A focused mapping review and synthesis of a priori risk factors associated with medical misconduct.

Background: Medical misconduct is an international problem. It is judged according to whether a doctor has endangered the health of the public. Little is known about the risk factors associated with medical misconduct. To inform patient safety, we undertook a focused mapping review and synthesis (FMRS) of tribunal reports retrieved from the Medical Practitioners Tribunal Service (MPTS). Methods: A four-phase FMRS was undertaken: (1) identification and retrieval of 1-year tribunal transcripts from the MPTS (focus), (2) analysis of transcripts to identify patterns mapped to 'a priori' risk factors (mapping), (3) peer review of the data (calibration) and (4) creation of a risk profile (synthesis). Results: Out of the 351 investigative tribunals, 249 (70.94%) resulted in a guilty verdict. 82.73% of all guilty verdicts led to the removal of the doctor from practice. Through the identification of four a priori risk factors, we developed a model of risk associated with medical misconduct: (1) being male, (2) primary medical qualification (PMQ) outside of the UK, (3) working within general practice and surgical specialties, and (4) having passed PMQ more than 20 years ago. Notable 'unconfirmed' factors, such as locum work, PMQ achieved outside of the European Union, increasing age and lack of clinical guidance are also relevant to what is deemed professional behaviour and what is not. Conclusions: The findings can inform debates about patient safety and lay the groundwork for further research into medical misconduct. Prospective studies should focus on confirming the contributory factors and relationship between these four a priori risk factors for medical misconduct: being male, PMQ outside of the UK, increasing age and working in general practice or surgical settings.