Speaking up: using OSTEs to understand how medical students address professionalism lapses.
BACKGROUND
Objective-structured teaching encounters (OSTEs) are used across many disciplines to assess teaching ability. The OSTE detailed in this paper assesses 191 fourth-year medical students' (M4) ability to identify and address lapses in professionalism based on Association of American Medical Colleges' professionalism competencies. The research questions addressed are How frequently do M4s address professionalism lapses observed during an OSTE? What factors influence whether M4s provide feedback when they observe professionalism lapses in an OSTE?


METHODS
Standardized patients (SPs) and standardized learners (SLs) were recruited and trained to participate in a standardized encounter with specific cognitive, social, and behavioral errors, including professionalism lapses. M4s viewed this encounter and then offered feedback to the SL, while remotely observed by faculty. Post-encounter, the SL and faculty completed identical checklists to assess both teaching readiness and ability to address professionalism concerns.


RESULTS
An analysis of frequencies showed that six of the Association of American Medical Colleges' nine professional competencies were addressed in the checklist and/or discussed in the focus group. Analysis of transcribed debriefing sessions confirmed that M4s did not consistently address professionalism lapses by their peers.


CONCLUSIONS
In focus groups, M4s indicated that, while they noticed professionalism issues, they were uncomfortable discussing them with the SLs. Findings of the current study suggest how medical educators might support learners' ability to address lapses in professionalism as well as topics for future research.
Faculty Development, McGlothlin Medical Education Center, Virginia Commonwealth University School of Medicine, Richmond, VA, USA; constance.tucker@vcuhealth.org.
Constance R
CR
Tucker
Department of Medical Education, University of Tennessee Health Science Center, Memphis, TN, USA.
Beth A
BA
Choby
Graduate Medical Education, University of Tennessee Health Science Center, Memphis, TN, USA.
Andrew
A
Moore
Graduate Medical Education, University of Tennessee Health Science Center, Memphis, TN, USA.
Robert Scott
RS
Parker
Graduate Medical Education, University of Tennessee Health Science Center, Memphis, TN, USA.
Benjamin R
BR
Zambetti
Graduate Medical Education, University of Tennessee Health Science Center, Memphis, TN, USA.
Sarah
S
Naids
Graduate Medical Education, University of Tennessee Health Science Center, Memphis, TN, USA.
Jillian
J
Scott
Graduate Medical Education, University of Tennessee Health Science Center, Memphis, TN, USA.
Jennifer
J
Loome
Graduate Medical Education, University of Tennessee Health Science Center, Memphis, TN, USA.
Sierra
S
Gaffney
D001519:Behavior; D003219:Confidentiality; D054521:Cultural Competency; D004504:Education, Medical, Undergraduate / Q000379:methods*; D004645:Empathy; D005260:Female; D006801:Humans; D008297:Male; D016544:Patient Simulation; D010817:Physician-Patient Relations; D000068616:Professionalism / Q000193:education*; D013337:Students, Medical / Q000523:psychology*
assessment; medicine; professionalism; simulation; teaching and learning