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Ryan A, Moran CN, Byrne D, Hickey A, Boland F, Harkin DW, Guraya SS, Bensaaud A, Doyle F. Do professionalism, leadership, and resilience combine for professional identity formation? Evidence from confirmatory factor analysis. Front Med (Lausanne) 2024; 11:1385489. [PMID: 38938377 PMCID: PMC11208471 DOI: 10.3389/fmed.2024.1385489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/27/2024] [Indexed: 06/29/2024] Open
Abstract
Introduction Professional identity formation (PIF) is an ongoing, self-reflective process involving habits of thinking, feeling and acting like a physician and is an integral component of medical education. While qualitative work has suggested that PIF is informed by professionalism, resilience, and leadership, there is a dearth of quantitative work in this area. Multiple methods build rigor and the present study aimed to quantitatively assess the relative psychometric contributions of professionalism, resilience, and leadership constructs to informing PIF, using a latent factor analysis approach. Methods We analyzed data from the PILLAR study, which is an online cross-sectional assessment of a pre-clinical cohort of medical students in the RCSI University of Medicine and Health Sciences, Dublin, using established and validated quantitative measures in each area of interest: PIF, professionalism, leadership and resilience. A total of 76 items, combining four validated scales, along with a selection of demographic questions, were used. The hypothesis that PIF is informed by, and correlates with, professionalism, resilience and leadership was examined by conducting a confirmatory factor analysis of a proposed three-factor higher-order model. Model estimation used Maximum Likelihood Method (MLM) with geomin rotation. The hypothesized (measurement) model was examined against an alternative (saturated) model, as well as a three-factor model. Results Latent variable analysis from 1,311 students demonstrated that a three-factor higher-order model best fit the data; suggesting PIF is informed by professionalism, resilience, and leadership, and that these constructs are statistically distinct and account for differential aspects of PIF. This higher-order model of PIF outperformed both the saturated model and the three-factor model. The analysis of which component may be the most or least influential was inconclusive, and the overall model was not influenced by year of training. Discussion Building upon existing conceptual contentions, our study is the first to quantitatively support the contribution of professionalism, resilience, and leadership to the development of professional identity, and to delineate the inter-relationships between PIF and these constructs. This information can be used by medical educators when designing curricula and educational strategies intended to enhance PIF. Future work should seek to assess the influence of these constructs longitudinally.
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Affiliation(s)
- Aine Ryan
- Centre for Professionalism in Medicine and Health Sciences at Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Catherine N. Moran
- Department of Health Psychology, School of Population Health, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - David Byrne
- Department of Health Psychology, School of Population Health, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Anne Hickey
- Department of Health Psychology, School of Population Health, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Fiona Boland
- Data Science Centre, School of Population Health, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Denis W. Harkin
- Centre for Professionalism in Medicine and Health Sciences at Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Shaista S. Guraya
- Institute of Learning, Mohammad Bin Rashid University, Dubai, United Arab Emirates
| | - Abdelsalam Bensaaud
- Centre for Professionalism in Medicine and Health Sciences at Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Frank Doyle
- Department of Health Psychology, School of Population Health, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
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McGurgan P, Calvert K, Celenza A, Nathan EA, Jorm C. The Schweitzer effect: The fundamental relationship between experience and medical students' opinions on professional behaviours. MEDICAL TEACHER 2024; 46:782-791. [PMID: 38048408 DOI: 10.1080/0142159x.2023.2284660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
PURPOSE We examined whether medical students' opinions on the acceptability of a behaviour were influenced by previously encountering a similar professionally challenging situation, assessed the magnitude of effect of 'experience' compared to other demographic factors which influence medical students' opinions, and evaluated whether opinions regarding some situations/behaviours were more susceptible to 'experience' bias? METHODS Confidential, on-line survey for medical students distributed to Australian and New Zealand (AUS/NZ) medical schools. Students submitted de-identified demographic information, provided opinions on the acceptability of a wide range of student behaviours in professionally challenging situations, and whether they had encountered similar situations. RESULTS 3171 students participated from all 21 Aus/NZ medical schools (16% of registered students). Medical students reported encountering many of the professionally challenging situations, with varying opinions on what was acceptable behaviour. The most significant factor influencing acceptability towards a behaviour was whether the student reported encountering a similar situation. The professional dilemmas most significantly influenced by previous experience typically related to behaviours that students could witness in clinical environments, and often involved breaches of trust. CONCLUSIONS Our results demonstrate the relationship between experience and medical students' opinions on professional behaviour- the 'Schweitzer effect'. When students encounter poor examples of professional behaviour, especially concerning trust breaches, it significantly influences their perception of the behaviour. These results highlight the importance of placing students in healthcare settings with positive professional role modelling/work cultures.
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Affiliation(s)
- Paul McGurgan
- Division of Obstetrics and Gynaecology, UWA Medical School, Perth, Australia
| | - Katrina Calvert
- Dept. of Post-Graduate Medical Education (PGME), K.E.M.H., Perth, Australia
| | - Antonio Celenza
- Division of Emergency Medicine, UWA Medical School, Perth, Australia
| | - Elizabeth A Nathan
- Division of Obstetrics and Gynaecology, UWA Medical School, Perth, Australia
| | - Christine Jorm
- School of Public Health, University of Sydney, Australia
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Ramanathan V, Pushpanathan P, Bodhare T, Bele S. Perceptions on Medical Professionalism Among Future Healthcare Professionals: A Mixed Method Study. Cureus 2024; 16:e57573. [PMID: 38707144 PMCID: PMC11069035 DOI: 10.7759/cureus.57573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2024] [Indexed: 05/07/2024] Open
Abstract
Background Accreditation councils across the world constantly examine policies and practices in professionalism in their medical curriculum. The National Medical Commission (NMC) in India has recognized the pressing need to reform and include professionalism in its undergraduate curriculum. Objectives The objective of this study was to explore the perspectives of medical and nursing students on professional behavior, suitable teaching-learning methods, and assessment strategies for curriculum integration. Methodology The study utilized a concurrent triangulation mixed method design, collecting both qualitative and quantitative data simultaneously to gain a comprehensive understanding of medical and nursing students' perceptions of professionalism. It included 83 final-year undergraduate medical students and 42 final-year undergraduate nursing students. The approval of the Institutional Review Board of Meenakshi Medical College Hospital & Research Institute was obtained. A semi-structured questionnaire consisting of demographic characteristics and opinions regarding academic professional behavior, teaching-learning, and evaluation of professionalism was used. Perceptions regarding the meaning of professionalism, behavior of professionalism to be emphasized in teaching, and pressing challenges of professionalism were explored. Students were also asked to rank the best behavior associated with professionalism. Frequency and percentages were used for descriptive statistics. Means and standard deviations were calculated for continuous variables. An unpaired t-test was used to determine a statistically significant difference between the means in the two groups. The quantitative data was analyzed with R programming and content analysis was performed for the qualitative data using ATLAS.ti qualitative data analysis software. Results Unexplained/unauthorized absence from academic activities (2.39 ± 1.553), not following the timeline (2.41 ± 1.560), making fun of patients and peers (2.16 ± 1.619), cheating in the exams (2.37 ± 1.651), and inebriation (2.39 ± 1.666) were unacceptable behaviors by undergraduate medical students compared with nursing students. Clinical experience (1.54 ± 0.857) and role models (1.74 ± 0.935) were the highly acceptable methods of teaching professionalism and interprofessional interactions (1.58 ± 0.650) and awards (1.98 ± 1.100) were the most common suggestions to improve the course curriculum by both groups. Community/field activity (1.78 ± 0.860) and clinical examination (1.89 ±1.123) were the most preferred methods of evaluation of professionalism. According to the students, dedication, honesty, respect, and self-improvement were identified as the best behaviors associated with professionalism. Conclusions The study revealed that students had a wide range of perspectives about professionalism. Different unprofessional acts were acceptable to students. The causes of these perspectives need to be explored and resolved to promote professionalism. Students identified the need for strong positive role models and frequent clinical experiences, along with improved interprofessional interactions and awards to improve teaching and learning professionalism. Community/field activity was the preferred assessment method proposed by the students. Medical institutions must promote these components in curriculum, faculty development, and clinical settings to foster the development of professionalism among students.
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Affiliation(s)
- Vijaya Ramanathan
- Anatomy, All India Institute of Medical Sciences, Madurai, IND
- Anatomy, Meenakshi Medical College Hospital & Research Institute, Meenakshi Academy of Higher Education & Research (Deemed to be University), Kanchipuram, IND
| | - Punita Pushpanathan
- Physiology, Meenakshi Medical College Hospital & Research Institute, Meenakshi Academy of Higher Education & Research (Deemed to be University), Kanchipuram, IND
| | - Trupti Bodhare
- Community & Family Medicine, All India Institute of Medical Sciences, Madurai, IND
| | - Samir Bele
- Community Medicine, Velammal Medical College Hospital & Research Institute, Madurai, IND
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Keshmiri F, Raadabadi M. Perception and engagement in unprofessional behaviors of medical students and residents: a mixed-method study. BMC PRIMARY CARE 2023; 24:191. [PMID: 37723441 PMCID: PMC10506320 DOI: 10.1186/s12875-023-02153-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/06/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND The present study aimed to investigate perception and engagement in unprofessional behavior of residents and medical interns and explore the factors affecting their engagement in unprofessional behavior. METHOD This study has an explanatory (quantitative-qualitative) mixed-method design. This study was conducted at Shahid Sadoughi University of Medical Sciences in 2022-2023. Participants, including residents and medical interns (n = 169), were entered by stratified random sampling. A survey was conducted in the quantitative step. A by an unprofessional behavior in clinical practice questionnaire (29 items) was used. For each behavior, the participants were asked to report whether they (a) participated in the behavior and (b) stated that the behavior Is unprofessional. In the qualitative step, 17 participants contributed. The qualitative data were collected by semi-structured interviews and analyzed according to the conventional content analysis approach Graneheim and Lundman introduced. RESULTS The highest ratio of participants' engagement in unprofessional behavior was reported in 'failure to introduce yourself and nurses and physician assistants to the patient and his family' (n = 145 (85.8%)). The results showed the proportion of participants who engaged in unprofessional behavior more than those who did not participate. There were associations between participants' engagement in each behavior and their perception of that particular behavior as unprofessional. (p = 0.0001). In the following behaviors, although the participants acknowledged that these behaviors were unprofessional, those who participated in the unprofessional behaviors were significantly more than those who did not participate: failure to comply with clinic regulations and policy (p = 0.01), eating or drinking in the hallway of the clinic (p = 0.01), medical negligence in duties in the clinic setting (p = 0.04) and failure to perform duties in teamwork (p = 0.04). The qualitative results were explored in a theme entitled "internalized unprofessional culture," including three categories "encouraging contextual risk factors towards unprofessionalism," "suppressing of unprofessionalism reporting," and "disbelieving professionalism as a key responsibility." CONCLUSION The results indicated that most participants engaged in unprofessional behaviors. The findings resulted from the internalized unprofessional culture in the workplace. The findings showed that engagement in unprofessional behaviors resulted from personal and systemic factors. The weakness of responsibility recognition and identity formation as a professional facilitated the engagement in unprofessional behaviors at the personal level. Furthermore, systemic factors including the contextual risk factors (such as deficiency of explicit and hidden curriculum), and the suppression of unprofessionalism reporting mechanism as a hidden factor played an important role in normalizing unprofessional behavior and promoting engagement in unprofessional behaviors among the participants. Recognition of the nature and extent of students' unprofessional behaviors facilitates educational discussion among teachers and students in this field. The results might assist to establish an assessment system and feedback mechanism to solve the problem of the "failure to fail" problem. In addition, these results provide medical educators insights into the development of professional courses that equip learners with adherence to professionalism and coping skills to deal with unprofessionalism in the healthcare system.
