Using Studentsʼ Perceptions of Internal Medicine Teachersʼ Professionalism

Abstract

Objective: Curricular initiatives and evaluation systems have been developed to enhance and reinforce the importance of professional behaviors among medical students. A critical aspect of student learning is exposure to role models who exhibit the highest standards of professionalism. Several articles have addressed the evaluation of students' behaviors and the problems with professional development among trainees, but less has been written about students' perceptions of the professional behaviors of their preceptors. We developed a process for identifying problems in preceptors' behaviors and for giving feedback and appropriate faculty development in professionalism. Description: Our internal medicine clerkship is an eight-week inpatient experience. After each four—week ward assignment, the students are required to evaluate their faculty and supervising residents. A section on professionalism was added to the evaluation form for the 1999–2000 academic year as a way to identify possible problems in resident and faculty behaviors. Seven response items, each beginning with the statement “I observed my faculty/housestaff …” address these issues: making derogatory statements about patients or their families; making derogatory statements about other services; discussing confidential information in public; inappropriately withholding information or intentionally giving incorrect information to a patient; using disrespectful terminology to describe patients; treating non-physician healthcare workers inappropriately; and demonstrating specific behavior toward a patient because of lifestyle or ethnic, religious, or socioeconomic background. The students responded to each statement using a five-point scale of never, rarely, occasionally, frequently, and consistently. Also, space for written comments was provided. The results from evaluations of 412 faculty and 443 housestaff were reviewed in order to study their behavior. The unprofessional behavior most commonly identified by the students for each group was the use of derogatory comments in discussing other services. The use of derogatory comments about patients and the use of disrespectful terminology to describe patients were the other behaviors most frequently reported. Discussion: These student evaluations of their faculty and supervising housestaff have provided the information needed to plan feedback and faculty development. The majority of problems identified involved the use of unprofessional language and derogatory comments in various contexts. According to the students' written comments, the unprofessional remarks were often made casually. It is possible that the preceptors do not recognize that their informal comments might be perceived as objectionable and unprofessional. Collecting information about students' perceptions of the professional behaviors of faculty has proved to be useful and practical. The information is now being studied as part of all the school's year-three clinical clerkships. Through identification of problem areas and focused intervention, we hope to continue to optimize the professional atmosphere of our learning environment.