title: Study of medical students' malpractice fear and defensive medicine: a "hidden curriculum?".
abstract: BACKGROUND
  Defensive medicine is a medical practice in which health care providers' primary intent is to avoid criticism and lawsuits, rather than providing for patients' medical needs. The purpose of this study was to characterize medical students' exposure to defensive medicine during medical school rotations.
  
  
  METHODS
  We performed a cross-sectional survey study of medical students at the beginning of their third year. We gave students Likert scale questionnaires, and their responses were tabulated as a percent with 95% confidence interval (CI).
  
  
  RESULTS
  Of the 124 eligible third-year students, 102 (82%) responded. Most stated they rarely worried about being sued (85.3% [95% CI=77.1% to 90.9%]). A majority felt that faculty were concerned about malpractice (55.9% [95% CI=46.2% to 65.1%]), and a smaller percentage stated that faculty taught defensive medicine (32.4% [95% CI=24.1% to 41.9%]). Many students believed their satisfaction would be decreased by MC and lawsuits (51.0% [95% CI=41.4% to 60.5%]). Some believed their choice of medical specialty would be influenced by MC (21.6% [95% CI=14.7% to 30.5%]), and a modest number felt their enjoyment of learning medicine was lessened by MC (23.5% [95% CI=16.4% to 32.6%]). Finally, a minority of students worried about practicing and learning procedures because of MC (16.7% [95% CI=10.7% to 25.1%]).
  
  
  CONCLUSIONS
  Although third-year medical students have little concern about being sued, they are exposed to malpractice concerns and taught considerable defensive medicine from faculty. Most students believe that fear of lawsuits will decrease their future enjoyment of medicine. However, less than a quarter of students felt their specialty choice would be influenced by malpractice worries and that malpractice concerns lessened their enjoyment of learning medicine. [West J Emerg Med. 2014;15(3):293-298.].
authors.affiliation: Hackensack University Medical Center, Department of Emergency Medicine, Hackensack, New Jersey.
authors.forename: William F
authors.initials: WF
authors.lastname: Johnston
authors.affiliation: University of California at San Francisco, Department of Emergency Medicine, San Francisco, California.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Rodriguez
authors.affiliation: Kaiser Permanente Oakland Medical Center, Department of Internal Medicine, Oakland, California.
authors.forename: David
authors.initials: D
authors.lastname: Suarez
authors.affiliation: University of California at San Francisco, Department of Emergency Medicine, San Francisco, California.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Fortman
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002321:Career Choice; D003430:Cross-Sectional Studies; D003479:Curriculum; D003675:Defensive Medicine / Q000193:education* / Q000331:legislation & jurisprudence*; D004504:Education, Medical, Undergraduate / Q000592:standards / Q000639:trends*; D005239:Fear; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008318:Malpractice / Q000331:legislation & jurisprudence; D008511:Medicine; D012495:San Francisco / Q000453:epidemiology; D013337:Students, Medical / Q000523:psychology / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires