In surgery, unprofessional behaviors have been shown to affect team and individual performance and result in greater risk for surgical complications and malpractice claims.^1-4 Until now, there have been limited data to support early-career identification of surgeons at risk of unprofessional practices, which could guide potential prevention efforts. In this issue of JAMA Surgery, Kopp et al⁵ assessed the association between American Board of Surgery examination performance and subsequent severe medical license disciplinary action for 44 290 surgeons who applied for certification between 1976 and 2017 using linked data from the American Board of Surgery and state medical licensure boards. Surgeons who failed to obtain certification had a 3-fold increased risk of later severe disciplinary action compared with surgeons who obtained certification (hazard ratio, 3.38; 95% CI, 2.79-4.10). Interestingly, surgeons who failed either or both the written qualifying (QE) or oral certifying (CE) examination at least 1 time (32% of the cohort) were all at significant risk for subsequent severe disciplinary action even if they passed a repeated examination.

在外科手术中，非专业行为已被证明会影响团队和个人的表现，并导致更大的手术并发症和不当行为索赔风险。^{1 -4}到现在为止，只有很少的数据可以支持在职业生涯中识别具有非专业实践风险的外科医生，这可以指导潜在的预防工作。在本期JAMA Surgery中，Kopp等人⁵评估了美国外科手术委员会的考试成绩与随后的严重医疗执照纪律处分之间的关​​联性，该研究使用了美国外科手术委员会和各州医疗许可委员会的链接数据，对1976年至2017年之间申请认证的44 290名外科医生进行了评估。与未获得认证的外科医生相比，未获得认证的外科医生进行后期严重纪律处分的风险增加了3倍（危险比，3.38； 95％CI，2.79-4.10）。有趣的是，至少通过一次书面合格（QE）或口试（CE）一项或两项考试均未通过的外科医生，即使他们通过了重复检查，也都面临着随后严厉纪律处分的重大风险。