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1.  Evaluating professionalism in medical undergraduates using selected response questions: findings from an item response modelling study 
BMC Medical Education  2011;11:43.
Background
Professionalism is a difficult construct to define in medical students but aspects of this concept may be important in predicting the risk of postgraduate misconduct. For this reason attempts are being made to evaluate medical students' professionalism. This study investigated the psychometric properties of Selected Response Questions (SRQs) relating to the theme of professional conduct and ethics comparing them with two sets of control items: those testing pure knowledge of anatomy, and; items evaluating the ability to integrate and apply knowledge ("skills"). The performance of students on the SRQs was also compared with two external measures estimating aspects of professionalism in students; peer ratings of professionalism and their Conscientiousness Index, an objective measure of behaviours at medical school.
Methods
Item Response Theory (IRT) was used to analyse both question and student performance for SRQs relating to knowledge of professionalism, pure anatomy and skills. The relative difficulties, discrimination and 'guessabilities' of each theme of question were compared with each other using Analysis of Variance (ANOVA). Student performance on each topic was compared with the measures of conscientiousness and professionalism using parametric and non-parametric tests as appropriate. A post-hoc analysis of power for the IRT modelling was conducted using a Monte Carlo simulation.
Results
Professionalism items were less difficult compared to the anatomy and skills SRQs, poorer at discriminating between candidates and more erratically answered when compared to anatomy questions. Moreover professionalism item performance was uncorrelated with the standardised Conscientiousness Index scores (rho = 0.009, p = 0.90). In contrast there were modest but significant correlations between standardised Conscientiousness Index scores and performance at anatomy items (rho = 0.20, p = 0.006) though not skills (rho = .11, p = .1). Likewise, students with high peer ratings for professionalism had superior performance on anatomy SRQs but not professionalism themed questions. A trend of borderline significance (p = .07) was observed for performance on skills SRQs and professionalism nomination status.
Conclusions
SRQs related to professionalism are likely to have relatively poor psychometric properties and lack associations with other constructs associated with undergraduate professional behaviour. The findings suggest that such questions should not be included in undergraduate examinations and may raise issues with the introduction of Situational Judgement Tests into Foundation Years selection.
doi:10.1186/1472-6920-11-43
PMCID: PMC3146946  PMID: 21714870
2.  Personality traits predict job stress, depression and anxiety among junior physicians 
BMC Medical Education  2013;13:150.
Background
High levels of stress and deteriorating mental health among medical students are commonly reported. In Bergen, Norway, we explored the impact of personality traits measured early in their curriculum on stress reactions and levels of depression and anxiety symptoms as junior physicians following graduation.
Methods
Medical students (n = 201) from two classes participated in a study on personality traits and mental health early in the curriculum. A questionnaire measuring personality traits (Basic Character Inventory (BCI)) was used during their third undergraduate year. BCI assesses four personality traits: neuroticism, extroversion, conscientiousness and reality weakness. Questionnaires measuring mental health (Hospital Anxiety and Depression Scale (HADS) and Symptom Checklist 25 (SCL-25)), and stress (Perceived Medical School Stress (PMSS)) were used during their third and sixth undergraduate year. During postgraduate internship, Cooper’s Job Stress Questionnaire (CJSQ) was used to measure perceived job stress, while mental health and stress reactions were reassessed using HADS and SCL-25.
Results
Extroversion had the highest mean value (5.11) among the total group of participants, while reality weakness had the lowest (1.51). Neuroticism and reality weakness were related to high levels of perceived job stress (neuroticism r = .19, reality weakness r = .17) as well as higher levels of anxiety symptoms (neuroticism r = .23, reality weakness r = .33) and symptoms of depression (neuroticism r = .21, reality weakness r = .36) during internship. Neuroticism indirectly predicted stress reactions and levels of depression and anxiety symptoms. These relations were mediated by perceived job stress, while reality weakness predicted these mental health measures directly. Extroversion, on the other hand, protected against symptoms of depression (r = −.20). Furthermore, females reported higher levels of job stress than males (difference = 7.52).
Conclusions
Certain personality traits measured early in the course of medical school relates to mental health status as junior physicians during postgraduate internship training. This relation is mediated by high levels of perceived job stress.
doi:10.1186/1472-6920-13-150
PMCID: PMC3842670  PMID: 24207064
Junior physicians; Personality; Intervention studies; Medical students; Longitudinal study; Male; Female; Undergraduate medical education; Anxiety; Depression; Stress
3.  Exploring reflective 'critical incident' documentation of professionalism lapses in a medical undergraduate setting 
Background
Measuring professionalism in undergraduate medical students is a difficult process, and no one method has currently emerged as the definitive means of assessment in this field. Student skills in reflection have been shown to be highly important in the development of professional behaviours. By studying student reflections on lapses in professional judgement, recorded as 'critical incidents', it is possible to explore themes which are significant for the development of professional behaviour in an undergraduate setting.
