[Chalky] Losing it? NO.
Let's have a look at where we are.
The AOTC is not a behavior in and of itself. It is the result of more than one behavior. Though no one asked specifically, the AOTC is the result of human behavior. One of behaviors associated with the AOTC has an element of performance about it though it is not a performance in the traditional fine art or entertainment sense. If the behavior were a performance, however, the AOTC could be likened to the finale of same. Peer pressure is often involved. Though not an award per se, one or more of the behaviors associated with giving an an award are also associated with the AOTC. I will throw in for free that the AOTC is a noun.

[CdM] On the job? YES. Professional behavior is involved.*approving applause*

[Chalky] It's academic? NO. But *applause* because that's a noun and the final result of a series of behaviors.

[Chalky] Climbing the ladder? NO.

[GL] An acronym I had to look up? NO.
[Rosie] Sportsman-like? NO. But there are winners and losers associated. *applause*

By which I mean, for example, the 'wooden spoon' in a sporting tournament.

[Lovely Gravy] Unhappy face? MAYBE. (See "there are winners and losers associated" above.)

[Dujon] Love or marriage? NO.
[Chalky] Mortality? NO.

Twenty-nine questions over twenty days might indicate scant interest in this little puzzler - even my curiousity meter is twitching around 'indifferent'.
So it's not connected to love, marriage, birth, death, academia, job development, sport or the performing arts - is not a well-known phrase or saying or an an 'award', per se?

[Chalky] Particular geographical location? NO, it happens in many locations.
[Chalky 2] Involves voting? YES, often.
[Chalky 3] Medical connection? YES and NO. It is not a critical connection but some of the most famous examples include a medical connection.
[Chalky 4] Possible 30 years ago? YES. And also 300 years ago.
*vigorous applause for the somewhat indifferent player*