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Formation of medical student professional identity: categorizing lapses of professionalism, and the learning environment. Walter Hendelman W et al. BMC Medical Education 2014, 14:139.

Reviewed by Marc Zucker

What was the study question?
What are the lapses in professionalism that medical students witnessed at one medical school in Canada? Who was involved and where did these witnessed events take place?

How was the study done?
An electronic survey (qualitative and open-ended) was developed and circulated to all medical students at the University of Ottawa. Students were questioned about witnessed lapses in professionalism and asked to identify where the incidents took place, as well as the sources of the lapses.

What were the results?
There was a response rate of 45% with 255 responses from the four medical student classes. 64.3% of the students had witnessed a lapse in professionalism during their training with a higher proportion occurring in clerkship (72.3%) compared to pre-clerkship (59.6%) years. 38% had witnessed or been a part of an exemplary demonstration of professionalism. Preclerkship students most often identified lapses in professionalism by fellow students, with the lapses most often categorized as arrogance (42.2%), impairment (24.2%) and cultural or religious insensitivity (20.5%). Clerkship students most often identified lapses by faculty and other staff with arrogance (55.3%), breach of confidentiality (28.7%) and cultural or religious insensitivity (23.4%) being the most common. Lapses in professionalism most often occurred on the hospital wards for clinical students. It was not clear whether the lapses by medical students were occurring during medical school activities or during personal time.

What are the implications of these findings?
The authors conclude that students do witness lapses in professionalism by both fellow students as well as by faculty members and administrative staff. These lapses fall into identifiable categories that vary in frequency based on level of training. Furthermore, the authors conclude that these witnessed events influence the formation of medical student professional identity and as such need to be addressed through faculty development and role modeling.

Editor's note: It is interesting to consider this study in light of what we know about adult development, specifically that young people can be highly motivated to emulate those they see as role models. If the faculty and staff leaders in our institutions are acting unprofessionally then it is likely that at least some of their behaviors will be adopted by impressionable learners. We do need to work, as an academic medicine community, to remind those who work with students about their responsibility for modeling the professional behaviors we expect our learners to display (LL).

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