Speaking up: using OSTEs to understand how medical students address professionalism lapses

Abstract

BackgroundObjective-structured teaching encounters (OSTEs) are used across many disciplines to assess teaching ability. The OSTE detailed in this paper assesses 191 fourth-year medical students’ (M4) ability to identify and address lapses in professionalism based on Association of American Medical Colleges’ professionalism competencies. The research questions addressed areHow frequently do M4s address professionalism lapses observed during an OSTE?What factors influence whether M4s provide feedback when they observe professionalism lapses in an OSTE?MethodsStandardized patients (SPs) and standardized learners (SLs) were recruited and trained to participate in a standardized encounter with specific cognitive, social, and behavioral errors, including professionalism lapses. M4s viewed this encounter and then offered feedback to the SL, while remotely observed by faculty. Post-encounter, the SL and faculty completed identical checklists to assess both teaching readiness and ability to address professionalism concerns.ResultsAn analysis of frequencies showed that six of the Association of American Medical Colleges’ nine professional competencies were addressed in the checklist and/or discussed in the focus group. Analysis of transcribed debriefing sessions confirmed that M4s did not consistently address professionalism lapses by their peers.ConclusionsIn focus groups, M4s indicated that, while they noticed professionalism issues, they were uncomfortable discussing them with the SLs. Findings of the current study suggest how medical educators might support learners’ ability to address lapses in professionalism as well as topics for future research.

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

“…Our findings are based on experiences of medical students, by contrast with earlier findings that come from simulated circumstances and questionnaires, or from residents . Roff and Dherwani investigated medical educators' advice for students to respond, which included ignore , challenge the individual , discuss the lapse with peers or report .…”

“…For medical students, who are still learning and are dependent on their teachers for grades, it is particularly difficult. Although medical students endorse a professional obligation to respond to professionalism lapses, they experience difficulties in meeting this obligation . It is still unclear what motivates students to overcome these difficulties and how they actually respond.…”

O profissionalismo e suas formas de avaliação em estudantes de Medicina: uma revisão integrativa

“…The assessment through OSTEs (Objective Structured Teaching Encounter), or OST Exercise, promotes the inverse process. It shows cases, using a standardized student who presents various professionalism lapses, like missed hand hygiene, lack of attention to patient comfort, poor interpersonal communication, overuse of medical terminology, unprofessional attire, and assesses how students perceive and remediate these attitudes, complemented by feedback 23 .…”

Residente como Professor: uma Iniciação à Docência

“…O professor observa o AP tratar o PP e, em seguida, oferece feedback oral direto ao AP sobre como melhorar o cuidado ao paciente. Após essa troca, tanto o AP quanto o observador da instituição completam uma lista de verificação que avalia componentes de ensino 29 .…”