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Flier LA, Richards JB, Hacker MR, Hovaguimian A, Vanka A, Sullivan A, Royce CS. "Should I Say Something?": A Simulation Curriculum on Addressing Lapses in Professionalism to Improve Patient Safety. MedEdPORTAL 2023; 19:11359. [PMID: 38089936 PMCID: PMC10713868 DOI: 10.15766/mep_2374-8265.11359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/18/2023] [Indexed: 12/18/2023]
Abstract
Introduction Medical students may witness lapses in professionalism but lack tools to effectively address such episodes. Current professionalism curricula lack opportunities to practice communication skills in addressing professionalism lapses. Methods We designed a simulation curriculum to introduce professionalism expectations, provide communication tools using elements of the Agency for Healthcare Research and Quality TeamSTEPPS program, and address observed professionalism lapses involving patient safety in hierarchical patient care teams. Students were surveyed on knowledge, skills, and attitude regarding professionalism before, immediately after, and 6 months after participation. Results Of 253 students, 70 (28%) completed baseline and immediate postsurveys, and 39 (15%) completed all surveys. In immediate postsurveys, knowledge of communication tools (82% to 94%, p = .003) and empowerment to address residents (19% to 44%, p = .001) and attendings (15% to 39%, p < .001) increased. At 6 months, 96% of students reported witnessing a professionalism lapse. Discussion The curriculum was successful in reported gains in knowledge of communication tools and empowerment to address professionalism lapses, but few students reported using the techniques to address witnessed lapses in real life.
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Affiliation(s)
- Lydia A. Flier
- Instructor, Department of Medicine, Mount Auburn Hospital and Harvard Medical School
| | - Jeremy B. Richards
- Assistant Professor of Medicine, Harvard Medical School and Mount Auburn Hospital
| | - Michele R. Hacker
- Associate Professor, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School
| | - Alexandra Hovaguimian
- Assistant Professor, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School
| | - Anita Vanka
- Assistant Professor, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School
| | - Amy Sullivan
- Director of Education Research, Shapiro Institute for Education and Research, Beth Israel Deaconess Medical Center and Harvard Medical School
| | - Celeste S. Royce
- Assistant Professor, Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, and Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center
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Pieterse AH, Gulbrandsen P, Ofstad EH, Menichetti J. What does shared decision making ask from doctors? Uncovering suppressed qualities that could improve person-centered care. Patient Educ Couns 2023; 114:107801. [PMID: 37230040 DOI: 10.1016/j.pec.2023.107801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/12/2023] [Accepted: 05/17/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Shared decision making (SDM) is infrequently seen in clinical practice despite four decades of efforts. We propose a need to explore what SDM asks from doctors in terms of enabling competencies and necessary, underlying qualities, and how these can be nurtured or suppressed in medical training. DISCUSSION Key SDM tasks call for doctors to understand communication and decision mechanisms to carry them out well, including reflecting on what they know and do not know, considering what to say and how, and listening unprejudiced to patients. Different doctor qualities can support accomplishing these tasks; humility, flexibility, honesty, fairness, self-regulation, curiosity, compassion, judgment, creativity, and courage, all relevant to deliberation and decision making. Patient deference to doctors, lack of supervised training opportunities with professional feedback, and high demands in the work environment may all inflate the risk of only superficially involving patients. CONCLUSIONS We have identified ten professional qualities and related competencies required for SDM, with each to be selected based on the specific situation. The competencies and qualities need to be preserved and nurtured during doctor identity building, to bridge the gap between knowledge, technical skills, and authentic efforts to achieve SDM.
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Affiliation(s)
- Arwen H Pieterse
- Department of Biomedical Data Sciences, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands.
| | - Pål Gulbrandsen
- Institute of Clinical Medicine, University of Oslo, 0316 Oslo, Norway; Health Services Research Unit (HØKH), Akershus University Hospital, 1478 Lørenskog, Norway
| | - Eirik H Ofstad
- The Medical Clinic, Nordland Hospital Trust, 8005 Bodø, Norway
| | - Julia Menichetti
- Health Services Research Unit (HØKH), Akershus University Hospital, 1478 Lørenskog, Norway
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Abstract
Surgeons are famously decisive, assertive, and confident. Unfortunately, we also often have a reputation for being blunt, harsh, and unprofessional. Unprofessional behaviors are unacceptable, and we believe that they are a symptom of surgeon distress and burnout. Unprofessional behaviors should be prevented, but equally importantly, so should the stressors that drive them. This is critically important for the future of our profession.