Methods
We examined critical incident reporting combined with optional written student reflection as a method for exploring professionalism in undergraduate medical students. 228 students split between Year 1 and 2 of one academic year of undergraduate medicine were studied retrospectively and a grounded theory approach to analysis was employed.
Results
This year generated 16 critical incident reports and corresponding student reflections, all of which were considered. In addition to identifying the nature of the critical incidents, 3 principal themes emerged. These were the impact and consequences of the report having been made, student reactions to the events (both positive and negative), and student responses regarding future actions.
Conclusion
This study indicates that unprofessional behaviour can be identified and challenged by both the faculty and the students involved, and suggests that positive behavioural changes might be made with the aim of preventing future occurrences. We provide a low cost approach of measuring and recording professional behaviour.
doi:10.1186/1472-6920-9-44
PMCID: PMC2714848  PMID: 19604378
4.  Does Gender Moderate Medical Students’ Assessments of Unprofessional Behavior? 
Journal of General Internal Medicine  2012;27(12):1643-1648.
ABSTRACT
BACKGROUND
Despite widespread acceptance of professionalism as a clinical competency, the role of certain contextual factors in assessing certain behaviors remains unknown.
OBJECTIVE
To examine the potential moderating role of gender in assessing unprofessional behaviors during undergraduate medical training.
DESIGN
Randomized, anonymous, self-administered questionnaire.
PARTICIPANTS
Ninety seven (97) third-year students from a southeastern U.S. medical school (participation rate = 95.1 %).
MAIN MEASURES
Using a 4-point Likert-type scale, subjects reviewed two subsets of randomly administered, equally weighted hypothetical vignettes depicting potentially unprofessional behaviors that could occur during medical students’ clinical training. Ratings were categorized from 1 –“Not a Problem” to 4 –“A Severe Problem”, based on the perceived degree of unprofessionalism. In each written scenario, trainee gender was systematically varied.
KEY RESULTS
Across all scenario subsets, male and female students’ mean ratings of hypothetical behaviors did not differ significantly. Further, male and female students tended, on average, to rate behaviors similarly regardless of the trainee’s gender.
CONCLUSION
Study findings suggest that: (1) neither students’ gender nor that of the hypothetical “actor” moderates the assessment of unprofessional behaviors; and (2) male and female students assign roughly the same overall rankings to potentially unprofessional behaviors.
Electronic supplementary material
The online version of this article (doi:10.1007/s11606-012-2152-z) contains supplementary material, which is available to authorized users.
doi:10.1007/s11606-012-2152-z
PMCID: PMC3509307  PMID: 22829292
professionalism; gender; medical education; unprofessional behavior
5.  Complementary and Alternative Medicine Familiarization: What's happening in Medical Schools in Wales? 
Despite recommendations that complementary and alternative medicine (CAM) familiarization should be offered to UK medical students, in Wales little such teaching was offered. We decided to assess medical students’ knowledge of CAMs, perceived training needs in CAMs, their view of its role in the National Health Service (NHS) and current teaching given. Analysis of data from a questionnaire given to medical students and direct questioning of senior academic medical school staff in Cardiff and Swansea Medical Schools was carried out. The participants comprised 78 first year medical students in the undergraduate entry program in Cardiff and 58 first year medical students from the graduate entry program in Swansea. Senior academic medical school staff at Cardiff and Swansea Medical Schools were asked about current CAM teaching. Results revealed that 32% of undergraduate entry students (UGES) had previous knowledge of CAMs compared with 51% of graduate entry students (GES). Of the UGES, 62% believed they should be taught about CAM's compared with 94% of GES. Of UGES 31% felt that CAMs have a role in the NHS compared with 50% of GES. None of the students had received teaching about CAMs and little formal CAM teaching is currently included in the curricula at each site. The majority of medical students in Wales would like to receive CAM teaching and significant numbers support a role for CAMs in the NHS. Little formal teaching is currently provided.
doi:10.1093/ecam/nem185
PMCID: PMC2862934  PMID: 18955309
CAM teaching; medical students; integrated healthcare
6.  Promises and hurdles of undergraduate medical development in Greece 
Aim
In this paper we sought to explore undergraduate medical students’ views about their professional development during their studies that are considered to be related to medical professionalism.
Method
A descriptive cross-sectional study using interpretative analysis of anonymous 10-item questionnaires was conducted at the University of Patras Medical School (UPMS), Greece. The study sample consisted of 134 undergraduate students in their fifth and sixth year of study at UPMS.
