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Wanted: role models - medical students' perceptions of professionalism. Byszewski et al. BMC Medical Education 2012;12:115.
Reviewed by Virginia Randall

What was the study question?
What are medical students' perceptions of professionalism, the professionalism curriculum, the current learning environment, and suggestions for improvement

How was the study done?
The authors administered a survey via email to all University of Ottawa medical students in December 2006. The survey was developed by a team of faculty and medical students reviewing professionalism as part of a larger curriculum review.

What were the results?
The response rate was 45.6% overall, and 63% of respondents were in years 1 and 2. "Clinical interaction-role modeling" was cited most frequently as the single most effective means of learning professionalism (93.5%) and faculty led small group discussions with professionalism case scenarios was next, chosen by 83.3% of students. Students identified attributes of professionalism not adequately emphasized by faculty including self-improvement, compassion and empathy. Among other questions, the students were asked how the professionalism curriculum could be improved. Pre-clerkship students focused on discussions that integrated professionalism into the PBL sessions. Clerkship students commented on opportunities to develop professional behavior during clinical encounters.

What are the implications of these findings?
The results of a survey of students using questions that students helped to develop provided a multi-level picture of the effectiveness of the professionalism curriculum. The authors of this study go beyond acknowledging the importance of role modeling to propose a series of comprehensive concrete changes, based on student suggestions, to the professionalism curriculum. These include developing a longitudinal curriculum through the 4 years of medical school that highlights inspiring guest lecturers, awards for students and faculty who exhibit exemplary professionalism, and small group discussions led by trained faculty that are case-based real professionalism scenarios. To combat the negative influence of the "hidden curriculum', the authors (and students) propose that administrative procedures be developed for reporting and disciplining lapses in professionalism.

Editor's note: Here is another validation of what we all already know – it is our role modeling of professional behaviors that has the most influence on our learners, despite our attempts to put professionalism into the explicit curriculum. Interestingly, the students identified self-improvement as an area that is lacking as a curricular topic; perhaps we need to pay more attention to how we can role model our self-improvement efforts (rather than looking like we think we always know everything) so that our students will develop this attribute (LOL).

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