Teachers as Learners: Developing Professionalism Feedback Skills via Observed Structured Teaching Encounters

ABSTRACT

This Conversations Starter article presents a selected research abstract from the 2017 Association of American Medical Colleges Southern Region Group on Educational Affairs annual spring meeting. The abstract is paired with the integrative commentary of 4 experts who shared their thoughts stimulated by the study. These thoughts explore the value of the Observed Structured Teaching Encounter in providing structured opportunities for medical students to engage with the complexities of providing peer feedback on professionalism.

AAMC SGEA 2017 ABSTRACT

Speaking Up: Using OSTEs to Understand How Medical Students Address Professionalism Lapses

Constance Tucker

Office of the Provost, Oregon Health & Science University, Portland, Oregon, USA

Beth Choby, Andrew Moore, Robert Scott Parker, II, Benjamin R. Zambetti, Sarah Naids, Jillian Scott, Jennifer Loome, and Sierra Gaffney

Departments of Medical Education, Graduate Medical Education, Cardiovascular Surgery, Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA

Construct: Medical educators have been charged with teaching and evaluating professionalism in themselves and their students. This study examines the use of an objective-structured teaching encounters (OSTE) to do both.

Background: OSTEs are performance-based teaching assessments using standardized learners (SLs) and are based on Ericsson's theory of deliberate practice in the development of expertise. Whereas OSTEs are typically used to assess residents and faculty, this study took a novel approach in assessing 4th-year medical students (M4s) as teachers. In this approach, a medical student, soon to become resident teacher, was able to observe and provide feedback to an SL on professionalism lapses but also be to observed and receive feedback on teaching from medical faculty and the SL. Two research questions were addressed: How frequently do M4s address professionalism lapses deliberately presented during an OSTE? What factors influence whether M4s provide feedback when they observe professionalism lapses in an OSTE?

Approach: Standardized patients and learners were trained to enact a clinical encounter with specific cognitive, social, and behavioral errors, including professionalism lapses. M4s viewed this encounter and then offered feedback to the SL while being remotely observed by faculty. Post encounter, the SL and faculty filled out identical checklists to assess M4s' teaching readiness and ability to address lapses in professionalism. To answer the first research question, the researchers examined the frequency of deliberate professionalism lapses discussed by the M4s with the SLs. To answer the second research question, the researchers transcribed and coded post-OSTE debriefing sessions to determine why M4s avoided or addressed professionalism lapses.

Results: An analysis of frequencies showed that 4 of the AAMC's 9 professional competencies were noted in the checklist: honor and integrity 189 (99.2%), respect 101 (52.6%), caring and compassion 99 (51.8%), and cultural competency 53 (28.4%). Two additional competencies were captured during the debriefing session: excellence and scholarship and confidentiality. The most common issues identified by M4s were grouped under professionalism/respect, ignoring the patient, and attire. The least common issues identified on M4s' note sheets were draping and inappropriate social history questions. During the debrief with M4s, students responded to the guided facilitator questions with rich narrative. Of the 171 coded responses over 2 years, 136 codes were in the competencies of caring and compassion (66) and respect (70). The remaining competencies were coded 35 times. Additional themes that emerged from the debriefs included (a) the impact of hidden curriculum and (b) professional behaviors as interrelated, context dependent, and in conflict with one another. M4s described the clinical environment as having unintended lessons that sometimes contradicted classroom teaching (i.e., residents and faculty with unprofessional attire). M4s described their ability to address unprofessional behaviors as being in conflict with maintaining respect and compassion (i.e., desire to maintain relationships with peers and attendings is hindered by directly addressing unprofessional behavior).

Conclusions: OSTEs are an important and effective format for faculty and students to practice, assess, and reflect on how to address professionalism lapses and what hidden curriculum exists that promotes or hinders professionalism. Although learners addressed professionalism lapses with their simulated peers, only 6 of 9 competencies defined by AAMC were addressed. If students are not aware and do not address lapses in medical school, will they do so after graduation?

Additional information

Notes on contributors

Anna T. Cianciolo

Anna T. Cianciolo, Ph.D., is Associate Professor, Department of Medical Education, at Southern Illinois University School of Medicine and Editor of Teaching and Learning in Medicine. Her research focuses on understanding and improving the performance of individuals, teams, and groups as they seek to solve the complex problems of academic health care, including diagnosis, collaborative learning, and clinical teaching and supervision.

Leslie A. Hoffman

Leslie A. Hoffman, Ph.D., is Assistant Professor, Department of Anatomy and Cell Biology at Indiana University School of Medicine–Fort Wayne. Her research focuses on medical student reflection and how reflective activities can be incorporated into the medical curriculum to improve students' study strategies and self-directed learning skills.

Jaden R. Kohn

Jaden R. Kohn, B.S., M.P.H., is a 4th-year medical student at Baylor College of Medicine. Her academic interests include health services research, quality improvement, and medical education—including team dynamics in academic medicine and professionalism education for trainees.

Patricia S. O'Sullivan

Patricia S. O'Sullivan, Ed.D., is Professor, Departments of Medicine and Surgery, at the University of California San Francisco School of Medicine and directs research and development in the Center for Faculty Educators. Her research foci span performance assessment through portfolios to surgical skills acquisition and faculty development to study the role of developers on success for their own identity and impact on others.

Robert L. Trowbridge

Robert L. Trowbridge, M.D., is Associate Professor of Medicine at Tufts University School of Medicine and Director of Undergraduate Medical Education in the Department of Medicine at Maine Medical Center in Portland, Maine. He is an internist and clinician-educator, and his major focus is on means of teaching clinical reasoning, longitudinal medical education, and faculty development.