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Affiliation(s)
- Fatemeh Keshmiri
- Medical Education Department, Educational Developmental Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
- National Agency for Strategic Research in Medical Education, Tehran, Iran.
| | - Mehdi Raadabadi
- National Agency for Strategic Research in Medical Education, Tehran, Iran
- Health Policy and Management Research Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Ryan A, Hickey A, Harkin D, Boland F, Collins ME, Doyle F. Professional Identity Formation, Professionalism, Leadership and Resilience (PILLAR) in Medical Students: Methodology and Early Results. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231198921. [PMID: 37692556 PMCID: PMC10483968 DOI: 10.1177/23821205231198921] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/13/2023] [Indexed: 09/12/2023]
Abstract
Objectives The fundamental role of medical education is the transformation of students to doctors, through a process of education and professional identity formation (PIF), which can be informed by several educational, behavioural and emotional factors. PIF has been deemed to be of equal importance to the acquisition of clinical knowledge and skills and includes constructs such as professionalism, leadership and resilience. We aimed to assess professional identity formation, professionalism, leadership and resilience (PILLAR) in the junior years of medical school in the 2020/2021 academic year and illustrate the potential role of quantitative assessment to demonstrate progression in these areas. In this research, we provide the methods and baseline results for the PILLAR study. Methods We implemented a compulsory assessment in pre-clinical years of graduate entry and direct entry medicine at the Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland. Validated scales were used to assess students' PILLAR. Descriptive and univariable statistical techniques were used to compare student scores between respective years. Results A total of 1311 students (92% response rate) provided their consent for research. For the psychometric scales, there were no evident trends among the years on these assessment measures. Results indicated significant differences in all measures, however, these did not correspond to ascending years of seniority. Conclusion The PILLAR methodology provides important information on the challenges of quantitatively assessing medical students in the four key areas of PIF, professionalism, leadership, and resilience. Our cross-sectional results point to cohort effects, without the expected progression per year in the cross-sectional data, or suggest that the chosen quantitative measures may be problematic for these constructs in pre-clinical students. Therefore, while we believe that PILLAR has potential as a progress test for these constructs, this will only truly be elucidated by repeated measures of each cohort over time.
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Affiliation(s)
- Aine Ryan
- Centre for Professionalism in Medicine and Health Sciences, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Anne Hickey
- Department of Health Psychology, School of Population Health, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Denis Harkin
- Centre for Professionalism in Medicine and Health Sciences, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Fiona Boland
- Data Science Centre, School of Population Health, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Mary E. Collins
- Royal College of Surgeons in Ireland Graduate School of Healthcare Management, Dublin, Ireland
| | - Frank Doyle
- Department of Health Psychology, School of Population Health, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
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Douglas AH, Acharya SP, Allery LA. Communication skills learning through role models in Nepal; what are medical students really learning? A qualitative study. BMC MEDICAL EDUCATION 2021; 21:625. [PMID: 34930237 PMCID: PMC8691070 DOI: 10.1186/s12909-021-03049-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 11/18/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Communication skills (CS) are important and teachable, however, many Asian medical schools' curricula do not incorporate them. Patan Academy of Health Sciences in Nepal identifies CS within its' aims and curriculum. CS are taught from commencement of medical school and re-emphasised throughout preclinical learning (first 2 years). There is no explicit CS teaching in clinical years but placements allow students to learn through observation. These 'role-modelling' interactions form part of CS learning and development. METHODS This study is a qualitative evaluation of CS learning in PAHS, through participants' experiences. Through purposive sampling, twenty medical students from 2nd, 4th and Intern years were selected for inclusion. Data were collected via audio recorded, semi-structured interviews, employing a piloted schedule. Transcripts were manually coded and analysed thematically. Codes were organised into themes and subthemes. This paper discusses themes related to role-modelling. RESULTS The majority of participants described role-modelling in CS learning, recounting both positive and negative incidents, reflected in the themes of; Positive and Negative experiences. Subthemes of Personal Qualities and Inspiring, emerged from positive experiences, describing students' desire to imitate or aspire to be like their role models. Learners reported predominantly negative experiences and interns exclusively so. From these emerged subthemes of; Good doctors but.., Contradictory messages, How not to behave, Unprofessional behaviour and Affect-Emotional Distress. Learners received conflicting messages from observing behaviour contradictory to explicit CS teaching. Many identified learning "how not to behave" from such incidents, however, several described feeling distressed. DISCUSSION Role-modelling is a powerful and important CS learning tool, seen as positively reinforcing or negatively contradicting explicit CS teaching. Negative modelling created internal conflict, confusion and distress amongst learners, despite its' potential for positive learning. The worldwide problem of negative role-modelling is also prevalent in Nepal. Medical educators need to ensure the explicit curriculum aligns with implicit learning. Clinical tutors must be alerted to their powerful role-model position and supported in developing intentional modelling skills. Learners' reflections upon their experiences should be facilitated, enabling them to critically evaluate observations and hence consciously adopt or reject role-modelled behaviour and attitudes.
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Affiliation(s)
- Amanda Helen Douglas
- Department of GP, Patan Academy of Health Sciences (PAHS), Lalitpur, P.O.Box 26500, Kathmandu, Nepal
| | - Samita Pant Acharya
- Department of GP, Patan Academy of Health Sciences (PAHS), Lalitpur, P.O.Box 26500, Kathmandu, Nepal
| | - Lynne A. Allery
- Reader in Medical Education, Centre for Medical Education, Cardiff University, Heath Park, Cardiff, CF14 4YS UK
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García-Estañ J, Cabrera-Maqueda JM, González-Lozano E, Fernández-Pardo J, Atucha NM. Perception of Medical Professionalism among Medical Residents in Spain. Healthcare (Basel) 2021; 9:1580. [PMID: 34828626 PMCID: PMC8623659 DOI: 10.3390/healthcare9111580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Medical professionalism, defined as commitment to the primacy of patient welfare, is the basis for doctor-patient-society relationships, but previous research with medical students has shown that professionalism and social commitment to medicine may be waning. To determine if this trend also appears in recently qualified practicing doctors, we surveyed 90 newly graduated doctors currently working as medical residents in two university hospitals in Murcia, Spain. A previously validated questionnaire that studies the perception of six categories (responsibility, altruism, service, excellence, honesty and integrity, and respect) defining medical professionalism was used. RESULTS A good perception of professionalism was found among medical residents, with more than 70% positive responses in all these six categories. There is an increasing trend in the number of negative responses as the residency goes on. Altruism was the category with the greatest percentage of negative answers (22.3%) and Respect was the category with the lowest percentage (12.9%). CONCLUSIONS The results show a good professionalism perception in medical residents, but also a slight decline in positive answers that began during medical school. A significant trend was found when including both students and residents. Although there were some differences between students and residents, these were not statistically significant. Educational interventions are needed both at the level of medical school and postgraduate medical residency.
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Affiliation(s)
- Joaquín García-Estañ
- Centro de Estudios en Educación Médica, Universidad de Murcia, 30120 Murcia, Spain;
| | - Jose María Cabrera-Maqueda
- Servicio de Docencia y Formación, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain; (J.M.C.-M.); (E.G.-L.)
| | - Eduardo González-Lozano
- Servicio de Docencia y Formación, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain; (J.M.C.-M.); (E.G.-L.)
| | | | - Noemí M. Atucha
- Centro de Estudios en Educación Médica, Universidad de Murcia, 30120 Murcia, Spain;
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Butler J, Kassel L, Miesner AR, Grady S, Wall GC. Incidence of a negative hidden curriculum, cynicism, and burnout within pharmacy resident education: A nationwide survey. CURRENTS IN PHARMACY TEACHING & LEARNING 2021; 13:922-927. [PMID: 34294255 DOI: 10.1016/j.cptl.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/29/2021] [Accepted: 06/08/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The term "hidden curriculum" (HC) is a set of ethical, moral, and value-based teachings communicated in a non-explicit manner. Recent literature has described increasing awareness of the prevalence of the HC and potential negative impact on medical learners; however, this information is lacking in pharmacy resident education. Consequently, we conducted a survey study of United States pharmacy residents to learn their perceptions concerning the HC in pharmacy residency training. METHODS A nationwide survey of pharmacy residents was conducted in June 2019. The survey assessed the following: presence of negative HC (score 0 to 80), cynicism (score 0 to 25), burnout via Maslach Burnout Inventory depersonalization (MBI-D) (range 0 to 30), and emotional exhaustion via Maslach Burnout Inventory emotional exhaustion (MBI-EE) (range 0 to 54). Higher scores represent increased occurrences of each domain. RESULTS The mean HC score was 20 (SD 14.7), mean cynicism score was 9 (SD 5.5), MBI-D was 5.5 (SD 4.5), and MBI-EE was 24.2 (SD 12.4). Of those completing an MBI score, 40.4% (82/203) reported burnout in one area, while 15.8% (32/203) reported burnout in both areas. Residents reporting burnout had higher mean HC and cynicism scores. CONCLUSIONS Awareness to develop and grow cultures that minimize the presence of a negative HC is essential to improve postgraduate pharmacy training.
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Affiliation(s)
- Jared Butler
- Drake University College of Pharmacy & Health Sciences, 2507 University Avenue, Des Moines, IA 50311, United States.
| | - Lynn Kassel
- Drake University College of Pharmacy & Health Sciences, 2507 University Avenue, Des Moines, IA 50311, United States.
| | - Andrew R Miesner
- Drake University College of Pharmacy & Health Sciences, 2507 University Avenue, Des Moines, IA 50311, United States.
| | - Sarah Grady
- Drake University College of Pharmacy & Health Sciences, 2507 University Avenue, Des Moines, IA 50311, United States.
| | - Geoffrey C Wall
- Drake University College of Pharmacy & Health Sciences, 2507 University Avenue, Des Moines, IA 50311, United States.
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Beltran-Aroca CM, Ruiz-Montero R, Labella F, Girela-López E. The role of undergraduate medical students training in respect for patient confidentiality. BMC MEDICAL EDUCATION 2021; 21:273. [PMID: 33980240 PMCID: PMC8117324 DOI: 10.1186/s12909-021-02689-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 04/25/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Encouraging professional integrity is vital for providing a standard of excellence in quality medical care and education and in promoting a culture of respect and responsibility. The primary objective of this work consisted of studying the relationship of medical students to the right to patient privacy in Spain, specifically by analysing the conditions for accessing patient clinical histories (CHs). METHODS A cross-sectional study was conducted based on a questionnaire sent by e-mail to final-year students at 41 Spanish universities. It had 14 multiple choice and closed questions framed in 3 large blocks. The first question addressed basic general knowledge issues on the right to privacy and the obligation for confidentiality. The two remaining blocks were made up of questions directed towards evaluating the frequency with which certain requirements and action steps related to students attending patients were performed and regarding the guarantees associated with accessing and handling patient CHs both on paper and in the Electronic Medical Record. RESULTS A total of 245 valid replies were considered. A total of 67.8 % of participants were women, with an average age of 24.05 ± 3.49 years. Up to 90.6 % were aware that confidentiality affected the data in CHs, although 43.3 % possessed non-anonymized photocopies of patient clinical reports outside the healthcare context, and only 49.8 % of the students were always adequately identified. A total of 59.2 % accessed patient CHs on some occasions by using passwords belonging to healthcare professionals, 77.2 % of them did not have the patients' express consent, and 71.9 % accessed a CH that was not anonymised. CONCLUSIONS The role of healthcare institutions and universities is considered to be fundamental in implementing educational measures regarding the risks and ethical and legal problems arising from the use of CHs among professionals and students. A thorough study of medical ethics is needed through the analysis of clinical cases and direct exposure to situations in which the patient's confidentiality is questioned.
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Affiliation(s)
- Cristina M Beltran-Aroca
- Sección de Medicina Legal y Forense, Facultad de Medicina y Enfermería, Universidad de Córdoba, 14004 Córdoba, Spain
| | - Rafael Ruiz-Montero
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain
| | - Fernando Labella
- Sección de Oftalmología, Facultad de Medicina y Enfermería, Universidad de Córdoba, 14004 Córdoba, Spain
| | - Eloy Girela-López
- Sección de Medicina Legal y Forense, Facultad de Medicina y Enfermería, Universidad de Córdoba, 14004 Córdoba, Spain
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Herr KD, George E, Agarwal V, McKnight CD, Jiang L, Jawahar A, Pakkal M, Ulano A, Ganeshan D. Aligning the Implicit Curriculum with the Explicit Curriculum in Radiology. Acad Radiol 2020; 27:1268-1273. [PMID: 32061468 DOI: 10.1016/j.acra.2019.12.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/22/2019] [Accepted: 12/27/2019] [Indexed: 12/01/2022]
Abstract
Physician education occurs through two mechanisms that operate in tandem: the explicit and the implicit curriculum. The explicit, or formal, curriculum is the official version that is usually taken as the one-and-only curriculum and which is detailed in official documentation; however, an implicit curriculum exists, comprised of subtle messaging about professional norms, values, and beliefs that are tacitly communicated through both positive and negative role modeling. Both contribute to the overall education of the medical student and physician-in-training. Despite its well-documented influence in medical education, much of the teachings of the implicit curriculum occurs in the shadows, unspoken and unarticulated, and outside the awareness of both teacher and student. As panel members of the The Implicit Curriculum in Radiology Task Force of the Association of University Radiologists-Radiology Research Alliance (AUR-RRA), we present a review of the implicit curriculum, exploring its origin and impact on medical education, and on the overall professional development of medical students, post-graduate medical trainees and practicing physicians. Strategies for recognizing and contending with the implicit curriculum in radiology training are discussed, with a special emphasis on opportunities to leverage its potential through positive role modeling.
