Assessing professional behaviour: Overcoming teachers’ reluctance to fail students

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Abstract

Background

Developing professional behaviour is an important goal of medical education in which teachers play a significant part. Many teachers can be reluctant to fail students demonstrating unprofessional behaviour. We hypothesize that supporting teachers in teaching and assessing professional behaviour and involving them in remediation will reduce this reluctance.

Findings

In 2010, VUmc School of Medical Sciences Amsterdam introduced an educational theme on professional behaviour for the bachelor's and master's programmes in medicine with a special emphasis on supporting teachers in teaching and assessing professional behaviour and involving them in the remediation process. Information was extracted from the student database on the number of unprofessional behaviour judgments awarded over 2008-2010 (before the intervention), and 2010-2013 (after introducing the intervention), which was compared. To find out if teachers' reluctance to fail had decreased, qualitative feedback from the teachers was gathered and analysed. Since the implementation of the educational theme, the number of unprofessional behaviour judgments has risen. The teachers are positive about the implemented system of teaching and assessing professional behaviour, and feel less reluctant to award an unsatisfactory professional behaviour judgment.

Conclusions

Supporting teachers in teaching and assessing professional behaviour and involving them in students' remediation appears to reduce their reluctance to fail students demonstrating unprofessional behaviour.

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Most cited references 8

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Disciplinary action by medical boards and prior behavior in medical school.

Maxine A Papadakis, Arianne Teherani, Mary Banach … (2005)

Evidence supporting professionalism as a critical measure of competence in medical education is limited. In this case-control study, we investigated the association of disciplinary action against practicing physicians with prior unprofessional behavior in medical school. We also examined the specific types of behavior that are most predictive of disciplinary action against practicing physicians with unprofessional behavior in medical school. The study included 235 graduates of three medical schools who were disciplined by one of 40 state medical boards between 1990 and 2003 (case physicians). The 469 control physicians were matched with the case physicians according to medical school and graduation year. Predictor variables from medical school included the presence or absence of narratives describing unprofessional behavior, grades, standardized-test scores, and demographic characteristics. Narratives were assigned an overall rating for unprofessional behavior. Those that met the threshold for unprofessional behavior were further classified among eight types of behavior and assigned a severity rating (moderate to severe). Disciplinary action by a medical board was strongly associated with prior unprofessional behavior in medical school (odds ratio, 3.0; 95 percent confidence interval, 1.9 to 4.8), for a population attributable risk of disciplinary action of 26 percent. The types of unprofessional behavior most strongly linked with disciplinary action were severe irresponsibility (odds ratio, 8.5; 95 percent confidence interval, 1.8 to 40.1) and severely diminished capacity for self-improvement (odds ratio, 3.1; 95 percent confidence interval, 1.2 to 8.2). Disciplinary action by a medical board was also associated with low scores on the Medical College Admission Test and poor grades in the first two years of medical school (1 percent and 7 percent population attributable risk, respectively), but the association with these variables was less strong than that with unprofessional behavior. In this case-control study, disciplinary action among practicing physicians by medical boards was strongly associated with unprofessional behavior in medical school. Students with the strongest association were those who were described as irresponsible or as having diminished ability to improve their behavior. Professionalism should have a central role in medical academics and throughout one's medical career. Copyright 2005 Massachusetts Medical Society.

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Failure to fail: the perspectives of clinical supervisors.

Nancy L Dudek, Meridith B Marks, Glenn Regehr (2005)

Clinical supervisors often do not fail students and residents even though they have judged their performance to be unsatisfactory. This study explored the factors identified by supervisors that affect their willingness to report poor clinical performance when completing In-Training Evaluation Reports (ITERs). Semistructured interviews with 21 clinical supervisors at the University of Ottawa were conducted and qualitatively analyzed. Participants identified four major areas of the evaluation process that act as barriers to reporting a trainee who has performed poorly: (1) lack of documentation, (2) lack of knowledge of what to specifically document, (3) anticipating an appeal process and (4) lack of remediation options. The study provides insight as to why supervisors fail to fail the poorly performing student and resident. It also offers suggestions of how to support supervisors, increasing the likelihood that they will provide a valid ITER when faced with an underachieving trainee.

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Teaching compassion and respect. Attending physicians' responses to problematic behaviors.

J D Carline, R A Root, J Burack … (1998)

To describe how and why attending physicians respond to learner behaviors that indicate negative attitudes toward patients. Inpatient general internal medicine service of a university-affiliated public hospital. Four ward teams, each including an attending physician, a senior medicine resident, two interns, and up to three medical students. Teams were studied using participant observation of rounds (160 hours); in-depth semistructured interviews (n = 23); a structured task involving thinking aloud (n = 4, attending physicians); and patient chart review. Codes, themes, and hypotheses were identified from transcripts and field notes, and iteratively tested by blinded within-case and cross-case comparisons. Attending physicians identified three categories of potentially problematic behaviors: showing disrespect for patients, cutting corners, and outright hostility or rudeness. Attending physicians were rarely observed to respond to these problematic behaviors. When they did, they favored passive nonverbal gestures such as rigid posture, failing to smile, or remaining silent. Verbal responses included three techniques that avoided blaming learners: humor, referring to learners' self-interest, and medicalizing interpersonal issues. Attending physicians did not explicitly discuss attitudes, refer to moral or professional norms, "lay down the law," or call attention to their modeling, and rarely gave behavior-specific feedback. Reasons for not responding included lack of opportunity to observe interactions, sympathy for learner stress, and the unpleasantness, perceived ineffectiveness, and lack of professional reward for giving negative feedback. Because of uncertainty about appropriateness and effectiveness, attending physicians were reluctant to respond to perceived disrespect, uncaring, or hostility toward patients by members of their medical team. They tended to avoid, rationalize, or medicalize these behaviors, and to respond in ways that avoided moral language, did not address underlying attitudes, and left room for face-saving reinterpretations. Although these oblique techniques are sympathetically motivated, learners in stressful clinical environments may misinterpret, undervalue, or entirely fail to notice such subtle feedback.

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Author and article information

Contributors

Marianne Mak–van der Vossen

Saskia Peerdeman

Walther van Mook

Gerda Croiset

Rashmi Kusurkar

Journal

Journal ID (nlm-ta): BMC Res Notes

Journal ID (iso-abbrev): BMC Res Notes

Title: BMC Research Notes

Publisher: BioMed Central

ISSN (Electronic): 1756-0500

Publication date Collection: 2014

Publication date (Electronic): 17 June 2014

Volume: 7

Page: 368

Affiliations

[1 ]VUmc School of Medical Sciences, P.O. box 7057, 1007 MB Amsterdam, the Netherlands

[2 ]LEARN! Research Institute for Learning and Education, VU University Amsterdam, Amsterdam, the Netherlands

[3 ]VU University Medical Centre Amsterdam, P.O. box 7057, 1007 MB Amsterdam, the Netherlands

[4 ]Department of Intensive Care Medicine, University Hospital Maastricht, Maastricht, the Netherlands

[5 ]Department of Medical Education Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands

Article

Publisher ID: 1756-0500-7-368

DOI: 10.1186/1756-0500-7-368

PMC ID: 4080734

PubMed ID: 24938392

SO-VID: 20152715-8040-410b-8ff3-1eb01ce413f5

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Assessing professional behaviour: Overcoming teachers’ reluctance to fail students

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Abstract

Background

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Conclusions

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Special feature: Lessons Learned From Professional Doctorates

Most cited references 8

Disciplinary action by medical boards and prior behavior in medical school.

Failure to fail: the perspectives of clinical supervisors.

Teaching compassion and respect. Attending physicians' responses to problematic behaviors.

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