Results
Undergraduate students emphasized the great significance of daily clinically-oriented practice in the wards in the group of behaviors consistent with medical professionalism. The integrated curriculum and informal discussions with members of the academic staff in the form of role models were also regarded as valuable approaches strongly enhancing professionalism. Students’ personal statements contained attributes regarding premium professional skills, including constancy and perfectionism throughout a lifelong learning process, so as to be able to provide high quality medical care to patients.
Conclusion
According to our undergraduate medical students themselves, the last 2 years of their studies are important to understand the essence of professionalism and develop their professional medical attitudes. Clinically-oriented teaching activities together with the informal curriculum of enhanced role modeling promote medical professional behaviors and increase standards of health care provided to patients.
doi:10.2147/AMEP.S25200
PMCID: PMC3661258  PMID: 23745091
undergraduate students; medicine; professionalism; medical education; Greece
7.  Professional Development and the Informal Curriculum in End-of-Life Care 
Journal of Cancer Education  2011;26(3):444-450.
Although professionalism has emerged as a key competency for today’s physicians, there exists little insight into how best to teach medical students the relevant skills or instill in them the commitment required to practice according to the highest professional standards. Ten UCSF medical students were interviewed at three time points (second, third, and fourth years of school). Interviews focused on students’ learning and development regarding end-of-life care (EOLC). Students described varying steps in their professional development from their second to fourth years of school, including feeling confused about the definition of professionalism and integrating their personal and professional identities. In addition to professional development, four other themes contributed to the development of medical student understanding of how to provide EOLC as a professional: (1) curricular discordance, (2) role models, (3) the tightrope between trained versus human reactions, and (4) ethical dilemmas. These five themes represent dilemmas that students often learned how to respond to over the course of school. Professional development in EOLC required the acquisition of skills necessary to balance the tension between and navigate conflicting messages present in medical student training.
doi:10.1007/s13187-011-0199-x
PMCID: PMC3161185  PMID: 21350931
Professionalism; Medical practice; End-of-life care; Professional development
8.  Can gynaecology teaching associates provide high quality effective training for medical students in the United Kingdom? Comparative study 
BMJ : British Medical Journal  2003;327(7428):1389-1392.
Objectives To train laywomen to become professional patients in order to teach medical students speculum and bimanual examination, to assess their effectiveness in this role, and to incorporate this method of teaching into the undergraduate curriculum of a medical school in the United Kingdom.
Design Comparative study.
Setting Guy's, King's, and St Thomas's School of Medicine, London.
Participants 44 medical students trained by gynaecology teaching associates; 48 control students.
Main outcome measure Skills in pelvic examination.
Results Six laywomen were recruited and all successfully graduated to become gynaecology teaching associates. At assessment 1, in the third week of the reproductive and sexual health block, the mean score achieved by students trained by gynaecology teaching associates was 155, compared with 104 for control group students (difference in mean scores 51 (95% confidence interval 41 to 61), P < 0.001). Similar results were obtained at assessment 2, at the end of the attachment—the mean score for trained students was 148, compared with a mean score of 114 for control group students (difference in mean scores 34 (21 to 46), P < 0.001).
Conclusions Laywomen can be trained to teach pelvic examination to medical students in the United Kingdom. Students who receive this training have better skills than students who receive the traditional training alone.
PMCID: PMC292994  PMID: 14670887
9.  Australian medical students' perceptions of professionalism and ethics in medical television programs 
BMC Medical Education  2011;11:50.
Background
Medical television programs offer students fictional representations of their chosen career. This study aimed to discover undergraduate medical students' viewing of medical television programs and students' perceptions of professionalism, ethics, realism and role models in the programs. The purpose was to consider implications for teaching strategies.
Methods
A medical television survey was administered to 386 undergraduate medical students across Years 1 to 4 at a university in New South Wales, Australia. The survey collected data on demographics, year of course, viewing of medical television programs, perception of programs' realism, depiction of ethics, professionalism and role models.
Results
The shows watched by most students were House, Scrubs, and Grey's Anatomy, and students nominated watching 30 different medical programs in total. There was no statistical association between year of enrolment and perceptions of accuracy. The majority of students reported that friends or family members had asked them for their opinion on an ethical or medical issue presented on a program, and that they discussed ethical and medical matters with their friends. Students had high recall of ethical topics portrayed on the shows, and most believed that medical programs generally portrayed ideals of professionalism well.
Conclusions
Medical programs offer considerable currency and relevance with students and may be useful in teaching strategies that engage students in ethical lessons about practising medicine.
doi:10.1186/1472-6920-11-50
PMCID: PMC3162942  PMID: 21798068
10.  Wanted: role models - medical students’ perceptions of professionalism 
BMC Medical Education  2012;12:115.
Background
Transformation of medical students to become medical professionals is a core competency required for physicians in the 21st century. Role modeling was traditionally the key method of transmitting this skill. Medical schools are developing medical curricula which are explicit in ensuring students develop the professional competency and understand the values and attributes of this role. The purpose of this study was to determine student perception of professionalism at the University of Ottawa and gain insights for improvement in promotion of professionalism in undergraduate medical education.
