title: The anatomy of the professional lapse: bridging the gap between traditional frameworks and students' perceptions.
abstract: OBJECTIVE
  To support students' developing professionalism, it is necessary to understand the professional challenges and dilemmas they perceive in the clinical setting. This study systematically documented and catalogued students' reports of professional lapses.
  
  
  METHODS
  Six focus groups were conducted with senior medical students (n = 29) at three universities. Using a grounded-theory approach, three researchers analyzed the students' reports of specific lapses in professionalism for recurrent themes. The resulting coding structure was applied using NVivo qualitative data analysis software.
  
  
  RESULTS
  A total of 120 pages of text yielded 48 specific incidents of professional lapses, which were analyzed by three researchers using grounded theory. Most incidents were witnessed (n = 34) or known about (n = 4), as opposed to self-reported (n = 10). Six critical "issues" emerged: communicative violations (to or about patients or other health care professionals); role resistance (individuals chafing against constraints or expectations of their perceived roles); objectification of patients (ignoring patients or treating patients as vehicles for learning); accountability (to colleagues or patients, including avoiding patients, failing to disclose information, or failing to treat appropriately); physical harm (to patients or others); and crossfire (being put in the middle of a struggle between superiors).
  
  
  CONCLUSIONS
  This study explored how students experienced and operationalized professionalism in clinical settings at a variety of universities. Interestingly, the critical issues they reported as salient did not map easily onto standard, abstract definitions of professionalism. This incongruence suggested that the development of effective curricula in this domain must bridge the gap between traditional taxonomies and students' perceptions of professionalism.
authors.affiliation: Department of Surgery, University of Toronto, Mount Sinai Hospital, ON M5G 1X5, Canada.
authors.forename: Shiphra
authors.initials: S
authors.lastname: Ginsburg
authors.forename: Glenn
authors.initials: G
authors.lastname: Regehr
authors.forename: David
authors.initials: D
authors.lastname: Stern
authors.forename: Lorelei
authors.initials: L
authors.lastname: Lingard
mesh_terms: D002170:Canada; D026690:Ethics, Clinical; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D010819:Physician's Role; D010817:Physician-Patient Relations; D011361:Professional Competence; D028743:Professional Misconduct; D012938:Social Perception; D012941:Social Responsibility; D013337:Students, Medical / Q000523:psychology*; D014481:United States