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Abstract
The hidden curriculum is considered to be between the designed and experienced curricula. One of the challenges that medical educators face is to understand what students learn in real clinical settings. The aim of the present study was to answer this question: What is hidden in hidden medical curriculum? This study was a qualitative content analysis. Participants were selected through purposive sampling. Data collection was performed through unstructured interviews and continued until data saturation. Data were analyzed simultaneously with data collection using MAXQDA10 software. Data validity was confirmed based on the proposed Lincoln and Guba criteria. The main theme that emerged in this study was implicit learning. Professional ethics, spiritual, social and cultural issues, and clinical skills are the five major themes that were presented in this study. These themes and their subthemes are transferred during an implicit learning experience in hidden curriculum. Since a wide range of issues are mostly transferred by hidden curriculum, it is essential to have a dynamic approach to educational environments. This is especially important in clinical settings, as the process of learning is constantly happening in the backyard.
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Affiliation(s)
- Shahram Yazdani
- Professor, School of Medical Education Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Andarvazh
- PhD Graduate of Medical Education, School of Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Assistant Professor, Nasibeh School of Nursing and Midwifery, Educational Development Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Leila Afshar
- Associate Professor, Department of Medical Ethics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Poola VP, Suh B, Parr T, Boehler M, Han H, Mellinger J. Medical students' reflections on surgical educators' professionalism: Contextual nuances in the hidden curriculum. Am J Surg 2020; 221:270-276. [PMID: 32943180 DOI: 10.1016/j.amjsurg.2020.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 08/13/2020] [Accepted: 09/01/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Surgical educators' professional behavior constitutes a hidden curriculum and impacts trainee's professional identity formation. This study explores the nuances of professional behaviors as observed in varying surgical settings. METHODS 411 Transcripts originated from essays written by MS3 students during their surgical clerkship from 2010 to 2016 were collated. Employing a qualitative research methodology, we conducted a thematic analysis to uncover specific meaning emerging from medical student reflections' on surgical professionalism. RESULTS In clinics, taking time and protecting patient privacy; in the OR, control over emotion during difficult situations and attention to learners; and in the inpatient setting, showing accountability above normal expected behavior were noted as professional. Similarly, unprofessional behaviors in these contexts paralleled lack of these attributes. CONCLUSIONS Behaviors observed and the attributes of professionalism in the surgical learning environment have contextual nuances. These variations in professionalism can be utilized in deliberate development of professionalism in surgery.
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Affiliation(s)
- V Prasad Poola
- SIU School of Medicine, Department of Surgery, 701 North Rutledge Street, PO Box 19638, Springfield, IL, 62794-9638, USA
| | - Boyung Suh
- SIU School of Medicine, Department of Surgery, 701 North Rutledge Street, PO Box 19638, Springfield, IL, 62794-9638, USA.
| | - Trevor Parr
- SIU School of Medicine, Department of Surgery, 701 North Rutledge Street, PO Box 19638, Springfield, IL, 62794-9638, USA
| | - Margaret Boehler
- SIU School of Medicine, Department of Surgery, 701 North Rutledge Street, PO Box 19638, Springfield, IL, 62794-9638, USA
| | - Heeyoung Han
- SIU School of Medicine, Department of Surgery, 701 North Rutledge Street, PO Box 19638, Springfield, IL, 62794-9638, USA
| | - John Mellinger
- SIU School of Medicine, Department of Surgery, 701 North Rutledge Street, PO Box 19638, Springfield, IL, 62794-9638, USA
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Sarikhani Y, Shojaei P, Rafiee M, Delavari S. Analyzing the interaction of main components of hidden curriculum in medical education using interpretive structural modeling method. BMC Med Educ 2020; 20:176. [PMID: 32487128 PMCID: PMC7269001 DOI: 10.1186/s12909-020-02094-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 05/28/2020] [Indexed: 05/31/2023]
Abstract
BACKGROUND Hidden curriculum (HC) is considered as unintended learning experiences in medical education (ME). This may include values, norms, beliefs, skills, and knowledge which could potentially influence learning outcomes. HC has key components that must be identified and considered properly by individuals and organizations involved in ME. OBJECTIVES This study aimed to determine the main components of hidden curriculum in medical education (HCME) and the interrelationships among them. METHODS In this mixed-method study initially we performed a scoping review and determined the main components of HCME using qualitative content analysis approach. Then, the interrelationships among these components were investigated using Interpretive Structural Modeling (ISM). RESULTS Ten key components for HCME were identified in scoping review. We classified them into four main categories including structural, educational, cultural, and social factors. The ISM analysis revealed that organizational rules and structure, dominant culture of educational environments, teaching and assessment approaches, as well as clinical and educational physical setting were the independent or driving factors. While, social components were dependent and influenced by basic components. CONCLUSION The ISM model indicated that role modeling behaviors and interpersonal relationships (social factors) are under influence of underlying organizational and educational factors. These results should be considered at all stages of educational management including planning process, implementation of the programs, and development of formal curricula. According to the importance of contextual factors, components of HC must be analyzed and interpreted based on the specific conditions of each educational institution.
