January 2023


The days are getting longer.   Hopefully your pineal gland has told your limbic area, and you are feeling a little lightening in your step.

Please enjoy this month’s JC with those few extra minutes of daylight.

Amit, Karen and Jon


Professionalism –in the Eye of the Beholder

Tabatabaei ZS, Mirzazadeh A, Amini H, Mafinejad MK. What We Think About Professional and Unprofessional Behaviors: Differences Between the Perception of Clinical Faculty Members and Medical Students. BMC Med Educ 2022; 22:866. https://doi.org/10.1186/s12909-022-03874-x

Reviewed by Gary L. Beck Dallaghan


What was the study  question?

What are the perspectives of medical students and faculty about prioritization of elements of professional conduct and how are they different?


How was this study done?

A multi-stage qualitative study was conducted at Tehran University of Medical Sciences from 2020-2021. In the first phase, a systematic review of the literature was conducted. This was followed by a consensus method to combine the viewpoints of clinical faculty members and students. As part of the consensus method, participants were asked to produce 5-7 common professional and unprofessional behaviors that were then combined with the codes from the literature search then categorized into six domains: Honor/Integrity, Altruism, Excellence, Justice, Respect, and Responsibility.  The resulting behaviors were then prioritized based on importance and compared between clinical faculty and students.


What were the results?

Of the 1,547 articles identified, 62 were included for data extraction.  From these articles, codes were extracted and classified as professional or unprofessional behaviors. In prioritizing behaviors important to evaluate, clinical faculty ranked unprofessional behaviors over the medical students, who felt that focus should be on professional behaviors. Interestingly, the most important domain of professional and unprofessional behaviors as rated by medical students was Altruism, which was the least important for clinical faculty.


How can I apply this article to my work in education?

Clarifying professional and unprofessional behaviors is essential for developing fair evaluation tools. More importantly, having a conversation among clinical faculty and medical students regarding what these behaviors are and addressing conflicting perspectives paves the way for better understanding by both clinical faculty and medical students. 


Editor’s Note: Buried in this somewhat complicated article are other interesting differences in values between students and faculty, among them that students consider paying attention to necessary safety measures for themselves and others a high priority while faculty do not and faculty consider ‘not showing respect and gratitude towards the more experienced faculty members’ more important than students.  One thing is clear–the road to professional identity formation is neither smooth nor direct. (JG)



Are You Even Remotely Interested?

Charondo LB, Duque JB, Kirsch HE, Brondfield S. Maintaining Medical Student Motivation During Remote Clinical Learning. Acad Med. 2023 Jan 1;98(1):105-111. https://dx.doi.org/10.1097/ACM.0000000000004954

Reviewed by Andrew Zale

What was the study question?

What factors affect medical student motivation during remote clinical learning (RCL) experiences and what are potential strategies to increase motivation?


How was the study done?

 The authors conducted semi-structured interviews with third- and fourth-year medical students at one medical school who had participated in RCL. Individual interviews were conducted via Zoom during December 2020, and all interviews were conducted by the same medical student interviewer. Each interview was audio-recorded, professionally transcribed, and coded using inductive thematic analysis with self-determination theory (which theorizes that autonomy, competence and relatedness are essential for motivation) as the sensitizing framework. Interviews were analyzed for themes relating to factors that affect motivation during RCL experiences and potential strategies to augment student motivation.


What were the results?

 There were approximately 300 third- and fourth-year medical students who received email invitations to interview. Out of those, 18 responded, and 12 completed interviews. Nine out of the 12 interviewees identified as female, seven out of the 12 interviewees identified as White, and all had completed their core clerkship year. Most remote clinical learning in this group was through telehealth visits, remote rounds, and small-group teaching sessions. Students noted RCL provided increased flexibility compared to in-person curricula but preferred that the flexibility be combined with structure. Students also preferred that the list of resources for each RCL experience be shortened and carefully curated to match the learning objectives. They also reported that RCL did not meet all their learning goals, such as physical examination skills, and felt that in-person care is vital to their professional identity. Finally, the students reported less ability to build and maintain community with decreased access to mentors and disconnectedness from their peers during RCL experiences.


How can this be applied to my work in education?

 This work identifies strategies to optimize motivation, ranging from holding an introduction to telehealth orientation to openly discussing learning goals and expectations to guide student learning. Given the growth of remote clinical learning, it is imperative that medical schools further optimize their curricula to maintain student engagement and prepare their students for remote clinical encounters.


Editor’s Note: This study provides a unique student viewpoint on remote clinical learning. Having built some of these curricula myself I can say that these viewpoints will be beneficial in future iterations. While the study methods are well done the recruitment (only interviewing those who responded) could have been performed better to increase generalizability. (AP)


When Patients Harass Students

Mahurin, H.M., Garrett, J., Notaro, E. et al. Sexual harassment from patient to medical student: a cross-sectional survey. BMC Med Educ 22, 824 (2022). https://doi.org/10.1186/s12909-022-03914-6

Reviewed by Sanghamitra Misra


What was the study question? 

What is the incidence of sexual harassment and sexual assault from patient to medical student?


How was the study done? 

An anonymous survey was sent electronically to all students at one medical school (n=1183) in April 2019. Survey questions included demographics, respondents’ experiences with SH/SA from patient(s), and their responses to SH/SA.


What were the results? 

From 268 respondents (23% response rate), 56% (149/268) reported ever experiencing SH from a patient and 49% (131/268) reported experiencing SH from a patient in the last year.  Of those who experienced SH from a patient in the last year, 91 (69%) reported experiencing SH 1–3 times over the year and 7 (5%) reported experiencing SH more than once a month.   Prevalence of SH from a patient was reported by significantly more females compared to males  (66% (121/183) vs 31% (25/80); p <.001), BUT similar frequencies of experiencing SH within the last year were reported (90% (106/118) of females and 88% (22/25) of males; p =.96).

 Thirty-five respondents reported that experiencing SH or SA by a patient contributed to feelings of burnout, with females 4.6 times more likely than males to report this (CI=1.34,15.70). Six percent (9/149) of those who reported prior SH or SA reported having terminated a relationship with a patient based on the unwanted behavior. Nine students (6%) reported that they sought counseling or spoke with a mental health professional after experiencing unwelcome sexual behavior from a patient.


How can this be applied to my work in education? 

This is an important aspect of creating a safe learning environment for clerkship directors to consider. Unfortunately, this is an aspect over which we have little control, because we cannot provide guidance/training to patients or their families before it happens. It is important to discuss SH/SA with all students at orientation, and make sure they know how to react to and/or deal with the situation if it were to arise. Clerkship directors should be aware of resources within the institution to support students and reporting structures within their hospital/clinic system to adequately address the issue with offending patients and/or family members.

Editor’s Note:  It will be difficult to support students if we don’t know they are facing difficulties.  In this study, 71% of victims of SH or SA did not report it, most commonly because they weren’t sure it was serious enough.  Addressing this issue will require not just system change but culture change.  (JG)