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A common struggle

How do medical schools identify and remediate professionalism lapses in medical students? A study of US and Canadian medical schools. Ziring D et al. Academic Medicine 2015; 90: 913-920.


Reviewed by Michael Ryan

What was the study question?
How do medical schools identify and remediate lapses in professionalism?

How was the study done?
The researchers conducted semi-structured interviews which were analyzed using both qualitative and quantitative methods to answer the research question. A “key person responsible for professionalism remediation” was identified by participating schools. He/she participated in a 30-minute phone interview which consisted of 16-19 questions including sections on local policies, identification of students with professionalism lapses, administrative response, and remediation.

What were the results?
A representative from 93 of the 153 (60.8%) LCME-accredited medical schools in the US and Canada participated in the research study. The vast majority (79.6%) of respondents had formal policies in place regarding lapses in professionalism. Lapses in the clinical phase were most commonly identified using discrete items on student evaluations (97.8%) and/or incident-based reporting mechanisms (92%). Methods of remediation included mandated mental health evaluations, assignments, mentorship, and counseling. There was significant controversy expressed over the nature and ethics of “feeding forward” professionalism concerns. Finally, there was marked variability and concern expressed in the role of faculty and evaluating the success of remediation efforts.

What are the implications of these findings?
While the medical profession has done an excellent job describing what constitutes professional behavior, we often struggle determining how to handle lapses in professionalism. This article elegantly describes the commonality between medical schools’ approaches while highlighting our challenges. The authors propose consideration for the development of an online repository of policies and strategies for remediation, faculty development to assist in remediation efforts, and further scholarly exploration to examine the outcomes and implications of remediation strategies.

Editor’s note: This article clearly demonstrates our struggle with lapses in professionalism in our students, and points out the lack of proven approaches to remediation. As has been repeatedly demonstrated, students with professionalism issues in medical school have an increased risk of major professionalism issues later in their careers. It is in our best interests to study different approaches to these problems to find those that can have a measurable impact on these students’ future practices (LOL).

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