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Affiliation(s)
- Keith D Herr
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 550 Peachtree Street, Atlanta, GA 30308.
| | - Elizabeth George
- Fellow in Neuroradiology, Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Vikas Agarwal
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Colin D McKnight
- Vanderbilt University Medical Center, R-1302 MCN, South Nashville, Tennessee
| | - Liwei Jiang
- Integrated Interventional Radiology Resident, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Anugayathri Jawahar
- Clinical Instructor in Radiology, Stanford University, Palo Alto, California
| | - Mini Pakkal
- Toronto General Hospital, Department of Medical Imaging, Toronto, Ontario
| | - Adam Ulano
- Department of Radiology, University of Vermont Medical Center, The Robert Larner MD College of Medicine at the University Of Vermont, Burlington, Vermont
| | - Dhakshinamoorthy Ganeshan
- Department of Abdominal Radiology, Unit 1473, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Harris M, Camenzind AL, Fankhauser R, Streit S, Hari R. Does a home-based interview with a chronically ill patient help medical students become more patient-centred? A randomised controlled trial. BMC MEDICAL EDUCATION 2020; 20:217. [PMID: 32652987 PMCID: PMC7353797 DOI: 10.1186/s12909-020-02136-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/02/2020] [Indexed: 05/07/2023]
Abstract
BACKGROUND While patient-centred care improves patient outcomes, studies have shown that medical students become less patient-centred with time, so it is crucial to devise interventions that prevent this. We sought to determine whether first-year medical students who had a structured home-based interview with a chronically ill patient became more patient-centred than those who had a sham intervention. METHODS This randomised controlled trial assigned first-year students from the University of Bern, Switzerland, to either an interview with a chronically ill patient at the patient's home or to a sham comparator. We used the PPOS-D12 questionnaire to measure students' levels of patient-centredness at baseline, and changes in these levels during their longitudinal primary care clerkship. RESULTS A total of 317 students participated. Patient-centred attitudes increased during the study. A home-based interview with a chronically ill patient had no additional effect. Being female and having been exposed to patients before medical school were associated with being more patient-centred at baseline. Students were less patient-centred than their General Practitioner teachers. CONCLUSIONS A structured, home-based interview with a chronically ill patient did not change students' patient-centred attitudes, so cannot be recommended as a way to influence those attitudes. However, patient-centred attitudes increased during the students' first year of study, possibly because of their longitudinal primary care clerkship. TRIAL REGISTRATION Clinicaltrials.gov reference: NCT03722810 , registered 29th October 2018.
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Affiliation(s)
- Michael Harris
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- College of Medicine & Health, University of Exeter, Exeter, UK
- Gore Cottage, Emborough, Radstock, BA3 4SJ UK
| | - Anna-Lea Camenzind
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Rita Fankhauser
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Roman Hari
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
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Li H, Novack DH, Duke P, Gracely E, Cestone C, Davis T. Predictors of medical students' ethical decision-making: A pilot study using the Theory of Interpersonal Behavior. PATIENT EDUCATION AND COUNSELING 2020; 103:S0738-3991(20)30292-5. [PMID: 32540095 DOI: 10.1016/j.pec.2020.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 05/15/2020] [Accepted: 05/20/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To understand medical students' (MS) ethical decision-making using the Theory of Interpersonal Behavior (TIB). METHODS We conducted two rounds of focus groups to develop a TIB-based questionnaire by eliciting students' perspectives on an ethical dilemma they will encounter in a standardized patient (SP) station, in which an SP "surgeon" asked them to intubate a sedated patient whom the student knew had requested no student involvement. We administrated questionnaires to 241 third-year MS following this SP station, asking for their decisions in the SP station and if a surgeon made the same request in their clerkship. Confirmatory factor analysis (CFA) was used to test whether observed data fit the proposed TIB-based model. RESULTS The CFA provided an acceptable fit to the a priori proposed model. Fifty-five percent of students indicated they would intubate in an actual situation versus 18% in the SP station (p < 0.05). Using logistic regression, TIB domains affect and facilitating factors reported significant association with students' decisions in both the SP and hypothesized actual situations. CONCLUSIONS The TIB appears to be an effective theoretical framework for explaining students' ethical decision-making. PRACTICE IMPLICATIONS The TIB may guide design and assessment of educational programs for professional formation.
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Affiliation(s)
- Honghe Li
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, China; Cambridge Health Alliance, Harvard Medical School, Cambridge, USA.
| | - Dennis H Novack
- Office of Educational Affairs, Drexel University College of Medicine, Philadelphia, USA
| | - Pamela Duke
- Office of Educational Affairs, Drexel University College of Medicine, Philadelphia, USA
| | - Edward Gracely
- Family Community and Preventive Medicine, Drexel University College of Medicine, Philadelphia, USA
| | - Christina Cestone
- Office of Educational Affairs, Drexel University College of Medicine, Philadelphia, USA
| | - Tiffany Davis
- Office of Educational Affairs, Drexel University College of Medicine, Philadelphia, USA
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McGurgan P, Calvert KL, Narula K, Celenza A, Nathan EA, Jorm C. Medical students' opinions on professional behaviours: The Professionalism of Medical Students' (PoMS) study. MEDICAL TEACHER 2020; 42:340-350. [PMID: 31738619 DOI: 10.1080/0142159x.2019.1687862] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Introduction: The Professionalism of Medical Students (PoMS) study aimed to develop a comprehensive understanding of Australian and New Zealand (Aus/NZ) medical students' opinions and experience with professionalism dilemmas.Methods: A confidential, online survey for medical students was developed and distributed to all Aus/NZ medical schools. Students submitted de-identified demographic information, gave opinions on the acceptability of a range of student behaviours for professionally challenging situations, and whether they had encountered similar situations.Results: 3171 medical students participated from all 21 Aus/NZ medical schools (16% of the total student population). Medical students reported encountering many of the professionally challenging situations and had varying opinions on what was acceptable behaviour for the scenarios. In general, students' opinions were not influenced by the seniority, gender or the type of health professional involved in the scenario. Participant demographic factors appeared to have significant effects on professional opinions - particularly male gender and being a student in the latter stages of the course.Discussion: Medical students' professional opinions are a complex area. The PoMS data provides a reference point for students, their educators and other health professionals in identifying current student professional behaviour norms, determining the effects of demographic factors on their decision making, and where important gaps exist in medical students' approaches to professionalism.
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Affiliation(s)
- P McGurgan
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Australia
| | - K L Calvert
- Obstetrics and Gynaecology, King Edward Memorial Hospital, Perth, Australia
| | - K Narula
- Fiona Stanley Hospital, Perth, Australia
| | - A Celenza
- Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Australia
| | - E A Nathan
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Australia
| | - C Jorm
- School of Medicine and Public Health, Newcastle University, Australia
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Larramendy-Magnin S, Anthoine E, L’Heude B, Leclère B, Moret L. Refining the medical student safety attitudes and professionalism survey (MSSAPS): adaptation and assessment of patient safety perception of French medical residents. BMC MEDICAL EDUCATION 2019; 19:222. [PMID: 31226982 PMCID: PMC6588893 DOI: 10.1186/s12909-019-1667-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 06/12/2019] [Indexed: 05/30/2023]
Abstract
BACKGROUND Implementing a patient safety curriculum for medical students requires to identify their needs and current awareness of the topic. Several tools have been developed to measure patient safety culture, but none of them have been developed in the French context. Our objective was to adapt and refine the psychometric properties of the MSSAPS, developed by Liao et al, to use it among general practice (GP) residents. METHODS 1-We conducted a translation and transcultural adaptation of the MSSAPS questionnaire (28 items, 5 dimensions: safety culture, teamwork culture, experiences with professionalism, error disclosure culture and comfort expressing professional concerns) in accordance with the international recommendations. 2-We studied the new questionnaire' psychometric properties on a sample of GP residency students in 2016. This validation comprised 2 steps: a confirmatory factor analysis (CFA) for each dimension of the MSAPPS to explore the adequacy of the structure of the questionnaire; an exploratory factor analysis to refine the instrument, using a principal component analysis and Cronbach's α-coefficients calculation. A final CFA examined the structure validity of the refined questionnaire. 3-We described the items and the safety cultural scores in our sample of residents. RESULTS Among 391 eligible students, 213 responded (54%). The initial structure was not confirmed by CFAs, showing a poor fit for 3 of the 5 dimensions: safety culture, teamwork culture and professionalism. Exploratory PCA led to 3 dimensions: Safety culture (PVE: 18.5% and 7 of 8 initial items), Experiences with professionalism (PVE: 17.8% and 5 of 7 initial items) and Error disclosure culture (PVE: 13.6% and 3 of 4 original items). Cronbach's α-coefficients were 0.74, 0.78 and 0.76 respectively. The final CFA confirmed the existence of the 3 latent dimensions with a good fit to the and highly significant structural coefficients (P < 0.001). Mean scores were equal to 65.4 [63.6; 67.6] for the safety culture, 66.9 [63.8; 70.1] for the experience with professionalism, and 54.4 [51.6; 57.2] for the error disclosure culture. CONCLUSION This study reports satisfactory psychometrics properties of the French version of the MSAPPS and provides evidence of important training needs for GP residents in the field of patient safety culture.
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Affiliation(s)
| | - Emmanuelle Anthoine
- Department of Public Health, Nantes University Hospital, 85 rue Saint Jacques 44093 Nantes Cedex 1, Nantes, France
- UMR 1246 INSERM SPHERE “MethodS in Patients-centered outcomes and HEalth ResEarch”, Universities of Nantes and Tours, Nantes, France
| | | | - Brice Leclère
- Department of Public Health, Nantes University Hospital, Nantes, France
| | - Leïla Moret
- Department of Public Health, Nantes University Hospital, 85 rue Saint Jacques 44093 Nantes Cedex 1, Nantes, France
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Keis O, Schneider A, Heindl F, Huber-Lang M, Öchsner W, Grab-Kroll C. How do German medical students perceive role models during clinical placements ("Famulatur")? An empirical study. BMC MEDICAL EDUCATION 2019; 19:184. [PMID: 31159794 PMCID: PMC6547468 DOI: 10.1186/s12909-019-1624-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 05/22/2019] [Indexed: 05/11/2023]
Abstract
BACKGROUND Studies have demonstrated the importance of role models in medical education. Medical students in Germany participate in clinical placements ("Famulatur") that last 4 months in total and represent the first real-world setting where students encounter possible role models in their clinical education. These placements are an extracurricular activity, however, and regarded as the "black box" of medical education. This study aimed to evaluate whether and how students experience role models during clinical placements, the qualities associated with potential role models and whether role model-related learning gains are relevant. METHODS We recruited 96 students (mean age: 23.83 years; 75% female) in their 5th to 9th semesters at the Faculty of Medicine at the University of Ulm, Germany, who were participating in a clinical placement between July and October 2015. Participants completed a questionnaire at the beginning of a 5-day working week to record sociodemographic and other information and another one at the end of the week to assess various aspects of their experiences. On each of the 5 days, they completed a structured questionnaire to record their perceived role models and self-assessed learning gains. RESULTS Role models and role modelling play an important role in clinical placements. The positive function of medical staff as role models predominated (88.4%) across all specialties. Junior doctors were the most frequently perceived role models (28.5%), followed by consultants (25.1%) and nursing staff (22.4%). The most commonly perceived positive quality was the interaction with students (16.5%), followed by team behaviour (13.6%), interaction with patients (13.6%) and professional expertise (13.4%). Students also had various kinds of learning gains such as knowledge or skills. CONCLUSIONS Although these clinical placements are extracurricular activities in Germany and their content is not regulated, they are home to a relevant amount of role modelling. Students experience the various medical professions in different roles and in a range of tasks and interactions. Defining basic learning objectives could help to increase the relevance of these placements for the medical curriculum in Germany and transfer the associated learning gains from the hidden to the open curriculum.
