This study examines the way in which student characteristics and pre-admissions measures are statistically associated with the likelihood a student will require remediation for academic and professionalism offenses. We anchor our inquiry within Irby and Hamstra’s (2016) conceptual framework of constructs of professionalism. Data from five graduating cohorts (2014–2018) from McMaster University (Hamilton, Canada) (N = 1,021) were retroactively collected and analyzed using traditional and multinominal logistic regression analyses. The relationship among student characteristics, pre-admissions variables, and referral for potential remediation both by occurrence (yes/no) as well as type (academic/professional/no referral) were examined separately. Findings indicate that gender (OR = 0.519, 95% CI 0.326–0.827, p < 0.01) and undergraduate grade point average (GPA) (OR = 0.245, 95% CI 0.070–0.855, p < 0.05) were significantly associated with instances of referral for potential professionalism and academic remediation, respectively. Women were less likely than men to require remediation for professionalism (OR = 0.332, 95% CI 0.174–0.602, p < 0.001). Undergraduate GPAs (OR = 0.826, 95% CI 0.021–0.539, p < 0.01) were significantly associated with remediation for academic reasons. Lower undergraduate GPAs were associated with a higher likelihood of remediation. These findings point to the admissions variables that are associated with instances that prompt referral for potential remediation. Where associations are not significant, we consider the application of different conceptualizations of professionalism across periods of admissions and training. We encourage those involved in applicant selection and student remediation to emphasize the importance of the interactions that occur between personal and contextual factors to influence learner behaviour and professional identity formation.
This is a preview of subscription content,to check access.
Access this article
Baird, J., & Vanstone, M. (2017a). Professionalism’s contextual nature: A call for compassionate, constructive responses. Medical Education, 51, 676–682.
Baird, J., & Vanstone, M. (2017b). Professionalism’s contextual nature: A call for compassionate, constructive responses. Medical Education, 51(7), 678–679.
Baldwin, D. C. J. R. (2006). Two faces of professionalism. In K. Parsi & M. N. Sheehan (Eds.), Healing as vocation: A medical professionalism primer. Rowman & Littlefield.
Barber, C., Hammond, R., Gula, L., Tithecott, G., & Chahine, S. (2018). In search of black swans: Identifying students at risk of failing licensing examinations. Academic Medicine, 93(3), 478–485.
Bates, J., & Ellaway, R. H. (2016). Mapping the dark matter of context: A conceptual scoping review. Medical Education, 50(8), 807–816.
Bernzweig, J., Takayama, J. I., Phibbs, C., Lewis, C., & Pantell, R. H. (1997). Gender differences in physician-patient communication: Evidence from pediatric visits. Archives of Pediatrics and Adolescent Medicine, 151(6), 586–591.
Beron, K. J., & Piquero, A. R. (2016). Studying the determinants of student-athlete grade point average: The roles of identity, context, and academic interests. Social Science Quarterly, 97(2), 142–160.
Betts, J. R., & Morell, D. (1999). The determinants of undergraduate grade point average: The relative importance of family background, high school resources, and peer group effects. Journal of Human Resources, 56, 268–293.
Birden, H., Glass, N., Wilson, I., Harrison, M., Usherwood, T., & Nass, D. (2014). Defining professionalism in medical education: A systematic review. Medical Teacher, 36(1), 47–61.
Borry, E. L. (2017). Ethical climate and rule bending: How organizational norms contribute to unintended rule consequences. Public Administration, 95(1), 78–96.
Branch, W. T., Jr. (2000). Supporting the moral development of medical students. Journal of General Internal Medicine, 15, 503–508.
Brennan, W. K. (2018). Shaping the education of slow learners (Vol. 3). Routledge.
Brody, H., & Doukas, D. (2014). Professionalism: A framework to guide medical education. Medical Education, 48, 980–987.
Burgess, R., Vanstone, M., Mountjoy, M., & Grierson, L. (2019). Key differences between severity of disciplinary issues and medical student insights. Medical Education, 53(8), 824–832.
Cleland, J., Leggett, H., Sandars, J., Costa, M. J., Patel, R., & Moffat, M. (2013). The remediation challenge: Theoretical and methodological insights from a systematic review. Medical Education, 47(3), 242–251.
