Formation of medical student professional identity: categorizing lapses of professionalism, and the learning environment

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.

Adaptation and validation of the instrument Clinical Learning Environment and Supervision for medical students in primary health care

“…It has been shown in a study of Hendelman and colleagues that 72 % of the medical students have, sometime during their clerkship, witnessed a lapse in professionalism, carried out by for example physicians, nurse or other staff [22, 23]. …”

Humanidades Médicas como Campo de Conhecimento em Medicina

“…Há consciência de que não basta bom senso ou uma suposta vocação para a atuação médica para alcançar os padrões internacionais de profissionalismo 5 na relação médico-paciente ou médico e sociedade. É também necessário investimento educacional com estratégias adequadas para o desenvolvimento do ser médico.…”

“…É também necessário investimento educacional com estratégias adequadas para o desenvolvimento do ser médico. Os evidentes ganhos até o momento, ainda que significativos, não eliminam os problemas 4,5,6 que ainda observamos no ensino de humanidades em muitas escolas médicas: falta de integração curricular, uso de metodologias de ensino inadequadas, falta de professores capacitados. Os problemas não são mais em relação à tomada de consciência da necessidade da abordagem humanística na formação médica, já bem estabelecida, mas em relação às suas fronteiras de campo de conhecimento específico, que não se confunde nem subsume outros campos de conhecimento da área da saúde ou da medicina, tais como o campo das ciências humanas e sociais em saúde, da medicina preventiva e social, da medicina de família ou da saúde coletiva, que também tomam como objeto de estudo, entre outros, algumas dimensões do humano na medicina e suas práticas.…”

Assumed or Assessed? The Affective Domain in Health Care Education

“…While students have identified role-modeling as a desirable means of teaching professionalism [16], critics argue that students are left vulnerable to the negative effects of the hidden curriculum [17][18][19]. Studies have reported that students witness lapses in professionalism among faculty and clinical supervisors during both clinical and pre-clinical training [20]. The finding of "erosion of empathy" among third year medical students, just at the time when patient interactions increase [21], suggests we cannot continue to assume these qualities are being developed in future health care providers merely through clinical emersion.…”