Papadakis M A, Osborn E H, Cooke M, Healy K
University of California, San Francisco (UCSF) School of Medicine, 94143, USA.
Acad Med. 1999 Sep;74(9):980-90. doi: 10.1097/00001888-199909000-00009.
The authors describe the first four years (1995-1998) in which the University of California, San Francisco School of Medicine operated an evaluation system to monitor students' professional behaviors longitudinally through their clinical rotations. The goals of this system are to help "turn around" students found to have behaved unprofessionally, to demonstrate the priority placed by the school on the attainment of professional behavior, and to give the school "muscle" to deal with issues of professionalism. A student whose professional skills are rated less than solid at the end of the clerkship receives a "physicianship report" of unprofessional behavior. If the student receives such a report from two or more clerkships, he or she is placed on academic probation that can lead to dismissal even if passing grades are attained in all rotations. Counseling services and mentoring by faculty are provided to such students to improve their professional behaviors. From 1995 to 1998, 29 reports of unprofessional behavior on the part of 24 students were submitted to the dean's office; five students received two reports. The clerkship that submitted the most reports was obstetrics-gynecology. The most common complaint for the five students who received two reports was a poor relationship with the health care team. Four of these students had their difficulties cited in their dean's letters and went on to residency; the fifth voluntarily withdrew from medical school. The authors describe the students' and faculty members' responses to the system, discus lessons learned, difficulties, and continuing issues, review future plans (e.g., the system will be expanded to the first two years of medical school), and reflect on dealing with issues of professionalism in medical school and the importance of a longitudinal (i.e., not course-by-course) approach to monitoring students' behaviors. The authors plan to compare the long-range performances of students identified by the evaluation system with those of their classmates.
作者描述了加利福尼亚大学旧金山分校医学院运行评估系统的头四年（1995 - 1998年），该系统通过临床轮转对学生的职业行为进行纵向监测。这个系统的目标是帮助“扭转”被发现有不专业行为的学生，展示学校对职业行为达成的重视程度，并赋予学校处理职业素养问题的“力量”。在实习结束时职业技能被评定为不扎实的学生，会收到一份关于不专业行为的“医师素养报告”。如果学生从两个或更多实习中收到这样的报告，即使所有轮转成绩都及格，他或她也会被置于学业留校察看期，这甚至可能导致被开除。学校会为这些学生提供咨询服务和教师指导，以改善他们的职业行为。1995年至1998年期间，24名学生的29份不专业行为报告被提交至院长办公室；5名学生收到了两份报告。提交报告最多的实习科室是妇产科。收到两份报告的5名学生中，最常见的投诉是与医疗团队关系不佳。这些学生中有4人的问题在院长推荐信中被提及，之后继续进入住院医师培训阶段；第五名学生则自愿从医学院退学。作者描述了学生和教师对该系统的反应，讨论了吸取的教训、困难和持续存在的问题，回顾了未来计划（例如，该系统将扩展至医学院的前两年），并思考了在医学院处理职业素养问题以及采用纵向（即非逐门课程）方法监测学生行为的重要性。作者计划将评估系统识别出的学生与他们同学的长期表现进行比较。