Cleland, J., Mackenzie, R. K., Ross, S., Sinclair, H. K., & Lee, A. J. (2010). A remedial intervention linked to a formative assessment is effective in terms of improving student performance in subsequent degree examinations. Medical Teacher, 32(4), e185–e190.
Cohn, E., Cohn, S., Balch, D. C., & Bradley, J., Jr. (2004). Determinants of undergraduate GPAs: SAT scores, high-school GPA and high-school rank. Economics of Education Review, 23(6), 577–586.
College of Physicians Surgeons of Ontario (CPSO) and Ontario Hospital Association (OHA). (2008). Guidebook for managing disruptive physician behavior (pp. 1–48). College of Physicians and Surgeons of Ontario.
Cooke, M., Irby, D., & O’Brien, B. (2010). Educating physicians: A call for reform of medical school and residency. Jossey-Bass.
Cruess, R. L., Cruess, S. R., Boudreau, J. D., Snell, L., & Steinert, Y. (2014). Reframing medical education to support professional identity formation. Academic Medicine, 89, 1446–1451.
Cruess, R. L., Cruess, S. R., Boudreau, J. D., Snell, L., & Steinert, Y. (2015). A schematic representation of the professional identity formation and socialization of medical students and residents: A guide for medical educators. Academic Medicine, 90, 718–725.
Cruess, S. R., & Cruess, R. L. (2008). Understanding medical professionalism: A plea for an inclusive and integrated approach. Medical Education, 42(8), 755–757.
Dore, K. L., Reiter, H. I., Eva, K. W., et al. (2009). Extending the interview to all medical school candidates-Computer-Based Multiple Sample Evaluation of Noncognitive Skills (CMSENS). Academic Medicine, 84(10), S9–S12.
Dore, K. L., Reiter, H. I., Kreuger, S., & Norman, G. R. (2017a). CASPer, an online pre-interview screen for personal/professional characteristics: Prediction of national licensure scores. Advances in Health Sciences Education, 22(2), 327–336.
Dore, K. L., Reiter, H. I., Kreuger, S., & Norman, G. R. (2017b). CASPer, an online pre-interview screen for personal/professional characteristics: Prediction of national licensure scores. Advances in Health Sciences Education, 22(2), 327–336.
DuBois, J. M., Anderson, E. E., Chibnall, J. T., Mozersky, J., & Walsh, H. A. (2019). Serious ethical violations in medicine: A statistical and ethical analysis of 280 cases in the United States from 2008–2016. American Journal of Bioethics, 19(1), 16–34.
Durning, S. J., Cohen, D. L., Cruess, D., McManigle, J. M., & MacDonald, R. (2008). Does student promotions committee appearance predict below-average performance during internship? A seven-year study. Teaching and Learning in Medicine, 20(3), 267–272.
Eva, K. W., Reiter, H. I., Trinh, K., Wasi, P., Rosenfeld, J., & Norman, G. R. (2009). Predictive validity of the multiple mini-interview for selecting medical trainees. Medical Education, 43, 767–775.
Eva, K. W., Rosenfeld, J., Reiter, H. I., & Norman, G. R. (2004). An admissions OSCE: The multiple mini-interview. Medical Education, 38(3), 314–326.
Freidson, E. (2001). Professionalism, the third logic: On the practice of knowledge. University of Chicago Press.
Ginsburg, S. (2014). Duty hours as viewed through a professionalism lens. BMC Medical Education, 14, S15.
Greenburg, D. L., Durning, S. J., Cohen, D. L., Cruess, D., & Jackson, J. L. (2007). Identifying medical students likely to exhibit poor professionalism and knowledge during internship. Journal of General Internal Medicine, 22(12), 1711–1717.
Guerrasio, J., Garrity, M. J., & Aagaard, E. M. (2014). Learner deficits and academic outcomes of medical students, residents, fellows, and attending physicians referred to a remediation program, 2006–2012. Academic Medicine, 89(2), 352–358.
Hafferty, F. W. (2006). Definitions of professionalism: A search for meaning and identity. Clinical Orthopaedics and Related Research, 449, 193–204.
