Early detection and evaluation of professionalism deficiencies in medical students: one school's approach

Professionalism in Physician Assistant Education as a Predictor of Future Licensing Board Disciplinary Actions

PURPOSE

The purpose of this study was to evaluate associations between postgraduate disciplinary actions (PGDA) by state licensing boards and physician assistant (PA) school documented professionalism violations (DPV) and academic probation.

METHODS

This was a retrospective cohort study comprising PA graduates from 2001 to 2011 at 3 institutions (n = 1364) who were evaluated for the main outcome of PGDA and independent variable of DPV and academic probation. Random-effects multiple logistic regression and accelerated failure time parametric survival analysis were used to investigate the association of PGDA with DPV and academic probation.

RESULTS

Postgraduate disciplinary action was statistically significant and positively associated with DPV when unadjusted (odds ratio [OR] = 5.15; 95% CI: 1.62-16.31; P = .01) and when adjusting for age, sex, overall PA program GPA (GPA), and Physician Assistant National Certifying Exam Score (OR = 5.39; 95% CI: 1.54-18.85; P = .01) (fully adjusted). Academic probation increased odds to 8.43 times (95% CI: 2.85-24.92; P < .001) and 9.52 times (95% CI: 2.38-38.01; P < .001) when fully adjusted.

CONCLUSION

Students with professionalism violation or academic probation while in the PA school had significant higher odds of receiving licensing board disciplinary action compared with those who did not. Academic probation had a greater magnitude of effect and could represent an intersection of professionalism and academic performance.

The assessment of personal and professional identity development in an undergraduate medical curriculum: A scoping review protocol

Background: Over recent years there has been significant interest in the field of medical education in understanding how medical students develop their personal and professional identity as they transition through medical school and into their early career. Despite the growing amount of research that focuses on the best methods of incorporating this area into medical school curricula, there has been less focus on how to assess this construct and how it might be associated with student progression. Therefore, a scoping review is being undertaken to identify the various methods or tools currently being implemented to assess the development of personal and professional identity, including the concepts of professionalism, leadership and resilience, in medical education and outline an optimal assessment framework. Methods: The proposed scoping review of the literature will be conducted under the guidance of the methodology of the Joanna Briggs Institute for scoping reviews across multiple electronic databases. Electronic database, reference list, and citation searching from the year 2000 will be undertaken. Peer reviewed publications involving assessment methods for personal and/or professional identity formation, professionalism, leadership, and resilience being utilised with direct-entry or graduate-entry medical students will be selected. The search strategy will remain dynamic and may be further delineated as necessary during the review process. All studies that meet this study’s inclusion criteria will undergo thematic analysis. The overall findings of this analysis will be presented in a narrative format. Conclusion: In this scoping review protocol, the current methods and tools for assessment of personal and/or professional identity formation, professionalism, leadership, and resilience will be identified and synthesised into a proposed assessment framework. The hope is that this framework will then serve as an aid to support the assessment of this multi-dimensional, complex construct.

Professionalism development of undergraduate medical students: Effect of time and transition

Changeover phases are essential and inevitable times in professional life, which let the learners adapt and grasp emerging opportunities for learning based on the past experiences with the catering of novel creativity as required in the present as well as emerging time. This study was carried out to examine the effectiveness of a professionalism course, during the transition from a non-clinical to clinical setting, within the context of undergraduate medical education.This observational study was conducted during 2019 to 2020, with pre- and post-professionalism course evaluation. We used the Dundee Poly-professionalism inventory-1: Academic Integrity, among the undergraduate medical students.Our results are based on the medical student's professional progress with the transition from 2nd year to 3rd year. During the 1st phase of the study, the participants at their Pre-Professionalism Course (PrPC) level in their 2nd medical year (only attended the introductory lectures for professionalism), showed a good understanding of professionalism. For the 2nd phase, when the same students, at their Post-Professionalism Course (PoPC) level, in their 3rd year (completed professionalism course) filled the same survey and it was found that there was no decline in their understanding of the topic, even after more than a year. They were even more aware of the significance of professionalism in their clinical settings.Despite a year gap, the understanding of professionalism among students was stable. Results helped us infer that time laps did not affect the professionalism concept learned earlier; rather during clinical settings, students become more aware of professionalism.

Validity, reliability and acceptability of Professionalism Mini-Evaluation Exercise (P-MEX) for emergency medicine residency training

Professionalism is a core competency in the medical profession. In this paper, we aimed to confirm the validity, reliability and acceptability of the Professionalism Mini-Evaluation Exercise (P-MEX) instrument for the emergency medicine (EM) residency program. Twenty-two EM attending physicians completed 383 P-MEX forms (the Persian version) for 90 EM residents. Construct validity was assessed via structural equation modeling (SEM). The reliability coefficient was estimated by the generalizability theory, and acceptability was assessed using two researcher-made questionnaires to evaluate the perspectives of residents and assessors. There was a consensus among the participants regarding the content of P-MEX. According to the results of SEM, the first implementation of the original model was associated with a moderate fit and high item loadings. The model modified with correlated error variances for two pairs of items showed an appropriate fit. The reliability of P-MEX was 0.81 for 14 occasions. The perception survey indicated high acceptability for P-MEX from the viewpoint of the residents and increasing satisfaction with P-MEX among the assessors over time.

According to the results of the research, P-MEX is a reliable, valid, and acceptable instrument for assessing professionalism in EM residents.

Patient-centered medical education: A proposed definition

Multiple papers have been presented to define patient-centered care, with regulatory bodies such as the General Medical Council mapping this in their professional standards. Educational institutions clearly value instilling appreciation of patient-centredness in medical training, and attempts have been made to make medical education more patient-centered in practice. Such attempts are often limited to expert patients sharing personal stories, and public involvement in teaching. Despite the drive towards patient-centered care and medical education, there has been no attempt to formally define what patient-centered medical education is and what it means to medical educators globally. This paper proposes a definition of patient-centered medical education that is about the patients, with the patients, and for the patients, to ensure current and future doctors remain sensitive to all of the needs of the people they care for. This should be considered at both the micro and macro community levels.

Longitudinal evaluation of student professionalism throughout the professional didactic curriculum of a pharmacy program

INTRODUCTION

The purpose of this study is to evaluate longitudinal changes in professionalism of pharmacy students across the curriculum using a validated instrument that minimizes ceiling effect.

METHODS

The Professionalism Assessment Tool (PAT) was administered to first, second, and third year PharmD students twice throughout the first and second professional year (P1 and P2) and three times throughout the third professional year (P3).