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Affiliation(s)
- Yaser Sarikhani
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Payam Shojaei
- Department of Management, School of Economics, Management and Social Sciences, Shiraz University, Shiraz, Iran
| | - Mohammad Rafiee
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sajad Delavari
- Health Human Resources Research Center, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Abstract
Professional identity and professionalism education are increasingly important to veterinary education, but many of the concepts remain intangible to veterinary students, and engagement is a persistent challenge. While whole-curriculum integration is recommended for a successful professional studies program, this is complicated by clinical faculty's discomfort with the content. Where professional studies education is centered around professional identity formation, a key element of this is the multi-perspective nature of veterinary work, with the veterinarian negotiating the needs of multiple stakeholders in animal care. Constructing teaching around a framework of professional reasoning, which incorporates the negotiation of different stakeholder needs, ethical decision making, communication, teamwork, and outcome monitoring, offers the potential to make professional identity a concept more visible to students in veterinary work, and guides students in the contextualization of taught material. A framework is presented for veterinary professional reasoning that signposts wider curriculum content and helps illustrate where material such as veterinary business studies, animal welfare, the human-animal bond, and professional responsibility, as well as attributes such as empathy and compassion, all integrate in the decisions and actions of the veterinary professional. The aims of this framework are to support students' engagement in professional studies teaching and help them use workplace learning experiences to construct an appropriate professional identity for competence and resilience in the clinic. For faculty involved in curriculum design and clinical teaching, the framework provides a tool to support the integration of professional identity concepts across the extended curriculum.
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Chrouser KL, Partin MR. Intraoperative Disruptive Behavior: The Medical Student's Perspective. J Surg Educ 2019; 76:1231-1240. [PMID: 31029574 DOI: 10.1016/j.jsurg.2019.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/05/2019] [Accepted: 04/02/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Intraoperative disruptive behavior can reduce psychological safety and hinder teamwork and communication. Medical students may provide unique insights into how to prevent these adverse impacts. We sought to characterize medical student perspectives on the causes and consequences of intraoperative disruptive behavior and ideal intraoperative working environments. DESIGN In this retrospective qualitative analysis, authors coded de-identified field notes from residency interviews to identify themes and key insights and to explore gender differences in perspectives. SETTING A tertiary academic medical training center in the Midwestern United States. PARTICIPANTS Forty-two medical students applying for urology residency placement. RESULTS Students were 57% male with an average age of 26 years (range 23-34). Most students witnessed intraoperative disruptive behavior (usually by surgeons) such as yelling, throwing instruments, or blaming others. Students described frustration with missing instruments and incompetent assistants as the most common instigators of disruptive behavior. They noted undesirable effects of disruptive behavior, including decreased communication/teamwork, lack of learning, increased technical mistakes, and recalled feeling afraid and stressed by these situations. They described ideal intraoperative working environments as calm, efficient and collaborative environments where questioning and learning is encouraged. CONCLUSIONS Students provide a valuable perspective on the causes and consequences of disruptive behavior during surgery and point to potential pathways to improvement. Their experiences suggest prevention or reduction of surgeon frustration might be a fruitful target for intervention efforts to prevent intraoperative disruption.
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Affiliation(s)
- Kristin L Chrouser
- Department of Urology, University of Minnesota and University of Michigan, Minneapolis VA Health Care Center, Minneapolis, Minnesota.
| | - Melissa R Partin
- Department of Medicine, University of Minnesota, VA Center for Chronic Disease and Outcomes Research (CCDOR), Minneapolis, Minnesota.
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Cox ML, Henry BV, Sudan R. Opportunities in Medical Student Education. In: Pugh CM, Sippel RS, editors. Success in Academic Surgery: Developing a Career in Surgical Education. Cham: Springer International Publishing; 2019. pp. 5-15. [DOI: 10.1007/978-3-030-19179-5_2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Lases LSS, Arah OA, Busch ORC, Heineman MJ, Lombarts KMJMH. Learning climate positively influences residents' work-related well-being. Adv Health Sci Educ Theory Pract 2019; 24:317-330. [PMID: 30519786 PMCID: PMC6483960 DOI: 10.1007/s10459-018-9868-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 11/21/2018] [Indexed: 06/09/2023]
Abstract
An optimal learning climate is crucial for the quality of residency training and may also improve residents' well-being and empathy. We investigated the associations of learning climate with residents' work-related well-being. A multicenter questionnaire study was performed among 271 surgery and gynaecology residents in 21 training programs from September 2012 to February 2013. Residents were asked to complete work-related well-being measurements: work engagement (Utrecht Work Engagement Scale), job and specialty satisfaction (measures from Physician Worklife Study), and physician empathy (Jefferson Scale of Physician Empathy). The Dutch Residency Educational Climate Test was used to evaluate learning climate. Multivariate adjusted linear regression analyses were used to estimate associations of learning climate with work-related well-being measures. Well-being measures were completed by 144 residents (53.1%). Learning climate was evaluated by 193 residents, yielding 9.2 evaluations per training program on average. Overall learning climate score was positively associated with work engagement [regression coefficient b = 0.58; 95% confidence interval (CI) 0.18-0.98; p = 0.004] and job satisfaction (b = 0.80; 95% CI 0.48-1.13; p < 0.001). No associations were found between learning climate and empathy and specialty satisfaction. Residents' work engagement and job satisfaction are positively related to the learning climate and may be further enhanced by improved learning climates of training programs.