Methods
Survey on student perception of professionalism in general, the curriculum and learning environment at the University of Ottawa, and the perception of student behaviors, was developed by faculty and students and sent electronically to all University of Ottawa medical students. The survey included both quantitative items including an adapted Pritzker list and qualitative responses to eight open ended questions on professionalism at the Faculty of Medicine, University of Ottawa. All analyses were performed using SAS version 9.1 (SAS Institute Inc. Cary, NC, USA). Chi-square and Fischer’s exact test (for cell count less than 5) were used to derive p-values for categorical variables by level of student learning.
Results
The response rate was 45.6% (255 of 559 students) for all four years of the curriculum. 63% of the responses were from students in years 1 and 2 (preclerkship). Students identified role modeling as the single most important aspect of professionalism. The strongest curricular recommendations included faculty-led case scenario sessions, enhancing interprofessional interactions and the creation of special awards to staff and students to “celebrate” professionalism. Current evaluation systems were considered least effective. The importance of role modeling and information on how to report lapses and breaches was highlighted in the answers to the open ended questions.
Conclusions
Students identify the need for strong positive role models in their learning environment, and for effective evaluation of the professionalism of students and teachers. Medical school leaders must facilitate development of these components within the MD education and faculty development programs as well as in clinical milieus where student learning occurs.
doi:10.1186/1472-6920-12-115
PMCID: PMC3537482  PMID: 23153359
Professionalism; Curriculum; Undergraduate medical education; Learning environment
11.  Organizational Philosophy as a New Perspective on Understanding the Learning of Professionalism 
Objective. To define the concept of “organizational philosophy” through identification of elements within undergraduate pharmacy curricula in the United Kingdom that contribute to students’ learning of professionalism.
Methods. A qualitative study using curriculum mapping was conducted to identify “intended,” “taught,” and “received” curriculum in 3 schools of pharmacy. The study involved review of course materials, interviews with teaching staff members, focus groups with final year students, and observation of classes.
Results. “Organizational philosophy” (totality of all contributors) played a vital part in students’ professionalism learning. Key contributions were not restricted to the “taught” curriculum but extended to the wider academic environment. Setting of high standards appeared important; role models had particular significance. Importance of professionalism learning being grounded and longitudinal throughout the curriculum was highlighted. An “integrated” organizational philosophy appeared to be achieved where maximum overlap occurred between “intended,” “taught,” and “received” curricula.
Conclusions. Professionalism learning goes beyond the “taught” curriculum in pharmacy schools. The concept of “organizational philosophy” acknowledges the importance of integration between “intended,” “taught,” and “received” curriculum in the context of overall organization.
doi:10.5688/ajpe7710214
PMCID: PMC3872933  PMID: 24371338
professionalism; professionalism learning; organizational philosophy; curriculum mapping; hidden curriculum
12.  Professional Competencies Learned Through Working on a Medication Education Project 
Objectives
To implement a medication education project and assess the competencies students learned and implemented in professional practice after graduation.
Design
Fourth-year pharmacy students planned, carried out, and reported on a real-life project during 1 study year. Outside experts and 2 faculty members facilitated the work. The aim of the medication education project was to create material that schoolteachers could use to teach children about rational use of medicines.
Assessment
All students who had participated in the medication education program during its 3 years were contacted (n = 31). A questionnaire was sent to the 21 students who had graduated (18 responded), and a focus group was conducted with the 10 students completing their final year of pharmacy school (9 participants). The competencies that the students reported learning most were teamwork and social interaction skills. They considered the project motivating but also found it challenging and the deadlines frustrating.
Conclusions
Through participation in a medication education project, students learned interpersonal skills, time management, conflict resolution, and other skills that many of them already were finding valuable in their professional practice.
PMCID: PMC2933019  PMID: 21045952
competencies; project-based learning; team; assessment; social science
13.  The hidden curriculum in undergraduate medical education: qualitative study of medical students' perceptions of teaching 
BMJ : British Medical Journal  2004;329(7469):770-773.
Objective To study medical students' views about the quality of the teaching they receive during their undergraduate training, especially in terms of the hidden curriculum.
Design Semistructured interviews with individual students.
Setting One medical school in the United Kingdom.
Participants 36 undergraduate medical students, across all stages of their training, selected by random and quota sampling, stratified by sex and ethnicity, with the whole medical school population as a sampling frame.
Main outcome measures Medical students' experiences and perceptions of the quality of teaching received during their undergraduate training.
Results Students reported many examples of positive role models and effective, approachable teachers, with valued characteristics perceived according to traditional gendered stereotypes. They also described a hierarchical and competitive atmosphere in the medical school, in which haphazard instruction and teaching by humiliation occur, especially during the clinical training years.