RESULTS

Longitudinal increases in all five domains of professionalism of the PAT were noted as students progressed through each year of the didactic curriculum. Most demographic categories (sex, age, employment in a pharmacy, and number of other degrees held) of respondents did not affect self-assessment results. Two demographic categories, the number of student organizations and age group, had statistically significant impact on self-reported professionalism.

CONCLUSIONS

This pilot study showed longitudinal improvement in student self-assessment of professionalism over the course of the didactic curriculum at one school. Self-assessment of pharmacy student professionalism increased over the course of the didactic curriculum and was not affected by most demographics.

Quantitative and Qualitative Analysis of the Impact of Adoption of a Mobile Application for the Assessment of Professionalism in Medical Trainees

PURPOSE

Capturing either lapses or excellence in behaviors related to medical professionalism is difficult. The authors report a mixed-methods analysis of a novel mobile platform for assessing medical professionalism in a training environment.

METHOD

A mobile Web-based platform to facilitate professionalism assessment in a situated clinical setting (Professional Mobile Monitoring of Behaviors [PROMOBES]) was developed. A professionalism framework consisting of six domains (reliability, adaptability, peer relationships, upholding principles, team relationships, and scholarship) encompassing 25 subelements underpins the reporting structure. This pilot study involved 26 faculty supervising 93 medical trainees at two sites from January 12 to August 8, 2016. Notable professionalism behaviors were linked to the framework domains and elements; narrative details about incidences were captured on mobile devices. Surveys gauged the technological functionality and impact of PROMOBES on faculty assessment of professionalism. Qualitative focus groups were employed to elucidate user experience.

RESULTS

Although users anticipated PROMOBES's utility would be for reporting lapses in professionalism, 94.7% of reports were for commendation. Comfort assessing professionalism (P = .04) and recognition of the reporting procedures for professionalism-related concerns (P = .01) improved. PROMOBES attained high acceptance ratings. Focus group analysis revealed that the explicit connection to the professionalism framework was powerful; similarly, the near real-time reporting capability, multiple observer inputs, and positive feedback facilitation were strengths.

CONCLUSIONS

Making the professionalism framework visible and accessible via a mobile platform significantly strengthens faculty knowledge and behaviors regarding assessment. The strong desire to capture positive behaviors was an unexpected finding.

A Novel Approach to Assessing Professionalism in Preclinical Medical Students Using Multisource Feedback Through Paired Self- and Peer Evaluations

Phenomenon: Professionalism is integral to the role of the physician. Most professionalism assessments in medical training are delayed until clinical rotations where multisource feedback is available. This leaves a gap in student assessment portfolios and potentially delays professional development.

APPROACH

A total of 246 second-year medical students (2013-2015) completed self- and peer assessments of professional behaviors in 2 courses following a series of Team-Based Learning exercises. Correlation and regression analyses were used to examine the alignment or misalignment in the relationship between the 2 types of assessments. Four subgroups were formed based on observed patterns of initial self- and peer assessment alignment or misalignment, and subgroup membership stability over time was assessed. A missing data analysis examined differences between average peer assessment scores as a function of selective nonparticipation.

FINDINGS

Spearman correlation demonstrated moderate to strong correlation between self-assessments completed alone (no simultaneous peer assessment) and self-assessments completed at the time of peer assessments (ρ = .59, p < .0001) but weak correlation between the two self-assessments and peer assessments (alone: ρ = .13, p < .013; at time of peer: ρ = .21, p < .0001). Generalized estimating equation models revealed that self-assessments done alone (p < .0001) were a significant predictor of self-assessments done at the time of peer. Course was also a significant predictor (p = .01) of self-assessment scores done at the time of peer. Peer assessment score was not a significant predictor. Bhapkar's test revealed subgroup membership based on the relationship between self- and peer ratings was relatively stable across Time 1 and Time 2 assessments (χ² = 0.83, p = .84) for all but one subgroup; members of the subgroup with initially high self-assessment and low peer assessment were significantly more likely to move to a new classification at the second measurement. A missing data analysis revealed that students who completed all self-assessments had significantly higher average peer assessment ratings compared to students who completed one or no self-assessments with a difference of -0.32, 95% confidence interval [-0.48, -0.15]. Insights: Multiple measurements of simultaneous self- and peer assessment identified a subgroup of students who consistently rated themselves higher on professionalism attributes relative to the low ratings given by their peers. This subgroup of preclinical students, along with those who elected to not complete self-assessments, may be at risk for professionalism concerns. Use of this multisource feedback tool to measure perceptual stability of professionalism behaviors is a new approach that may assist with early identification of at-risk students during preclinical years.

A preliminary survey of professionalism teaching practices in anatomy education among Indian Medical Colleges

Professionalism and ethics have gained widespread recognition as competencies to be fulfilled, taught, and assessed within medical education. The role of the anatomy course in developed nations has evolved over time and now encompasses multiple domains, including knowledge, skills, and the inculcation of professionalism and ethics. The Medical Council of India recently recommended the integration of professionalism teaching in undergraduate medical curricula. The authors investigated whether the initial orientation lectures and instructions given by faculty at the outset of undergraduate medical anatomy courses throughout India served a "hidden curriculum" regarding professionalism practices, and whether these orientation messages could serve as an early exposure to medical professionalism and ethics for medical students. An online survey was carried out among 102 anatomy faculty members across India requesting details about specific professionalism protocols and instructions regarding behavior in the dissection hall that are routinely given to preclinical students, as well as the importance that they placed on professional behavior. It was found that most faculty members regularly instruct students regarding expected behavior during the anatomy course, including dissection practices. These instructions stress attributes of professionalism like humanism, accountability, and honesty. However, there needs to be a more concentrated effort by educators to prohibit such unprofessional practices like dissection hall photography, and better information is required regarding biomedical waste disposal. Despite the absence of clear guidelines for professionalism teaching in medical education in India, the existing framework of anatomy education provides an opportunity to introduce the concept of professionalism to the first-year medical student. This opportunity may provide an early foundation for designing a professionalism-integrated curriculum. Anat Sci Educ 10: 433-443. © 2017 American Association of Anatomists.

Development an instrument assessing residents' attitude towards professionalism lapses in training

PURPOSE

Medical professionalism is a fundamental competency for all physicians and continuous development of professionalism during residency training is crucial. The purpose of this study was to develop an instrument assessing residents' attitudes toward unprofessional behaviors.

METHODS

A questionnaire survey was conducted in cooperation with the Korea Resident Association from May to July 2013. A total of 317 residents from seven university-affiliated hospitals in South Korea participated in the survey.

