医学院校如何识别和纠正医学生的职业素养缺失？一项对美国和加拿大医学院校的研究。

How Do Medical Schools Identify and Remediate Professionalism Lapses in Medical Students? A Study of U.S. and Canadian Medical Schools.

作者信息

Ziring Deborah, Danoff Deborah, Grosseman Suely, Langer Debra, Esposito Amanda, Jan Mian Kouresch, Rosenzweig Steven, Novack Dennis

机构信息

D. Ziring is assistant professor, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania. D. Danoff is adjunct professor, Department of Medicine, and an affiliate member, Centre for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada. S. Grosseman is professor, Department of Pediatrics, Universidade Federal de Santa Catarina, Florianópolis, Brazil. D. Langer is a doctoral candidate, Department of Community Health and Prevention, Drexel University, Philadelphia, Pennsylvania. A. Esposito is a fourth-year medical student, Drexel University College of Medicine, Philadelphia, Pennsylvania. M.K. Jan is a fourth-year medical student, Drexel University College of Medicine, Philadelphia, Pennsylvania. S. Rosenzweig is clinical associate professor, Department of Emergency Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania. D. Novack is professor, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania.

出版信息

Acad Med. 2015 Jul;90(7):913-20. doi: 10.1097/ACM.0000000000000737.

DOI:10.1097/ACM.0000000000000737

PMID:25922920

Abstract

PURPOSE

Teaching and assessing professionalism is an essential element of medical education, mandated by accrediting bodies. Responding to a call for comprehensive research on remediation of student professionalism lapses, the authors explored current medical school policies and practices.

METHOD

In 2012-2013, key administrators at U.S. and Canadian medical schools accredited by the Liaison Committee on Medical Education were interviewed via telephone or e-mail. The structured interview questionnaire contained open-ended and closed questions about practices for monitoring student professionalism, strategies for remediating lapses, and strengths and limitations of current systems. The authors employed a mixed-methods approach, using descriptive statistics and qualitative analysis based on grounded theory.

RESULTS

Ninety-three (60.8%) of 153 eligible schools participated. Most (74/93; 79.6%) had specific policies and processes regarding professionalism lapses. Student affairs deans and course/clerkship directors were typically responsible for remediation oversight. Approaches for identifying lapses included incident-based reporting and routine student evaluations. The most common remediation strategies reported by schools that had remediated lapses were mandated mental health evaluation (74/90; 82.2%), remediation assignments (66/90; 73.3%), and professionalism mentoring (66/90; 73.3%). System strengths included catching minor offenses early, emphasizing professionalism schoolwide, focusing on helping rather than punishing students, and assuring transparency and good communication. System weaknesses included reluctance to report (by students and faculty), lack of faculty training, unclear policies, and ineffective remediation. In addition, considerable variability in feedforward processes existed between schools.

CONCLUSIONS

The identified strengths can be used in developing best practices until studies of the strategies' effectiveness are conducted.

摘要

目的

教学与评估职业素养是医学教育的一项基本要素，这是认证机构所要求的。应全面研究纠正学生职业素养失误的呼吁，作者们探究了当前医学院校的政策与实践。

方法

2012 - 2013年，通过电话或电子邮件对美国和加拿大经医学教育联络委员会认证的医学院校的关键管理人员进行了访谈。结构化访谈问卷包含关于监测学生职业素养的实践、纠正失误的策略以及当前系统的优势与局限的开放式和封闭式问题。作者采用了混合方法，运用基于扎根理论的描述性统计和定性分析。

结果

153所符合条件的学校中有93所（60.8%）参与了调查。大多数学校（74/93；79.6%）有关于职业素养失误的具体政策和流程。学生事务主任和课程/实习主任通常负责纠正监督。识别失误的方法包括基于事件的报告和常规学生评估。已纠正失误的学校报告的最常见纠正策略是强制进行心理健康评估（74/90；82.2%）、纠正任务（66/90；73.3%）和职业素养指导（66/90；73.3%）。系统优势包括及早发现轻微违规行为、在全校范围内强调职业素养、注重帮助而非惩罚学生以及确保透明度和良好沟通。系统弱点包括（学生和教师）不愿报告、缺乏教师培训、政策不明确以及纠正无效。此外，各学校之间在前馈流程方面存在很大差异。