Journal of General Internal Medicine

, Volume 23, Issue 7, pp 942–947 | Cite as

Know When to Rock the Boat: How Faculty Rationalize Students’ Behaviors

  • Shiphra Ginsburg
  • Lorelei Lingard
  • Glenn Regehr
  • Kathryn Underwood
Original Article

Abstract

BACKGROUND

When faculty evaluate medical students’ professionalism, they make judgments based on the observation of behaviors. However, we lack an understanding of why they feel certain behaviors are appropriate (or not).

OBJECTIVE

To explore faculty’s reasoning around potential student behaviors in professionally challenging situations.

DESIGN

Guided interviews with faculty who were asked to respond to 5 videotaped scenarios depicting students in professionally challenging situations.

SUBJECTS

Purposive sample of 30 attending Internists and surgeons.

APPROACH

Transcripts were analyzed using modified grounded theory to search for emerging themes and to attempt to validate a previous framework based on student responses.

RESULTS

Faculty’s reasoning around behaviors were similar to students’ and were categorized by three general themes: Imperatives (e.g., take care of patients, behave honestly, know your place), Affect (factors relating to a student’s “gut instincts” or personality), or Implications (for the student, patients, and others). Several new themes emerged, including “know when to fudge the truth”, “do what you’re told”, and “know when to step up to the plate”. These new codes, along with a near ubiquitous reference to Affect, suggests that faculty feel students are responsible for knowing when (and how) to bend the rules. Potential reasons for this are discussed.

CONCLUSIONS

Although faculty are aware of the conflicts students face when encountering professional challenges, their reliance on students to “just know” what to do reflects the underlying complexity and ambiguity that surrounds decision making in these situations. To fully understand professional decision-making, we must acknowledge and address these issues from both students’ and faculty’s points of view.

KEY WORDS

professionalism medical education undergraduate education 

Notes

Acknowledgments

This study was funded by a research grant from the Medical Council of Canada. Additional support was provided by the Wilson Centre for Research in Education, University of Toronto. Lorelei Lingard is supported by a CIHR New Investigators Award and as the BMO Financial Group Professor in Health Professions Education Research. Glenn Regehr is supported as the Richard and Elizabeth Currie Chair in Health Professions Education Research.

Conflicts of Interest

No author has any conflict of interest.

References

  1. 1.
    Arnold L. Assessing professional behaviour: yesterday, today, and tomorrow. Acad Med. 2002;77(6):502–15.CrossRefPubMedGoogle Scholar
  2. 2.
    Stern DT, ed. Measuring Medical Professionalism, 1st Edn. New York, NY: Oxford University Press: 2006.Google Scholar
  3. 3.
    Ginsburg S, Regehr G, Hatala R, et al. Context, conflict, and resolution: a new conceptual framework for evaluating professionalism. Acad Med. 2000;10;75(10 Suppl):S6–11.Google Scholar
  4. 4.
    Ginsburg S, Regehr G, Lingard L. Basing the evaluation of professionalism on observable behaviours: a cautionary tale. Acad Med. 2004;79(10 Suppl):S1–4.CrossRefPubMedGoogle Scholar
  5. 5.
    Rees CE, Knight LV. Viewpoint: the trouble with assessing students’ professionalism: theoretical insights from sociocognitive psychology. Acad Med. 2007;82(1):46–50.CrossRefPubMedGoogle Scholar
  6. 6.
    Ginsburg S, Regehr G, Lingard L. The disavowed curriculum: understanding students’ reasoning in professionally challenging situations. J Gen Intern Med. 2003;18(12):1015–22.CrossRefPubMedGoogle Scholar
  7. 7.
    Creswell JW. Data collection. In: Creswell JW, ed. Qualitative Inquiry and Research Design: Choosing Among Five Traditions. Thousand Oaks, CA: Sage; 1998:109–35.Google Scholar
  8. 8.
    Glaser BG. Basics of Grounded Theory Analysis. Mill Valley, CA: Sociology Press: 1992.Google Scholar
  9. 9.
    Kennedy TJ, Lingard L. Making sense of grounded theory in medical education. Med Educ. 2006;40(2):101–8.CrossRefPubMedGoogle Scholar
  10. 10.
    NVivo qualitative data analysis program. Version 2.0. QSR International Pty Ltd.; 2002.Google Scholar
  11. 11.
    Burack JH, Irby DM, Carline JD, Root RK, Larson EB. Teaching compassion and respect: attending physicians’ responses to problematic behaviours. J Gen Intern Med. 1999;14(1):49–55.CrossRefPubMedGoogle Scholar
  12. 12.
    Ginsburg S, Regehr G, Stern DT, Lingard L. The anatomy of the professional lapse: bridging the gap between traditional frameworks and students’ perceptions. Acad Med. 2002;77(6):516–22.CrossRefPubMedGoogle Scholar
  13. 13.
    Wallace DS, Paulson RM, Lord CG, Bond CF. Which behaviours do attitudes predict? Meta-analyzing the effects of social pressure and perceived difficulty. Rev Gen Psychol. 2005;9(3):214–27.CrossRefGoogle Scholar
  14. 14.
    Lavine E, Regehr G, Garwood K, Ginsburg S. The role of attribution to clerk factors and contextual factors in supervisors’ perceptions of clerks’ behaviours. Teach Learn Med. 2004;16(4):403–8.CrossRefGoogle Scholar
  15. 15.
    Hafferty FW, Franks R. The hidden curriculum, ethics teaching, and the structure of medical education. Acad Med. 1994;69(11):861–71.CrossRefPubMedGoogle Scholar
  16. 16.
    Stern DT. Practicing what we preach? an analysis of the curriculum of values in medical education. Am J Med. 1998;104(6):569–75.CrossRefPubMedGoogle Scholar
  17. 17.
    Fryer-Edwards K, Wilkins MD, Baernstein A, Braddock CH. Bringing ethics education to the clinical years: ward ethics sessions at the University of Washington. Acad Med. 2006;81(7):626–31.CrossRefPubMedGoogle Scholar
  18. 18.
    Baernstein A, Fryer-Edwards K. Promoting reflection on professionalism: a comparison trial of educational interventions for medical students. Acad Med. 2003;78(7):742–7.CrossRefPubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Shiphra Ginsburg
    • 1
    • 4
    • 6
  • Lorelei Lingard
    • 2
    • 4
  • Glenn Regehr
    • 3
    • 4
  • Kathryn Underwood
    • 4
    • 5
  1. 1.Department of Medicine, Faculty of MedicineUniversity of TorontoTorontoCanada
  2. 2.Department of Pediatrics, Faculty of MedicineUniversity of TorontoTorontoCanada
  3. 3.Department of Surgery, Faculty of MedicineUniversity of TorontoTorontoCanada
  4. 4.Wilson Centre for Research in Education, University Health Network, Faculty of MedicineUniversity of TorontoTorontoCanada
  5. 5.Ontario Institute for Studies in Education, Faculty of Community ServicesRyerson UniversityTorontoCanada
  6. 6.Mount Sinai HospitalTorontoCanada

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