RESULTS

In the exploratory factor analysis, seven factors were extracted from the data; factor loadings of the 44 items ranged between 0.40 and 0.89. Through iterative discussion, three items below 0.45 were deleted and one additional item was removed due to its irrelevance. Twelve items included in Factor 1 were divided into two different categories. A final version of the questionnaire containing 40 items in eight categories was assessed using confirmatory factor analysis. It was deemed to have a good fit; the root mean square error of approximation and comparative fit index were 0.07 and 0.9, respectively. The reliability (Cronbach's α) of the inventory was 0.97.

CONCLUSION

The items of this instrument encompass a broad range of residents' behaviors in clinical practice, research, and publication. In addition, it includes some types of misconduct that can be considered unique features of the authors' cultural backgrounds. We recommend this instrument as an assessment tool to diagnose residents' perceptions and attitudes towards professionalism lapses and to provide insight regarding potential improvement in professionalism education.

Current Practices in Assessing Professionalism in United States and Canadian Allopathic Medical Students and Residents

Professionalism is a critically important competency that must be evaluated in medical trainees but is a complex construct that is hard to assess. A systematic review was undertaken to give insight into the current best practices for assessment of professionalism in medical trainees and to identify new research priorities in the field. A search was conducted on PubMed for behavioral assessments of medical students and residents among the United States and Canadian allopathic schools in the last 15 years. An initial search yielded 594 results, 28 of which met our inclusion criteria. Our analysis indicated that there are robust generic definitions of the major attributes of medical professionalism. The most commonly used assessment tools are survey instruments that use Likert scales tied to attributes of professionalism. While significant progress has been made in this field in recent years, several opportunities for system-wide improvement were identified that require further research. These include a paucity of information about assessment reliability, the need for rater training, a need to better define competency in professionalism according to learner level (preclinical, clerkship, resident etc.) and ways to remediate lapses in professionalism. Student acceptance of assessment of professionalism may be increased if assessment tools are shifted to better incorporate feedback. Tackling the impact of the hidden curriculum in which students may observe lapses in professionalism by faculty and other health care providers is another priority for further study.

Preclinical medical student observations associated with later professionalism concerns

PURPOSE

Professionalism is a core physician competency and identifying students at risk for poor professional development early in their careers may allow for mentoring. This study identified indicators in the preclinical years associated with later professionalism concerns.

METHODS

A retrospective analysis of observable indicators in the preclinical and clinical years was conducted using two classes of students (n = 226). Relationships between five potential indicators of poor professionalism in the preclinical years and observations related to professional concerns in the clinical years were analyzed.

RESULTS

Fifty-three medical students were identified with at least one preclinical indicator and one professionalism concern during the clinical years. Two observable preclinical indicators were significantly correlated with unprofessional conduct during the clinical years: Three or more absences from attendance-required sessions (odds ratio 4.47; p=.006) and negative peer assessment (odds ratio 3.35; p=.049).

CONCLUSIONS

We identified two significant observable preclinical indicators associated with later professionalism concerns: excessive absences and negative peer assessments. Early recognition of students at risk for future professionalism struggles would provide an opportunity for proactive professional development prior to the clinical years, when students' permanent records may be affected. Peer assessment, coupled with attention to frequent absences, may be a method to provide early recognition.

Roadmap for creating an accelerated three-year medical education program

Medical education is undergoing significant transformation. Many medical schools are moving away from the concept of seat time to competency-based education and introducing flexibility in the curriculum that allows individualization. In response to rising student debt and the anticipated physician shortage, 35% of US medical schools are considering the development of accelerated pathways. The roadmap described in this paper is grounded in the experiences of the Consortium of Accelerated Medical Pathway Programs (CAMPP) members in the development, implementation, and evaluation of one type of accelerated pathway: the three-year MD program. Strategies include developing a mission that guides curricular development - meeting regulatory requirements, attaining institutional buy-in and resources necessary to support the programs, including student assessment and mentoring - and program evaluation. Accelerated programs offer opportunities to innovate and integrate a mission benefitting students and the public.

ABBREVIATIONS

CAMPP: Consortium of accelerated medical pathway programs; GME: Graduate medical education; LCME: Liaison committee on medical education; NRMP: National residency matching program; UME: Undergraduate medical education.

Not all unprofessional behaviors are equal: The creation of a checklist of bad behaviors

INTRODUCTION

Professionalism is a key component of medical education and training. However, there are few tools to aid educators in diagnosing unprofessional behavior at an early stage. The purpose of this study was to employ policy capturing methodology to develop two empirically validated checklists for identifying professionalism issues in early-career physicians.

METHOD

In a series of workshops, a professionalism competency model containing 74 positive and 70 negative professionalism behaviors was developed and validated. Subsequently, 23 subject matter experts indicated their level of concern if each negative behavior occurred 1, 2, 3, 4, or 5 or more times during a six-month period. These ratings were used to create a "brief" and "extended" professionalism checklist for monitoring physician misconduct.

RESULTS

This study confirmed the subjective impression that some unprofessional behaviors are more egregious than others. Fourteen negative behaviors (e.g. displaying obvious signs of substance abuse) were judged to be concerning if they occurred only once, whereas many others (e.g. arriving late for conferences) were judged to be concerning only when they occurred repeatedly.

DISCUSSION

Medical educators can use the professionalism checklists developed in this study to aid in the early identification and subsequent remediation of unprofessional behavior in medical students and residents.

Professionalism among multicultural medical students in the United Arab Emirates

BACKGROUND

Moral competencies and ethical practices of medical professionals are among the desired outcomes of academic training. Unfortunately, academic dishonesty and misconduct are reported from medical colleges across the world. This study investigates the level of academic dishonesty/misconduct among multicultural medical students.

OBJECTIVE

The aim of this study is to investigate the level of academic dishonesty/misconduct among multicultural medical students.

DESIGN

Validated and customized version of Dundee Polyprofessionalism Inventory-1 detailing lapses of professionalism in undergraduate health professions education was used to determine the perceived prevalence and self-reported lapses of academic integrity in this study.

RESULTS

This study shows that the majority (458/554, 83%) of medical students have admitted to acts of academic dishonesty mentioned in the questionnaire. Approximately 42% (231/554) of the students have given proxy for attendance and 71% of them considered this as an offense. Similarly, 12% (66/554) have copied from the record books of others, and 86% (477/554) have considered it unethical. In addition, 5% (28/554) of the students revealed forging a teacher's signature in their record or logbooks, with 16% (91/554) of them reporting that they have seen others forge signatures.

CONCLUSION

This is the first multi-center, multi-cultural and multi-ethnic study involving a large number of participants that addresses academic professionalism among medical students in the Middle East. Certainly, the paucity of data limits definitive conclusions about the best approach to prevent academic misconduct in the UAE medical schools. Yet, the results of our study are anticipated not only to benefit the UAE but also to find application in the Arab world, with similar medical school programs, values, culture and tradition.

