title: 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.
  
  
  OBJECTIVE
  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.
authors.affiliation: University of California, San Francisco, CA 94143-3202, USA. arianne.teherani@ucsf.edu
authors.forename: Arianne
authors.initials: A
authors.lastname: Teherani
authors.forename: Patricia S
authors.initials: PS
authors.lastname: O'Sullivan
authors.forename: Mark
authors.initials: M
authors.lastname: Lovett
authors.forename: Karen E
authors.initials: KE
authors.lastname: Hauer
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D004521:Educational Measurement / Q000379:methods*; D006801:Humans; D007407:Interviews as Topic; D010817:Physician-Patient Relations; D028743:Professional Misconduct; D015203:Reproducibility of Results; D013337:Students, Medical