June 2024 - educator workshop on low grade unprofessional behaviour
(Un)professional Behaviour.pdf2024-06-05 educator workshop June menti.pdfPresentation
Addressing Unprofessional Behaviour in Medical Students During GP Placements
Examples of Suspected Unprofessional Behaviour
Whispering in front of patients.
Making assumptions based on stereotypes but being open to correction and learning.
Occasionally not noticing a patient’s discomfort but responding appropriately once it’s brought to their attention.
Using a casual tone with patients or colleagues, which might be seen as unprofessional though not overtly disrespectful.
Tensions and Dilemmas
Feedback Concerns: Providing constructive criticism might lead to negative feedback from students, affecting overall evaluations.
Addressing Issues Publicly: Deciding whether to address unprofessional behaviour in front of patients raises concerns about patient reactions and student responses.
Time Constraints: Balancing teaching responsibilities and attending meetings can limit the time available to address these issues promptly.
Prioritising Learning: Determining the balance between teaching professionalism and imparting clinical knowledge.
Understanding Medical Professionalism
Medical professionalism encompasses the values and behaviours that foster public trust in doctors. The General Medical Council (GMC) plays a crucial role in teaching medical students, ensuring they are prepared for their regulated roles in patient care.
A notable example is Lavinia Woodward, a medical student who faced disciplinary action for serious misconduct. This underscores the expectation of professionalism in medical education.
Papadakis's seminal study highlights that unprofessional behaviour during undergraduate training is predictive of similar behaviour in professional practice. Although up to 20% of students exhibit unprofessional behaviour, only 3–5% of these cases are reported (Papadakis et al). This is the failure-to-fail phenomenon.
Key Principles and Values
Development and Learning: Students should be encouraged to develop and learn professionalism.
Lapses in Professionalism: Recognize that lapses can occur and should be addressed constructively.
Positive Approach: Foster a positive approach to correcting unprofessional behaviour.
Failure to Fail: Understand the phenomenon where educators hesitate to fail students who exhibit unprofessional behaviour.
Consider Neurodiversity: Acknowledge and accommodate neurodiversity, which is not typically addressed in AMEE guidelines.
Roadmap for Addressing Unprofessional Behaviour
Explore and Understand: Investigate the reasons behind the unprofessional behaviour.
Remediate: Provide opportunities for students to learn and correct their behaviour.
Gather Evidence for Dismissal: If necessary, gather sufficient evidence to support dismissal.
Issues can be raised with the year or module lead at CBME for further action.
Discussions
Engagement and Expectations
A student aspiring to be a surgeon was disengaged during their GP placement. General practice offers a valuable opportunity to learn about holistic healthcare, making it important to understand the student and set clear expectations.
Learning from Challenging Experiences
As educators, we must adapt and learn from challenging experiences. Epistemic injustice can occur in these settings, where certain types of knowledge, like medical expertise, are privileged over others. GPs make complex decisions in low-tech environments, managing significant cognitive loads.
Addressing Punctuality and Professionalism
When a student consistently arrives late, addressing the issue without singling them out is challenging. Changing expectations is also important, considering generational differences in dress codes and phone usage. Discussing professionalism during the induction is crucial.
Progress in Medical Education
Medical education has made strides in addressing professionalism earlier in training. Previously, these lessons came later in a student's education. Introducing role play can effectively highlight professionalism issues.
Communication and Sensitivity
An example was shared of a vocal student who frequently answered questions directed at others. Speaking to this student sensitively is necessary, as other students noticed this behaviour. Teaching professionalism should be a two-way conversation.
Dress Codes and Psychological Safety
Dress codes can be a source of unprofessional behaviour. Ensuring psychological safety and training students in bystander intervention are important steps. Raising professionalism issues kindly is key.
Feedback and Patient Involvement
Feedback is crucial for student learning. Involving patients by asking them to highlight what makes a student professional can provide valuable insights.
Considering Contributory Factors
Factors like poverty can affect student behaviour. Many students work while at university, which can lead to lateness or absenteeism. Some students might not realise they are struggling financially, contributing to stress and poor attendance.
Reflective Fine-Tuning of Professionalism
Continual improvement in medical professionalism is vital, as human behaviour evolves. We should consistently seek missed opportunities to enhance professionalism.
Multiple Learning Opportunities
At any given moment, multiple learning opportunities exist. Prioritising these can be challenging, but values can guide decisions. Discussing how others can help in learning and vice versa during inductions can set a collaborative tone.
Addressing Early Behaviours
Addressing challenging behaviours early in medical training is crucial, as these can permeate future clinical practice.
Inclusive Inductions
The Year 3 team introduced a one-to-one 'inclusive induction,' which was very helpful. For example, it helped discover a student who had developed a phobia of blood.
Supporting Students with ASD
Supporting students with ASD is essential. One student reflected on how the medical school's failure to address his needs led to significant challenges later in his career.
Social Media Stress
In the social media era, students may feel stressed about being on camera and how they look. Addressing these concerns can help create a supportive learning environment.