Parting the Clouds: Three Professionalism Frameworks in Medical Education

Current controversies in medical education associated with professionalism, including disagreements about curriculum, pedagogy, and assessment, are rooted in part in the differing frameworks that are used to address professionalism. Three dominant frameworks, which have evolved in the medical education community, are described. The oldest framework is virtue based and focuses on the inner habits of the heart, the development of moral character and reasoning, plus humanistic qualities of caring and compassion: The good physician is a person of character. The second framework is behavior based, which emphasizes milestones, competencies, and measurement of observable behaviors: The good physician is a person who consistently demonstrates competence in performing patient care tasks. The third framework is identity formation, with a focus on identity development and socialization into a community of practice: The good physician integrates into his or her identity a set of values and dispositions consonant with the physician community and aspires to a professional identity reflected in the very best physicians. Although each professionalism framework is useful and valid, the field of medical education is currently engaged in several different discourses resulting in misunderstanding and differing recommendations for strategies to facilitate professionalism. In this article, the assumptions and contributions of each framework are described to provide greater insight into the nature of professionalism. By examining each discourse in detail, underlying commonalities and differences can be highlighted to assist educators in more effectively creating professionalism curricula, pedagogy, and assessment.

Your professionalism is not my professionalism: congruence and variance in the views of medical students and faculty about professionalism

BACKGROUND

Medical professionalism is an essential aspect of medical education and practice worldwide and it must be adopted according to different social and cultural contexts. We examined the current congruence and variance in the perception of professionalism in undergraduate medical students and faculty members in one medical school in Saudi Arabia.

METHODS

The target population was first year to final year medical students of College of Medicine, King Saud University. Out of a total of 1431 students at College of Medicine 750 students (52 %) participated in the study. Fifty faculty members from clinical and non-clinical departments of the College of Medicine were randomly selected for this study and all participated in the study. The respondents recorded their responses through the Bristol online survey system, using a bilingual (English and Arabic) version of the Dundee Polyprofessionalism Inventory I: Academic integrity, which has 34 items.

RESULTS

There are 17 lapses (50 % of the total) in professional behaviour where none of the faculty recommend the ignore sanction while students recommended a variable ignore sanction in a range of 6-29 % for different behaviours. Students and faculty recommended similar sanctions for 5 lapses (14.7 % of the total) in professional behaviours. Furthermore, there is statistically significant two level difference between the sanctions approved by faculty and students in the recommended sanctions for 12 lapses (35 % of the total (p < 0.050).

CONCLUSIONS

These results raised concerns in relation to the students' understanding of professionalism. It is therefore, important to enhance their learning around the attributes of medical professionalism.

Feasibility and Outcomes of Implementing a Portfolio Assessment System Alongside a Traditional Grading System

PURPOSE

Portfolios are a powerful tool to collect and evaluate evidence of medical students' competence across time. However, comprehensive portfolio assessment systems that are implemented alongside traditional graded curricula at medical schools in the United States have not been described in the literature. This study describes the development and implementation of a longitudinal competency-based electronic portfolio system alongside a graded curriculum at a relatively large U.S. medical school.

METHOD

In 2009, the authors developed a portfolio system that served as a repository for all student assessments organized by competency domain. Five competencies were selected for a preclerkship summative portfolio review. Students submitted reflections on their performance. In 2014, four clinical faculty members participated in standard-setting activities and used expert judgment and holistic review to rate students' competency achievement as "progressing toward competence," "progressing toward competence with some concern," or "progressing toward competence pending remediation." Follow-up surveys measured students' and faculty members' perceptions of the process.

RESULTS

Faculty evaluated 156 portfolios and showed high levels of agreement in their ratings. The majority of students achieved the "progressing toward competence" benchmark in all competency areas. However, 31 students received at least one concerning rating, which was not reflected in their course grades. Students' perceptions of the system's ability to foster self-assessment were mixed.

CONCLUSIONS

The portfolio review process allowed faculty to identify students with a concerning rating in a behavioral competency who would not have been identified in a traditional grading system. Identification of these students allows for intervention and early remediation.

Distinguishing Three Unprofessional Behavior Profiles of Medical Students Using Latent Class Analysis

PURPOSE

Because unprofessional behavior of physicians is associated with unprofessional behavior in medical school, identifying unprofessional behavior in medical school is critical. Research has noted the difficulty in assessing professional behavior. Instead of identifying isolated behaviors, it could be more helpful to recognize behavioral patterns to evaluate students' professional behavior. The authors aimed to identify patterns in the unprofessional behaviors of medical students and to construct descriptions based on these patterns.

METHOD

Content analysis of research articles yielded a template of unprofessional behaviors for coding student evaluation forms indicating unsatisfactory professional behavior, collected from 2012 to 2014 at the VUmc School of Medical Sciences, Amsterdam, the Netherlands. Latent class analysis was used to identify classes of students with a high chance of displaying comparable unprofessional behaviors. Teachers' feedback of prototype students was summarized to generate profile descriptions.

RESULTS

A template of 109 behaviors was used to code 232 evaluation forms of 194 students (3.9% students/year). Latent class analysis identified three hypothetical classes of students: Class 1 (43%) was labeled as "Poor reliability," class 2 (20%) was labeled as "Poor reliability and poor insight," and class 3 (37%) was labeled as "Poor reliability, poor insight, and poor adaptability."

CONCLUSIONS

These profiles of unprofessional behavior might help to improve the evaluation of unprofessional behavior in medical school. Further research should provide evidence for confidently accepting or rejecting the profiles as an instrument to identify which students are expected to benefit from remediation trajectories.

The Desired Concept Maps and Goal Setting for Assessing Professionalism in Medicine

Due to the multi-dimensional characteristics of professionalism, no single assessment modality has shown to reliably assess professionalism. This review aims to describe some of the popular assessment tools that are being used to assess professionalism with a view to formulate a framework of assessment of professionalism in medicine. In December 2015, the online research databases of MEDLINE, the Educational Resources Information Center (ERIC), Elton Bryson Stephens Company (EBSCO), SCOPUS, OVID and PsychINFO were searched for full-text English language articles published during 2000 to 2015. MeSH terms "professionalism" AND "duty" AND "assessment" OR "professionalism behavioural" AND "professionalism-cognitive" were used. The research articles that assessed professionalism across medical fields along with other areas of competencies were included. A final list of 35 articles were selected for this review. Several assessment tools are available for assessing professionalism that includes, but not limited to, mini clinical evaluation exercise, standardised direct observation of procedural skills, professionalism mini-evaluation exercise, multi-source feedback and 360 degree evaluation, and case based discussions. Because professionalism is a complex construct, it is less likely that a single assessment strategy will adequately measure it. Since every single assessment tool has its own weaknesses, triangulation involving multiple tools can compensate the shortcomings associated with any single approach. Assessment of professionalism necessitates a combination of modalities at individual, interpersonal, societal, and institutional levels and should be accompanied by feedback and motivational reflection that will, in turn, lead to behaviour and identity formation. The assessment of professionalism in medicine should meet the criteria of validity, reliability, feasibility and acceptability. Educators are urged to enhance the depth and quality of assessment instruments in the existing medical curricula for ensuring validity and reliability of assessment tools for professionalism.

