Twelve tips for addressing medical student and resident physician lapses in professionalism

Abstract

Medical educators have gained significant ground in the practical and scholarly approach to professionalism. When a lapse occurs, thoughtful remediation to address the underlying issue can have a positive impact on medical students and resident physicians, while failure to address lapses, or to do so ineffectively, can have long-term consequences for learners and potentially patients. Despite these high stakes, educators are often hesitant to address lapses in professionalism, possibly due to a lack of time and familiarity with the process. Attention must be paid to generalizable, hands-on recommendations for daily use so that clinicians and administrators feel well equipped to tackle this often difficult yet valuable task. This article reviews the literature related to addressing unprofessional behavior among trainees in medicine and connects it to the shared experience of medical educators at one institution. The framework presented aims to provide practical guidance and empowerment for educators responsible for addressing medical student and resident physician lapses in professionalism.

Causes and characteristics of medical student referrals to a professional behaviour board

“…Teachers are indeed known to experience barriers in referring students. 31 - 33 Unprofessional behaviour might be underreported for reasons similar to those of clinical lecturers who do not fail students. Dudek et al identified four major barriers to failing trainees: ‘(1) lack of documentation, (2) lack of knowledge of what to specifically document, (3) anticipating an appeal process, and (4) lack of remediation options’.…”

How to identify, address and report students’ unprofessional behaviour in medical school

“…This theory encompasses that a student's ultimate behaviour is influenced by intentions and beliefs about the behaviour and its outcomes, the subjective norm, and the perceived behavioural control. Another (Howe et al 2010) Stress the effect of students' unprofessional behaviour on future patient-safety (Howe et al 2010;Yepes-Rios et al 2016;Wong et al 2017) Emphasize role modeling of responding to unprofessionalism to educators (Rougas et al 2015) Inform teachers about policies (Rougas et al 2015) Offer the possibility to educators to discuss their experiences with colleagues and get mutual support (e.g. in teacher communities The student displays an accidental professionalism lapse and is capable to prevent future professionalism lapses with help from regular teachers in the medical curriculum.…”

“…For most students, this approach is sufficient to prevent future unprofessional behaviour. Furthermore, these conversations can yield important information about (hidden) organizational and contextual causes for students' unprofessional behaviour that can be fed back into the organization (Lesser et al 2010;Rougas et al 2015).…”

Tutor uncertainty in dealing with unprofessional behaviours of medical students and trainees: a mixed methods study

“…19 Limited time to identify and managing unprofessionalism issues can also lead to a lack of uncertainty for tutors in reporting incidences, either formally or informally. 23 This was highlighted in relation to con dence in dealing with a professionalism issue. It has been reported that some faculty see formal professionalism curricula as an attempt to "force all students into the straightjacket of political correctness" 4 and this may explain some of the reluctance of our tutors to follow a formal route when intervening.…”