Hauer, K. E., Ciccone, A., Henzel, T. R., Katsufrakis, P., Miller, S. H., Norcross, W. A., Papadakis, M. A., & Irby, D. M. (2009). Remediation of the deficiencies of physicians across the continuum from medical school to practice: A thematic review of the literature. Academic Medicine, 84(12), 1822–1832.
Hickson, G. B., Pichert, J. W., Webb, L. E., & Gabbe, S. G. (2007). A complementary approach to promoting professionalism: Identifying, measuring, and addressing unprofessional behaviors. Academic Medicine, 82, 1040–1048.
Holtman, M. C. (2008). A theoretical sketch of medical professionalism as a normative complex. Advances in Health Sciences Education, 13(2), 233–245.
Irby, D. M., & Hamstra, S. J. (2016). Parting the clouds: Three professionalism frameworks in medical education. Academic Medicine, 91(12), 1606–1611.
Johnston, J. L., Cupples, M. E., McGlade, K. J., & Steele, K. (2011). Medical students’ attitudes to professionalism: An opportunity for the GP tutor? Education for Primary Care, 22(5), 321–327.
Kohn, J. R., Armstrong, J. M., Taylor, R. A., Whitney, D. L., & Gill, A. C. (2017). Student-derived solutions to address barriers hindering reports of unprofessional behaviour. Med Educ., 51(7), 708–717.
Kreiter, C. D., Yin, P., Solow, C., & Brennan, R. L. (2004). Investigating the reliability of the medical school admissions interview. Advances in Health Sciences Education: Theory and Practice, 9(2), 147–159.
Krupat, E., Dienstag, J. L., Padrino, S. L., et al. (2020). Do professionalism lapses in medical school predict problems in residency and clinical practice? Academic Medicine, 95(6), 888–895.
Kulatunga Moruzi, C., & Norman, G. R. (2002). Validity of admissions measures in predicting performance outcomes: The contribution of cognitive and non-cognitive dimensions. Teaching and Learning in Medicine, 14(1), 34–42.
Lesser, C. S., Lucey, C. R., Egener, B., Braddock, C. H., 3rd., Linas, S. L., & Levinson, W. (2010). A behavioral and systems view of professionalism. JAMA, 304, 2732–2737.
Levinson, W., Ginsburg, S., Hafferty, F., & Lucey, C. (2014). Understanding Medical Professionalism. McGraw Hill.
Lucey, C. R. (2015). The problem with professionalism. In R. L. Byyny, M. A. Papadakis, & D. S. Paauw (Eds.), Medical professionalism: Best practices (pp. 9–21). Alpha Omega Alpha Honor Medical Society.
Lurie, S. J., Lambert, D. R., Nofziger, A. C., Epstein, R. M., & Grady-Weliky, T. A. (2007). Relationship between peer assessment during medical school, dean’s letter rankings, and ratings by internship directors. Journal of General Internal Medicine, 22(1), 13–16.
Martimianakis, M. A., Maniate, J. M., & Hodges, B. D. (2009). Sociological interpretations of professionalism. Medical Education, 43(9), 829–837.
McMaster University. (2012). Professionalism in practice. McMaster University. https://mdprogram.mcmaster.ca/docs/defaultsource/general-resources-page/professionalism/professionalism_in_practice.pdf?sfvrsn=4. Accessed August 16, 2018.
Meeker, B. F., & Weitzel-O’Neill, P. A. (1977). Sex roles and interpersonal behavior in task-oriented groups. American Sociological Review, 56, 91–105.
Monrouxe, L. V., Rees, C. E., & Hu, W. (2011). Differences in medical students’ explicit discourses of professionalism: Acting, representing, becoming. Medical Education, 45(6), 585–602.
Morrison, E. (2006). Doing the job well: An investigation of pro-social rule breaking. Journal of Management Studies, 32(1), 5–28.
Murden, R. A., Way, D. P., Hudson, A., & Westman, J. A. (2004). Professionalism deficiencies in a first-quarter doctor–patient relationship course predict poor clinical performance in medical school. Academic Medicine, 79(10), S46–S48.
Papadakis, M. A. (2015). Introduction. In R. L. Byyny, M. A. Papadakis, & D. S. Paauw (Eds.), Medical professionalism: Best practices (pp. 3–8). Alpha Omega Alpha Honor Medical Society.