The relationship between promotions committees' identification of problem medical students and subsequent state medical board actions

Studies have found unprofessional behavior in medical school was associated with disciplinary action by state medical boards. For medical schools, promotions committees are responsible for identifying which students do not demonstrate academic performance and professional behavior acceptable for promotion and graduation. The objective of this study was to determine if student identification by promotions committees during medical school was associated with disciplinary actions by state medical boards later in practice. We reviewed 20 years of promotions committees' records from a single institution and noted students identified by promotions committees for performance or behavioral issues. These were compared with disciplinary action reports from the Federation of State Medical Boards (FSMB) for graduates. Over the two decades, 2,131 students matriculated and 2,078 of these graduated. The promotions committees identified 140 students for poor academic performance or behavioral problems (140/2,078, 6.7 %). Of these, 108 students graduated. FSMB records showed 29 of the 2,078 graduates had sanctions by state boards (29/2,078, 1.4 %). Only four students that had actions by state medical boards were among the 108 graduated students identified by medical school promotions committees (4/108, 3.7 %). Of the students not identified by promotions committees, 25 eventually had disciplinary actions (25/1,970, 1.3 %). The odds of having state medical board action if identified by promotions committees was 3.0 (CI 1.02-8.8, p < 0.05). In conclusion, identification of students by medical school promotions committees was later associated with state medical board actions. However, most graduates with state medical board actions were not identified by medical school promotions committees.

Preventing and managing unprofessionalism in medical school faculties

Professionalism is a required competency for medical students, residents, practicing physicians, and academic faculty. Faculty members must adhere to codes of conduct or risk discipline. The authors describe issues of unprofessionalism that culminate in allegations of faculty misconduct or filing of grievances in academic medicine and outline strategies for early intervention and prevention. The authors, vice and associate deans and executive director of the office of faculty affairs at a large U.S. medical school, have handled many allegations of unprofessional conduct over the past decade. They present case examples based on behaviors such as lack of respect, inappropriate language and behavior, failure to cooperate with members of the health care team, and sexual harassment/discrimination. They discuss factors complicating evaluation of these behaviors, including variable definitions of respect, different cultural norms, and false allegations. The authors make recommendations for prevention and intervention, including early identification, performance management, education about sexual harassment, and referrals to professional coaches, anger management classes, and faculty-staff assistance programs.

Twelve tips for addressing medical student and resident physician lapses in professionalism

Medical educators have gained significant ground in the practical and scholarly approach to professionalism. When a lapse occurs, thoughtful remediation to address the underlying issue can have a positive impact on medical students and resident physicians, while failure to address lapses, or to do so ineffectively, can have long-term consequences for learners and potentially patients. Despite these high stakes, educators are often hesitant to address lapses in professionalism, possibly due to a lack of time and familiarity with the process. Attention must be paid to generalizable, hands-on recommendations for daily use so that clinicians and administrators feel well equipped to tackle this often difficult yet valuable task. This article reviews the literature related to addressing unprofessional behavior among trainees in medicine and connects it to the shared experience of medical educators at one institution. The framework presented aims to provide practical guidance and empowerment for educators responsible for addressing medical student and resident physician lapses in professionalism.

Learning medical professionalism with the online concordance-of-judgment learning tool (CJLT): A pilot study

CONTEXT

Professionalism development entails learning to make judgments in ambiguous situations. A Concordance of Judgment Learning Tool (CJLT), comprised of 20 vignettes involving professionalism issues, was developed. Students obtained a measure of how concordant their judgments were with a panel of experts and learned from given explanations.

METHOD

Twenty clinical vignettes implying professionalism issues were written including, for each, four possible courses of action. Expert panel, nominated by all clerkship students, was made up of attending physicians that best represented professionalism role models. Experts completed CJLT and gave explanations for their answers. All clerks were invited to answer each vignette, and then received automated expert feedback including explanations.

RESULTS

Seventy-nine students sat for the activity. The optimized test included 20 cases and 54 questions (Cronbach's alpha coefficient of 0.64). Student - expert concordance scores ranged from 54 to 77 with a mean at 64.6 (standard deviation 5.1). Satisfaction survey results indicated high satisfaction and relevance of tool despite some pitfalls. Post-test focus group data revealed relevant experiential learning on professionalism issues.

DISCUSSION

Students' scores and perceptions suggest pedagogic relevance of the CJLT in fostering professionalism development in clerkship. CJLT is user-friendly and shows promise as a situation experiential learning activity.

Remediation practices in Canadian psychiatry clerkships

OBJECTIVES

There is a lack of information regarding interventions for undergraduate students at Canadian medical schools who require remediation during their psychiatric training. The need for a theoretical framework to guide remediation has been identified. In this study, we sought to characterize remediation taking place in undergraduate psychiatry education, particularly during clerkship. A secondary goal was to ascertain whether those responsible for remediation were aware of the stages of change (transtheoretical) model, and whether they formally incorporated this framework (or another) into their remediation processes.

METHODS

A short six-question survey on remediation practices was e-mailed to educators responsible for undergraduate psychiatry education at all 17 Canadian medical schools as identified through the Canadian Organization of Undergraduate Psychiatry Educators (COUPE).

RESULTS

The response rate was 67 %. Respondents' overall impressions of their school's remediation process were that it was "highly effective" (25 %), or "somewhat effective" (67 %); 8 % reported being unsure of its effectiveness. While 75 % of survey respondents were aware of the stages of change model, only 17 % reported using this framework: no alternate theoretical frameworks were reported.

CONCLUSIONS

The most common form of evaluation was multiple-choice question (MCQ) exams, and the most common form of remediation was exam rewrites. There is little information regarding the long-term outcomes of remediation, and further research would be useful in formulating recommendations regarding best practices.

Is embellishing UCAS personal statements accepted practice in applications to medicine and dentistry?

BACKGROUND

The assessment of non-academic achievements through the personal statement remains part of the selection process at most UK medical and dental schools. Such statement offers applicants an opportunity to highlight their non-academic achievements, but the highly competitive nature of the process may tempt them to exaggerate their accomplishments. The challenge is that selectors cannot discern applicants' exaggerated claims from genuine accounts and the system risks preferentially selecting dishonest applicants.

