Categorization of unprofessional behaviours identified during administration of and remediation after a comprehensive clinical performance examination using a validated professionalism framework

Abstract

Background: Unprofessional behaviours by medical students predict future disciplinary outcomes. Comprehensive clinical performance examinations (CPXs) that are commonly employed to evaluate learners may provide an opportunity to identify unprofessional behaviours.

Aims: To categorize the professionalism problems that occur during the CPX and subsequent remediation of students who perform poorly.

Methods: We interviewed 33 individuals responsible for remediation after the CPX at 33 medical schools. We applied a validated framework for characterizing unprofessional behaviours to the professionalism problems described. We searched transcripts for 119 descriptors representing eight categories of unprofessional behaviour from this framework.

Results: Eighteen interviewees identified professionalism as a problem during the examination and subsequent remediation. Unprofessional behaviours reported to occur in order of most to least mentioned, where a diminished capacity for self-improvement, impaired relationships with patients, irresponsibility, poor initiative and unprofessional behaviour associated with anxiety.

Conclusions: Unprofessional behaviours are exhibited during the CPX and subsequent remediation. The frequently occurring behaviours of irresponsibility and diminished capacity for self-improvement are predictive of future professionalism problems and co-occur with behaviours that preclude meaningful patient relationships. A framework for identifying unprofessional behaviours may be useful in the formal assessment of professionalism during the CPX.

Additional information

Notes on contributors

Arianne Teherani

Arianne Teherani, PhD, is Associate Professor of Medicine and Director of Program Evaluation at the University of California, San Francisco. Her research has focused on professionalism, clinical teaching and assessment.

Patricia S. O'Sullivan

Patricia O’ Sullivan, EdD, is Associate Director for Educational Research and Professor of Medicine at the University of California, San Francisco. Her research focuses on clinical assessment and teaching staff development.

Mark Lovett

Mark Lovett, MPIA, is Senior Evaluation and Research Analyst at the Office of Medical Education, University of California, San Francisco. His research has been both qualitative and quantitative with a focus on evaluation and assessment.

Karen E. Hauer

Karen E. Hauer, MD, is Associate Professor of Medicine, Director of Internal Medicine Clerkships and Director of the Clinical Performance Exam at the University of California, San Francisco. Her research focuses on clinical skills assessment.