title: 'Is that normal?' Pre-clerkship students' approaches to professional dilemmas.
abstract: OBJECTIVE
  Context has been recognised as a key variable in studies of medical student professionalism, yet the effect of students' stage of training has not been well explored, despite growing recognition that medical students begin to form their professional ethos from their earliest medical school experiences. The purpose of this study, which builds on previous research involving clinical clerks, was to explore the decision-making processes of pre-clerkship medical students in the face of standardised professional dilemmas.
  
  
  METHODS
  Structured interviews were conducted with 30 pre-clerkship (Years 1 and 2) medical students at one institution. During the interviews, students were asked to respond to five videotaped scenarios, each of which depicted a student facing a professional dilemma. Transcripts were analysed using an existing theoretical framework based on a constructivist grounded theory approach.
  
  
  RESULTS
  Pre-clerkship students' approaches to professional dilemmas were largely similar to those of clerks, despite their limited clinical experience, with several notable exceptions. For example, reliance on instincts and emotions was not as pervasive, but concerns with systems-associated issues were more recurrent. These findings were explored in the context of theory on professional identity formation.
  
  
  CONCLUSIONS
  As the novice student constructs a professional identity, he or she may feel the need to take on the role of doctor and shed that of student, a process that involves the suppressing of emotions, but this may be misguided. Educators should be aware of these stages of identity formation and tailor their teaching and evaluation of professionalism accordingly.
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Ontario, Canada. shiphra.ginsburg@utoronto.ca
authors.forename: Shiphra
authors.initials: S
authors.lastname: Ginsburg
authors.forename: Lorelei
authors.initials: L
authors.lastname: Lingard
mesh_terms: D001291:Attitude of Health Personnel; D002982:Clinical Clerkship; D015331:Cohort Studies; D003657:Decision Making; D004504:Education, Medical, Undergraduate / Q000379:methods* / Q000592:standards; D006801:Humans; D010817:Physician-Patient Relations; D011361:Professional Competence / Q000592:standards*; D013663:Teaching / Q000379:methods* / Q000592:standards; D014743:Videotape Recording / Q000706:statistics & numerical data