AIM

To explore the level and perception of deception on UCAS personal statements among applicants to medical and dental schools. To investigate the association between attitudes towards deception and various other demographic variables and cognitive ability via the UKCAT.

METHODS

An online survey was completed with first year students from six UK medical schools and one dental school. Questionnaire items were classified into three categories involving individual acts, how they suspect their peers behave, and overall perceptions of personal statements to influence the selection process. Descriptive statistics were used to investigate responses to questionnaire items. t-Tests were used to investigate the relationship between items, demographic variables and cognitive ability.

RESULTS

Candidates recognized that putting fraudulent information or exaggerating one's experience on UCAS personal statement was dishonest; however there is a widespread belief that their peers do it. Female respondents and those with a higher UKCAT score were more likely to condemn deceptive practices.

CONCLUSION

The existing selection process is open to abuse and may benefit dishonest applicants. Admission systems should consider investing in systems that can pursue traceable information that applicants provide, and nullify the application should it contain fraudulent information.

Assessment of professionalism: a consolidation of current thinking

CONTEXT

Professionalism has become a hot topic in medical education. Professionalism needs to be assessed if it is to be viewed as both positive and relevant.

OBJECTIVES

The assessment of professionalism is an evolving field. This review aims to consolidate current thinking.

IMPLICATIONS

Assessment of professionalism has progressed from an initial focus on the development and attainment of professional identity, through identifying areas of deficiency, to the attainment of a set of identifiable positive attributes and behaviours. It is now beginning to recognise the challenge of assessing a multi-dimensional construct, looking beyond the measurement of behaviour to embrace a diversity of approaches.

CONCLUSIONS

Professionalism should be assessed longitudinally. It requires combinations of different approaches, assessing professionalism at individual, interpersonal and societal/institutional levels. Increasing the depth and the quality of reliability and validity of existing programmes in various contexts may be more appropriate than concentrating on developing new instruments. Increasing the number of tests and the number of relevant contexts will increase the reliability of the result. Similarly increasing the number of observers increases reliability. Feedback, encouraging reflection, can promote change in behaviour and identity formation.

Perspective: the education community must develop best practices informed by evidence-based research to remediate lapses of professionalism

In July 2011, the Alpha Omega Alpha Honor Medical Society sponsored a think tank of experts in the field of medical professionalism to focus on interventions and remediation strategies for those-medical students, residents, faculty, and practicing physicians-who demonstrate lapses in professional performance, particularly if the lapses are repeated. Several participants have produced scholarly work on the assessment of professionalism. However, assessment has a limited purpose unless it leads to improvements at both the organizational and individual levels. The field of professionalism has matured enough to recognize that one of the contemporary issues within the self-regulation framework is the task of remediation. Yet there is a paucity of evidence to inform best practices to help those who have lapses. Ultimately, the most effective response to an individual's lapse in professionalism may not be simply to gather knowledge about remedial practices but also to understand organizational responses to the information about such practices already possessed by the institution.The authors report the think tank participants' recommendations on (1) how to use existing data on professionalism remediation and (2) what new evidence is needed to advance approaches to remediation of professional performance. Participants also recommended that the education community can focus on interventions and remediation by (1) performing studies about improving medical professionalism when lapses occur, (2) identifying best evidence-based remediation practices, (3) widely disseminating those practices, and (4) moving over time from a best-practices approach to remediation (which does not yet exist) to a best-evidence model.

A review of the patterns of unprofessional behavior and evaluation programs to prevent misconduct by medical students

In recent years, several high-profile cases related with misconduct by doctors and medical students have led to increased media interest and public concern regarding doctors who fail to maintain the expected professional standards. In response to these concerns and the increasing awareness of the social responsibility of medicine, the importance of professionalism in medical school is receiving renewed attention in our medical society. Many studies in other countries have stressed the early detection and intervention of unprofessional behaviors in medical students using an adequate evaluation system. The authors intended to explore strategies that reinforce professionalism education and prevent misconduct in medical students. We conducted an extensive literature review to identify patterns and categorize issues of misconduct and unprofessional behavior by medical students; existing evidence to determine why early detection and intervention of are crucial to prevent future misbehavior and disciplinary action by doctors; and education and evaluation systems to enhance professionalism for medical students.

Cultural similarities and differences in medical professionalism: a multi-region study

CONTEXT

Over the last two decades, many medical educators have sought to define professionalism. Initial attempts to do so were focused on defining professionalism in a manner that allowed for universal agreement. This quest was later transformed into an effort to 'understand professionalism' as many researchers realised that professionalism is a social construct and is culture-sensitive. The determination of cultural differences in the understanding of professionalism, however, has been subject to very little research, possibly because of the practical difficulties of doing so. In this multi-region study, we illustrate the universal and culture-specific aspects of medical professionalism as it is perceived by medical practitioners.

METHODS

Forty-six professional attributes were identified by reviewing the literature. A total of 584 medical practitioners, representing the UK, Europe, North America and Asia, participated in a survey in which they indicated the importance of each of these attributes. We determined the 'essentialness' of each attribute in different geographic regions using the content validity index, supplemented with kappa statistics.

RESULTS

With acceptable levels of consensus, all regional groups identified 29 attributes as 'essential', thereby indicating the universality of these professional attributes, and six attributes as non-essential. The essentialness of the rest varied by regional group.

CONCLUSIONS

This study has helped to identify regional similarities and dissimilarities in understandings of professionalism, most of which can be explained by cultural differences in line with the theories of cultural dimensions and cultural value. However, certain dissonances among regions may well be attributable to socio-economic factors. Some of the responses appear to be counter-cultural and demonstrate practitioners' keenness to overcome cultural barriers in order to provide better patient care.

Cross-validation of an instrument for measuring professionalism behaviors

OBJECTIVE

To cross-validate an instrument to measure behavioral aspects of professionalism in pharmacy students using a rating scale that minimizes ceiling effects.

METHODS

Seven institutions collaborated to create a 33-item assessment tool that included 5 domains of professionalism: (1) Reliability, Responsibility and Accountability; (2) Lifelong Learning and Adaptability; (3) Relationships with Others; (4) Upholding Principles of Integrity and Respect; and (5) Citizenship and Professional Engagement. Each item was rated based on 5 levels of competency which were aligned with a modified Miller's Taxonomy (Knows, Knows How, Shows, Shows How and Does, and Teaches).

RESULTS

Factor analyses confirmed the presence of 5 domains for professionalism. The factor analyses from the 7-school pilot study demonstrated that professionalism items were good fits within each of the 5 domains.