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Affiliation(s)
- Oliver Keis
- Medical Faculty, Office of the Dean of Studies, University of Ulm, Albert Einstein Allee 7, 89081 Ulm, Germany
| | - Achim Schneider
- Medical Faculty, Office of the Dean of Studies, University of Ulm, Albert Einstein Allee 7, 89081 Ulm, Germany
| | - Felix Heindl
- Medical Faculty, Office of the Dean of Studies, University of Ulm, Albert Einstein Allee 7, 89081 Ulm, Germany
| | - Markus Huber-Lang
- Institute for Clinical and Experimental Trauma Immunology, Ulm University Medical Center, Helmholtzstr. 8/2, 89081 Ulm, Germany
| | - Wolfgang Öchsner
- Center for Surgery / Department for Cardiac Anesthesiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Claudia Grab-Kroll
- Medical Faculty, Office of the Dean of Studies, University of Ulm, Albert Einstein Allee 7, 89081 Ulm, Germany
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Cusimano MC, Ting DK, Kwong JL, Van Melle E, MacDonald SE, Cline C. Medical Students Learn Professionalism in Near-Peer Led, Discussion-Based Small Groups. TEACHING AND LEARNING IN MEDICINE 2019; 31:307-318. [PMID: 30554529 DOI: 10.1080/10401334.2018.1516555] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Problem: Medical educators recognize that professionalism is difficult to teach to students in lecture-based or faculty-led settings. An underused but potentially valuable alternative is to enroll near-peers to teach professionalism. Intervention: We describe a novel near-peer curriculum on professionalism developed at Queen's University School of Medicine. Senior medical students considered role models by their classmates were nominated to facilitate small-group seminars with junior students on topics in professionalism. Each session was preceded by brief pre-readings or prompts and engaged students in semistructured, open-ended discussion. Three 2-hour sessions have occurred annually. Context: The near-peer sessions are a required component (6 hours; 20%) of the 1st-year professionalism course at Queen's University (30 hours), which otherwise includes faculty-led seminars, lectures, and online modules. Senior facilitators are selected through a peer nomination process during their 3rd year of medical school. This format was chosen to create a highly regarded position to which students could aspire by demonstrating positive professionalism. Outcome: We performed a qualitative descriptive evaluation of the near-peer curriculum. Fifty-six medical students participated in 11 focus group interviews, which were coded and analyzed for themes inductively and deductively. Quantitative reviews of student feedback forms and a third-party thematic analysis were performed to triangulate results. Medical students preferred the near-peer-led discussion-based curriculum to faculty-led seminars and didactic or online formats. Junior students could describe specific examples of how the curriculum had influenced their behavior in academic, clinical, and personal settings. They cited senior near-peer facilitators as the strongest aspect of the curriculum for their social and cognitive congruence. Senior students who had facilitated sessions regarded the peer teaching experience as formative to their own understanding of professionalism. Lessons Learned: Formal medical curricula on professionalism should emphasize near-peer-led small-group discussion as it fosters a nuanced understanding of professionalism for both early level students and senior students acting as teachers.
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Affiliation(s)
- Maria C Cusimano
- a Department of Obstetrics and Gynecology , University of Toronto , Toronto , Ontario , Canada
- d Undergraduate Medical Education , Queen's University , Kingston , Ontario , Canada
| | - Daniel K Ting
- b Department of Emergency Medicine , University of British Columbia , Kelowna , British Columbia , Canada
- d Undergraduate Medical Education , Queen's University , Kingston , Ontario , Canada
| | - Jonathan L Kwong
- c MD Program , University of Toronto , Toronto , Ontario , Canada
- d Undergraduate Medical Education , Queen's University , Kingston , Ontario , Canada
| | - Elaine Van Melle
- d Undergraduate Medical Education , Queen's University , Kingston , Ontario , Canada
| | - Susan E MacDonald
- d Undergraduate Medical Education , Queen's University , Kingston , Ontario , Canada
| | - Cheryl Cline
- d Undergraduate Medical Education , Queen's University , Kingston , Ontario , Canada
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Ross PT, Keeley MG, Mangrulkar RS, Karani R, Gliatto P, Santen SA. Developing Professionalism and Professional Identity Through Unproctored, Flexible Testing. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:490-495. [PMID: 30188372 DOI: 10.1097/acm.0000000000002444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The medical education community has devoted a great deal of attention to the development of professionalism in trainees within the context of clinical training-particularly regarding trainees' handling of ethical dilemmas related to clinical care. The community, however, knows comparatively less about the development of professional behavior in medical students during the preclerkship years. In medical schools with flexible testing, students take quizzes or examinations in an unproctored setting at a time of their choosing-as long as it falls within a specified window of time. Unproctored, flexible testing offers students early opportunities to develop appropriate professional behavior. In this Perspective, the authors outline different flexible testing models from three institutions-University of Virginia School of Medicine, University of Michigan Medical School, and Icahn School of Medicine at Mount Sinai-all of which offer various levels of testing flexibility in relation to time and location. The authors' experiences with these models suggest that preclinical medical students' early development of professional behavior requires scaffolding by faculty and staff. Scaffolding involves setting clear, specific expectations for students (often through the form of an honor code), as well as active engagement and discussion with learners about the expectations and procedures for self-regulation in the academic environment.
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Affiliation(s)
- Paula T Ross
- P.T. Ross is director, Advancing Scholarship, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0001-7751-784X. M.G. Keeley is assistant dean for student affairs and professor of pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia; ORCID: https://orcid.org/0000-0001-8602-2638. R.S. Mangrulkar is associate dean for medical student education and associate professor of internal medicine and learning health sciences, University of Michigan Medical School, Ann Arbor, Michigan. R. Karani is senior associate dean for undergraduate medical education and curricular affairs; director, Institute for Medical Education; and professor of medical education, medicine, and geriatrics and palliative medicine, Icahn School of Medicine at Mount Sinai, New York, New York. P. Gliatto is senior associate dean for undergraduate medical education and student affairs and associate professor of medical education, medicine, and geriatric and palliative medicine, Icahn School of Medicine at Mount Sinai, New York, New York. S.A. Santen is senior associate dean for assessment, evaluation and scholarship, professor, Department of Emergency Medicine, Virginia Commonwealth School of Medicine, Richmond, Virginia, and former assistant dean for educational research and quality improvement, associate chair for education, and professor, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-8327-8002
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Holmes CL, Hubinette MM, Maclure M, Miller H, Ting D, Costello G, Reed M, Regehr G. Reflecting on what? The difficulty of noticing formative experiences in the moment. PERSPECTIVES ON MEDICAL EDUCATION 2018; 7:379-385. [PMID: 30421332 PMCID: PMC6283774 DOI: 10.1007/s40037-018-0486-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION In the spirit of enacting an educational model of guided, collective reflection to support positive professional identity construction in healthcare learners, we implemented a reflection-based course for medical students transitioning to clerkship with three goals: to sensitize learners to the hidden curriculum; to provide a safe and confidential forum to discuss their experiences; and to co-construct strategies to deal with the pressures in the clinical environment METHODS: We used a design-based research protocol. Twelve students participated in ten sessions starting during their transition to clerkship. Faculty debriefed after each session, adjusting the format of the subsequent sessions. Data included student logs, transcripts of the course sessions, faculty debriefings, and the course evaluation. Data were analyzed via an iterative process of independent coding and discussion. RESULTS The main adjustments to the course were to eliminate didactic content in favour of using prompts prior to course sessions and de-emphasizing written reflection. Participants felt the course achieved its three goals and students reported enhanced resiliency during transition to clerkship, although, despite prompting, students offered no examples of their joining in with the negative behaviours around them. CONCLUSIONS The course was successful in its key objectives. However, a key aspect of reflection, students noticing their own behaviour in the moment as something that needs to be reflected on, was challenging. Future research exploring the value of reflection as an intervention to redress the unwanted aspects of the hidden curriculum might focus on efforts to move the students to explicitly explore the enculturation process in themselves.
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Affiliation(s)
- Cheryl L Holmes
- Faculty of Medicine, University of British Columbia, Vancouver, B.C., Canada.
| | - Maria M Hubinette
- Faculty of Medicine, University of British Columbia, Vancouver, B.C., Canada
| | - Malcolm Maclure
- Faculty of Medicine, University of British Columbia, Vancouver, B.C., Canada
| | - Harry Miller
- Faculty of Medicine, University of British Columbia, Vancouver, B.C., Canada
| | - Daniel Ting
- Faculty of Medicine, University of British Columbia, Vancouver, B.C., Canada
| | - Greg Costello
- Faculty of Medicine, University of British Columbia, Vancouver, B.C., Canada
| | - Melanie Reed
- Faculty of Medicine, University of British Columbia, Vancouver, B.C., Canada
| | - Glenn Regehr
- Faculty of Medicine, University of British Columbia, Vancouver, B.C., Canada
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Dilday JC, Miller EA, Schmitt K, Davis B, Davis KG. Professionalism: A Core Competency, but What Does it Mean? A Survey of Surgery Residents. JOURNAL OF SURGICAL EDUCATION 2018; 75:601-605. [PMID: 29111163 DOI: 10.1016/j.jsurg.2017.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 09/08/2017] [Accepted: 09/29/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Professionalism is 1 of the 6 core competencies of the Accreditation Council of Graduate Medical Education. Despite its obvious importance, it is poorly defined in the literature and an understanding of its meaning has not been evaluated on surgical trainees. The American College of Surgeons (ACS) has previously published tenets of surgical professionalism. However, surgery residents may not share similar views on professionalism as those of the ACS. DESIGN Surgical residents of all levels at 2 surgery residencies located in the same city were interviewed regarding their personal definitions, thoughts, and experiences regarding professionalism during their training. They were then queried regarding 20 points of professionalism as outlined by the ACS tenets of professionalism. SETTING The study utilized the surgery residencies at William Beaumont Army Medical Center and Texas Tech University Health Science Center in El Paso, Texas. PARTICIPANTS All general surgery residents at each program were invited to participate in the study. Eighteen residents volunteered to take the survey and be interviewed. RESULTS The definitions of professionalism centered on clinical competence. Surgery residents conveyed experiences with both professional and unprofessional behavior. Seven of the 20 ACS tenets of professionalism were unanimously agreed upon. There were key differences between resident definitions and those as outlined by the ACS. The least agreed upon ACS tenets of professionalism include professionalism education, public education, and public health. CONCLUSIONS Surgical trainees express personal experiences in both professional and unprofessional behavior. Their definitions of professionalism are not as expansive as those of the ACS and seem to focus on patient and colleague interaction. Due to the lack of congruency, a tailored curriculum for professionalism based upon ACS tenets appears warranted.
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Affiliation(s)
- Joshua C Dilday
- General Surgery, William Beaumont Army Medical Center, El Paso, Texas.
| | | | - Kyle Schmitt
- General Surgery, Louisiana State University, Health Sciences Center, New Orleans, Louisiana
| | - Brian Davis
- General Surgery, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Kurt G Davis
- General Surgery, Louisiana State University, Health Sciences Center, New Orleans, Louisiana
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Tucker C, Choby B, Moore A, Parker RS, Zambetti BR, Naids S, Scott J, Loome J, Gaffney S, Cianciolo AT, Hoffman LA, Kohn JR, O'Sullivan PS, Trowbridge RL. Teachers as Learners: Developing Professionalism Feedback Skills via Observed Structured Teaching Encounters. TEACHING AND LEARNING IN MEDICINE 2017; 29:373-377. [PMID: 29020524 DOI: 10.1080/10401334.2017.1365001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This Conversations Starter article presents a selected research abstract from the 2017 Association of American Medical Colleges Southern Region Group on Educational Affairs annual spring meeting. The abstract is paired with the integrative commentary of 4 experts who shared their thoughts stimulated by the study. These thoughts explore the value of the Observed Structured Teaching Encounter in providing structured opportunities for medical students to engage with the complexities of providing peer feedback on professionalism.
