Journal Club

Student perceptions of the professional behavior of faculty physicians. Szauter K, Williams B, Ainsworth MA et al. Med Educ Online [serial online] 2003; 8:17. Available from http://www.med-ed-online.org

Reviewed by Michael Barone, John Hopkins University

The medical community believes, and the public demands, that physicians not only be knowledgeable, but also demonstrate the attitudes and values on the profession. Many organizations have published statements or standards on the elements and measurement of professionalism in trainees. Medical students learn much through modeling of behaviors. This study attempted to create a "snapshot" of student perceptions of faculty professional behavior.

Over the course of one academic year, medical students at the end of each clerkship were asked to anonymously complete a 7 item questionnaire evaluating faculty professional behavior along a scale that included "consistently," "frequently," "occasionally," and "never." For example, "I observed my faculty treating non-physician healthcare workers in a disrespectful or inappropriate manner." Students were asked to complete a form for each faculty member with whom they worked. Forms did not identify faculty by name.

Two hundred students completed more than 2600 evaluations during the study period. The data were primarily analyzed and presented in binary fashion, examining the proportion of "never" responses compared to the proportion of "issue identified" responses, i.e, any recording of "consistently," "frequently," or "occasionally." The clerkship discipline names were suppressed by the authors in order to not fuel stereotypes. Identifying which clerkship had the most unprofessional faculty was not a stated objective of the study. Nevertheless, the author found that, in comparing clerkships, there were large differences in the prevalence of "issues identified" vs. "no issues identified" for certain questions. For example, "I observed my faculty making derogatory comments about other services;" responses ranged from 98.9% "never" to 73% "never." Derogatory comments about other services, patients or their families were the most common misbehaviors. Other areas identified by students were inappropriate humor or language, and disinterest in teaching.

While this study is limited by its cross-sectional nature and reliance on students interpreting and reporting comments similarly, it provides a basis to understand areas for cultural change. Many curricula on "Professionalism" deal with issues of patient confidentiality and disclosure. Many times, disrespectful behaviors are overlooked, particularly if an individual displaying them is highly influential in the clinical or research arenas. Until we move toward an institutional standard of attitudes and behaviors, to which all are subject, we will continue to expose our students to an "environment of conflicting guidelines and practices."

(Comment: Despite copious instruction, medical students continue to auscultate the lungs through the shirts of their patients because they see that behavior modeled. Is it any wonder that we still turn out physicians who act unprofessionally toward each other? We need to ensure that those people who are in a position to influence behavior demonstrate the correct behaviors. - Bill Raszka)