Conclusions Following on from the recent reforms of the manifest curriculum, the hidden curriculum now needs attention to produce the necessary fundamental changes in the culture of undergraduate medical education.
PMCID: PMC520997  PMID: 15459051
14.  Clinical teachers as humanistic caregivers and educators: perceptions of senior clerks and second-year residents 
BACKGROUND: The acquisition and nurturing of humanistic skills and attitudes constitute an important aim of medical education. In order to assess how conducive the physician-learning environment is to the acquisition of these skills, the authors determined the extent to which clinical teachers are perceived by their trainees as humanistic with patients and students, and they explored whether undergraduate and graduate students share the same perceptions. METHODS: A mail survey was conducted in 1994/95 of all senior clerks and second-year residents at Laval University, University of Montreal and University of Sherbrooke medical schools. Of 774 trainees, 259 senior clerks and 238 second-year residents returned the questionnaire, for an overall response rate of 64%. Students' perceptions of their teachers were measured on a 6-point Likert scale applied to statements about teachers' attitudes toward the patient (5 items) and toward the student (5 items). RESULTS: On average, only 46% of the senior clerks agreed that their teachers displayed the humanistic characteristics of interest. They were especially critical of their teachers' apparent lack of sensitivity, with as many as 3 out of 4 declaring that their teachers seemed to be unconcerned about how patients adapt psychologically to their illnesses (75% of clerks) and that their teachers did not try to understand students' difficulties (78%) or to support students who have difficulties (77%). Compared with the clerks, the second-year residents were significantly less critical, those with negative perceptions varying from 27% to 58%, 40% on average. Except for this difference, their pattern of responses from one item to another was similar. INTERPRETATION: This study suggests the existence of a substantial gap between what medical trainees are expected to learn and what they actually experience over the course of their training. Because such a gap could represent a significant barrier to the acquisition of important skills, more and urgent research is needed to understand better the factors influencing students' perceptions.
PMCID: PMC1232732  PMID: 9805021
15.  Learning health professionalism at Makerere University: an exploratory study amongst undergraduate students 
BMC Medical Education  2010;10:76.
Background
Anecdotal evidence shows that unprofessional conduct is becoming a common occurrence amongst health workers in Uganda. The development of appropriate professional values, attitudes and behaviors is a continuum that starts when a student joins a health professional training institution and as such health professionals in training need to be exposed to the essence of professionalism. We sought to explore undergraduate health professions students' perceptions and experiences of learning professionalism as a preliminary step in addressing the problem of unprofessional conduct amongst health workers in Uganda.
Methods
Eight focus group discussions were conducted with 49 first to fifth year health professions undergraduate students of the 2008/2009 academic year at Makerere University College of Health Sciences. The focus group discussions were recorded and transcribed, and were analyzed using content analysis with emergent coding.
Results
The difference in the way first and fifth year students of Makerere University College of Health Sciences conceptualized professionalism was suggestive of the decline in attitude that occurs during medical education. The formal curriculum was described as being inadequate while the hidden and informal curricula were found to play a critical role in learning professionalism. Students identified role models as being essential to the development of professionalism and emphasized the need for appropriate role modeling. In our setting, resource constraints present an important, additional challenge to learning universal standards of health professionalism. Furthermore, students described practices that reflect the cultural concept of communalism, which conflicts with the universally accepted standard of individual medical confidentiality. The students questioned the universal applicability of internationally accepted standards of professionalism.
Conclusions
The findings call for a review of the formal professionalism curriculum at Makerere University College of Health Sciences to make it more comprehensive and to meet the needs expressed by the students. Role models need capacity building in professionalism as health professionals and as educators. In our setting, resource constraints present an additional challenge to learning universal standards of health professionalism. There is need for further research and discourse on education in health professionalism in the Sub-Saharan context of resource constraints and cultural challenges.
doi:10.1186/1472-6920-10-76
PMCID: PMC2987936  PMID: 21050457
16.  Using movies to teach professionalism to medical students 
BMC Medical Education  2011;11:60.
Background
Professionalism topics are usually not covered as a separate lesson within formal curriculum, but in subtler and less officially recognized educational activities, which makes them difficult to teach and assess. Interactive methods (e.g. movies) could be efficient teaching methods but are rarely studied. The aims of this study were: 1) to test the relevance and usefulness of movies in teaching professionalism to fourth year medical students and, 2) to assess the impact of this teaching method on students' attitudes towards some professionalism topics.
Method
This was an education study with qualitative data analysis in a group of eleven fourth year medical students from the Medical School of University Maribor who attended an elective four month course on professionalism. There were 8 (66.7%) female students in the group. The mean age of the students was 21.9 ± 0.9 years. The authors used students' written reports and oral presentations as the basis for qualitative analysis using thematic codes.
