How to identify, address and report students’ unprofessional behaviour in medical school

Abstract

This AMEE guide provides a research overview of the identification of, and responding to unprofessional behaviour in medical students. It is directed towards medical educators in preclinical and clinical undergraduate medical education. It aims to describe, clarify and categorize different types of unprofessional behaviours, highlighting students’ unprofessional behaviour profiles and what they mean for further guidance. This facilitates identification, addressing, reporting and remediation of different types of unprofessional behaviour in different types of students in undergraduate medical education. Professionalism, professional behaviour and professional identity formation are three different viewpoints in medical education and research. Teaching and assessing professionalism, promoting professional identity formation, is the positive approach. An inevitable consequence is that teachers sometimes are confronted with unprofessional behaviour. When this happens, a complementary approach is needed. How to effectively respond to unprofessional behaviour deserves our attention, owing to the amount of time, effort and resources spent by teachers in managing unprofessional behaviour of medical students. Clinical and medical educators find it hard to address unprofessional behaviour and turn toward refraining from handling it, thus leading to the ‘failure to fail’ phenomenon. Finding the ways to describe and categorize observed unprofessional behaviour of students encourages teachers to take the appropriate actions.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Additional information

Notes on contributors

Marianne Mak-van der Vossen

Marianne Mak-van der Vossen, MD, PhD, is a Medical Educator and Education Researcher at Amsterdam UMC, Faculty of Medicine VU University in Amsterdam, the Netherlands. She received her MD in 1986, and completed residency training in general practice at the University of Amsterdam in 1990. Marianne worked in general practice for 15 years, combining this work with teaching clerks in the workplace, and from 2001 with other educational activities at the Faculty of Medicine at the VU University. From 2010 onwards, she has been coordinating the educational theme 'Professional behaviour' at the school. Recently, Marianne received her PhD with distinction. Her research explores how educators and peer students perceive and respond to unprofessional behaviours of medical students.

Arianne Teherani

Arianne Teherani PhD, is a Professor of Medicine and Education Scientist, Department of Medicine and Center for Faculty Educators, University of California, San Francisco, School of Medicine, San Francisco, USA. She is also Director for Educational Evaluation for the University of California, San Francisco, School of Medicine, a role in which she leads design, development, and policy for evaluation of the school’s curriculum and programs. Arianne’s main research interests are in the areas of professionalism, professional identity formation, and equity in medical education. She has led studies aimed at identification and remediation of unprofessional behaviours, the role of clinical education in shaping the professional identity of learners and teachers, and the role of assessment and learning environment practices in perpetuating educational disparities and interventions aimed at creating equity during medical school.

Walther van Mook

Walther N.K.A. van Mook, MD, PhD, is a professor of Medical Education and Dean for Postgraduate Medical Training and internist/intensivist in the department of Intensive Care Medicine in Maastricht University Medical Center, Maastricht, the Netherlands. His current medical education research focuses on generic aspects of (post)graduate training, and on intensive care medicine specifically, including the supervision of national and international PhD students. In addition he performs research in the fields of organ donation, hematological diseases, neurophysiology and infectious diseases in the ICU.

Gerda Croiset

Gerda Croiset, MD, PhD, is a Professor of Education and Training in Health and Life Sciences and Dean of Education and Training at the University Medical Center Groningen, Groningen, the Netherlands.

Rashmi A. Kusurkar

Rashmi A. Kusurkar, MD, PhD, is an Associate Professor and Head of the Department of Research in Education at Amsterdam UMC, Faculty of Medicine at the VU University Amsterdam, Amsterdam, the Netherlands. Her focus of research is motivation in education. Additionally, she investigates different topics in medical education through the lens of motivation. Her other area of interest is assessment. She is also a member of the institutional Examination Board, a function in which she regularly deals with observed and reported unprofessional behaviour of medical students. She is international faculty on Self-determination Theory (SDT) of motivation. She is also a member of the Fellowship Committee of AMEE.