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Affiliation(s)
- Constance Tucker
- a Office of the Provost , Oregon Health & Science University , Portland , Oregon , USA
| | - Beth Choby
- b Department of Medical Education , University of Tennessee Health Sciences Center , Memphis , Tennessee , USA
| | - Andrew Moore
- c Graduate Medical Education , University of Tennessee ; Memphis , Tennessee , USA
| | - Robert Scott Parker
- d University of Tennessee College of Medicine , Chattanooga , Tennessee , USA
| | - Benjamin R Zambetti
- e Department of Cardiovascular Surgery , University of Tennessee Health Science Center , Memphis , Tennessee , USA
| | - Sarah Naids
- c Graduate Medical Education , University of Tennessee ; Memphis , Tennessee , USA
| | - Jillian Scott
- f Department of Surgery , University of Tennessee College of Medicine , Chattanooga , Tennessee , USA
| | - Jennifer Loome
- c Graduate Medical Education , University of Tennessee ; Memphis , Tennessee , USA
| | - Sierra Gaffney
- g Department of Health Policy and Management , Emory University , Atlanta , Georgia , USA
| | - Anna T Cianciolo
- h Department of Medical Education , Southern Illinois University School of Medicine , Springfield , Illinois , USA
| | - Leslie A Hoffman
- i Department of Anatomy and Cell Biology , Indiana University School of Medicine , Fort Wayne , Indiana , USA
| | - Jaden R Kohn
- j Baylor College of Medicine , Houston , Texas , USA
| | - Patricia S O'Sullivan
- k Office of Medical Education , University of California San Francisco , San Francisco , California , USA
| | - Robert L Trowbridge
- l Department of Medicine , Tufts University School of Medicine , Portland , Maine , USA
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Mak-van der Vossen M, van Mook W, van der Burgt S, Kors J, Ket JC, Croiset G, Kusurkar R. Descriptors for unprofessional behaviours of medical students: a systematic review and categorisation. BMC MEDICAL EDUCATION 2017; 17:164. [PMID: 28915870 PMCID: PMC5603020 DOI: 10.1186/s12909-017-0997-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 09/04/2017] [Indexed: 05/17/2023]
Abstract
BACKGROUND Developing professionalism is a core task in medical education. Unfortunately, it has remained difficult for educators to identify medical students' unprofessionalism, because, among other reasons, there are no commonly adopted descriptors that can be used to document students' unprofessional behaviour. This study aimed to generate an overview of descriptors for unprofessional behaviour based on research evidence of real-life unprofessional behaviours of medical students. METHODS A systematic review was conducted searching PubMed, Ebsco/ERIC, Ebsco/PsycINFO and Embase.com from inception to 2016. Articles were reviewed for admitted or witnessed unprofessional behaviours of undergraduate medical students. RESULTS The search yielded 11,963 different studies, 46 met all inclusion criteria. We found 205 different descriptions of unprofessional behaviours, which were coded into 30 different descriptors, and subsequently classified in four behavioural themes: failure to engage, dishonest behaviour, disrespectful behaviour, and poor self-awareness. CONCLUSIONS This overview provides a common language to describe medical students' unprofessional behaviour. The framework of descriptors is proposed as a tool for educators to denominate students' unprofessional behaviours. The found behaviours can have various causes, which should be explored in a discussion with the student about personal, interpersonal and/or institutional circumstances in which the behaviour occurred. Explicitly denominating unprofessional behaviour serves two goals: [i] creating a culture in which unprofessional behaviour is acknowledged, [ii] targeting students who need extra guidance. Both are important to avoid unprofessional behaviour among future doctors.
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Affiliation(s)
- Marianne Mak-van der Vossen
- Department of Research in Education, VUmc School of Medical Sciences, Amsterdam, the Netherlands
- LEARN! Research Institute for Education and Learning, VU University, Amsterdam, the Netherlands
- Department for General Practice and Elderly Care Management, VU Medical Center, Amsterdam, the Netherlands
| | - Walther van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Medical Education Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Stéphanie van der Burgt
- Department of Research in Education, VUmc School of Medical Sciences, Amsterdam, the Netherlands
- LEARN! Research Institute for Education and Learning, VU University, Amsterdam, the Netherlands
| | - Joyce Kors
- AVAG Midwifery Academy Amsterdam Groningen, Amsterdam, the Netherlands
| | - Johannes C.F. Ket
- Medical Library, University Library, Vrije Universiteit, Amsterdam, the Netherlands
| | - Gerda Croiset
- Department of Research in Education, VUmc School of Medical Sciences, Amsterdam, the Netherlands
- LEARN! Research Institute for Education and Learning, VU University, Amsterdam, the Netherlands
| | - Rashmi Kusurkar
- Department of Research in Education, VUmc School of Medical Sciences, Amsterdam, the Netherlands
- LEARN! Research Institute for Education and Learning, VU University, Amsterdam, the Netherlands
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Kohn JR, Armstrong JM, Taylor RA, Whitney DL, Gill AC. Student-derived solutions to address barriers hindering reports of unprofessional behaviour. MEDICAL EDUCATION 2017; 51:708-717. [PMID: 28418106 PMCID: PMC5605389 DOI: 10.1111/medu.13271] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 11/07/2016] [Accepted: 12/29/2016] [Indexed: 05/28/2023]
Abstract
BACKGROUND Barriers hinder medical students from reporting breaches in professional behaviour, which can adversely impact institutional culture. No studies have reported student perspectives on how to address these barriers successfully. Our study (i) evaluated the likelihood of reporting based on violation severity, (ii) assessed barriers to reporting and (iii) elicited students' proposed solutions. METHODS Four medical students designed a cross-sectional study in 2015. In response to seven scenarios, students rated the likelihood of reporting the violation, indicated perceived barriers and identified solutions. Additional questions investigated the perceived importance of professionalism, confidence in understanding professionalism and trust in administrative protection from negative consequences. RESULTS Two hundred and seventy-two students in their clinical years (MS2-4) responded to the survey (RR = 50%). Students were 70-90% likely to report major violations, but < 30% likely to report minor or moderate violations. Barriers included concerns about an uncomfortable relationship (41%), potential negative repercussions on grades or opportunities (23%), and addressing by direct discussion rather than reporting (23%). Solutions included simplified reporting, control over report release date, improved feedback to reporters, training for real-time resolution of concerns and a neutral resource to help students triage concerns. No differences existed between classes regarding the importance or understanding of professionalism. In linear regression, only importance of professionalism predicted likelihood of reporting and this did not change with training. CONCLUSIONS Hindered by common barriers, students are unlikely to report a violation unless it is a serious breach of professionalism. Student-derived solutions should be explored by medical school administrators to encourage reporting of violation of professionalism.
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Affiliation(s)
| | - Joseph M. Armstrong
- Department of Urology, University of Utah School of Medicine, Salt Lake City, UT
| | - Rachel A. Taylor
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA
| | - Diana L. Whitney
- Departments of Medicine and Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Anne C. Gill
- Department of Pediatrics and Center for Medical Ethics, Baylor College of Medicine, Houston, TX
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Mostaghimi A, Olszewski AE, Bell SK, Roberts DH, Crotty BH. Erosion of Digital Professionalism During Medical Students' Core Clinical Clerkships. JMIR MEDICAL EDUCATION 2017; 3:e9. [PMID: 28468745 PMCID: PMC5438450 DOI: 10.2196/mededu.6879] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 12/19/2016] [Accepted: 02/18/2017] [Indexed: 05/28/2023]
Abstract
BACKGROUND The increased use of social media, cloud computing, and mobile devices has led to the emergence of guidelines and novel teaching efforts to guide students toward the appropriate use of technology. Despite this, violations of professional conduct are common. OBJECTIVE We sought to explore professional behaviors specific to appropriate use of technology by looking at changes in third-year medical students' attitudes and behaviors at the beginning and conclusion of their clinical clerkships. METHODS After formal teaching about digital professionalism, we administered a survey to medical students that described 35 technology-related behaviors and queried students about professionalism of the behavior (on a 5-point Likert scale), observation of others engaging in the behavior (yes or no), as well as personal participation in the behavior (yes or no). Students were resurveyed at the end of the academic year. RESULTS Over the year, perceptions of what is considered acceptable behavior regarding privacy, data security, communications, and social media boundaries changed, despite formal teaching sessions to reinforce professional behavior. Furthermore, medical students who observed unprofessional behaviors were more likely to participate in such behaviors. CONCLUSIONS Although technology is a useful tool to enhance teaching and learning, our results reflect an erosion of professionalism related to information security that occurred despite medical school and hospital-based teaching sessions to promote digital professionalism. True alteration of trainee behavior will require a cultural shift that includes continual education, better role models, and frequent reminders for faculty, house staff, students, and staff.
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Affiliation(s)
- Arash Mostaghimi
- Department of Dermatology, Brigham & Women's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Aleksandra E Olszewski
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, United States
| | - Sigall K Bell
- Harvard Medical School, Boston, MA, United States
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | | | - Bradley H Crotty
- Center for Patient Care and Outcomes Research, Health Systems Research Unit, Division of General Internal Medicine, Froedtert & Medical College of Wisconsin, Milwaukee, WI, United States
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24
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Didwania A, Farnan JM, Icayan L, O'Leary KJ, Saathoff M, Bellam S, Humphrey HJ, Wayne DB, Arora VM. Impact of a Video-Based Interactive Workshop on Unprofessional Behaviors Among Internal Medicine Residents. J Grad Med Educ 2017; 9:241-244. [PMID: 28439361 PMCID: PMC5398139 DOI: 10.4300/jgme-d-16-00289.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 08/24/2016] [Accepted: 11/13/2016] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Unprofessional behaviors undermine the hospital learning environment and the quality of patient care. OBJECTIVE To assess the impact of an interactive workshop on the perceptions of and self-reported participation in unprofessional behaviors. METHODS We conducted a pre-post survey study at 3 internal medicine residency programs. For the workshop we identified unprofessional behaviors related to on-call etiquette: "blocking" an admission, disparaging a colleague, and misrepresenting a test as urgent. Formal debriefing tools were utilized to guide the discussion. We fielded an internally developed 20-item survey on perception and participation in unprofessional behaviors prior to the workshop. An online "booster" quiz was delivered at 4 months postworkshop, and the 20-item survey was repeated at 9 months postworkshop. Results were compared to a previously published control from the same institutions, which showed that perceptions of unprofessional behavior did not change and participation in the behaviors worsened over the internship. RESULTS Of 237 eligible residents, 181 (76%) completed both pre- and postsurvey. Residents perceived blocking an admission and the misrepresentation of a test as urgent to be more unprofessional at a 9-month follow-up (2.0 versus 1.74 and 2.63 versus 2.28, respectively; P < .05), with no change in perception for disparaging a colleague. Participation in unprofessional behaviors did not decrease after the workshop, with the exception of misrepresenting a test as urgent (61% versus 50%, P = .019). CONCLUSIONS The results of this multi-site study indicate that an interactive workshop can change perception and may lower participation in some unprofessional behaviors.
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Franco RS, Franco CAG, Kusma SZ, Severo M, Ferreira MA. To participate or not participate in unprofessional behavior - Is that the question? MEDICAL TEACHER 2017; 39:212-219. [PMID: 28024438 DOI: 10.1080/0142159x.2017.1266316] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Medical education provides students with abundant learning opportunities, each of which is embodied with messages concerning what is expected from students. This paper analyses students? exposure to instances of unprofessional behavior, investigating whether they judge such behavior to be unprofessional and whether they also participate in unprofessional behavior. METHODS The survey developed in the Pritzker School of Medicine at the University of Chicago was the basis of this questionnaire that was answered by 276 students from two medical schools in Brazil and Portugal. RESULTS Unprofessional behavior was observed frequently by students in both universities, and the mean participation rates were similar (26% and 27%). Forty-five percent of students? participation in unprofessional behavior was explained by academic year, prior observation, and judgment. DISCUSSION The results indicate that once students have observed, participated in or misjudged unprofessional behavior, they tend to participate in and misjudge such behavior. The frequency with which students judged behaviors they had observed or participated in as ?borderline? or unprofessional could mean that they are experiencing moral distress. CONCLUSION Proper discussion of unprofessional behavior should foster a broad debate to encourage empowered students, faculties, and physicians to co-create a more professional environment for patient care.
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Affiliation(s)
- Renato Soleiman Franco
- a Medicine School, Pontifical Catholic University of Paraná , Curitiba , Brazil
- b Department of Medical Education and Simulation, Faculty of Medicine , University of Porto , Porto , Portugal
| | - Camila Ament Giuliani Franco
- a Medicine School, Pontifical Catholic University of Paraná , Curitiba , Brazil
- b Department of Medical Education and Simulation, Faculty of Medicine , University of Porto , Porto , Portugal
| | - Solena Ziemer Kusma
- a Medicine School, Pontifical Catholic University of Paraná , Curitiba , Brazil
| | - Milton Severo
- b Department of Medical Education and Simulation, Faculty of Medicine , University of Porto , Porto , Portugal
| | - Maria Amélia Ferreira
- b Department of Medical Education and Simulation, Faculty of Medicine , University of Porto , Porto , Portugal
- c Faculty of Medicine , University of Porto , Porto , Portugal
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Mak-van der Vossen MC, van Mook WNKA, Kors JM, van Wieringen WN, Peerdeman SM, Croiset G, Kusurkar RA. Distinguishing Three Unprofessional Behavior Profiles of Medical Students Using Latent Class Analysis. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:1276-83. [PMID: 27119326 DOI: 10.1097/acm.0000000000001206] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
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.
