Abstract
BackgroundAcquiring 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.MethodsAn 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.ResultsThe 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.ConclusionsMedical 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.
Highlights
Acquiring the values of medical professionalism has become a critical issue in medical education
In 1990 the American Board of Internal Medicine (ABIM) “established a project to enhance the evaluation of professionalism as a component of clinical competence and to promote the integrity of internal medicine.”
The survey questions were electronically set so that once the respondent indicated that a lapse had occurred in one of these domains, she/he could not proceed further until the information was provided as to where this incident had occurred, and the identity of the source of the lapse in professionalism, the person involved in the incident: tutor, faculty member, preceptor, clinician, nurse, student, administrative staff, other hospital staff
Summary
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. In 1990 the American Board of Internal Medicine (ABIM) “established a project to enhance the evaluation of professionalism as a component of clinical competence and to promote the integrity of internal medicine.”. Robins et al [2] examined undergraduate (second year) medical students’ “perceptions of the ethical climate for learning” using open-ended questions. Their responses were analyzed using the ABIM taxonomy and the challenges to professionalism as defined, indicating the usefulness of this framework for studies of this nature
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