New way of gauging professional behavior in medical students

May 27, 2009,

A new way of assessing professionalism among medical students could help to make better doctors, a new research study suggests.

A score given to medical students, called the Conscientiousness Index, can detect behaviours which may need investigation at an early stage, allowing targeted support to be given to ultimately make for better , according to the Durham University study.

The Conscientiousness Index (CI) is believed to be the first ever index to measure diligence among undergraduate medical students, and the researchers say it could contribute to improving doctors' performance after qualification.

Evidence from US studies has shown that negative behaviour by medical students is linked to the likelihood of subsequent negative behaviour in later careers, say the scientists. The research team believes the early identification of problems could be vital in addressing issues and giving support to ultimately produce better doctors.

The Conscientiousness Index measures the diligence of students in their day-to-day behaviour on the course by gaining and losing points. For example, students can receive points for submitting compulsory information such as CRB checks within deadline, but are deducted points for failing to attend compulsory teaching sessions without good reason.

The study, published in the current issue of the peer-reviewed journal Academic Medicine, found that those students who were extremely conscientious according to the index were also independently perceived by staff as being highly professional. Those students that did not score highly received mixed responses from staff demonstrating that students are never consistently worrying but mostly conscientious with some lapses. The researchers say it is these lapses that could be identified and addressed with the right support.

Lead author Professor John McLachlan from Durham University's School of Medicine and Health said: "A doctor's behaviour is as important as his or her knowledge. In fact, most complaints to the General Medical Council are about doctors' behaviours, not their lack of knowledge.

"In medical training, it is vital that we train people to be rounded, knowledgeable and professional. However, measuring professionalism is problematic because it is difficult to define and often relies on qualitative judgements.

"Using the index, we found that the vast majority of students are highly conscientious making a very small percentage stand out when they lapse. This makes it easier for staff to identify those students and take early steps to help them."

In the study, just over 200 students were assessed using the Conscientiousness Index which had no impact on their academic grading. They were awarded or deducted points in various categories such as attendance, submission of data, feedback and assignments, and other areas of positive and negative behaviour such as professionally responding to a medical emergency or reading but failing to respond to repeated emails from staff.

The vast majority of the students in the pilot were assessed as being extremely conscientious with only a very small proportion showing some inconsistencies in assessments of their professionalism.

In addition to a score given to the students, a group of nine experienced staff members were asked to express an expert judgement on the professionalism of the students. These staff were not aware of the students' scores on the Conscientiousness Index. The staff were asked if they were happy with the professionalism shown by the student, had concerns about a student's professionalism, or did not know the student well enough to comment.

The scientists say the pilot has already attracted attention from other universities in the UK, and could also be implemented at post-qualifying level amongst junior doctors.

Professor McLachlan said: "Our findings suggest that in encouraging desirable professional behaviour, targeting students' conscientiousness might be a good place to start. This index is an easy, objective and uncontroversial method for exploring students' professionalism.

"The Index is a bit like a screening test, much as they do for breast cancer. Over 90 per cent of women who are referred further for a biopsy prove not to have cancer but it is still considered worthwhile to screen them. In the same way, about 98 per cent of students who display unprofessional behaviour as students do not get into disciplinary trouble later but it may well still be worth screening to help them early on."

General Medical Council guidance identifies six key principles in its Good Medical Practice (source: General Medical Council)

  • Make the care of the patient the doctors' first concern.
  • Protect and promote the health of patients and the public.
  • Ensure a good standard of practice and care, which includes keeping knowledge and skills up to date, working within personal limitations, and working cooperatively.
  • Treat patients as individuals and respect their dignity, which includes treating them considerately but also with confidentiality.
  • Work in partnership with patients, listen to their concerns, give them information appropriately, respect their decisions, and support their self-care.
  • Practice medicine with honesty, openness, and integrity. This category includes non-discrimination, meriting trust, and acting without delay if the doctor or a colleague is putting patients at risk.
Source: Durham University

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not rated yet May 27, 2009
I've witnessed first hand the different stresses which challenge Good Practice Principles evolve over the last 30 years. A paradigm shift occurred. Health Care providers time is limited, education of the patient, presentation of choices and treatment regimes, take all important TIME. LISTENING skills and interpretation is the ART in the practice of medicine/health. All too often time does not allow it or too many competing priorities limit the development of that skill only gained through experience.
Conscientious directives can be misguided when listening skills and time are constrained too profoundly which is missed but still give the provider a high score.

Although modeling of behaviors and that of consciousness is a good first step-mentoring could also prove to be helpful as well as fully utilizing a team approach to identifying patient care and needs.

A team approach inclusive of RNs trained well in assessment skills both physical and in taking careful histories and/or time for careful followup status of the chronically ill, could help minimize time allowing the physician to focus on the evidence which requires conscientious attention/investigation.

There is no substitute for time, listening skills, and careful physical assessments in a patient centric health care environment. Inclusive of this is time for physicians to assess clinical/instigative material other than on the fly for complicated cases either outpatient or inpatient. The physician/nurse/patient relationship/outcomes are enhanced by consistency and PERSONAL familiarity which also require that element of time that this old-style former practitioner finds missing in todays paradigms of health care provision in most every environment of acute and chronic care.

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