Clinical Medical Students’ Experiences of Unprofessional Behaviour and How These Should Inform Approaches to Teaching of Professionalism

Abstract

This article was migrated. The article was marked as recommended. Objectives:This mixed method research explores unprofessional behaviour experienced by clinical Medical students, during clinical training in Ireland; with a view to obtaining learning points that inform future design of modules on Professionalism. It also looks at the impact of these on students and the relationship between gender/ethnicity and students' experiences of these behaviours. Methods:A survey using the QUBPI (Queens University Belfast Professionalism Index) questionnaire was disseminated among a random sample of 139 (100% response rate) fourth year medical students in College from February to May 2014 to identify the frequency and nature of unprofessional behaviours experienced. Subsequently, 10 semi structured interviews were conducted with two students from each of the five blocks of students completing their Psychiatry Clinical placement during the year. This was to obtain in-depth insights into students' experiences, the impact of these and to establish learning points from these. These different types of data were then analysed iteratively using SPSS and NVIVO software respectively, to allow for triangulation, member checking and reflexivity. Results:There was no significant difference in students' experiences of unprofessional behaviour based on Gender, entry level (graduate or under-graduate entry) or Ethnicity. There was however a moderate/small effect size in terms of male vs. female gender and ethnicity (Caucasian vs. non-Caucasian) (Males=Cohen's d of 0.38, females=Cohen's D of 0.2) which could be explained by the fact that in group and out group dynamics rise such that as students move away from the dominant mentor/teacher characteristic, they may start to experience or perceive the occurrence of higher levels of unprofessional behaviour. The Qualitative arm of the study confirm that some students even experience marked levels of discrimination; with students' often been shouted out/criticised publicly during clinical training. Conclusions:More practical vignettes/role playing of common ethical dilemmas should be introduced into Professionalism training and these should not target only students, but also mentors to reduce students' experiences of unprofessional behaviours. Feedback training and awareness of contextual issues in Medical clinical training must be provided to clinical trainers.