Among practicing physicians, professionalism lapses—a form of misconduct that does not necessarily result in harm—are the most common cause of disciplinary action. There has always been a long-standing goal among the medical establishment to find ways to reduce these incidents in order to strengthen the profession as a whole and maintain the trust and confidence of both current and future patients. A new study from the Indiana University School of Medicine has added to this effort with findings that risks for future lapses may be identified among medical students.
The study focused on a reflective narrative essay that medical students write in their third year. The assignment is an open-ended prompt that has the student describe an experience during their medical rotation where an interaction with patients or a physician taught them something about professionalism. The essays were examined for what was dubbed a “reflection score”, a representation of the student’s ability to understand the nature of care involved in their described case and how they can be personally incorporated.
The researchers compared the reflective scores of 70 students who had been previously cited for professionalism lapses to a control group of 229 randomized students who had no known professionalism issues. For students, the sort of professionalism lapses found were falsifying notes in a patient’s record, skipping out on assigned clinical duties, not getting vaccinations required for patient safety, and forms of academic cheating.
It was found that the students with known professional lapses had significantly lower reflective scores than the control group, suggesting a correlation between reflective ability and likelihood of committing a lapse. Incidentally, gender was not observed by the researchers to have an association with professional lapses.
The study does suffer from several limitations, including a small sample pool and the use of a single assignment to determine reflective score. Another issue is that the study only suggests a correlation between reflective score and professional lapses—the structure of the study makes it unviable for assessing predictive potential. What the authors do conclude, however, is that some relationship between the two factors exists and that more research could better narrow down risk or causal factors that, if identified early, could be used to offer additional training to medical students so they can avoid committing offenses in their careers.
Sources for Today’s Article:
“Low Reflective Ability Is Risk for Professionalism Lapses during Medical School and beyond,” EurekAlert! web site, January 21, 2016; http://www.eurekalert.org/pub_releases/2016-01/iu-lra012116.php.