Journal Club

Jones WS, Hanson JL, Longacre JL. An Intentional Modeling Process to Teach Professional Behavior: Students' Clinical Observations of Preceptors. Teach Learn Med 16(3):264-269.

Reviewed by Karen Marcdante, Medical College of Wisconsin

While the previous article talked about our direct observation of learners, this article, authored by several COMSEP members, demonstrates that direct observation of faculty can be an excellent learning tool. The background provides a nice review of some components of professionalism, how it is taught and what we know about how it is learned. Role modeling is a key component of how our learners identify professional behavior. Thus, the use of role modeling combined with a form (based on Lindsey Lane's structured clinical observation form) to emphasize professionalism and interpersonal communication skills was described. This method was known as the Students' Clinical Observation of Preceptors (or SCOOP). Students were given the forms and instructed to observe an interaction between the faculty member and parent/patient. A post-encounter discussion would review what was observed, making things more explicit. The results are presented as the perspectives of faculty and students. It was positively received by 83% of the students although 24% felt uncomfortable critiquing their preceptor. A significant percentage of students (64%) were, at the end of the clerkship, able to identify one or more of the behaviors they were directed to observe. Only 5 faculty were involved and comments about their perspective are fairly broad, although the discussions of being "SCOOPed" focused on how faculty dealt with the unexpected arose (e.g. sensitive subjects such as non-accidental trauma). There is no information on the time it took to complete this or on the frequency of various discussions.

(This article is a nice demonstration of the scholarship of application and innovation! The authors built on previous work (courtesy of Lindsey Lane and colleagues), modifying it so that the student is doing the observing. Knowing how often students comment on being passive learners, this is a great way to activate the students, providing explicit behaviors to watch for and then discussing their perceptions with the preceptor at the end of a patient interaction. I did find myself wanting more information about how the students were oriented to the information and what training the faculty required. I also wondered about some of the discussions. Did they occur after each session? Were there themes? If so, was there any interest in altering curriculum to make sure things were addressed routinely? I found the title a little misleading since much of what was described had to do with respect and interpersonal communica-tion between physician and patient. However, that is part of professionalism. I also think it could be further modified to include some of the more "difficult" components of professionalism (e.g. honesty, duty, excellence, altruism and accountability) and am eager to pilot that. It is such a beautifully simple idea that it could also be used for other components of competency training. So, can you identify ways that SCOOPing would help in your clerkship? Would you focus on one area, such as communication skills, problem-solving, etc? What do you think you would learn about the students? Would it help you design better curriculum? What a lot of opportunities! KM)