How Do Medical Schools Identify and Remediate Professionalism Lapses in Medical Students? A Study of U.S. and Canadian Medical Schools

Ziring, Deborah; Danoff, Deborah; Grosseman, Suely; Langer, Debra; Esposito, Amanda; Jan, Mian Kouresch; Rosenzweig, Steven A; Novack, Dennis H.

doi:10.1097/acm.0000000000000737

Cited by 76 publications

(80 citation statements)

References 33 publications

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“…According to a recent systematic report of U.S. and Canadian medical schools, incident reports and review of routine student evaluations are what most schools rely on to identify the majority of professionalism lapses [13]. But faculty and students are often reluctant to or unaware how to report.…”

Section: Discussionmentioning

confidence: 99%

An investigation of professionalism reflected by student comments on formative virtual patient encounters

et al. 2017

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BackgroundThis study explored the use of virtual patient generated data by investigating the association between students’ unprofessional patient summary statements, which they entered during an on-line virtual patient case, and detection of their future unprofessional behavior.MethodAt the USUHS, students complete a number of virtual patient encounters, including a patient summary, to meet the clerkship requirements of Internal Medicine, Family Medicine, and Pediatrics. We reviewed the summary statements of 343 students who graduated in 2012 and 2013. Each statement was rated with regard to four features: Unprofessional, Professional, Equivocal (could be construed as unprofessional), and Unanswered (students did not enter a statement). We also combined Unprofessional and Equivocal into a new category to indicate a statement receiving either rating. We then examined the associations of students’ scores on these categories (i.e. whether received a particular rating or not) and Expertise score and Professionalism score reflected by a post-graduate year one (PGY-1) program director (PD) evaluation form. The PD forms contained 58 Likert-scale items designed to measure the two constructs (Expertise and Professionalism).ResultsThe inter-rater reliability of statements coding was high (Cohen’s Kappa = .97). The measure of receiving an Unprofessional or Equivocal rating was significantly correlated with lower Expertise score (r = −.19, P < .05) as well as lower Professionalism score (r = −.17, P < .05) during PGY-1.ConclusionIncident reports and review of routine student evaluations are what most schools rely on to identify the majority of professionalism lapses. Unprofessionalism reflected in student entries may provide additional markers foreshadowing subsequent unprofessional behavior.

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Section: Discussionmentioning

confidence: 99%

An investigation of professionalism reflected by student comments on formative virtual patient encounters

et al. 2017

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“…Literature reviews were categorized according to the most reported assessment setting, which was shown to be problem-based learning (PBL) settings, and “on doctoring courses” [23-24]. Behavioral assessments among medical students in their didactic years were generally found to be longitudinal group settings, such as PBL group interactions or gross anatomy courses (n=9).…”

Section: Reviewmentioning

confidence: 99%

“…Literature reviews were listed under most commonly reported assessment tool by paper which was Likert-evaluation forms and qualitative feedback [23-24]. Over half (n=18) of the included papers utilized a validated point scale system broken down into behavioral subcomponents, used among both medical students and residents [25-27,29,31-32-33,35-39,41-43].…”

Section: Reviewmentioning

confidence: 99%

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

Nittur

Kibble

2017

Cureus

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

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“…While objective structured clinical exams, multiple mini-interviews, and other techniques hold promise for identifying some at-risk behaviors, longitudinal tools and techniques are needed that can be used across the training continuum [7,8]. A variety of processes are used throughout North American medical schools to identify or track professionalism issues, including incident-based reports, courses on professionalism, and peer assessment [9]. Interpreting the growing literature on professionalism is complicated by various classification systems used to group types of behaviors deemed as unprofessional [10,11].…”

Section: Introductionmentioning

confidence: 99%

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

Ainsworth

Szauter

2018

Medical Education Online

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Background: An early concern note (ECN) program is used by some medical schools to identify, counsel, and intervene when students exhibit unprofessional behavior. Student maturity, insight, propensity for reflection, and receptiveness to feedback have been suggested as predictors of future behavior. Objective: We hypothesized that (a) classifying students with a first ECN based on their response to the report would identify students at risk of repeat ECNs better than the action that prompted it and (b) receipt of multiple ECNs would identify students at risk of adverse academic events.Design: For this study, 459 ECNs were classified based on students’ (1) recognition that their behavior was inappropriate and (2) acceptance of responsibility for the behavior. Student academic progress and receipt of subsequent ECNs were tracked.Results: Students who recognized their behavior was inappropriate and accepted responsibility after an initial ECN received subsequent ECNs at lower rates (14–19%) than students who disagreed with the significance of their behavior or were resistant to accepting responsibility (36–59%). Students with limited insight and adaptability appeared to be at highest risk. Seventy-one percent of students with three or more ECNs encountered adverse academic events during enrollment.Conclusion: Student reactions to reports of unprofessional behavior may be useful as a tool to help assess risk of recurrent lapses. Students with diminished capacity to recognize behaviors as unprofessional or accept responsibility for them appear to be at highest risk for additional adverse academic and professionalism events while in medical school.

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How Do Medical Schools Identify and Remediate Professionalism Lapses in Medical Students? A Study of U.S. and Canadian Medical Schools

Abstract: The identified strengths can be used in developing best practices until studies of the strategies' effectiveness are conducted.

Cited by 76 publications

References 33 publications

An investigation of professionalism reflected by student comments on formative virtual patient encounters

An investigation of professionalism reflected by student comments on formative virtual patient encounters

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

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

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