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Affiliation(s)
- Marianne C Mak-van der Vossen
- M.C. Mak-van der Vossen is a general practitioner, PhD student, Department of Research in Education, and coordinator of the educational theme "Professional behavior," VUmc School of Medical Sciences, Amsterdam, the Netherlands. W.N.K.A. van Mook is internist/intensivist, Department of Intensive Care Medicine, Maastricht University Medical Center, and associate professor, Medical Education, Maastricht University, Maastricht, the Netherlands. J.M. Kors is a midwife and medical educator, AVAG Midwifery Academy, Amsterdam Groningen, the Netherlands. W.N. van Wieringen is biostatistician, Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, the Netherlands. S.M. Peerdeman is neurosurgeon, VU University Medical Centre, and professor of professional development, VUmc School of Medical Sciences, Amsterdam, the Netherlands. G. Croiset is professor of medical education and director, VUmc School of Medical Sciences, Amsterdam, the Netherlands. R.A. Kusurkar is head, Department of Research in Education, VUmc School of Medical Sciences, Amsterdam, the Netherlands
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Tariq SG, Thrush CR, Gathright M, Spollen JJ, Graham J, Shorey JM. Crystal clear or tin ear: how do medical students interpret derogatory comments about patients and other professionals? MEDICAL EDUCATION ONLINE 2016; 21:31221. [PMID: 27422126 PMCID: PMC4947194 DOI: 10.3402/meo.v21.31221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 06/10/2016] [Accepted: 06/13/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE To assess the learning environment at our medical school, third-year medical students complete an 11-item survey called the Learning Environment for Professionalism (LEP) at the end of each clerkship. The LEP survey asks about the frequency of faculty and resident professional and unprofessional behaviors that students observed; two of the items specifically address derogatory comments. This study used focus group methodology to explore how medical students interpret the derogatory comments they reported on the LEP survey. METHODS Seven focus groups were conducted with 82 medical students after they completed the LEP survey. Analysis of focus group transcripts was performed to better understand the nature and meaning that students ascribe to derogatory comments. RESULTS The study results provide insights into the types of derogatory comments that medical students heard during their clerkship rotations, why the comments were made and how they were interpreted. Emergent themes, labeled by the authors as 1) 'onstage-offstage', 2) 'one bad apple', and 3) 'pressure cooker environment', highlight the contextual aspects and understandings ascribed by students to the derogatory comments. Incidentally, students felt that the comments were not associated with fatigue, but were associated with cumulative stress and burn-out. CONCLUSIONS The results suggest students have a clear understanding of the nature of unprofessional comments made by role models during clerkships and point to important systems-related issues that could be leveraged to improve clinical learning environments.
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Affiliation(s)
- Sara G Tariq
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA;
| | - Carol R Thrush
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Molly Gathright
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - John J Spollen
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - James Graham
- Division of Academic Affairs, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeannette M Shorey
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Tagawa M. Effects of undergraduate medical students' individual attributes on perceptions of encounters with positive and negative role models. BMC MEDICAL EDUCATION 2016; 16:164. [PMID: 27334032 PMCID: PMC4918193 DOI: 10.1186/s12909-016-0686-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 06/14/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND The use of role models (RMs) is a successful educational strategy. In formal training and other settings during undergraduate education, students have the opportunity to recognize numerous traits and behaviors of their RMs, such as teaching skills, professionalism in the clinical setting, and personal qualities. Encountering both positive and negative RMs allows medical students to learn a variety of professional norms and values. This learning process is likely influenced by a student's developmental status, which itself is related to that student's personal attributes and experiences. The purpose of this study was to examine graduating medical students' perceptions of their RM encounters and their learning processes, and how these perceptions and processes are affected by their own personal attributes. METHODS Sixth-year medical students were asked to complete questionnaires in 2013 and 2014 regarding encounters with positive or negative RMs, in terms of patient relationships, clinical expertise, teaching ability, and other factors, during clinical training and other situations. Associations between gender, age, admission status, and recognition of self-achievement and joy of learning in relation to RM encounters were then analyzed. RESULTS Among 115 students (75 males, 40 females) who completed the questionnaires, 113 (98.3 %) and 85 (73.9 %) reported encountering positive and negative RMs, respectively. The majority of students reported encountering both positive and negative RMs in terms of relationships with patients, humanity, and teaching ability, and fewer negative RMs in terms of clinical expertise and contributions to the community. Older students, males, and those who had passed an entrance examination for bachelors reported encountering more negative RMs in terms of relationships with patients, humanity, and teaching ability than younger students, females, and general admission students. These results suggested an association between positive and negative RM encounters and recognition of self-achievement and joy of learning in formal clinical training. CONCLUSIONS Most medical students encountered both positive and negative RMs during undergraduate medical education. These findings suggest that encounters with not only positive, but also negative RMs might facilitate student learning. Therefore, personal development appears to affect student perception of RMs.
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Affiliation(s)
- Masami Tagawa
- Center for Innovation in Medical and Dental Education, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan.
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Hodges LE, Tak HJ, Curlin FA, Yoon JD. Whistle-blowing in Medical School: A National Survey on Peer Accountability and Professional Misconduct in Medical Students. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2016; 40:530-533. [PMID: 26319785 DOI: 10.1007/s40596-015-0405-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 07/27/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE This study examines medical students' attitudes towards peer accountability. METHODS A nationally representative sample of 564 third year medical students was surveyed. Students reported their agreement or disagreement with two statements: "I feel professionally obligated to report peers whose personal behaviors compromise their professional responsibilities" and "I feel professionally obligated to report peers who I believe are seriously unfit to practice medicine." RESULTS The majority of students (81.6 %) either agreed strongly or agreed somewhat that they feel obligated to report peers whose personal behaviors compromise their professional responsibilities. The majority (84.1 %) also agreed that they feel professionally obligated to report peers who they believe are seriously unfit to practice medicine. CONCLUSION In contrast with previous studies, this national study found that a significant majority of students reported that they feel obligated to report unfit peers.
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Affiliation(s)
| | - Hyo Jung Tak
- University of North Texas Health Science Center, Fort Worth, TX, USA
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30
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Fargen KM, Drolet BC, Philibert I. Unprofessional Behaviors Among Tomorrow's Physicians: Review of the Literature With a Focus on Risk Factors, Temporal Trends, and Future Directions. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:858-64. [PMID: 26910897 DOI: 10.1097/acm.0000000000001133] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE Recent reports have identified concerning patterns of unprofessional and dishonest behavior by physician trainees. Despite this publicity, the prevalence and impact of these behaviors is not well described; thus, the authors aimed to review and analyze the various studies on unprofessional behavior among U.S. medical trainees. METHOD The authors performed a literature review. They sought all reports on unprofessional and dishonest behavior among U.S. medical school students or resident physicians published in English and indexed in PubMed between January 1980 and May 2014. RESULTS A total of 51 publications met criteria for inclusion in the study. The data in these reports suggest that plagiarism, cheating on examinations, and listing fraudulent publications on residency/fellowship applications were reported in 5% to 15% of the student and resident populations that were studied. Other behaviors, such as inaccurately reporting that a medical examination was performed on a patient or falsifying duty hours, appear to be even more common (reportedly occurring among 40% to 50% of students and residents). CONCLUSIONS "Unprofessional behavior" lacks a unified definition. The data on the prevalence of unprofessional behavior in medical students and residents are limited. Unprofessional behaviors are common and appear to be occurring in various demographic groups within the medical trainee population. The relationship between unprofessional behaviors in training and future disciplinary action is poorly understood. Going forward, defining "unprofessional behavior"; developing validated instruments to evaluate such behaviors scientifically; and studying their incidence, motivations, and consequences are critical.
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Affiliation(s)
- Kyle M Fargen
- K.M. Fargen is assistant professor, Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina. B.C. Drolet is fellow of hand and upper extremity surgery, Department of Plastic Surgery, Johns Hopkins University, Baltimore, Maryland. I. Philibert is senior vice president of field activities, Accreditation Council for Graduate Medical Education, Chicago, Illinois
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Randall V, Matthews P, Garcia K, Warwick A, Pock A, Crouch G. Attitudes toward professionalism maintained after curriculum reform. EDUCATION FOR PRIMARY CARE 2016; 27:81-2. [DOI: 10.1080/14739879.2015.1133076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Virginia Randall
- Uniformed Services University of the Health Sciences, Bethesda, USA
| | | | - Kara Garcia
- Walter Reed Military Medical Center, Bethesda, USA
| | - Anne Warwick
- Uniformed Services University of the Health Sciences, Bethesda, USA
| | - Arnyce Pock
- Uniformed Services University of the Health Sciences, Bethesda, USA
| | - Gary Crouch
- Uniformed Services University of the Health Sciences, Bethesda, USA
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Hendelman W, Byszewski A. Formation of medical student professional identity: categorizing lapses of professionalism, and the learning environment. BMC MEDICAL EDUCATION 2014; 14:139. [PMID: 25004924 PMCID: PMC4102062 DOI: 10.1186/1472-6920-14-139] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 07/03/2014] [Indexed: 05/13/2023]
Abstract
BACKGROUND Acquiring the values of medical professionalism has become a critical issue in medical education. The purpose of this study was to identify lapses in professionalism witnessed by medical students during their four year MD curriculum, and to categorize, from the students' perspective, who was responsible and the settings in which these occurred. METHODS An electronic survey, developed by faculty and medical students, was sent to all students with two email reminders. It included quantitative responses and some open-ended opportunities for comments. All analyses were performed with SAS version 9.1. RESULTS The response rate was 45.6% (255 of 559 students) for all four years of the medical school curriculum. Thirty six percent of students had witnessed or been part of an exemplary demonstration of professionalism; 64% responded that they had witnessed a lapse of professionalism. At the pre-clerkship level, the most frequent lapses involved students: arrogance (42.2%), impairment (24.2%), followed by cultural or religious insensitivity (20.5%). At the clerkship level of training, where students are exposed to real clinical situations, the lapses involved primarily faculty (including preceptor and clinician) or other staff; these included arrogance (55.3%), breach of confidentiality (28.3%), and cultural or religious insensitivity (26.6%); impairment involved mostly students (25.5%). These findings are analyzed from the perspective of role modeling by faculty and in the context of the learning environment. CONCLUSIONS Medical students witnessed a lapse of professionalism involving both fellow students as well as faculty and administrative staff, in several domains. Results from this study emphasize the importance of role modeling and the need for faculty development, to improve the learning environment. This study adds to the limited emerging literature on the forces that influence medical student professional identity formation.
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Affiliation(s)
- Walter Hendelman
- Department of Cellular & Molecular Medicine, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada
| | - Anna Byszewski
- Professor of Medicine, Director of Professionalism, undergraduate curriculum, Faculty of Medicine, University of Ottawa, Division of Geriatrics, The Ottawa Hospital, Affiliate Investigator, Ottawa Hospital Research Institute (OHRI), Ottawa, Canada
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Arora VM, Berhie S, Horwitz LI, Saathoff M, Staisiunas P, Farnan JM. Using standardized videos to validate a measure of handoff quality: the handoff mini-clinical examination exercise. J Hosp Med 2014; 9:441-6. [PMID: 24665068 PMCID: PMC4079746 DOI: 10.1002/jhm.2185] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 02/25/2014] [Accepted: 02/28/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND The most recent iteration of the Accreditation Council for Graduate Medical Education duty-hour regulations includes language mandating handoff education for trainees and assessments of handoff quality by residency training programs. However, there is a lack of validated tools for the assessment of handoff quality and for use in trainee education. METHODS Faculty at 2 sites (University of Chicago and Yale University) were recruited to participate in a workshop on handoff education. Video-based scenarios were developed to represent varying levels of performance in the domains of communication, professionalism, and setting. Videos were shown in a random order, and faculty were instructed to use the Handoff Mini-Clinical Examination Exercise (CEX), a paper-based instrument with qualitative anchors defining each level of performance, to rate the handoffs. RESULTS Forty-seven faculty members (14 at site 1; 33 at site 2) participated in the validation workshops, providing a total of 172 observations (of a possible 191 [96%]). Reliability testing revealed a Cronbach α of 0.81 and Kendall coefficient of concordance of 0.59 (>0.6 = high reliability). Faculty were able to reliably distinguish the different levels of performance in each domain in a statistically significant fashion (ie, unsatisfactory professionalism mean 2.42 vs satisfactory professionalism 4.81 vs superior professionalism 6.01, P < 0.001 trend test). Two-way analysis of variance revealed no evidence of rater bias. CONCLUSIONS Using standardized video-based scenarios highlighting differing levels of performance, we were able to demonstrate evidence that the Handoff Mini-CEX can draw reliable and valid conclusions regarding handoff performance. Future work to validate the tool in clinical settings is warranted.
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Affiliation(s)
- Vineet M Arora
- Department of Medicine, University of Chicago, Chicago, Illinois; Pritzker School of Medicine, University of Chicago, Chicago, Illinois
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Mileder LP, Schmidt A, Dimai HP. Clinicians should be aware of their responsibilities as role models: a case report on the impact of poor role modeling. MEDICAL EDUCATION ONLINE 2014; 19:23479. [PMID: 24499869 PMCID: PMC3916672 DOI: 10.3402/meo.v19.23479] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Revised: 01/05/2014] [Accepted: 01/09/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Role modeling is an important and valuable educational method. It is predominant throughout (under-)graduate medical education, and attributes of exemplary medical role models are manifold. AIM This article describes the impact of poor role modeling on medical students' professional and personal development on the basis of a singular incident at an associated teaching hospital. In addition, scientific literature studying the effect of and the reasons behind poor role modeling in undergraduate and graduate medical education is analyzed and discussed. RESULTS To maximize the educational potential of clinical role modeling, medical schools have to consider strategies both on the individual as well as on the institutional level. Several suggestions are offered on both levels. DISCUSSION/CONCLUSION Based on a case report of significantly poor role modeling, this article outlines strategies through which academic medical institutions may maximize the educational potential of role modeling and lastingly enhance teaching proficiency of clinical faculty.
