Melissa Held, MD, Connecticut Children's Medical Center, University of Connecticut School of Medicine, Hartford, CT; Eve Colson, MD, Yale University School of Medicine, New Haven, CT
Background: Professionalism has become an important topic in medical education over the past decade. Students and physicians are expected to conduct themselves in a professional manner. Despite the focus on professionalism and on professional behavior, there may be significant barriers to effectively assessing professionalism and remediating unprofessional behaviors. Objective: To identify barriers to assessing and remediating unprofessional behaviors in medical students using questions in the yearly COMSEP (Committee on Medical School Education in Pediatrics) survey. Methods: Through the 2010 COMSEP survey to Pediatric Clerkship Directors (CDs) across the country, we asked questions about perceived barriers to assessing professionalism of students while on the pediatric clerkship and about systems set up at each location to remediate unprofessional behavior when identified. We used a previous qualitative study to develop the survey questions. Demographics about the clerkship directors and their institutions were collected. We calculated frequencies and proportions for all responses. Content analysis was used to develop themes from specific open-ended questions. Results: 334 surveys were sent via Survey Monkey and 153(47%) surveys were completed. Completed surveys represented 76% (105/144) of all allopathic medical schools in the US/Canada and 65% (95/144) of all CDs. We asked CDs to rank the most important barriers to providing useful assessments to professionalism. 62% of CDs listed “other evaluator” discomfort with assessing and giving feedback as the biggest barrier to assessment. Both “not enough time spent with the student” and “time to do an assessment” were also important barriers for 61% and 44%, respectively. Themes related to evaluator discomfort included wanting the CD to deal with the problem, lack of evaluator skills, reluctance to put anything in writing, giving the student the benefit of the doubt and fear of retaliation. Most schools do have information sharing about unprofessional behavior (70%) among course directors. Responsibility for remediating unprofessional behavior falls to multiple people/committees including medical school promotions or other committee (64%), individual clerkship or course directors (46%) and a dean’s office representative (45%). Most remediation is done through individual sessions with faculty members (71%). Only 45% of those surveyed reported that their school had a professionalism curriculum while 50% reported no curriculum or they didn’t know. Conclusions: CDs encounter barriers to assessing and remediating professionalism similar to those found in our previous qualitative work. There is no standard approach to assessing and remediating professionalism but there are common themes related to barriers when faced with a student having unprofessional behavior. The next step would be to identify ways to effectively and efficiently address some of these barriers.