Investigating US medical students' motivation to respond to lapses in professionalism

Abstract

ContextAs unprofessional behaviour in physicians can compromise patient safety, all physicians should be willing and able to respond to lapses in professionalism. Although students endorse an obligation to respond to lapses, they experience difficulties in doing so. If medical educators knew how students respond and why they choose certain responses, they could support students in responding appropriately.ObjectivesThe aim of this study was to describe medical students' responses to professionalism lapses in peers and faculty staff, and to understand students' motivation for responding or not responding.MethodsWe conducted an explorative, qualitative study using template analysis, in which three researchers independently coded transcripts of semi‐structured, face‐to‐face interviews. We purposefully sampled 18 student representatives convening at a medical education conference. Preliminary open coding of a data subset yielded an initial template, which was applied to further data and modified as necessary. All transcripts were coded using the final template. Finally, three sensitising concepts from the Expectancy–Value–Cost model were used to map participants' responses.ResultsStudents mentioned having observed lapses in professionalism in both faculty staff and peers. Students' responses to these lapses were avoiding, addressing, reporting or initiating policy change. Generally, students were not motivated to respond if they did not know how to respond, if they believed responding was futile and if they feared retaliation. Students were motivated to respond if they were personally affected, if they perceived the individual as approachable and if they thought that the whole group of students could benefit from their actions. Expectancy of success, value and costs each appeared to be influenced by (inter)personal and system factors.ConclusionsThe Expectancy–Value–Cost model effectively explains students' motivation for responding to lapses. The (inter)personal and system factors influencing students' motivation to respond are modifiable and can be used by medical educators to enhance students' motivation to respond to lapses in professionalism observed in medical school.

‘Failure to fail’: the teacher's dilemma revisited

“…A message is unpleasant because the effect of the message is not visible for the educator ( Expectancy ) , there is no personal interest for the educator ( Value ) , and she or he has to make the effort ( Costs ). Our research showed that expectancy, value and costs are all influenced by individual and institutional factors . The individual factors align with the factors that Scarff et al .…”

“…). This model appeared to effectively explain the motivation of students to respond (or not respond) to lapses in professionalism they observe in medical school . It could possibly also help to understand why educators are not motivated to deliver an unpleasant message to their students.…”

“…norms have been imposed), and if the costs of responding are high (e.g. much time needed to observe and evaluate performance) …”

“…This has enabled effective ‘blame‐free’ handling of medical errors, to enable a situation in which all stakeholders learn from errors and ultimately prevent them from happening . Given that ‘failure to fail’ has been theorised extensively, and that many practical recommendations have been proposed, we should not still be waiting for the change that we would like to see in practice. Rather, the time has come to acknowledge that students’ performance lapses inevitably will occur, and that they influence both the individual's well‐being and patient safety.…”

Profissionalismo na Formação do Especialista Médico: Revisão Integrativa da Literatura

“…The way in which professionalism is taught in specialist medical training affects behaviours in their professional activity after training, generating satisfaction for the program and the society. However, unprofessional behaviours, whether modulated or not, can threaten the patient's safety (29). The ACGME recommends teaching professionalism through role modeling, case studies on ethics and professionalism, journal clubs, videos and portfolios (3).…”