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Affiliation(s)
- Lukas P Mileder
- Clinical Skills Center, Medical University of Graz, Graz, Austria;
| | - Albrecht Schmidt
- Clinical Skills Center, Medical University of Graz, Graz, Austria; Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Hans P Dimai
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria; Vice-Rectorate for Teaching and Studies, Medical University of Graz, Graz, Austria
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Birden HH, Usherwood T. "They liked it if you said you cried": how medical students perceive the teaching of professionalism. Med J Aust 2013; 199:406-9. [PMID: 24033214 DOI: 10.5694/mja12.11827] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 05/07/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To discover what Australian medical students think about the way professionalism is taught in their medical curriculum. DESIGN, PARTICIPANTS AND SETTING Qualitative study including five focus groups between 2 June 2010 and 30 September 2010, comprised of medical students from both undergraduate and postgraduate entry programs who were in the last 1-2 years of the medical program and had undertaken rural longitudinal integrated clinical placements. RESULTS The five focus groups ran for a total of 5.5 hours. Participants (16 women and 24 men; mean age, 26 years [range 23-32 years]) expressed a low regard for the ways in which professionalism had been taught and assessed in their learning programs. They "gamed the system", giving assessors the results on reflective writing assignments that they believed would gain them a pass. They considered experiential learning - observing good professional practice - to be the best way (some view it as the only way) to learn professionalism and consolidate what they learned, and formed their individual mental model of professionalism through group reflection with their peers in medical school. CONCLUSIONS While students will always be critical of their curriculum, the universal negative views we captured indicate that current teaching would benefit from review. We suggest a less didactic approach in early years, with more evaluation and feedback from students to assure relevance; an emphasis on true reflection, as opposed to guided reflections linked to overformalised requirements; and more attention devoted to role-modelling and mentoring in the clinical years of training.
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Affiliation(s)
- Hudson H Birden
- University Centre for Rural Health, North Coast, Lismore, NSW, Australia.
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Kulac E, Sezik M, Asci H, Doguc DK. Medical students' participation in and perception of unprofessional behaviors: comparison of preclinical and clinical phases. ADVANCES IN PHYSIOLOGY EDUCATION 2013; 37:298-302. [PMID: 24292905 DOI: 10.1152/advan.00076.2013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We aimed to compare reported observations, participation in, and perceptions of unprofessional behaviors across preclinical and clinical medical students using a 23-item questionnaire that asked participants whether they witnessed or participated in the behavior and considered it unprofessional. Overall, 111 preclinical (year 3) and 104 clinical (year 4) students responded. For all of the behaviors, significant positive correlations were present between participation and affirmative perceptions. Participation rates for several unprofessional behaviors (14 of 23 items) were higher in the clinical phase. Clinical students more frequently perceived unprofessional behaviors as appropriate (17 of 23 items) compared with preclinical students. In conclusion, both preclinical and clinical medical students in our setting commonly witness unprofessional behaviors. Clinical students participate in and tend to rationalize these behaviors more frequently than preclinical students do.
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Affiliation(s)
- Esin Kulac
- Department of Medical Education and Informatics, Suleyman Demirel University School of Medicine, Isparta, Turkey
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Morihara SK, Jackson DS, Chun MBJ. Making the professionalism curriculum for undergraduate medical education more relevant. MEDICAL TEACHER 2013; 35:908-14. [PMID: 23931736 DOI: 10.3109/0142159x.2013.820273] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND This study was an assessment of the professionalism curriculum at a community-based medical school from the perspective of undergraduate medical students. AIMS The goal of this study was to ascertain the perspectives of faculty and students on their interpretations of professionalism and its role in medical education to improve and expand existing professionalism curricula. METHOD An online survey was created and sent to all students (n = 245) and selected faculty (n = 41). The survey utilized multiple choice and open-ended questions to allow responders to provide their insights on the definition of professionalism and detail how professionalism is taught and evaluated at their institution. A content analysis was conducted to categorize open-ended responses and the resulting themes were further examined using SPSS 20.0 for Windows (IBM Corp., Armonk, NY) frequency analyses. RESULTS Students and faculty respondents were similar in their definitions of medical professionalism and their perceptions of teaching methods. Role modeling was the most common and preferred method of professionalism education. Responses to whether evaluations of professional behavior were effective suggested both students and faculty are unclear about current professionalism assessments. CONCLUSION This study showed that a cohesive standardized definition of professionalism is needed, as well as clearer guidelines on how professionalism is assessed.
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Michalec B, Hafferty FW. Stunting professionalism: The potency and durability of the hidden curriculum within medical education. SOCIAL THEORY & HEALTH 2013. [DOI: 10.1057/sth.2013.6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Stratton TD, Conigliaro RL. Does gender moderate medical students' assessments of unprofessional behavior? J Gen Intern Med 2012; 27:1643-8. [PMID: 22829292 PMCID: PMC3509307 DOI: 10.1007/s11606-012-2152-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 03/14/2012] [Accepted: 06/18/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Despite widespread acceptance of professionalism as a clinical competency, the role of certain contextual factors in assessing certain behaviors remains unknown. OBJECTIVE To examine the potential moderating role of gender in assessing unprofessional behaviors during undergraduate medical training. DESIGN Randomized, anonymous, self-administered questionnaire. PARTICIPANTS Ninety seven (97) third-year students from a southeastern U.S. medical school (participation rate=95.1 %). MAIN MEASURES Using a 4-point Likert-type scale, subjects reviewed two subsets of randomly administered, equally weighted hypothetical vignettes depicting potentially unprofessional behaviors that could occur during medical students' clinical training. Ratings were categorized from 1 -"Not a Problem" to 4 -"A Severe Problem", based on the perceived degree of unprofessionalism. In each written scenario, trainee gender was systematically varied. KEY RESULTS Across all scenario subsets, male and female students' mean ratings of hypothetical behaviors did not differ significantly. Further, male and female students tended, on average, to rate behaviors similarly regardless of the trainee's gender. CONCLUSION Study findings suggest that: (1) neither students' gender nor that of the hypothetical "actor" moderates the assessment of unprofessional behaviors; and (2) male and female students assign roughly the same overall rankings to potentially unprofessional behaviors.
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Affiliation(s)
- Terry D Stratton
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY 40506-9983, USA.
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Reddy ST, Iwaz JA, Didwania AK, O'Leary KJ, Anderson RA, Humphrey HJ, Farnan JM, Wayne DB, Arora VM. Participation in unprofessional behaviors among hospitalists: a multicenter study. J Hosp Med 2012; 7:543-50. [PMID: 22592971 DOI: 10.1002/jhm.1946] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 03/26/2012] [Accepted: 03/31/2012] [Indexed: 11/06/2022]
Abstract
BACKGROUND Unprofessional behaviors undermine the hospital learning environment and quality of patient care. OBJECTIVE To quantify perceptions of, and participation in, unprofessional behaviors among hospitalists. DESIGN Observational survey study. SETTING Three academic health centers. SUBJECTS Hospitalists. MEASUREMENTS Observation, participation in, and perceptions of unprofessional behaviors. RESULTS Response rate was 76% (77/101). Nearly all behaviors were perceived as unprofessional ("unprofessional" or "somewhat unprofessional" on the Likert scale). Participation in egregious behaviors (ie, falsifying records) was low (<5%). The most frequent behaviors reported were having personal conversations in patient corridors (67.1%), ordering a test as "urgent" to expedite care (62.3%), and making fun of other physicians (40.3%). Four factors accounted for 76% of survey variance: (1) making fun of others; (2) learning environment (eg, texting during conferences); (3) workload management (eg, celebrating a blocked-admission); and (4) time pressure (eg, signing out work early). Hospitalists with less clinical time (<50% full-time equivalents [FTE]) were more likely to report making fun of others (β = 0.94 [95% CI 0.32-1.56], P = 0.004). Younger hospitalists (β = 0.87 [95% CI 0.07-1.67], P = 0.034) and those with administrative time (β = 0.61 [95% CI 0.11-1.10], P = 0.017) were more likely to report participating in workload management behaviors. Hospitalists who work night shifts were more likely to report participating in time-pressure behaviors (β = 0.67 [95% CI 0.17-1.17], P = 0.010). Workload management and learning environment varied by site. CONCLUSION While hospitalist participation in unprofessional behaviors is low, job characteristics (clinical, administrative, nights), age, and site were associated with different types of unprofessional behavior that may affect the learning environment and patient care.
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Affiliation(s)
- Shalini T Reddy
- Department of Medicine, The University of Chicago, Chicago, IL 60637, USA
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Rogers DA, Boehler ML, Roberts NK, Johnson V. Using the hidden curriculum to teach professionalism during the surgery clerkship. JOURNAL OF SURGICAL EDUCATION 2012; 69:423-7. [PMID: 22483148 DOI: 10.1016/j.jsurg.2011.09.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 09/20/2011] [Indexed: 05/09/2023]
Abstract
BACKGROUND It has been shown that medical student professionalism is influenced by the hidden curriculum, although the extent to which this occurs during the surgery clerkship is unknown. Furthermore, the processes within the hidden curriculum have been used to teach professionalism to medical students, but this strategy has not been used during the surgery clerkship. The purpose of this study was to review a 2-year experience with a surgery clerkship instructional session where the hidden curriculum was used to teach professionalism to medical students. STUDY DESIGN Medical student essays were analyzed to evaluate the influence of the hidden curriculum on their ideas about professionalism and to identify specific behaviors that they regarded as professional and unprofessional. The instructional session was evaluated using the average satisfaction session ratings and through an analysis of medical student session evaluation comments. RESULTS Seventy-five percent of medical students reported that their ideas about professionalism changed. This change involved their general concepts about professionalism, identifying specific behaviors that they planned to adopt or avoid, or developing opinions about the professionalism of surgeons. The average satisfaction rating was consistently high throughout the study period, and the most helpful session feature was reported as the opportunity to share and discuss their observations. CONCLUSIONS The hidden curriculum has a substantial influence on the development of professionalism of medical students during the surgery clerkship. It was possible to illuminate and use the hidden curriculum to create an instructional session devoted to professionalism for medical students on the surgery clerkship.
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Affiliation(s)
- David A Rogers
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA.
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Guedert JM, Grosseman S. Ethical problems in pediatrics: what does the setting of care and education show us? BMC Med Ethics 2012; 13:2. [PMID: 22424271 PMCID: PMC3317842 DOI: 10.1186/1472-6939-13-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 03/16/2012] [Indexed: 12/01/2022] Open
Abstract
Background Pediatrics ethics education should enhance medical students' skills to deal with ethical problems that may arise in the different settings of care. This study aimed to analyze the ethical problems experienced by physicians who have medical education and pediatric care responsibilities, and if those problems are associated to their workplace, medical specialty and area of clinical practice. Methods A self-applied semi-structured questionnaire was answered by 88 physicians with teaching and pediatric care responsibilities. Content analysis was performed to analyze the qualitative data. Poisson regression was used to explore the association of the categories of ethical problems reported with workplace and professional specialty and activity. Results 210 ethical problems were reported, grouped into five areas: physician-patient relationship, end-of-life care, health professional conducts, socioeconomic issues and health policies, and pediatric teaching. Doctors who worked in hospitals as well as general and subspecialist pediatricians reported fewer ethical problems related to socioeconomic issues and health policies than those who worked in Basic Health Units and who were family doctors. Conclusions Some ethical problems are specific to certain settings: those related to end-of-life care are more frequent in the hospital settings and those associated with socioeconomic issues and public health policies are more frequent in Basic Health Units. Other problems are present in all the setting of pediatric care and learning and include ethical problems related to physician-patient relationship, health professional conducts and the pediatric education process. These findings should be taken into consideration when planning the teaching of ethics in pediatrics. Trial registration This research article didn't reports the results of a controlled health care intervention. The study project was approved by the Institutional Ethical Review Committee (Report CEP-HIJG 032/2008).
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Affiliation(s)
- Jucélia Maria Guedert
- Postgraduate Program in Medical Sciences, Federal University of Santa Catarina, Florianópolis, Brazil.
