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Professionalism assessment-as simple as a checklist?

Not all unprofessional behaviors are equal: The creation of a checklist of bad behaviors. Cullen MJ, Konia MR, Borman-Shoap EC, Braman JP, Tiryaki E, Marcus-Blank B, Andrews JS.  Med Teach 2017;39(1):85-91.

Reviewed by Jeanine Ronan

Tags: Professionalism, Medical Students, Checklists

What was the study question?

The study question was to determine the relative egregiousness of unprofessional behaviors in medical trainees.  More specifically, are some unprofessional behaviors concerning if they happen only once while others are concerning after a pattern emerges?

How was the study done?

First, the authors conducted a review of the medical education literature on professionalism and identified 7 professionalism domains including conscientiousness, aspiring to excellence, integrity, accountability, teamwork, patient-centeredness and stress tolerance.  They then conducted three workshops involving 17 faculty from residency and fellowship programs (including 11 program directors).  Workshop participants refined and developed a list of 74 specific positive and 70 specific negative professionalism behaviors within all 7 domains.  The workshop participants then rated the 70 negative behaviors based on how concerned they would be if the behavior occurred 1, 2, 3, 4, or 5 or more times in a 6-month period.  A “concern index” was created for each behavior to identify the most egregious behaviors.

What were the results?

Two professionalism checklists were developed based on the “concern index”:

  1. Brief Checklist-to identify 14 behaviors, mainly those associated with integrity, that were judged to be concerning if they occurred only once. Examples included: signs of substance abuse, abusive behaviors, showing disrespect to patients, discriminating against co-workers.
  2. Extended Checklist: to assess patterns of misconduct for less serious behaviors that are concerning if occurring frequently and may require remediation. Examples included arriving late for conferences or not encouraging patients to ask questions.

What are the implications of these findings?

This study is the first to demonstrate that there are different levels of concerns based on the frequency of occurrence for unprofessional behaviors.  The use of these checklists may be a simple way to identify such behaviors from multiple sources and develop programs for further remediation.       

Editor’s Note: The article includes the entire list of 70 behaviors in a supplement, which is a great resource if any educator wants to institute a similar checklist.  The challenge will be to get faculty, peers and others to fill it out, especially for the less egregious behaviors.  (JG)

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