Papadakis, M. A., Hodgson, C. S., Teherani, A., & Kohatsu, N. D. (2004). Unprofessional behavior in medical school is associated with subsequent disciplinary action by a state medical board. Academic Medicine, 79, 244–249.
Papadakis, M. A., Teherani, A., Banach, M. A., et al. (2005). Disciplinary action by medical boards and prior behavior in medical school. New England Journal of Medicine, 353, 2673–2682.
Portillo, S. (2012). The paradox of rules: Rules as resources and constraints. Administration and Society, 44(1), 87–108.
Portillo, S., & DeHart-Davis, L. (2009). Gender and organizational rule abidance. Public Administration, 69(2), 339–347.
Reiter, H. I., Eva, K. W., Rosenfeld, J., & Norman, G. R. (2007). Multiple mini-interviews predict clerkship and licensing examination performance. Medical Education, 41(4), 378–384.
Salvatori, P. (2001). Reliability and validity of admissions tools used to select students for the health professions. Advances in Health Sciences Education, 6(2), 159–175.
Santen, S. A., Petrusa, E., & Gruppen, L. D. (2015). The relationship between promotions committees’ identification of problem medical students and subsequent state medical board actions. Advances in Health Sciences Education: Theory and Practice, 20, 421–430.
Schripsema, N. R., van Trigt, A. M., van der Wal, M. A., & Cohen-Schotanus, J. (2016). How different medical school selection processes call upon different personality characteristics. PLoS ONE, 11(3), e0150645.
Siu, E., & Reiter, H. I. (2009). Overview: What’s worked and what hasn’t as a guide towards predictive admissions tool development. Advances in Health Sciences Education: Theory and Practice, 14, 759–775.
Stem, D. T., Frohna, A. Z., & Gruppen, L. D. (2004). The prediction of professional behaviour. Medical Education, 39, 75–82.
Stern, D. T., & Papadakis, M. (2006). The developing physician—becoming a professional. New England Journal of Medicine, 355, 1794–1799.
Tamblyn, R., Abrahamowicz, M., Dauphinee, D., Wenghofer, E., Jacques, A., Klass, D., et al. (2007). Physician scores on a national clinical skills examination as predictors of complaints to medical regulatory authorities. JAMA, 298(9), 993–1001.
Tannenbaum, C., Greaves, L., & Graham, I. D. (2016). Why sex and gender matter in implementation research. BMC Medical Research Methodology, 16(1), 145–154.
Teherani, A., Hodgson, C. S., Banach, M., & Papadakis, M. A. (2005). Domains of unprofessional behavior during medical school associated with future disciplinary action by a state medical board. Academic Medicine, 80(10 suppl), S17–S20.
van Mook, W. N. K. A., Gorter, S. L., De Grave, W. S., et al. (2010). Bad apples spoil the barrel: Addressing unprofessional behaviour. Medical Teacher, 32, 891–898.
Vanstone, M., & Grierson, L. (2019). Medical student strategies for actively negotiating hierarchy in the clinical environment. Medical Education, 53(10), 1013–1024.
Ziring, D., Danoff, D., Grosseman, S., Langer, D., Esposito, A., Jan, M. K., Rosenzweig, S., & Novack, D. (2015). How do medical schools identify and remediate professionalism lapses in medical students? A study of U.S. and Canadian Medical Schools. Academic Medicine, 90(7), 913–920.
The authors would like to acknowledge the valuable contributions of Wendy Edge, Patricia Drochner, Dr. Amanda Bell, and Dr. Matthew Sibbald (Undergraduate MD Program, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada) for their support of this project.
The research was supported by the Undergraduate MD Program, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada.
Conflict of interest
The authors declare no conflicts of interest.
This research received approval from the Hamilton Integrated Research Ethics Board (Protocol # 4652) on December 3rd, 2018 (Hamilton, Canada). Approval was renewed on March 6th 2019, May 8th 2020, and March 18th, 2021.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Barber, C., Burgess, R., Mountjoy, M. et al. Associations between admissions factors and the need for remediation. Adv in Health Sci Educ 27, 475–489 (2022). https://doi.org/10.1007/s10459-022-10097-8