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Billings ME, Lazarus ME, Wenrich M, Curtis JR, Engelberg RA. The effect of the hidden curriculum on resident burnout and cynicism. J Grad Med Educ 2011. [PMID: 23205199 PMCID: PMC3244316 DOI: 10.4300/jgme-d-11-00044.1] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Residents learn and participate in care within hospital cultures that 5 tolerate unprofessional conduct and cynical attitudes, labeled the "hidden curriculum." We hypothesized that this hidden curriculum 5 have deleterious effects on residents' professional development and investigated whether witnessing unprofessional behavior during residency was associated with burnout and cynicism. METHODS We surveyed internal medicine residents at 2 academic centers for 3 years (2008-2010). Hidden curriculum items assessed exposure to unprofessional conduct. We used regression analyses to examine if hidden curriculum scores were associated with cynicism and the Maslach Burnout Inventory depersonalization and emotional exhaustion domain scores. RESULTS The response rate was 48% (337 of 708). In the 284 surveys analyzed, 45% of respondents met burnout criteria and had significantly higher hidden curriculum scores (26 versus 19, P < .001) than those not meeting criteria. In cross-sectional analyses, the hidden curriculum score was significantly associated with residents' depersonalization, emotional exhaustion, and cynicism scores. Cynicism scores were also associated with burnout. CONCLUSIONS Exposure to unprofessional conduct was associated with higher burnout and cynicism scores among internal medicine residents. We also found that cynicism and burnout were significantly associated and 5 be measures of similar but not necessarily identical responses to the challenges posed by residency. Measuring the hidden curriculum and cynicism 5 provide direction for educators attempting to reform hospital culture and improve resident well-being.
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Santen SA, Hemphill RR. A Window on Professionalism in the Emergency Department Through Medical Student Narratives. Ann Emerg Med 2011; 58:288-94. [DOI: 10.1016/j.annemergmed.2011.04.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Revised: 03/28/2011] [Accepted: 04/04/2011] [Indexed: 10/18/2022]
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Curry SE, Cortland CI, Graham MJ. Role-modelling in the operating room: medical student observations of exemplary behaviour. MEDICAL EDUCATION 2011; 45:946-57. [PMID: 21848723 DOI: 10.1111/j.1365-2923.2011.04014.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
CONTEXT Training future doctors to develop an appropriate professional persona is an important goal of medical student education and residency training. Most medical education research paradigms on professionalism have focused largely on lapses (e.g. yelling as an example of communication failure) and tend to emphasise behaviour that should be avoided. The assumption is that, if left unchecked, students will see these negative behaviours exhibited by their role models and possibly emulate them, allowing the potential reinforcement of the inappropriate behaviours. OBJECTIVES Identifying and characterising exemplary, or positive, behaviours can be similarly valuable to both medical students and residents as tangible examples of behaviours to strive towards. The goal of the present research was to determine and thematically define the exemplary professional actions that medical students observe in the intense and patient-focused environment of the operating room (OR). METHODS Using qualitative methodology of content analysis and theme identification, we systematically documented the type of exemplary professional behaviours reported by medical students (n=263) when observing health care teams on an anaesthesia rotation in the OR. RESULTS The analysis generated a taxonomy of exemplary OR behaviour that included six overarching themes (e.g. teamwork), 15 sub-themes (e.g. collegial) and numerous exemplars (e.g. showed mutual respect). These themes and sub-themes were then conceptually 'matched'--through the use of antonyms --to complement an existing framework focused on medical student reports of professional lapses witnessed during medical school. CONCLUSIONS Year 3 medical students in the USA reported observing very positive, exemplary health care provider interactions that were diverse in focus. Themes were identified regarding the OR team members' interactions with patients (calm, communication, comforting), with one another (teamwork, respect) and with the medical students (teaching). This classification of exemplary OR behaviour contributes to our understanding of how professional behaviour is viewed and potentially emulated by medical students on surgical rotations.
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Affiliation(s)
- Saundra E Curry
- Department of Anesthesia, Faculty of Columbia University, College of Physicians and Surgeons, Columbia University Medical Center, 622 West168th Street, New York, NY 10032,
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Bernard AW, Malone M, Kman NE, Caterino JM, Khandelwal S. Medical student professionalism narratives: a thematic analysis and interdisciplinary comparative investigation. BMC Emerg Med 2011; 11:11. [PMID: 21838887 PMCID: PMC3166891 DOI: 10.1186/1471-227x-11-11] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 08/12/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Professionalism development is influenced by the informal and hidden curriculum. The primary objective of this study was to better understand this experiential learning in the setting of the Emergency Department (ED). Secondarily, the study aimed to explore differences in the informal curriculum between Emergency Medicine (EM) and Internal Medicine (IM) clerkships. METHODS A thematic analysis was conducted on 377 professionalism narratives from medical students completing a required EM clerkship from July 2008 through May 2010. The narratives were analyzed using established thematic categories from prior research as well as basic descriptive characteristics. Chi-square analysis was used to compare the frequency of thematic categories to prior research in IM. Finally, emerging themes not fully appreciated in the established thematic categories were created using grounded theory. RESULTS Observations involving interactions between attending physician and patient were most abundant. The narratives were coded as positive 198 times, negative 128 times, and hybrid 37 times. The two most abundant narrative themes involved manifesting respect (36.9%) and spending time (23.7%). Both of these themes were statistically more likely to be noted by students on EM clerkships compared to IM clerkships. Finally, one new theme regarding cynicism emerged during analysis. CONCLUSIONS This analysis describes an informal curriculum that is diverse in themes. Student narratives suggest their clinical experiences to be influential on professionalism development. Medical students focus on different aspects of professionalism depending on clerkship specialty.
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Affiliation(s)
- Aaron W Bernard
- The Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus OH, USA.
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Brokaw JJ, Torbeck LJ, Bell MA, Deal DW. Impact of a competency-based curriculum on medical student advancement: a ten-year analysis. TEACHING AND LEARNING IN MEDICINE 2011; 23:207-214. [PMID: 21745054 DOI: 10.1080/10401334.2011.586910] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND In 1999, the Indiana University School of Medicine implemented a new curriculum based on the attainment of core competencies beyond medical knowledge. PURPOSE The objective was to document how the Student Promotions Committee (SPC) has adjudicated students' competency-related deficiencies over the past decade. METHODS Using SPC records, the authors determined the frequency of competency-related deficiencies reported to the SPC over time, the nature of those deficiencies, and how the deficiencies were remediated. For the purposes of this study, traditional knowledge-related deficiencies like course failures were excluded from analysis. RESULTS From 1999 to 2009, 191 students (138 male, 53 female) were referred to the SPC for competency-related deficiencies in 8 performance domains involving communication, basic clinical skills, lifelong learning, self-awareness, social context, ethics, problem solving, and professionalism. By comparison, 1,090 students were referred to the SPC for knowledge-related deficiencies during this time. Collectively, the 191 students were cited for 317 separate competency-related deficiencies (M ± SD = 1.7 ± 1.3; range = 1-10). Of these 317 deficiencies, the most prevalent were in the competencies of professionalism (29.3%), basic clinical skills (28.4%), and self-awareness (17.7%). Each of the remaining competencies constituted less than 10% of the total. Successful remediation utilized 12 methods ranging from a simple warning letter to repeating the year under close monitoring. Remediation was unsuccessful for 17 students (8.9%) who were dismissed from medical school primarily due to unprofessional behaviors and poor self-awareness. CONCLUSIONS Competency-related deficiencies can be identified and remediated in most cases, but deficiencies in professionalism and self-awareness are especially challenging.
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Affiliation(s)
- James J Brokaw
- Admissions and Medical Student Affairs, Indiana University School of Medicine, 635 Barnhill Drive, Indianapolis, IN 46202, USA.
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Ginsburg S, Lingard L. 'Is that normal?' Pre-clerkship students' approaches to professional dilemmas. MEDICAL EDUCATION 2011; 45:362-371. [PMID: 21401684 DOI: 10.1111/j.1365-2923.2010.03903.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Context has been recognised as a key variable in studies of medical student professionalism, yet the effect of students' stage of training has not been well explored, despite growing recognition that medical students begin to form their professional ethos from their earliest medical school experiences. The purpose of this study, which builds on previous research involving clinical clerks, was to explore the decision-making processes of pre-clerkship medical students in the face of standardised professional dilemmas. METHODS Structured interviews were conducted with 30 pre-clerkship (Years 1 and 2) medical students at one institution. During the interviews, students were asked to respond to five videotaped scenarios, each of which depicted a student facing a professional dilemma. Transcripts were analysed using an existing theoretical framework based on a constructivist grounded theory approach. RESULTS Pre-clerkship students' approaches to professional dilemmas were largely similar to those of clerks, despite their limited clinical experience, with several notable exceptions. For example, reliance on instincts and emotions was not as pervasive, but concerns with systems-associated issues were more recurrent. These findings were explored in the context of theory on professional identity formation. CONCLUSIONS As the novice student constructs a professional identity, he or she may feel the need to take on the role of doctor and shed that of student, a process that involves the suppressing of emotions, but this may be misguided. Educators should be aware of these stages of identity formation and tailor their teaching and evaluation of professionalism accordingly.
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Affiliation(s)
- Shiphra Ginsburg
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Thrush CR, Spollen JJ, Tariq SG, Williams DK, Ii JMS. Evidence for validity of a survey to measure the learning environment for professionalism. MEDICAL TEACHER 2011; 33:e683-e688. [PMID: 22225451 DOI: 10.3109/0142159x.2011.611194] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND With the emphasis on professionalism in academic health settings, including recently added accreditation requirements for US medical schools, there is a need for a valid and feasible method to assess the learning environment for professionalism. AIM This article describes the development and investigation of the validity of a brief measure, the learning environment for professionalism (LEP) survey, designed to assess medical student perceptions of professionalism among residents and faculty during clinical rotations. METHOD Two successive cohorts of third-year medical students completed the 22-item LEP survey at the conclusion of clerkship rotations, providing a total of 902 responses for scale reliability and principal components factor analysis, as well as assessment of changes in scores over time and correlations with a related clerkship evaluation item. RESULTS The internal structure of the LEP survey was consistent with intended goals to assess both positive and negative professionalism behaviors. Acceptable internal consistency, sensitivity to change over time, and positive relationships between LEP scores and a concurrent measure of professionalism were observed. CONCLUSIONS Use of the instrument could help identify clinical learning environments for professionalism that represent either best practices or areas in need of improvement, assess the impact of professionalism initiatives, and help satisfy accreditation requirements.
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Affiliation(s)
- Carol R Thrush
- Educational Development, University of Arkansas for Medical Sciences, Little Rock 72205, USA.
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Baingana RK, Nakasujja N, Galukande M, Omona K, Mafigiri DK, Sewankambo NK. Learning health professionalism at Makerere University: an exploratory study amongst undergraduate students. BMC MEDICAL EDUCATION 2010; 10:76. [PMID: 21050457 PMCID: PMC2987936 DOI: 10.1186/1472-6920-10-76] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 11/04/2010] [Indexed: 05/10/2023]
Abstract
BACKGROUND Anecdotal evidence shows that unprofessional conduct is becoming a common occurrence amongst health workers in Uganda. The development of appropriate professional values, attitudes and behaviors is a continuum that starts when a student joins a health professional training institution and as such health professionals in training need to be exposed to the essence of professionalism. We sought to explore undergraduate health professions students' perceptions and experiences of learning professionalism as a preliminary step in addressing the problem of unprofessional conduct amongst health workers in Uganda. METHODS Eight focus group discussions were conducted with 49 first to fifth year health professions undergraduate students of the 2008/2009 academic year at Makerere University College of Health Sciences. The focus group discussions were recorded and transcribed, and were analyzed using content analysis with emergent coding. RESULTS The difference in the way first and fifth year students of Makerere University College of Health Sciences conceptualized professionalism was suggestive of the decline in attitude that occurs during medical education. The formal curriculum was described as being inadequate while the hidden and informal curricula were found to play a critical role in learning professionalism. Students identified role models as being essential to the development of professionalism and emphasized the need for appropriate role modeling. In our setting, resource constraints present an important, additional challenge to learning universal standards of health professionalism. Furthermore, students described practices that reflect the cultural concept of communalism, which conflicts with the universally accepted standard of individual medical confidentiality. The students questioned the universal applicability of internationally accepted standards of professionalism. CONCLUSIONS The findings call for a review of the formal professionalism curriculum at Makerere University College of Health Sciences to make it more comprehensive and to meet the needs expressed by the students. Role models need capacity building in professionalism as health professionals and as educators. In our setting, resource constraints present an additional challenge to learning universal standards of health professionalism. There is need for further research and discourse on education in health professionalism in the Sub-Saharan context of resource constraints and cultural challenges.
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Affiliation(s)
- Rhona K Baingana
- College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Noeline Nakasujja
- College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Moses Galukande
- College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Kenneth Omona
- Lira Regional Referral Hospital, P. O. Box 2, Lira, Uganda
| | - David K Mafigiri
- Faculty of Social Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda
| | - Nelson K Sewankambo
- College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
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