CONCLUSIONS

Based on a multi-institutional pilot study, data from the Professionalism Assessment Tool (PAT), provide evidence for internal validity and reliability. Use of the tool by external evaluators should be explored in future research.

Emergency medicine directors' perceptions on professionalism: a Council of Emergency Medicine Residency Directors survey

OBJECTIVES

The Accreditation Council for Graduate Medical Education requires residency training programs to teach and assess professionalism in residents; however, programs may struggle to successfully remediate residents not meeting professionalism standards. To assist programs with this complex issue, a Professionalism Remediation Task Force was formed by the Council of Emergency Medicine Residency Directors (CORD-EM), which surveyed program directors (PDs) concerning their experiences. The purpose of this study is to report survey results regarding the identification and rating of unprofessional behaviors and challenges in the evaluation and remediation of professionalism.

METHODS

In June 2010, the task force sent an anonymous survey via the CORD-EM listserv to PDs with active EM programs.

RESULTS

Fifty percent (77/154) of eligible PDs responded to the survey. Most PDs rated the unprofessional behaviors of interpersonal/communication conflicts, lack of responsibility during patient care, lack of respect of coworkers, and reports of impairment as "critical"; repeated tardiness, incomplete work, poor ability to accept feedback, poor attitude, and repetitive unresponsiveness to aid colleagues were rated as "very serious"; frequent missed deadlines were "serious"; and repetitive failure to complete medical records was rated as "mildly serious." A resident with "less serious" professionalism issues was also felt to be likely to have "serious" or "critical" issues "often" (33.8% of respondents) or "always" (6.5%). The most common methods of assessment were clinical/advisor evaluations. However, existing assessment methods were described as inadequate in identifying serious professionalism issues by 50.7% of responding PDs. Unprofessionalism was most commonly discovered by unofficial faculty complaint (54.5%). Eighty percent report that professionalism is more difficult to remediate than other core competencies. Resident ownership of the problem was reported as most critical to remediation success (84.4%). PDs perceived the greatest challenges in residency remediation to be lack of resident insight or responsibility for the problem (45.2%) and personality/behavioral issues (32.9%).

CONCLUSIONS

Identification and remediation of professionalism in EM residents is challenging. A future goal is to create a system by which PDs can use standardized pathways as a guide to identify and remediate unprofessional conduct.

Unprofessional behaviour in medical students: a questionnaire-based pilot study comparing perceptions of the public with medical students and doctors

BACKGROUND

Evidence suggests that doctors and medical students use different strategies to evaluate unprofessional behaviour. Anecdotal evidence suggests that the public and profession may judge misdemeanours differently.

AIMS

To explore whether members of the public will judge examples of medical student misconduct more harshly than medical students and doctors.

METHODS

This was a pilot cross-sectional survey of the public, medical students and doctors. For 10 hypothetical examples of medical student misconduct and one of appropriate conduct in a questionnaire, participants were asked to (1) indicate the level of acceptability and (2) to choose the sanction they considered most appropriate for each.

RESULTS

Overall, doctors were harsher than students and the public were harsher than doctors in their choice of sanctions. The most lenient outcomes were selected by students for deception in an examination, nonattendance and dishonesty. The most punitive were chosen by the public for forgery, criminal conviction, misrepresenting qualifications, alcohol and drug misuse and lack of insight.

CONCLUSIONS

The public judge misdemeanours among medical students more harshly than do medical students and medical professionals. This implies that views of lay members should be sought by medical schools when promoting professionalism and considering cases of medical student misconduct.

What are the discussion topics and usefulness of clerkship directors' meetings within medical schools? A report from the CDIM 2007 national survey

PURPOSE

To characterize meetings among clerkship directors within medical schools, specifically with regard to topics of discussion, and usefulness of the meetings.

METHOD

In 2007, the Clerkship Directors in Internal Medicine surveyed its institutional members from 114 U.S. and Canadian medical schools. Respondents were asked about the frequency of meetings among clerkship directors, the topics of discussions, whether they were precluded from discussing students in academic difficulty, and the benefits and drawbacks of discussing students' performance. Analysis included descriptive statistics and qualitative analysis of free-text responses.

RESULTS

The response rate was 71% (81/114). The most common meeting frequencies were monthly (77%) or quarterly (15%). Topics discussed included deans' policies (91%), general announcements (90%), recommendations from clerkship directors to the dean (86%), Liaison Committee on Medical Education site visit preparation (84%), curricular input (82%), discussion of struggling students (49%), students' progress (48%), and planning for at-risk preclerkship students (22%). Some respondents (16%) were explicitly prevented from discussing student performance, for reasons of possible harm to the student (30/84; 36%), bias developing against the student (13/84; 16%), violation of privacy/lack of student confidentiality (4/84; 5%), and possible bias in grading or evaluation (8/84; 10%). Most respondents (94%) agreed there were benefits to students resulting from discussions: longitudinal tracking of concerns, designing remediation, tailoring teacher assignments, and societal obligations.

CONCLUSIONS

Clerkship directors meet frequently to discuss curriculum, policy, and students' performance. Most internal medicine clerkship directors believe discussing students' performance helps design educational interventions that balance societal obligations with student confidentiality.

Medical professionalism: what does the public think?

In the context of professionalism being viewed increasingly as a social contract, a survey was conducted to investigate the importance placed by the general public on doctors' professional attributes. A quota sample of 953 responded to a 55-item online inventory of professional attributes. The quotas closely represented the national census. The majority of the highly important attributes focused on the relationship with patients. Statistically, the responses emerged as a three-facet model (clinicianship, workmanship and citizenship) of medical professionalism. The general public did not equate professionalism with social standing, wealth production, physique or appearance. They recognised doctors as professionals by their good behaviour, high values and positive attitudes as clinicians, workmen and citizens. Although, their preference of professional attributes varied with the setting, eg patient consultation, working with others and behaving in society, they expected doctors to be confident, reliable, dependable, composed, accountable and dedicated across all settings.

Professing professionalism: are we our own worst enemy? Faculty members' experiences of teaching and evaluating professionalism in medical education at one school

PURPOSE

To explore clinical faculty members' knowledge and attitudes regarding their teaching and evaluation of professionalism.

METHOD

Clinical faculty involved in medical education at University of Toronto Faculty of Medicine were recruited to participate in focus groups between 2006 and 2007 to discuss their knowledge, beliefs, and attitudes about teaching and evaluating professionalism and to determine their views regarding faculty development in this area. Focus groups were transcribed, analyzed, and coded for themes using a grounded theory approach.

