Student response to reports of unprofessional behavior: assessing risk of subsequent professional problems in medical school

ProFESS: Changing the Way Multidisciplinary Student's Professional Behaviour Lapses Are Identified and Managed. An Evaluation of Educators' Perspectives

BACKGROUND

Best practice evidence for identifying and managing professional behaviour lapses in a multidisciplinary context is lacking. This study aimed to evaluate multidisciplinary educators' attitudes and perceptions of the ProFESS (Professional standards, Ethical Behaviour and Student Support) framework and its companion Fitness for Practice model, designed and implemented at a large Australian university to address this using a behaviour change approach.

METHODS

A 72-item survey based on the Context, Input, Process, Product evaluation framework was completed by 92 multidisciplinary faculty educators and analysed using descriptive and inferential statistics. Content analysis of open text responses occurred.

FINDINGS

ProFESS and Fitness for Practice were found to be acceptable irrespective of the discipline using them, providing a supportive, transparent, consistent approach for identifying and managing a professional behaviour lapse. Other key strengths of the framework included its student-centredness and fostering a sense of safety for respondents with potential to improve student-educator relationships.

DISCUSSION

Our findings suggest that ProFESS enhances educators' confidence in managing professional behaviour lapses and that its structural flexibility and adaptability underpin its acceptability for multidisciplinary educators. Many of its positive attributes address the failure to fail barriers. The ProFESS method provides opportunities for greater consistency of application as it does not require individual interpretation of behaviour but does require education and training to apply consistently.

CONCLUSIONS

The acceptability of the ProFESS/FfP framework in a multidisciplinary healthcare education context is promising for integrating support and standards, fostering a safety culture for educators and reducing 'failure to fail' barriers.

US Medical Schools' 2024 Commencements and Antisemitism: Addressing Unprofessional Behavior

INTRODUCTION

Antisemitism and antisemitic incidents have been increasing in United States medical institutions since the Hamas attack of October 7, 2023. Such incidents include anecdotal reports of antisemitic displays at medical school commencements. This study examined unprofessional behavior observed at the commencement ceremonies of the 25 US medical schools top-ranked for research excellence. This issue is significant since these graduates are expected to become future leaders in the field of medicine.

MATERIALS AND METHODS

Based on publicly available videotaped commencements, we assessed the number of students in the graduating classes wearing non-school-provided regalia, carrying signs, wearing protest buttons, or engaging in verbal protests related to the Israel-terror groups conflict that were either openly antisemitic or potentially offensive or insensitive.

RESULTS

Symbols representing antisemitic themes (keffiyehs and three-part graduation stoles conveying antisemitic messages) were worn by students at just over half (13) of the medical schools. The mean number of students in each school wearing keffiyehs or non-official school stoles was 4.0 (95% confidence interval [CI] 2.2-5.8), ranging from 0%-13% of the classes, or 2.5% of the overall graduating cohort. The wearing of buttons, carrying of banners or signs, verbal protests interrupting the ceremony, or students deviating from script ranged from 0% to 22.5% of graduating students, with a mean of 2.7 per school (95% CI -0.8-6.2), or 1.7% of the medical schools graduating cohort.

CONCLUSIONS

We identified unprofessional behavior at commencements of top-ranked medical schools consisting of antisemitism and displaying offensive and insensitive symbols and messaging. There is an urgent need for medical schools in the US to educate medical trainees about the dangers of antisemitism and all forms of hate and insensitivity.

The Schweitzer effect: The fundamental relationship between experience and medical students' opinions on professional behaviours

PURPOSE

We examined whether medical students' opinions on the acceptability of a behaviour were influenced by previously encountering a similar professionally challenging situation, assessed the magnitude of effect of 'experience' compared to other demographic factors which influence medical students' opinions, and evaluated whether opinions regarding some situations/behaviours were more susceptible to 'experience' bias?

METHODS

Confidential, on-line survey for medical students distributed to Australian and New Zealand (AUS/NZ) medical schools. Students submitted de-identified demographic information, provided opinions on the acceptability of a wide range of student behaviours in professionally challenging situations, and whether they had encountered similar situations.

