A Behavioral and Systems View of Professionalism

Lesser, Cara S.; Lucey, Catherine R.; Egener, Barry; Braddock, Clarence H.; Linas, Stuart L.; Levinson, Wendy

doi:10.1001/jama.2010.1864

Cited by 221 publications

(170 citation statements)

References 17 publications

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“…Lesser et al . suggest concrete avenues to promote individual and organizational behaviors that align with core values of respect, integrity, pursuit of excellence, and fairness [22]. As we propose to extend their framework to the educational realm, it may mitigate the confusion and uncertainty that medical students expressed in our study regarding what constitutes ‘mistreatment.’…”

Section: Discussionmentioning

confidence: 99%

Exploring medical students’ barriers to reporting mistreatment during clerkships: a qualitative study

Chung¹,

Thang²,

Vermillion³

et al. 2018

Medical Education Online

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Background: Despite widespread implementation of policies to address mistreatment, the proportion of medical students who experience mistreatment during clinical training is significantly higher than the proportion of students who report mistreatment. Understanding barriers to reporting mistreatment from students’ perspectives is needed before effective interventions can be implemented to improve the clinical learning environment.Objective: We explored medical students’ reasons for not reporting perceived mistreatment or abuse experienced during clinical clerkships at the David Geffen School of Medicine at UCLA (DGSOM).Design: This was a sequential two-phase qualitative study. In the first phase, we analyzed institutional survey responses to an open-ended questionnaire administered to the DGSOM graduating classes of 2013–2015 asking why students who experienced mistreatment did not seek help or report incidents. In the second phase, we conducted focus group interviews with third- and fourth-year medical students to explore their reasons for not reporting mistreatment. In total, 30 of 362 eligible students participated in five focus groups. On the whole, 63% of focus group participants felt they had experienced mistreatment, of which over half chose not to report to any member of the medical school administration. Transcripts were analyzed via inductive thematic analysis.Results: The following major themes emerged: fear of reprisal even in the setting of anonymity; perception that medical culture includes mistreatment; difficulty reporting more subtle forms of mistreatment; incident is not important enough to report; reporting process damages the student–teacher relationship; reporting process is too troublesome; and empathy with the source of mistreatment. Differing perceptions arose as students debated whether or not reporting was beneficial to the clinical learning environment.Conclusions: Multiple complex factors deeply rooted in the culture of medicine, along with negative connotations associated with reporting, prevent students from reporting incidents of mistreatment. Further research is needed to establish interventions that will help identify mistreatment and change the underlying culture.

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Section: Discussionmentioning

confidence: 99%

Exploring medical students’ barriers to reporting mistreatment during clerkships: a qualitative study

Chung¹,

Thang²,

Vermillion³

et al. 2018

Medical Education Online

View full text Add to dashboard Cite

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“…Such an approach emphasises that demonstrable operationalised capabilities across a number of domains are supported by foundations of knowledge, skills and attitudes (including personal qualities and attributes). Furthermore, the important focus on medical professionalism (Green et al 2010;Lesser et al 2010) has highlighted the role of these personal qualities in laying the foundations of such professionalism during medical school years. For example, the personal quality 'capacity for empathy' is likely to be a necessary component for the demonstration of effective communication skills with patients.…”

Section: Introductionmentioning

confidence: 99%

The desirable qualities of future doctors – A study of medical student perceptions

et al. 2013

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Background: There is a lack of consensus regarding the qualities possessed by the ideal doctor, and very limited research regarding the views of medical students on these qualities. Aims: To investigate the views of commencing medical students regarding the desirable qualities of doctors. Methods: A survey containing a set of proposed desirable qualities of doctors identified from the existing literature was completed by 158 first-year medical students. Results: The survey had a 75% response rate. Students rated the individual qualities of empathy, motivation to be a doctor, good verbal communication, ethically sound, integrity and honesty as the most important. A factor analysis identified six categories of qualities: methodical processing, cognitive capacity, people skills, generic work ethic, role certainty and warmth. Significant differences in factor scores were found across subgroups of students (international and domestic students, with and without prior tertiary studies) on the following factors: methodical processing, which was scored highest by domestic students with prior tertiary studies, cognitive capacity, which was scored highest by domestic students without prior tertiary studies and generic work ethic, which was scored highest by international students. Conclusions: Medical students identified a range of desirable personal qualities of a doctor which varied according to student characteristics, including their prior educational experience. Future research aiming to define such desirable qualities should include a broader range of stakeholders, including students at different training levels and institutions.

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“…Moreover, the static character of performance management systems negates the highly dynamic nature of performance within professional organizations (De Bruijn 2007, Teelken 2008. Similarly, professional processes are not driven primarily by the managerial objectives that characterize performance management systems, but rather by shared normative standards and cognitive beliefs about performance, on the basis of which professional autonomy is claimed (Frankel 1989, Freidson 2001, Evans and Harris 2004, Lesser, Lucey et al 2010, Vakkuri 2010. Thus, professional objectives and values may lead employees to respond to performance management systems in ways that conflict with the objectives set by the system managers Pandey 2010, May 2011).…”

Section: Conditions Triggering Perverse Effectsmentioning

confidence: 99%

Medical professionals’ responses to a DRG performance management system for hospital care in the Netherlands. Reinterpreting ‘perverse effects’, such as upcoding and patient selection, using arguments of professionalism and managerialism

2015

Bestuurskunde

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A Behavioral and Systems View of Professionalism

Abstract: Excellence is an art won by training and habituation. We do not act rightly because we have virtue or excellence but rather we have those because we have acted rightly. We are what we repeatedly do. Excellence then is not an act but a habit.

Cited by 221 publications

References 17 publications

Exploring medical students’ barriers to reporting mistreatment during clerkships: a qualitative study

Exploring medical students’ barriers to reporting mistreatment during clerkships: a qualitative study

The desirable qualities of future doctors – A study of medical student perceptions

Medical professionals’ responses to a DRG performance management system for hospital care in the Netherlands. Reinterpreting ‘perverse effects’, such as upcoding and patient selection, using arguments of professionalism and managerialism

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