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Affiliation(s)
- Lenny S S Lases
- Professional Performance Research Group, Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
- Department of Surgery, Isala, Zwolle, The Netherlands.
| | - Onyebuchi A Arah
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Olivier R C Busch
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Maas Jan Heineman
- Professional Performance Research Group, Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Kiki M J M H Lombarts
- Professional Performance Research Group, Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Abstract
PURPOSE To analyze the plural definitions and applications of the term "hidden curriculum" within the medical education literature and to propose a conceptual framework for conducting future research on the topic. METHOD The authors conducted a literature search of nine online databases, seeking articles published on the hidden, informal, or implicit curriculum in medical education prior to March 2017. Two reviewers independently screened articles with set inclusion criteria and performed kappa coefficient tests to evaluate interreviewer reliability. They extracted, coded, and analyzed key data, using grounded theory methodology. RESULTS The authors uncovered 3,747 articles relating to the hidden curriculum in medical education. Of these, they selected 197 articles for full review. Use of the term "hidden curriculum" has expanded substantially since 2012. U.S. and Canadian medical schools are the focus of two-thirds of the empirical hidden curriculum studies; data from African and South American schools are nearly absent. Few quantitative techniques to measure the hidden curriculum exist. The "hidden curriculum" is understood as a mostly negative concept. Its definition varies widely, but can be understood via four conceptual boundaries: (1) institutional-organizational, (2) interpersonal-social, (3) contextual-cultural, and/or (4) motivational-psychological. CONCLUSIONS Future medical education researchers should make clear the conceptual boundary or boundaries they are applying to the term "hidden curriculum," move away from general musings on its effects, and focus on specific methods for improving the powerful hidden curriculum.
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Affiliation(s)
- Carlton Lawrence
- C. Lawrence is researcher, Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa, and medical student, Harvard Medical School, Boston, Massachusetts; ORCID: http://orcid.org/0000-0001-7507-5582. T. Mhlaba is public health medicine specialist, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; ORCID: http://orcid.org/0000-0002-0178-2652. K.A. Stewart is associate professor, The Practice in Global Health and Cultural Anthropology, Duke Global Health Institute, Duke University, Durham, North Carolina. R. Moletsane is professor and J.L. Dube Chair of Rural Education, Department of Rural Education, University of KwaZulu-Natal, Durban, South Africa; ORCID: http://orcid.org/0000-0002-8493-7479. B. Gaede is chair, Discipline of Family Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa. M. Moshabela is chair, Centre for Rural Health, and Discipline of Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa, and Wellcome Trust fellow, Africa Centre for Population Health, Mtubatuba, South Africa; ORCID: http://orcid.org/0000-0002-9438-7095
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Abstract
BACKGROUND Using the frameworks of transformational learning and situated learning theory, we developed a technology-enhanced professionalism curricular model to build a learning community aimed at promoting residents' self-reflection and self-awareness. The RAPR model had 4 components: (1) Recognize: elicit awareness; (2) Appreciate: question assumptions and take multiple perspectives; (3) Practice: try new/changed perspectives; and (4) Reflect: articulate implications of transformed views on future actions. OBJECTIVE The authors explored the acceptability and practicality of the RAPR model in teaching professionalism in a residency setting, including how residents and faculty perceive the model, how well residents carry out the curricular activities, and whether these activities support transformational learning. METHODS A convenience sample of 52 postgraduate years 1 through 3 internal medicine residents participated in the 10-hour curriculum over 4 weeks. A constructivist approach guided the thematic analysis of residents' written reflections, which were a required curricular task. RESULTS A total of 94% (49 of 52) of residents participated in 2 implementation periods (January and March 2015). Findings suggested that RAPR has the potential to foster professionalism transformation in 3 domains: (1) attitudinal, with participants reporting they viewed professionalism in a more positive light and felt more empathetic toward patients; (2) behavioral, with residents indicating their ability to listen to patients increased; and (3) cognitive, with residents indicating the discussions improved their ability to reflect, and this helped them create meaning from experiences. CONCLUSIONS Our findings suggest that RAPR offers an acceptable and practical strategy to teach professionalism to residents.
