A Lack of Consensus on Appropriate Sanctions for Lapses in Medical Professionalism An Observational Cohort Study (Published 2015)
Apr 06, 2016
Kaul B, Teal C.R and Greenberg S.B
Medical students and faculty perceive appropriate consequences for lapses in medical professionalism differently. This study explores these differences.
Introduction: There has been a renewed emphasis placed on teaching and evaluating professionalism; however, little research has been done on addressing lapses when identified. In order to develop guidelines on remediation, we must first understand how learners and faculty view "unprofessional behavior." The goal of this study was to examine differences in perspective between medical students and faculty regarding appropriate consequences for lapses in medical professionalism.
Methods: An observation cohort design was utilized to survey a cross-sectional sample of medical students and Internal Medicine faculty at Baylor College of Medicine. Participants were asked to assign ordinal level sanctions to twenty-five scenarios involving first-time lapses in professionalism with optional area for open-ended text. A mixed methods analysis was conducted on data collected.
Results: 513 medical students and 37 faculty members completed the surveys. There was a significant decrease in the severity of sanctions applied between preclinical and clinical years. The faculty were more like preclinical students in their pattern of sanction assignment. Clinical students were less likely to choose "expulsion" than their preclinical counterparts but no cohort had >35% of respondents selecting expulsion.
Conclusion: Clinical students were more lenient than preclinical students and faculty in the severity of sanctions applied. There was no significant difference between preclinical students and faculty on these measures. All cohorts favored remediation suggesting that short of expulsion, there is a lack of consensus regarding appropriate consequences for lapses in professionalism.
I very much enjoyed reading this paper and it gives the reader a very broad insight into student and faculty thinking regarding the difficult issue of professionalism
I particularly thought that it was insightful in demonstrating the hierarchy of non-professional behaviour that students perceive, occasionally against what I feel faculty might imagine.
I would like to thank the authors for this paper. It has addressed an area that is a corner stone of medical degree programmes, is an area that is often debated and is perceived differently among different faculty members and staff. I have provided the link to this paper to members of the faculty professionalism and it has already sparked discussion and debate. I have also recommended that's paper is used as reading material for our in house CPD programme that introduces professionalism to teachers on the MBBS. As much as the paper highlights the variety of opinion between student and staff regarding 'what is unprofessional and sanctionable' it was also reassuring to see that there were clear differences in opinion among faculty members too. This reflects our medical school too. I am sure that many of these opinions are consistent on both sides of the atlantic and absolutely worth considering when we talk about professional behaviour with our students too.
This was a great paper to read as it provided a great introduction to professionalism and groundwork for the research. Assessment and remediation of unprofessional conduct is a very interesting area of research and this is a great example of the work being done in the area.
As a final year medical student at a British University the proof that students undergo a change in what they perceive as unprofessional behaviour was really interesting. I have seen first hand unprofessional behaviour from both students and staff which for better or worse, has gone unreported.
The paper is also a useful insight into the disciplinary processes in the USA, in the UK the process seems to be more dependent on outside guidance by the General Medical Council and the standards they set for medical students.
Thanks William, its great to get an inside view. Many papers are written by faculty members who may perceive the situation from an outside view and i wonder if you would care to expand on your thoughts by providing some examples
An example of unprofessional behaviour discussed at the recent AMEE conference was students turning up late for work, in the particular presentation this was seen by an American university as enough to justify an 'Early Concern Note' and an informal meeting with an associate dean. In the UK this is almost considered normal behaviour by consultants and not necessarily unprofessional behaviour by students.
Although this is a minor example talking about other examples may be inappropriate in this format?
Thanks William, an interesting example and goes to show the variation in interpretation.
I understand your concern regarding describing other examples, we should think of other outputs for your observations