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Evaluation of Medical Student Professionalism: A Practical Approach
Jay H. Menna, Ph.D., Michael Petty, Ph.D., Richard P. Wheeler, M.D. and Ong Vang, B.A.
University of Arkansas for Medical Sciences
Little Rock, AR 72205 U.S.A.
The College of Medicine at the University of Arkansas for Medical Sciences (UAMS) has developed an easy and practical method of evaluating medical student professionalism. The evaluation instrument is a single page document listing parameters of professionalism. Next to each parameter are the options of designating a student as either "Inadequate" or "Outstanding" i.e. is the student unable to meet or has he/she exceeded the College's expectations of professional behavior. The form also provides space for comments from the evaluator. A comment is required for all "Inadequate" ratings; "Outstanding" ratings do not require comments but are strongly encouraged. The process allows for faculty, nurses, residents, clerical staff, and even other medical students to submit a form. Generally, however, faculty is the major source of these reports. The use of this form greatly facilitates the evaluation of medical student professionalism and importantly saves faculty time.
Evaluation of medical student professionalism is as important as assessing knowledge and clinical skills. Medical educators have excellent assessment tools to measure student knowledge and clinical skills1-4 but the assessment of professionalism remains somewhat elusive. Often medical student professionalism is evaluated using rating scales that render quantifiable information.5-11 Such instruments afford the identification of problem students as well as those who may be border line; as does the evaluation instrument described in this report. Importantly, as well, such instruments help identify students who are exemplary in manifesting those qualities that constitute "professionalism".
Some medical schools use a global approach, called a 360° evaluation, to evaluate medical student professionalism.12,13 The 360° approach requires that a student's professional behavior be evaluated by a diversity of individuals who interact with the student. The 360° gives a rather panoramic view of a medical student's professionalism. There are, however, some drawbacks in using a 360° evaluation protocol. Clearly, one of the most significant concerns is the time required to carry out 360° evaluations. Clinical faculty members are now required to see more patients than in the past as a means of maintaining the sovereignty of the medical school enterprise. Also, basic science faculty are now being required to obtain more extramural research funding to supplement their incomes and generate funds for their medical schools. Obviously, the "faculty time crunch" generates a serious problem that impedes the evaluation process. Also faculty often feels that there is no reward (compensation) for taking the time to carry out 360° evaluations. Compounding the problem is the time required to collect the evaluations and carryout analyses.
MATERIALS AND METHODS
At the College of Medicine, UAMS the faculty has developed a list of student expectations that underpin the competency of professionalism. The competency of professionalism and six others serve as the infrastructure to measure educational outcomes, Figure 1. The student-expectations of professionalism serve as the backbone of the professionalism evaluation instrument.
Since 1980 the College of Medicine, UAMS has used a Scholastic Non-Cognitive Performance Evaluation instrument to evaluate medical student professionalism. This form was updated in 2004 to be consistent with the expectations that frame the current competency of professionalism, Figure 2 (Scholastic Non-Cognitive Performance Evaluation: Professionalism form). The course and the clerkship directors are trained in the use of the form and they in turn instruct their teaching faculty. Using this form the evaluator must decide if a student's professionalism is "Inadequate" or "Outstanding" relative to each professionalism-expectation. Any faculty member, resident, nurse, or other medical student can submit an evaluation on a medical student. Generally, however, most of the evaluations are submitted by faculty. A copy of the evaluation report is sent to the student, the Dean's Office and to the submitter's department or division.
When a student receives his/her first inadequate rating, the student is required to meet with the Executive Associate Dean for Academic Affairs to discuss the evaluation. At that time it is determined whether remediation is necessary. If the first negative evaluation report is of an egregious nature the student may, at the discretion of the Executive Associate Dean for Academic Affairs, be brought before his/her medical student promotions committee for remediation and possible disciplinary action. Medical students who receive two separate reports of professional inadequacy are, as a matter of policy, required to appear before their promotions committee. Depending on the nature of the reports the student may be dismissed from medical school for scholastic non-cognitive reasons. Students who do not receive inadequate evaluation reports are considered to be in compliance with the student-expectations of professionalism. When a student receives a positive report the report is put in their permanent student-file. The substance of the report is incorporated into their medical student performance letter that is sent to all student-selected potential residency programs.
RESULTS AND DISCUSSION
Rees and Shepherd 13 found several factors which limited the benefits of using 360° evaluations to rate professionalism, including variation in contact time and lack of discrimination by evaluators. While such factors should not obviate the use of this instrument they should be taken into consideration when interpreting results.
The basic science course directors and clerkship directors at the College of Medicine, UAMS approve of the use of the Scholastic Non-Cognitive Performance Evaluation: Professionalism instrument because of its ease of use and the directness of the process. The administration finds the use of this instrument to be efficient and appropriate. As the time for faculty to devote to medical education continues its steady decline efficient means of evaluating medical student professionalism are becoming essential.
The use of the evaluation instrument affords a record of medical student professionalism over time that facilitates reporting in the Dean's Letter (medical student performance evaluation document). Taken together with the evaluation of medical student professionalism in the clinical clerkship reports that are received for each student's junior and senior rotations, one is able to obtain a clear sense of a medical student's professionalism in a fashion that limits paper work and saves valuable faculty and office staff time.
While no numerical data have been developed, it is very apparent that the preponderance of the evaluations are positive and, further, that the evaluation form has been used more by basic science faculty than clinical faculty. That is not to say, however, that the form is not used during the junior and senior years of a student's education. There is no provision for the number of Scholastic Non-Cognitive Performance reports a student receives.
We evaluate student professionalism in other ways as well. During their freshman and sophomore years our student's professionalism is addressed using an objective-structured clinical examination format and well-trained standardized patients. Our students' professionalism is also evaluated in their junior and senior years as part of their subjective grade that is used along with their objective grade in calculating their final clerkship grade.
Finally, and importantly, the evaluation instrument links professionalism to scholastic-cognitive performance in a manner in which both are of equivalent importance in evaluating medical students.
Figure 1. Undergraduate Medical Education Competencies, College of Medicine, UAMS
1. Medical Knowledge
2. Patient Care
4. Interpersonal and Communication Skills
5. Medical Informatics
6. Population Health and Preventive Medicine
7. Practice-Based and Systems-Based Medical Care
Medical students must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Medical Students are expected to:
A. Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and society that supersedes self-interest; accountability to patients, society, and the profession; and a commitment to excellence and on-going professional development
B. Demonstrate a commitment to ethical principles pertaining to the provision of clinical care, confidentiality of patient information, and informed consent
C. Demonstrate sensitivity and responsiveness to patients' culture, religious beliefs and practices, age, sexual orientation, gender, and disabilities
D. Dress in a manner consistent with that of a medical professional
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