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Abstract
Communication ability is one of the core requirements of doctors' competency. Teaching communication to medical students and junior doctors has attracted much attention. With the challenge of escalating demands, the status of training communication skills has been promoted in the past several decades. The training content was integrated with other courses and various pedagogic approaches have been applied and proved to be effective. Practical strategies and mixed types were highly recommended. However, there are still many problems, including the fragmentation of the training, insufficient practice, inadequate qualified teachers, case adaptation, course localization and impediment from the environment. This paper proposes some suggestions to solve the problems.
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Affiliation(s)
- Ye Liu
- School of Basic Medical Sciences, Fudan University
| | | | - Hong Gao
- Zhongshan Hospital, Fudan University
| | - Xunjia Cheng
- School of Basic Medical Sciences, Fudan University
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Abstract
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.
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Affiliation(s)
- Nandini Nittur
- Medical Education, University of Central Florida College of Medicine
| | - Jonathan Kibble
- Medical Education, University of Central Florida College of Medicine
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15
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Abstract
The "hidden curriculum" has long been supposed to have an effect on students' learning during their clinical education, and in particular in shaping their ideas of what it means to be a professional. Despite this, there has been little evidence linking specific changes in professional attitudes to the individual components of the hidden curriculum. This study aimed to recognize those components that led to a change in students' professional attitudes at a UK veterinary school, as well as to identify the attitudes most affected. Observations were made of 11 student groups across five clinical rotations, followed by semi-structured interviews with 23 students at the end of their rotation experience. Data were combined and analyzed thematically, taking both an inductive and deductive approach. Views about the importance of technical competence and communication skills were promoted as a result of students' interaction with the hidden curriculum, and tensions were revealed in relation to their attitudes toward compassion and empathy, autonomy and responsibility, and lifestyle ethic. The assessment processes of rotations and the clinical service organization served to communicate the messages of the hidden curriculum, bringing about changes in student professional attitudes, while student-selected role models and the student rotation groups moderated the effects of these influences.
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Tucker CR, Choby BA, Moore A, Parker RS, Zambetti BR, Naids S, Scott J, Loome J, Gaffney S. Speaking up: using OSTEs to understand how medical students address professionalism lapses. Med Educ Online 2016; 21:32610. [PMID: 27814779 PMCID: PMC5097152 DOI: 10.3402/meo.v21.32610] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/31/2016] [Accepted: 09/26/2016] [Indexed: 05/27/2023]
Abstract
BACKGROUND Objective-structured teaching encounters (OSTEs) are used across many disciplines to assess teaching ability. The OSTE detailed in this paper assesses 191 fourth-year medical students' (M4) ability to identify and address lapses in professionalism based on Association of American Medical Colleges' professionalism competencies. The research questions addressed are How frequently do M4s address professionalism lapses observed during an OSTE? What factors influence whether M4s provide feedback when they observe professionalism lapses in an OSTE? METHODS Standardized patients (SPs) and standardized learners (SLs) were recruited and trained to participate in a standardized encounter with specific cognitive, social, and behavioral errors, including professionalism lapses. M4s viewed this encounter and then offered feedback to the SL, while remotely observed by faculty. Post-encounter, the SL and faculty completed identical checklists to assess both teaching readiness and ability to address professionalism concerns. RESULTS An analysis of frequencies showed that six of the Association of American Medical Colleges' nine professional competencies were addressed in the checklist and/or discussed in the focus group. Analysis of transcribed debriefing sessions confirmed that M4s did not consistently address professionalism lapses by their peers. CONCLUSIONS In focus groups, M4s indicated that, while they noticed professionalism issues, they were uncomfortable discussing them with the SLs. Findings of the current study suggest how medical educators might support learners' ability to address lapses in professionalism as well as topics for future research.