RESULTS

3171 students participated from all 21 Aus/NZ medical schools (16% of registered students). Medical students reported encountering many of the professionally challenging situations, with varying opinions on what was acceptable behaviour. The most significant factor influencing acceptability towards a behaviour was whether the student reported encountering a similar situation. The professional dilemmas most significantly influenced by previous experience typically related to behaviours that students could witness in clinical environments, and often involved breaches of trust.

CONCLUSIONS

Our results demonstrate the relationship between experience and medical students' opinions on professional behaviour- the 'Schweitzer effect'. When students encounter poor examples of professional behaviour, especially concerning trust breaches, it significantly influences their perception of the behaviour. These results highlight the importance of placing students in healthcare settings with positive professional role modelling/work cultures.

What we think about professional and unprofessional behaviors: differences between the perception of clinical faculty members and medical students

INTRODUCTION

Differences in the viewpoints of clinical faculty members and medical students about prioritizing professional norms accepted by the professional community and lack of alignment of these views can lead to distortion of understanding, problems in learning and assessment of professionalism, and failure in students' professional identity formation. This study aimed to identify the differences in viewpoints of clinical faculty members and medical students about prioritizing the importance and prevalence of professional and unprofessional behaviors among undergraduate medical students.

METHODS

A multi-stage qualitative study was conducted at Tehran University of Medical Sciences during 2020-2021. At first, a systematic search was conducted to identify professional and unprofessional behaviors using the directional content analysis method. A panel of experts was formed to check the codes obtained from reviewing the literature and to evaluate its compliance with the context. Then, the modified nominal group technique sessions were held with clinical faculty members and medical students to strengthen the codes extracted from the studies and systematically integrate their views to achieve a comprehensive list of professional and unprofessional behaviors in accordance with the context. Finally, a consensus was made among them about prioritizing the importance and prevalence of these behaviors in undergraduate medical students.

RESULTS

A total of 490 codes of professional behaviors and 595 unprofessional behavior codes were identified in the literature review. In the following sessions of the modified nominal group, 13 clinical faculty members listed 105 codes of professional and unprofessional behaviors, and 51 medical students also listed 313 codes. The results of the modified nominal group technique showed that the faculty members reported the importance of unprofessional behaviors higher than professional ones. At the same time, students rated the importance of professional behaviors higher than unprofessional ones. Both faculty members and students rate the prevalence of professional behaviors as high and the prevalence of unprofessional behaviors as low.

CONCLUSION

The results showed a difference of views between clinical faculty members and medical students about prioritizing professional and unprofessional behaviors. It is essential to align their viewpoints to understand, learn and value professionalism to develop a professional identity.

The association between Situational Judgement Test (SJT) scores and professionalism concerns in undergraduate medical education

Introduction: Situational judgement tests (SJTs) are widely used in selecting medical students and doctors. Emerging evidence suggests SJTs are capable of testing an individual's ability to respond to role-relevant professionalism scenarios, however, evidence is lacking for their use in identifying students with concerning professional behaviours.This study aimed to determine the association between medical student professionalism-based SJT scores and recorded professionalism concerns during training.Methods: A cross-sectional study was conducted utilising SJT scores from second-year medical students and occurrences of student professionalism concerns. Concerns were reviewed and mapped to General Medical Council standards. Multivariate logistic regression was used to determine associations between SJT scores and professionalism concerns.Results: 247 students were included in the study. For every point increase in SJT score, students were 10% less likely to have multiple professionalism concerns [OR (95% CI) 0.90 (0.83-0.97); p = .007].Students scoring below 1 and 2 standard deviations from the mean score were 4 and 11-times more likely to have multiple concerns [OR (95% CI) 4.52 (1.12-18.25); p = .034] and [OR (95% CI) 11.45 (1.72-76.15); p = .012].Conclusion: Lower SJT scores were significantly associated with an increased risk of professionalism concerns. These findings support the potential for SJT exams to identify medical students that may require closer supervision and remediation during undergraduate education.