Department of Anesthesia, Faculty of Columbia University, College of Physicians and Surgeons, Columbia University Medical Center, 622 West168th Street, New York, NY 10032,
Med Educ. 2011 Sep;45(9):946-57. doi: 10.1111/j.1365-2923.2011.04014.x.
Training future doctors to develop an appropriate professional persona is an important goal of medical student education and residency training. Most medical education research paradigms on professionalism have focused largely on lapses (e.g. yelling as an example of communication failure) and tend to emphasise behaviour that should be avoided. The assumption is that, if left unchecked, students will see these negative behaviours exhibited by their role models and possibly emulate them, allowing the potential reinforcement of the inappropriate behaviours.
Identifying and characterising exemplary, or positive, behaviours can be similarly valuable to both medical students and residents as tangible examples of behaviours to strive towards. The goal of the present research was to determine and thematically define the exemplary professional actions that medical students observe in the intense and patient-focused environment of the operating room (OR).
Using qualitative methodology of content analysis and theme identification, we systematically documented the type of exemplary professional behaviours reported by medical students (n=263) when observing health care teams on an anaesthesia rotation in the OR.
The analysis generated a taxonomy of exemplary OR behaviour that included six overarching themes (e.g. teamwork), 15 sub-themes (e.g. collegial) and numerous exemplars (e.g. showed mutual respect). These themes and sub-themes were then conceptually 'matched'--through the use of antonyms --to complement an existing framework focused on medical student reports of professional lapses witnessed during medical school.
Year 3 medical students in the USA reported observing very positive, exemplary health care provider interactions that were diverse in focus. Themes were identified regarding the OR team members' interactions with patients (calm, communication, comforting), with one another (teamwork, respect) and with the medical students (teaching). This classification of exemplary OR behaviour contributes to our understanding of how professional behaviour is viewed and potentially emulated by medical students on surgical rotations.
培养未来医生树立恰当的职业形象是医学生教育和住院医师培训的重要目标。大多数关于医学职业精神的教育研究范式主要集中在失误上（例如，大喊大叫是沟通失败的一个例子），并倾向于强调应该避免的行为。其假设是，如果不加控制，学生们将看到他们的榜样表现出这些负面行为，并可能效仿他们，从而有可能强化这些不恰当的行为。
识别和描述模范或积极的行为对于医学生和住院医师同样有价值，因为这些行为是他们努力追求的具体行为范例。本研究的目的是确定并从主题上定义医学生在手术室（OR）这种紧张且以患者为中心的环境中观察到的模范专业行为。
使用定性内容分析和主题识别方法，我们系统地记录了医学生（n=263）在 OR 进行麻醉轮转时观察到的医疗保健团队的模范专业行为类型。
分析产生了一个包括六个总体主题（例如团队合作）、15 个副标题（例如同事关系）和许多范例（例如表现出相互尊重）的模范 OR 行为分类法。然后，通过使用反义词，这些主题和副标题在概念上“匹配”，以补充一个专注于医学生在医学院期间观察到的专业失误报告的现有框架。
美国三年级医学生报告观察到非常积极、模范的医疗保健提供者互动，其关注点多种多样。确定了关于 OR 团队成员与患者（冷静、沟通、安慰）、彼此（团队合作、尊重）和与医学生（教学）互动的主题。这种对模范 OR 行为的分类有助于我们理解医学生在外科轮转中如何看待和可能效仿专业行为。