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Affiliation(s)
- Constance R Tucker
- Faculty Development, McGlothlin Medical Education Center, Virginia Commonwealth University School of Medicine, Richmond, VA, USA;
| | - Beth A Choby
- Department of Medical Education, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Andrew Moore
- Graduate Medical Education, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Robert Scott Parker
- Graduate Medical Education, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Benjamin R Zambetti
- Graduate Medical Education, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sarah Naids
- Graduate Medical Education, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jillian Scott
- Graduate Medical Education, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jennifer Loome
- Graduate Medical Education, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sierra Gaffney
- Graduate Medical Education, University of Tennessee Health Science Center, Memphis, TN, USA
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Armitage-Chan E, Maddison J, May SA. What is the veterinary professional identity? Preliminary findings from web-based continuing professional development in veterinary professionalism. Vet Rec 2016; 178:318. [DOI: 10.1136/vr.103471] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2016] [Indexed: 11/04/2022]
Affiliation(s)
- E. Armitage-Chan
- Department of Veterinary Clinical Sciences and Services; Royal Veterinary College, Hawkshead Lane North Mymms Hatfield AL9 7TA UK
| | - J. Maddison
- Department of Veterinary Clinical Sciences and Services; Royal Veterinary College, Hawkshead Lane North Mymms Hatfield AL9 7TA UK
| | - S. A. May
- Department of Veterinary Clinical Sciences and Services; Royal Veterinary College, Hawkshead Lane North Mymms Hatfield AL9 7TA UK
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Vidyarthi AR, Kamei R, Chan K, Goh SH, Ngee L. Factors associated with medical student clinical reasoning and evidence based medicine practice. Int J Med Educ 2015; 6:142-8. [PMID: 26547924 PMCID: PMC4646359 DOI: 10.5116/ijme.563a.5dd0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 11/04/2015] [Indexed: 05/21/2023]
Abstract
OBJECTIVES To identify the factors associated with medical students' clinical reasoning (CR) use and evidence-based medicine (EBM) use in the clinical setting. METHODS Our cross-sectional study surveyed 44 final-year medical students at an emerging academic medical center in Singapore. We queried the students' EBM and CR value and experiences in the classroom and clinical settings. We compared this to their perceptions of supervisors' value and experiences using t-tests. We developed measures of teaching culture and practice culture by combining relevant questions into summary scores. Multivariate linear regression models were applied to identify factors associated with the students' CR and EBM clinical use. RESULTS Eighty-nine percent of students responded (n=39). Students reported valuing CR (p=0.03) and EBM (p=0.001) more than their supervisors, but practiced these skills similarly (p=0.83; p=0.82). Clinical practice culture and classroom CR experience were independently associated with students' CR clinical use (p=0.05; p=0.04), and classroom EBM experience was independently associated with students' EBM clinical use (p=0.03). Clinical teaching culture was not associated with students' CR and EBM clinical use. CONCLUSIONS Our study found that medical students' classroom experience and the clinical practice culture influenced their CR and EBM use. The clinical teaching culture did not. These findings suggest that in order to increase student CR and EBM use, in addition to providing classroom experience, medical educators may need to change the hospital culture by encouraging supervisors to use these skills in their clinical practice.
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Affiliation(s)
- Arpana R. Vidyarthi
- Duke-NUS (National University of Singapore) Graduate Medical School, Singapore
| | - Robert Kamei
- Duke-NUS (National University of Singapore) Graduate Medical School, Singapore
| | - Kenneth Chan
- Duke-NUS (National University of Singapore) Graduate Medical School, Singapore
| | - Sok-Hong Goh
- Duke-NUS (National University of Singapore) Graduate Medical School, Singapore
| | - Lek Ngee
- Duke-NUS (National University of Singapore) Graduate Medical School, Singapore
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Abstract
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.
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Affiliation(s)
- Steven Rougas
- a The Warren Alpert Medical School of Brown University , Providence , RI , USA
| | - Bethany Gentilesco
- a The Warren Alpert Medical School of Brown University , Providence , RI , USA
| | - Emily Green
- a The Warren Alpert Medical School of Brown University , Providence , RI , USA
| | - Libertad Flores
- a The Warren Alpert Medical School of Brown University , Providence , RI , USA
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Klemenc-Ketis Z, Vrecko H. Development and validation of a professionalism assessment scale for medical students. Int J Med Educ 2014; 5:205-11. [PMID: 25382090 PMCID: PMC4249760 DOI: 10.5116/ijme.544b.7972] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 10/25/2014] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To develop and validate a scale for the assessment of professionalism in medical students based on students' perceptions of and attitudes towards professionalism in medicine. METHODS This was a mixed methods study with undergraduate medical students. Two focus groups were carried out with 12 students, followed by a transcript analysis (grounded theory method with open coding). Then, a 3-round Delphi with 20 family medicine experts was carried out. A psychometric assessment of the scale was performed with a group of 449 students. The items of the Professionalism Assessment Scale could be answered on a five-point Likert scale. RESULTS After the focus groups, the first version of the PAS consisted of 56 items and after the Delphi study, 30 items remained. The final sample for quantitative study consisted of 122 students (27.2% response rate). There were 95 (77.9%) female students in the sample. The mean age of the sample was 22.1 ± 2.1 years. After the principal component analysis, we removed 8 items and produced the final version of the PAS (22 items). The Cronbach's alpha of the scale was 0.88. Factor analysis revealed three factors: empathy and humanism, professional relationships and development and responsibility. CONCLUSIONS The new Professionalism Assessment Scale proved to be valid and reliable. It can be used for the assessment of professionalism in undergraduate medical students.