Results
Students recognised the following dimensions in the movie: communication, empathy, doctors' personal interests and palliative care. It also made them think about their attitudes towards life, death and dying.
Conclusions
The controlled environment of movies successfully enables students to explore their values, beliefs, and attitudes towards features of professionalism without feeling that their personal integrity had been threatened. Interactive teaching methods could become an indispensible aid in teaching professionalism to new generations.
doi:10.1186/1472-6920-11-60
PMCID: PMC3180297  PMID: 21861900
17.  Pilot study of the roles of personality, references, and personal statements in relation to performance over the five years of a medical degree 
BMJ : British Medical Journal  2003;326(7386):429-432.
Objectives
To compare the power of three traditional selection procedures (A levels, personal statements, and references) and one non-traditional selection procedure (personality) to predict performance over the five years of a medical degree.
Design
Cohort study over five years.
Setting
Nottingham medical school.
Participants
Entrants in 1995.
Main outcome measures
A level grades, amounts of information contained in teacher's reference and the student's personal statement, and personality scores examined in relation to 18 different assessments.
Results
Information in the teacher's reference did not consistently predict performance. Information in the personal statement was predictive of clinical aspects of training, whereas A level grades primarily predicted preclinical performance. The personality domain of conscientiousness was consistently the best predictor across the course. A structural model indicated that conscientiousness was positively related to A level grades and preclinical performance but was negatively related to clinical grades.
Conclusion
A teacher's reference is of no practical use in predicting clinical performance of medical students, in contrast to the amount of information contained in the personal statement. Therefore, simple quantification of the personal statement should aid selection. Personality factors, in particular conscientiousness, need to be considered and integrated into selection procedures.
PMCID: PMC163931  PMID: 12595384
18.  Differences in medical students' attitudes to academic misconduct and reported behaviour across the years—a questionnaire study 
Journal of Medical Ethics  2003;29(2):97-102.
Objectives: This study aimed to determine attitudinal and self reported behavioural variations between medical students in different years to scenarios involving academic misconduct.
Design: A cross-sectional study where students were given an anonymous questionnaire that asked about their attitudes to 14 scenarios describing a fictitious student engaging in acts of academic misconduct and asked them to report their own potential behaviour.
Setting: Dundee Medical School.
Participants: Undergraduate medical students from all five years of the course.
Method: Questionnaire survey.
Main measurements: Differences in medical students' attitudes to the 14 scenarios and their reported potential behaviour with regards to the scenarios in each of the years.
Results: For most of the scenarios there was no significant difference in the response between the years. Significant differences in the responses were found for some of the scenarios across the years, where a larger proportion of year one students regarded the scenario as wrong and would not engage in the behaviour, compared to other years. These scenarios included forging signatures, resubmitting work already completed for another part of the course, and falsifying patient information.
Conclusion: Observed differences between the years for some scenarios may reflect a change in students' attitudes and behaviour as they progress though the course. The results may be influenced by the educational experience of the students, both in terms of the learning environment and assessment methods used. These differences may draw attention to the potential but unintentional pressures placed on medical students to engage in academic misconduct. The importance of developing strategies to engender appropriate attitudes and behaviours at the undergraduate level must be recognised.
doi:10.1136/jme.29.2.97
PMCID: PMC1733713  PMID: 12672890
19.  Students' perception of the learning environment in a distributed medical programme 
Medical Education Online  2010;15:10.3402/meo.v15i0.5168.
Background
The learning environment of a medical school has a significant impact on students' achievements and learning outcomes. The importance of equitable learning environments across programme sites is implicit in distributed undergraduate medical programmes being developed and implemented.
Purpose
To study the learning environment and its equity across two classes and three geographically separate sites of a distributed medical programme at the University of British Columbia Medical School that commenced in 2004.
Method
The validated Dundee Ready Educational Environment Survey was sent to all students in their 2nd and 3rd year (classes graduating in 2009 and 2008) of the programme. The domains of the learning environment surveyed were: students' perceptions of learning, students' perceptions of teachers, students' academic self-perceptions, students' perceptions of the atmosphere, and students' social self-perceptions. Mean scores, frequency distribution of responses, and inter- and intrasite differences were calculated.
Results
The perception of the global learning environment at all sites was more positive than negative. It was characterised by a strongly positive perception of teachers. The work load and emphasis on factual learning were perceived negatively. Intersite differences within domains of the learning environment were more evident in the pioneer class (2008) of the programme. Intersite differences consistent across classes were largely related to on-site support for students.
