMC was chairman of the national medical examination committees. He cannot say anything more about the events in Rotterdam and the suspect’s study path than that it is “deeply sad” what happened. “I know nothing about the behavior the suspect exhibited during his studies.”
Also read: Fouad L. took out his frustrations on animals and dreamed of becoming a doctor
In general terms, he does say this: “The vast majority of students are suitable for the subject. But if that is not the case, trainers have few tools to remove students from medical training.”
Red flags
During their medical studies, students are continuously assessed, Maas explains. And if there are any “red flags” – students who are consistently late, treat patients unfairly, exhibit inappropriate behavior or perform medical procedures for which they are not authorized – these are recorded in their portfolio.
An examination board can then impose all kinds of additional requirements on students. If they want to succeed, these students will first have to undergo psychotherapeutic treatment, for example. Or they have to take a communication or aggression management course.
By the way, this always concerns behavior that becomes visible during the study. An examination board does not investigate what someone does in their private life, or whether someone has a criminal record. Maas: “We can’t do that either.” However, healthcare institutions – including for internships and internships – often require a declaration of good behavior. In that case, a criminal record can still be an obstacle in practice.
“Where it gets complicated,” says Maas, “is when there is repetitive unprofessional behavior.” Students who may function well medically, but continue to exhibit problematic behavior. That [als ze niet vrijwillig opstappen, red.] but remain stuck in the curriculum. “You can’t just send them away.”
Regulation
Since 2010, there has been a ‘back door’: a legal regulation (Iudicium Abeundi) that makes it possible to deny students of medicine, dentistry and veterinary medicine access to the training. The Executive Board makes such a decision at the request of the dean or the examination committee. For example, if patient safety has been compromised. Mario Maas argues for an expansion of the scheme: “Because we would of course prefer not to let it get to that point. We can’t afford that.”
In the first ten years of the scheme, students were forced to discontinue their studies via this route at least four times. This involved inappropriate behavior towards (underage) patients and intimidation of colleagues. And it was always preceded by a long series of incidents. In one case, a study was stopped only after fifteen years. “The Higher Education Act carries a lot of weight,” says Maas, and for good reason, “but if trainers consider a student unsuitable for the profession, that judgment should also carry more weight.” Maas refers to a 2004 studywhich shows that students who exhibit unprofessional behavior during their studies are also more likely to be disciplined during their careers.
After a call to relax the 2010 legal regulationthen Minister of Education Robbert Dijkgraaf (D66) know last year that he does not consider this desirable. The measure is precisely intended ‘for very exceptional circumstances’. It is about the “accessibility of higher education and the student’s interest in whether or not he or she can complete a course.”
Marjolein van de Pol is chairman of the national consultation of training directors of university hospitals. She also emphasizes that she cannot say anything related to the events in Rotterdam. When it comes to medical training, she says: “There is rightly more attention to the question of whether someone is suitable for the profession or not. Unfortunately, in every layer of the population there are people who may not be suitable for the position they want to hold.” But not in every profession can this have such far-reaching consequences as in the medical profession. In addition, students start working in practice even before they receive a diploma. “They come into contact with patients at an early stage.” If a student does not function properly, the right to education can conflict with the safety of patients. “That is why it is so important to pay so much attention to behavior and professional qualities during your studies.”