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Affiliation(s)
- Zalika Klemenc-Ketis
- Department of Family Medicine, Faculty of Medicine, Taborska 8, 2000 Maribor, Slovenia
| | - Helena Vrecko
- Department of Family Medicine, Faculty of Medicine, Taborska 8, 2000 Maribor, Slovenia
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Roberts NK, Dorsey JK, Wold B. Unprofessional behavior by specialty: a qualitative analysis of six years of student perceptions of medical school faculty. Med Teach 2014; 36:621-625. [PMID: 24787525 DOI: 10.3109/0142159x.2014.899690] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Unprofessional behavior has well documented negative effects both on the clinical care environment and on the learning environment. If unprofessional behavior varies by department or specialty, this has implications both for faculty development and for undergraduate and graduate level training. AIMS We sought to learn which unprofessional behaviors were endemic in our school, and which were unique to particular departments. METHODS Students graduating from medical school between 2007 and 2012 were asked to complete a questionnaire naming the most professional and least professional faculty members they encountered in during school. For the least professional faculty members, they were also asked to provide information about the unprofessional behavior. RESULTS Students noted several types of unprofessional behavior regardless of the department faculty were in; however, there were some behaviors only noted in individual departments. The unprofessional behavior profiles for Surgery and Obstetrics/Gynecology were markedly similar, and were substantially different from all other specialties. CONCLUSION Undergraduate, graduate, and faculty education focused on unprofessional behavior that may occur in various learning environments may provide a feasible, practical, and an effective approach to creating a culture of professional behavior throughout the organization.
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Dorsey JK, Roberts NK, Wold B. Feedback matters: the impact of an intervention by the dean on unprofessional faculty at one medical school. Acad Med 2014; 89:1032-1037. [PMID: 24979173 DOI: 10.1097/acm.0000000000000275] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE Unprofessional behavior by faculty can result in poor patient care, poor role modeling, and mistreatment of trainees. To improve faculty or institutional behavior, unprofessional faculty must be given direct feedback. The authors sought to determine whether annually surveying medical students for their nominations of most and least professional faculty, coupled with direct feedback to unprofessional faculty from the dean, improved faculty's professional behavior. METHOD From 2007 to 2012, senior medical students at Southern Illinois University School of Medicine completed an anonymous survey naming the "most professional" and "least professional" faculty in each department. Students described unprofessional behaviors, and their descriptions were qualitatively analyzed. The most unprofessional faculty met with the dean to discuss their behavior. The authors examined differences between faculty named most professional in their department versus those named least professional and whether behavior as measured by student nominations changed following feedback. RESULTS The response rate overall for six graduating classes was 92.5% (385/416). Faculty named most professional were highly associated with receiving teaching and humanism awards. Faculty named most unprofessional were shown to either leave the institution or improve their behavior after receiving feedback. CONCLUSIONS Attitudes and behaviors of teachers create the culture of their institution, and unprofessional behavior by these educators can have a profound, negative effect. Direct involvement by the dean may be an effective tool to improve the learning environment of a single institution, but universal application of such a program is needed if the profession as a whole is to improve its culture.
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Affiliation(s)
- J Kevin Dorsey
- Dr. Dorsey is dean and provost, Southern Illinois University School of Medicine, Springfield, Illinois. Dr. Roberts is director, Academy for Scholarship in Education, and associate professor, Department of Medical Education, Southern Illinois University School of Medicine, Springfield, Illinois. Dr. Wold was a research associate, Southern Illinois University School of Medicine, Springfield, Illinois, at the time this study was conducted
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Abstract
Moral distress is the experience of cognitive-emotional dissonance that arises when one feels compelled to act contrary to one's moral requirements. Moral distress is common, but under-recognized in medical education and training, and this relative inattention may undermine educators' efforts to promote empathy, ethical practice, and professionalism. Moral distress should be recognized as a feature of the clinical landscape, and addressed in conjunction with the related concerns of negative role modeling and the goals and efficacy of medical ethics curricula.