RESULTS

Five focus groups consisting of 14 faculty members from surgical specialties, psychiatry, anesthesia, and pediatrics were conducted. Grounded theory analysis of the 188 pages of text identified three major themes: Professionalism is not a static concept, a gap exists between faculty members' real and ideal experience of teaching professionalism, and "unprofessionalism" is a persistent problem. Important subthemes included the multiple bases that exist for defining professionalism, how professionalism is learned and taught versus how it should be taught, institutional and faculty tolerance and silence regarding unprofessionalism, stress as a contributor to unprofessionalism, and unprofessionalism arising from personality traits.

CONCLUSIONS

All faculty expressed that teaching and evaluating professionalism posed a challenge for them. They identified their own lapses in professionalism and their sense of powerlessness and failure to address these with one another as the single greatest barrier to teaching professionalism, given a perceived dominance of role modeling as a teaching tool. Participants had several recommendations for faculty development and acknowledged a need for culture change in teaching hospitals and university departments.

The anatomy of anatomy: a review for its modernization

Anatomy has historically been a cornerstone in medical education regardless of nation or specialty. Until recently, dissection and didactic lectures were its sole pedagogy. Teaching methodology has been revolutionized with more reliance on models, imaging, simulation, and the Internet to further consolidate and enhance the learning experience. Moreover, modern medical curricula are giving less importance to anatomy education and to the acknowledged value of dissection. Universities have even abandoned dissection completely in favor of user-friendly multimedia, alternative teaching approaches, and newly defined priorities in clinical practice. Anatomy curriculum is undergoing international reformation but the current framework lacks uniformity among institutions. Optimal learning content can be categorized into the following modalities: (1) dissection/prosection, (2) interactive multimedia, (3) procedural anatomy, (4) surface and clinical anatomy, and (5) imaging. The importance of multimodal teaching, with examples suggested in this article, has been widely recognized and assessed. Nevertheless, there are still ongoing limitations in anatomy teaching. Substantial problems consist of diminished allotted dissection time and the number of qualified anatomy instructors, which will eventually deteriorate the quality of education. Alternative resources and strategies are discussed in an attempt to tackle these genuine concerns. The challenges are to reinstate more effective teaching and learning tools while maintaining the beneficial values of orthodox dissection. The UK has a reputable medical education but its quality could be improved by observing international frameworks. The heavy penalty of not concentrating on sufficient anatomy education will inevitably lead to incompetent anatomists and healthcare professionals, leaving patients to face dire repercussions.

Bad apples spoil the barrel: Addressing unprofessional behaviour

Given the changes in society we are experiencing, the increasing focus on patient-centred care and acknowledgement that medical education including professionalism issues needs to continue not only in the residency programmes but also throughout the doctors career, is not surprising. Although most of the literature on professionalism pertains to learning and teaching professionalism issues, addressing unprofessional behaviour and related patient safety issues forms an alternative or perhaps complementary approach. This article describes the possibility of selecting applicants for a medical school based on personality characteristics, the attention to professional lapses in contemporary undergraduate training, as well as the magnitude, aetiology, surveillance and methods of dealing with reports of unprofessional behaviour in postgraduate education and CME.

Teaching and learning professional behavior in practice

This paper is the fourth article in a series on Professionalism and provides an overview of current methods used for teaching and learning about professionalism. The questions "whether" and "how" professionalism can be placed in the formal medical school curricula are addressed, and the informal learning related to professionalism reviewed.

General considerations regarding assessment of professional behaviour

Core medical knowledge has been assessed for over fifty years and technical and communication skills for at least twenty. The assessment of professionalism however has failed to achieve recognition within this time frame. The interest in the assessment of professionalism and professional behaviour thus is a fairly recent development. This article will firstly clarify how professional behaviour assessment relates to other assessment methods using the framework proposed by Miller6. Thereafter a brief overview will be provided of the current "tool box" of methods available to assess professionalism. Data on the validity, reliability, feasibility, acceptability and educational utility of these "tools" as derived from published evidence will be reviewed. Subsequently a general overview of the way forward in the assessment of professionalism and professional behaviour will be given.

Training and learning professionalism in the medical school curriculum: current considerations

Recommendations in the literature concerning measures to address the challenges to professionalism have converged on the establishment of an education community, on a structured curriculum dealing with professionalism, on developing programs for role modelling and mentoring, and on attention to the assessment of professional conduct. The interventions in the field of medical education appear central among these efforts, since it is during medical school that the template for professional conduct in medicine is primarily learned. This article attempts to provide a more in-depth discussion of the goals, purposes and current factors influencing teaching and learning professional behaviour in the medical school curriculum and the residency programs.

Shaping professionalism in pre-clinical medical students: Professionalism and the practice of medicine

BACKGROUND

Increasing emphasis is placed on teaching and assessment of professionalism in the continuum of medical education. Consistent and longitudinal instruction and assessment are crucial factors that learners need in order to internalize the tenets of professionalism.

AIM

We aimed to develop a novel longitudinal course in professionalism spanning the first 2 years in a medical curriculum.

METHODS

This is a description of the process undertaken over the past 7 years to develop and implement a professionalism curriculum. We used the conceptual framework of constructivism, principles of adult learning, experiential learning and reflective practice to integrate learning with experience. We included student input in session development. Faculty mentors serve as role models to guide, assist and counsel students. Assessment of learners is accomplished using self, peer and mentor evaluation, and a student portfolio. Program evaluation is by course and faculty evaluation.

RESULTS

Students are given a final grade of pass or fail, together with a brief narrative. Course evaluations were positive. A survey questionnaire showed that more than 60% of the students reported gaining skills related to course goals.

CONCLUSIONS

A longitudinal curriculum for the pre-clinical years was successfully launched. Plans are under way to expand this into the clinical years.

What qualities do medical school applicants need to have?--secondary publication

PURPOSE

Doctors are asked to play the roles of both a healer and a professional. In dealing with this inherent demand, we should first ask ourselves if we are selecting students who show traits that would enable them to become a good doctor. The primary concern of this study was to identify the core elements of medical professionalism that will develop into professional competence that we should be sought in medical school applicants.

MATERIALS AND METHODS

One hundred-six responses from the Delphi survey done by medical school professors and 230 completed questionnaires from medical students were used for analysis. We also set out to analyze the level of medical professionalism in newly entering medical students using a 5-point Likert scale.

RESULTS

Of the 27 elements of medical professionalism examined, the most important core element was thought to be 'life-long learning skills'. The level of professionalism in Korean medical students was mostly assessed to be less than the 3.0 mean score given by the professors. Medical students tended to rate themselves higher than did the professors for their level of medical professionalism.

CONCLUSION

Medical professionalism can be categorized into three domains; professional knowledge, professional skills, and professional attitude. For the prominent differences in the recognition of the levels of professionalism elements in medical students by students and professors, further studies investigating the reasons for discrepancy are needed.