Conclusions
Shared strengths and weaknesses in the learning environment at UBC sites were evident in areas that were managed by the parent institution, such as the attributes of shared faculty and curriculum. A greater divergence in the perception of the learning environment was found in domains dependent on local arrangements and social factors that are less amenable to central regulation. This study underlines the need for ongoing comparative evaluation of the learning environment at the distributed sites and interaction between leaders of these sites.
doi:10.3402/meo.v15i0.5168
PMCID: PMC2946853  PMID: 20922033
distributed programme; satellite sites; learning environment; technology enabled learning; evaluation
20.  A Leadership Elective Course Developed and Taught by Graduate Students 
Objective. To develop and implement a flexible-credit elective course to empower student pharmacists to develop lifelong leadership skills and provide teaching practice opportunities for graduate students.
Design. An elective course focusing on leadership development for second- and third-year doctor of pharmacy (PharmD) students was designed and taught by 4 graduate students under the mentorship of 2 faculty members. Student pharmacists could enroll in a 1-, 2-, or 3-credit-hour version of the course.
Assessment. Attainment of course objectives was measured using student pharmacist reflection papers and continuing professional development portfolios. Additionally, self-assessments of graduate students and faculty members delivering the course were conducted. In their responses on course evaluations, student pharmacists indicated they found the course a valuable learning experience. Graduate students found course development to be challenging but useful in developing faculty skills.
Conclusion. This flexible-credit elective course taught by graduate students was an innovative way to offer formal leadership instruction using limited college resources.
doi:10.5688/ajpe7710223
PMCID: PMC3872942  PMID: 24371347
leadership; graduate students; faculty development; pharmacy education; elective course
21.  Medical students’ and teachers’ perceptions of sexual misconduct in the student–teacher relationship 
Perspectives on Medical Education  2013;2(5-6):276-289.
Teachers are important role models for the development of professional behaviour of young trainee doctors. Unfortunately, sometimes they show unprofessional behaviour. To address misconduct in teaching, it is important to determine where the thresholds lie when it comes to inappropriate behaviours in student–teacher encounters. We explored to what extent students and teachers perceive certain behaviours as misconduct or as sexual harassment. We designed—with a reference group—five written vignettes describing inappropriate behaviours in the student–teacher relationship. Clinical students (n = 1,195) and faculty of eight different hospitals (n = 1,497) were invited to rate to what extent they perceived each vignette as misconduct or sexual harassment. Data were analyzed using t tests and Pearson’s correlations. In total 643 students (54 %) and 551 teachers (37 %) responded. All vignettes were consistently considered more as misconduct than as actual sexual harassment. At an individual level, respondents differed largely as to whether they perceived an incident as misconduct or sexual harassment. Comparison between groups showed that teachers’ and students’ perceptions on three vignettes differed significantly, although the direction differed. Male students were more lenient towards certain behaviours than female students. To conclude, perceptions of misconduct and sexual harassment are not univocal. We recommend making students and teachers aware that the boundaries of others may not be the same as their own.
doi:10.1007/s40037-013-0091-y
PMCID: PMC3824750  PMID: 24170538
Student–teacher relationship; Sexual harassment; Misconduct; Boundary issues; Unprofessional behaviour; Gender differences
22.  Requirements for admission to medical school: how many years of university study are necessary? 
OBJECTIVE: To assess whether students admitted to medical school after completing 2 years of undergraduate study performed as well as those admitted after longer periods of undergraduate study in terms of broad patient-care skills measured at the time of graduation. DESIGN: Retrospective study. SETTING: University of Alberta, Edmonton. PARTICIPANTS: Graduates of the classes of 1990 and 1991, of the 226 graduates 133 had entered medical school after 2 years of undergraduate training, 39 after 3 years and 54 after 4 or more years. Eight students had been excluded because they were either transfer students or international students. OUTCOME MEASURES: Objective and subjective assessments of the main clinical rotations (internal medicine, obstetrics and gynecology, pediatrics, psychiatry, radiology and surgery), results of the faculty's final comprehensive examination and of the Medical Council of Canada's Qualifying Examination. RESULTS: The students who had completed 2 years of undergraduate study before medical school were significantly younger than those who had completed 3 years and those who had completed 4 or more years (mean age [and standard deviation (SD)] 20.5 [2.1], 21.5 [2.4] and 25.1 [4.4] years respectively, p < 0.001). They also had a significantly higher mean grade point average (GPA) for the prerequisite courses for admission to medical school than those with 3 years and those with 4 or more years of undergraduate study (8.26 [SD 0.3], 7.95 [SD 0.3] and 7.80 [SD 0.5] respectively, p < 0.001). The overall mean GPA for the best 2 years of undergraduate study did not differ significantly between the three groups. The students with 2 years of undergraduate study had a significantly lower mean score for the pre-entry interview than those who had 4 or more years of undergraduate study (32.1 [SD 7.6] v. 38.3 [SD 8.5], p < 0.001). There were no significant differences between the three groups in the results of any of the subjective or objective outcome measures. CONCLUSION: Students who completed 2 years of undergraduate study before admission to medical school were able to achieve a satisfactory level of competency and maturity by the end of medical school. The 2-year option for entrance into medical school should be reconsidered.
