Importance of the past, future and being present: Undergraduate medical students with professionalism concerns reviewed by a competence committee

Identification of medical students who struggle with professionalism issues is a challenging mandate for our Undergraduate Medical Education Competence Committee (UMECC). The numbers are small, relevant data is scarce and important narrative comments may be difficult to retrieve within existing education assessment platforms. However, if students grappling with professionalism can be identified early, they may benefit from coaching, mentorship and close follow-up.

An in-depth assessment review was undertaken at one Canadian medical school for all students brought forward to their UMECC with professionalism issues documented during one academic year. Of the 76 students discussed over the course of the year, approximately one quarter involved professionalism concerns including attendance, missed deadlines and other issues such as communication, disrespect and plagiarism. For each of the identified students, all assessments within that academic year as well as those 1 year before and after were reviewed where possible, looking for hints of professionalism challenges that either foreshadowed or continued after their UMECC presentation.

This review revealed four insights that can be used to help guide our UMECC's handling of professionalism concerns going forward. First, reviewing professionalism issues with a longitudinal lens was most useful. Outside of clerkship, where the richest data was provided by multiple assessors in multiple contexts, recurrent professionalism problems were rarely found in the course where the original issue was identified; they were seen most often within other courses that preceded or followed. This aligns with the suggestion that professionalism assessment should involve a longitudinal trajectory through medical school, post-graduate training and beyond.¹ Second, examination scores had minimal correlation with professionalism breaches. Retrieving and reviewing exam grades for students struggling with professionalism was not productive and should be discontinued. Time spent digging deeper for narrative rather than numeric information yielded much richer results. Third, attendance issues were the best signal of future professionalism challenges. Nuanced descriptive comments such as lateness and unexcused absences were scattered throughout the narrative comments of previous courses for some students; however, these were not considered to reach a threshold significant enough to bring forward to the UMECC at the time and remained unseen. Communication to all small group facilitators and course chairs needs to be encouraged—attendance issues, no matter how seemingly trivial, should be brought onto the radar of the UMECC for correlation across time and courses. Finally, our education assessment platform needs to be optimised to allow for access and presentation of narrative data in a useful, readable way. Conducting this in-depth review required a substantial investment of time that would be prohibitive in regular preparation for monthly UMECC meetings.

In conclusion, UMECC's review of students struggling with professionalism requires a different process from those who struggle with knowledge and clinical reasoning. The application of a longitudinal lens coupled with close review of narrative comments (rather than numeric scores) in all courses and attention to attendance issues provided a much richer picture of the professionalism issues involved, which can be used to coach and mentor students as they progress.

Lisa Shepherd: Conceptualization; investigation; writing – original draft; writing – review and editing; formal analysis. John Johnson: Investigation; writing – review and editing; formal analysis.

The authors declare there was no potential conflict of interest encountered as part of this article.

The Office of Human Research Ethics (OHRE) has determined that this study did not require oversight by one of Western University's REBs.