Putting theory into practice – A case study in one UK medical school of the nature and extent of unprofessional behaviour over a 6-year period

Abstract

Background: Producing a medical profession which is fit for the demands and expectations of society involves ensuring that practitioners learn what it means to behave in a ‘professional’ way. Codes of professional conduct have been developed for medical students in the UK, but the literature on how medical schools actually apply these is small. More detail is needed to evaluate approaches to assessing professionalism, or to analyse the extent to which students ‘fail’ this aspect.

Aim: To describe one UK medical school's approach to monitoring and assessing aspects of professional behaviour; quantify the prevalence and severity of behaviours recognised as cause of concern in the first 6 years of the programme; evaluate whether there is evidence of any association between professional and academic underperformance and draw conclusions for further development of fitness to practice procedures.

Methods: Mixed methods utilising exam board and administrative data for statistical and descriptive analysis.

Results: Even under detailed scrutiny, only 3% of students received formal warnings for behavioural problems over the course of a 5-year programme, and notifications decreased as students entered the senior years. There was a trend towards association between academic and professional underperformance.

Conclusion: Creating clear expectations, providing positive role models and monitoring student behaviour makes explicit what is expected of students as ‘professionals in the making’, and contributes to overall low rates of misdemeanour. The predictive value of recurrent and serious behavioural problems is not yet known as it is too soon for these graduates to have established careers. Students who are struggling academically may also present with unprofessional behaviours but the cause of this is unclear. Further research is needed to benchmark systems across the UK, and to know whether formalising expectations of undergraduates result in less problems in subsequent practice.

Notes

1. Details of the UK accreditation scheme can be found at http://www.gmc-uk.org/education/undergraduate/qabme_programme.asp, downloaded 1 January2010.

2. This was less in the first intakes, hence lower overall numbers in these results.

3. Akin to Bentham's ‘Panopticon’, where people in an institution can be unknowingly observed at all times from any angle.