PMCID: PMC1488032  PMID: 7489552
23.  Self-reported tobacco smoking practices among medical students and their perceptions towards training about tobacco smoking in medical curricula: A cross-sectional, questionnaire survey in Malaysia, India, Pakistan, Nepal, and Bangladesh 
Background
Tobacco smoking issues in developing countries are usually taught non-systematically as and when the topic arose. The World Health Organisation and Global Health Professional Student Survey (GHPSS) have suggested introducing a separate integrated tobacco module into medical school curricula. Our aim was to assess medical students' tobacco smoking habits, their practices towards patients' smoking habits and attitude towards teaching about smoking in medical schools.
Methods
A cross-sectional questionnaire survey was carried out among final year undergraduate medical students in Malaysia, India, Nepal, Pakistan, and Bangladesh. An anonymous, self-administered questionnaire included items on demographic information, students' current practices about patients' tobacco smoking habits, their perception towards tobacco education in medical schools on a five point Likert scale. Questions about tobacco smoking habits were adapted from GHPSS questionnaire. An 'ever smoker' was defined as one who had smoked during lifetime, even if had tried a few puffs once or twice. 'Current smoker' was defined as those who had smoked tobacco product on one or more days in the preceding month of the survey. Descriptive statistics were calculated.
Results
Overall response rate was 81.6% (922/1130). Median age was 22 years while 50.7% were males and 48.2% were females. The overall prevalence of 'ever smokers' and 'current smokers' was 31.7% and 13.1% respectively. A majority (> 80%) of students asked the patients about their smoking habits during clinical postings/clerkships. Only a third of them did counselling, and assessed the patients' willingness to quit. Majority of the students agreed about doctors' role in tobacco control as being role models, competence in smoking cessation methods, counseling, and the need for training about tobacco cessation in medical schools. About 50% agreed that current curriculum teaches about tobacco smoking but not systematically and should be included as a separate module. Majority of the students indicated that topics about health effects, nicotine addiction and its treatment, counselling, prevention of relapse were important or very important in training about tobacco smoking.
Conclusion
Medical educators should consider revising medical curricula to improve training about tobacco smoking cessation in medical schools. Our results should be supported by surveys from other medical schools in developing countries of Asia.
doi:10.1186/1747-597X-5-29
PMCID: PMC2994841  PMID: 21080923
24.  Patient safety: helping medical students understand error in healthcare 
Quality & Safety in Health Care  2007;16(4):256-259.
Objective
To change the culture of healthcare organisations and improve patient safety, new professionals need to be taught about adverse events and how to trap and mitigate against errors. A literature review did not reveal any patient safety courses in the core undergraduate medical curriculum. Therefore a new module was designed and piloted.
Design
A 5‐h evidence‐based module on understanding error in healthcare was designed with a preliminary evaluation using self‐report questionnaires.
Setting
A UK medical school.
Participants
110 final year students.
Measurements and main results
Participants completed two questionnaires: the first questionnaire was designed to measure students' self‐ratings of knowledge, attitudes and behaviour in relation to patient safety and medical error, and was administered before and approximately 1 year after the module; the second formative questionnaire on the teaching process and how it could be improved was administered after completion of the module.
Conclusions
Before attending the module, the students reported they had little understanding of patient safety matters. One year later, only knowledge and the perceived personal control over safety had improved. The students rated the teaching process highly and found the module valuable. Longitudinal follow‐up is required to provide more information on the lasting impact of the module.
doi:10.1136/qshc.2006.021014
PMCID: PMC2464940  PMID: 17693671
25.  The International ‘Balint’ Award – a rising opportunity for Romanian Medical Students  
Journal of Medicine and Life  2010;3(1):106-109.
The International ‘Balint’ Award for students, instituted by the Foundation for Psychosomatic and Social Medicine in honor of Michael and Enid Balint, has been a rising opportunity for Romanian medical and psychology students to achieve international fame. Romanian students have been among the winners of this award for the last 10 years, in competition with students from Ivy League and other illustrious universities.
The ‘Ascona model’ case presentation debates the psychological side of a medical case, while keeping in focus the diagnostic, pathology and treatment issues. This article focuses on explaining this type of case presentation in correlation with one of the papers submitted in the contest that has received this award in the 15th International Balint Congress.
The exposed case is that of a 17–year–old boy presenting with apparent stupor encountered by an emergency mobile unit. The patient was suspected of substance abuse and overdose but these suspicions were denied by the clinical exam. Further encounters led to the conclusion that both the boy and his whole family needed psychotherapy counseling and were referred there with great success.
PMCID: PMC3019028  PMID: 20302207
psychotherapy; Balint method; , Ascona model case presentation

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