How Do Medical Schools Identify and Remediate Professionalism Lapses in Medical Students? A Study of U.S. and Canadian Medical Schools.
OBJECTIVE
Teaching and assessing professionalism is an essential element of medical education, mandated by accrediting bodies. Responding to a call for comprehensive research on remediation of student professionalism lapses, the authors explored current medical school policies and practices.


METHODS
In 2012-2013, key administrators at U.S. and Canadian medical schools accredited by the Liaison Committee on Medical Education were interviewed via telephone or e-mail. The structured interview questionnaire contained open-ended and closed questions about practices for monitoring student professionalism, strategies for remediating lapses, and strengths and limitations of current systems. The authors employed a mixed-methods approach, using descriptive statistics and qualitative analysis based on grounded theory.


RESULTS
Ninety-three (60.8%) of 153 eligible schools participated. Most (74/93; 79.6%) had specific policies and processes regarding professionalism lapses. Student affairs deans and course/clerkship directors were typically responsible for remediation oversight. Approaches for identifying lapses included incident-based reporting and routine student evaluations. The most common remediation strategies reported by schools that had remediated lapses were mandated mental health evaluation (74/90; 82.2%), remediation assignments (66/90; 73.3%), and professionalism mentoring (66/90; 73.3%). System strengths included catching minor offenses early, emphasizing professionalism schoolwide, focusing on helping rather than punishing students, and assuring transparency and good communication. System weaknesses included reluctance to report (by students and faculty), lack of faculty training, unclear policies, and ineffective remediation. In addition, considerable variability in feedforward processes existed between schools.


CONCLUSIONS
The identified strengths can be used in developing best practices until studies of the strategies' effectiveness are conducted.
D. Ziring is assistant professor, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania. D. Danoff is adjunct professor, Department of Medicine, and an affiliate member, Centre for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada. S. Grosseman is professor, Department of Pediatrics, Universidade Federal de Santa Catarina, Florianópolis, Brazil. D. Langer is a doctoral candidate, Department of Community Health and Prevention, Drexel University, Philadelphia, Pennsylvania. A. Esposito is a fourth-year medical student, Drexel University College of Medicine, Philadelphia, Pennsylvania. M.K. Jan is a fourth-year medical student, Drexel University College of Medicine, Philadelphia, Pennsylvania. S. Rosenzweig is clinical associate professor, Department of Emergency Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania. D. Novack is professor, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania.
Deborah
D
Ziring
Deborah
D
Danoff
Suely
S
Grosseman
Debra
D
Langer
Amanda
A
Esposito
Mian Kouresch
MK
Jan
Steven
S
Rosenzweig
Dennis
D
Novack
D002170:Canada; D004504:Education, Medical, Undergraduate / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D004521:Educational Measurement / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic; D008611:Mentors; D000068616:Professionalism / Q000193:education*; D012073:Remedial Teaching / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D012577:Schools, Medical; D013337:Students, Medical / Q000523:psychology*; D011795:Surveys and Questionnaires; D014481:United States