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Mak-van der Vossen M, Peerdeman S, Kleinveld J, Kusurkar R. How we designed and implemented teaching, training, and assessment of professional behaviour at VUmc School of Medical Sciences Amsterdam. Med Teach 2013; 35:709-14. [PMID: 23782044 DOI: 10.3109/0142159x.2013.799637] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Training of doctors in The Netherlands seeks to develop clinical competences including professional behaviour. Behaving as a professional is not just a desirable trait but a clearly stated requirement for doctors and medical students. RESULTS We designed an educational theme, Professional Behaviour (PB), as a longitudinal thread throughout our six-year curriculum after defining PB as "The observable aspects of practising professionalism". This definition was translated into a set of practical skills that can be observed: "The ability to deal with tasks, to deal with others and to deal with oneself". We assess PB 29 times in the course of the medical curriculum. Students with an unsatisfactory PB do not get their degree irrespective of their medical knowledge. We train teachers to identify and report unprofessional student behaviour, and we offer these students interventions and support. CONCLUSIONS With the educational theme "Professional Behaviour" we have defined PB for our institute and firmly embedded it in the medical curriculum. We use workplace learning and role models for teaching PB. Different teachers carry out multiple formative and summative assessments, using standardized assessment scales. With these measures we intend to promote a culture of excellence in PB in our institute.
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Wagner IJ, Hultman CS. Elevation: Developing a Mentorship Model to Raise the Next Generation of Plastic Surgery Professionals. Ann Plast Surg 2013; 70:606-12. [DOI: 10.1097/sap.0b013e31827ead57] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Deptula P, Chun MBJ. A literature review of professionalism in surgical education: suggested components for development of a curriculum. J Surg Educ 2013; 70:408-422. [PMID: 23618453 DOI: 10.1016/j.jsurg.2012.11.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 11/04/2012] [Accepted: 11/12/2012] [Indexed: 06/02/2023]
Abstract
BACKGROUND While it is evident that a surgeon must master medical knowledge and technical skill, there are other "soft skills" that are essential to a successful surgeon. One of these skills is professionalism. The challenge in surgical education lies in developing an effective professionalism curriculum and a related method of evaluation. OBJECTIVE Our review updates the literature and provides recommendations for improving instruction and evaluation of professionalism. DESIGN A literature review was conducted using PubMed, Google Scholar, and Web of Knowledge. We restricted our search to documents published from 2009 to 2012 that address methods of teaching and tools for assessing professionalism in surgical education. RESULTS Sixty-three documents were reviewed, with 14 fitting our search criteria for professionalism in surgical education completely. Other articles focused on the topics of professionalism in surgery, medical professionalism, and professionalism education in medical specialties other than surgery. CONCLUSIONS Development of a professionalism curriculum for surgical residents might begin with defining professionalism in terms of tangible behaviors. The program might also include a precurriculum preparatory course and simulation-based training. Residency programs must also maintain professionalism among its faculty. Assessment in the form of multisource feedback that is consistent with observable behavioral definitions of professionalism should also be considered in evaluating resident professionalism.
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Affiliation(s)
- Peter Deptula
- Department of Surgery, John A. Burns School of Medicine, University of Hawaii at Manoa, Hawaii, USA
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Al-Sudani D, Al-Abbas F, Al-Bannawi Z, Al-Ramadhan A. Professional attitudes and behaviors acquired during undergraduate education in the College of Dentistry, King Saud University. Saudi Dent J 2013; 25:69-74. [PMID: 23960558 DOI: 10.1016/j.sdentj.2013.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 02/20/2013] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES The purpose of the study was to investigate and evaluate the professional attitudes and behaviors acquired by students and recently graduated dentists during undergraduate education at King Saud University. METHODS This cross-sectional survey used a 27-item questionnaire covering four cumulative theoretical dimensions of professionalism. Questionnaires were distributed to fifth-year students, interns, and demonstrators in the College of Dentistry during the academic year 2010-2011, and 203 completed questionnaires were used in analyses. Descriptive statistics were used to summarize responses. Crosstab and chi-squared tests were used, with statistical significance set at P < 0.05. RESULTS The response rate was 79.3% (43.6% of males, 94% of females). Eighty-seven questionnaires were collected from fifth-year students, 92 from interns, and 24 from demonstrators. Many (59%) participants demonstrated high levels of professional attitudes and behaviors, whereas 40% did not comply with the elements of professionalism. Analyses revealed highly significant differences in certain responses with regard to gender, academic level, and grade point average. CONCLUSIONS Although some participants did not possess all professional qualities, all participants possessed at least some elements of professionalism measured in this study. We thus recommend a strategic effort to develop targeted plans emphasizing professionalism at all levels of the dental school curriculum. High-profile role modeling, lectures, seminars, and academic ceremonies are ways of achieving professional development among dental students in parallel with their acquisition of basic scientific knowledge and clinical skills. This approach will formally and informally communicate that professionalism is a core value.
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Koo K. Student narratives and the hidden curriculum in the surgery clerkship. J Surg Educ 2013; 70:1. [PMID: 23337662 DOI: 10.1016/j.jsurg.2012.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 06/22/2012] [Indexed: 06/01/2023]
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