M.C. Mak-van der Vossen is general physician, coordinator of professional behavior, and PhD student, Department of Research in Education, VUmc School of Medical Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands; ORCID: https://orcid.org/0000-0001-7810-6575. A. de la Croix is assistant professor, LEARN! Academy, Vrije Universiteit, and researcher, Department of Research in Education, VUmc School of Medical Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands. A. Teherani is professor of medicine and education researcher, Center for Faculty Educators, School of Medicine, University of California, San Francisco, San Francisco, California. W.N.K.A. van Mook is internist/intensivist, Department of Intensive Care Medicine, postgraduate dean, Maastricht University Medical Center, and professor of medical education, Maastricht University, Maastricht, The Netherlands. G. Croiset is professor of education and training, Health and Life Sciences, and dean of education and training, University Medical Center Groningen, Groningen, The Netherlands. R.A. Kusurkar is associate professor of medical education and head, Department of Research in Education, VUmc School of Medical Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands; ORCID: https://orcid.org/0000-0002-9382-0379.
Acad Med. 2019 Apr;94(4):570-578. doi: 10.1097/ACM.0000000000002537.
To develop a road map for educators attending to medical students' professionalism lapses, aiming to offer an empirical base for approaching students who display such lapses.
Between October 2016 and January 2018, 23 in-depth interviews with 19 expert faculty responsible for remediation from 13 U.S. medical schools were conducted about the way they handle students' professionalism lapses. Three researchers independently completed three rounds of coding. Data collection, coding, and analysis were performed in a constant comparative process. A constructivist grounded theory approach was used to develop an explanatory model for attending to students' professionalism lapses.
Based on participants' descriptions, the authors developed a three-phase approach for attending to professionalism lapses. In phase 1, experts enacted the role of concerned teacher, exploring the lapse from the student's perspective. In phase 2, they functioned as supportive coach, providing feedback on professionalism values, improving skills, creating reflectiveness, and offering support. In phase 3, if the student did not demonstrate reflectiveness and improvement, and especially if (future) patient care was potentially compromised, participants assumed an opposite role: gatekeeper of the profession.
An explanatory model for attending to professionalism lapses that fits in the overarching "communities of practice" framework was created. Whereas phase 1 and 2 aim at keeping students in the medical community, phase 3 aims at guiding students out. These findings provide empirical support to earlier descriptive, opinion-based models and may offer medical educators an empirical base for attending to students who display professionalism lapses.
为关注医学生专业素养缺失的教育工作者制定路线图，旨在为处理此类行为的学生提供实证基础。
2016 年 10 月至 2018 年 1 月，对来自 13 所美国医学院的 19 名负责补救的专家教师进行了 23 次深入访谈，了解他们处理学生专业素养缺失的方式。三名研究人员独立完成了三轮编码。数据收集、编码和分析是在一个持续比较的过程中进行的。采用建构主义扎根理论方法，为处理学生专业素养缺失问题开发一个解释模型。
基于参与者的描述，作者提出了一个处理专业素养缺失的三阶段方法。在第一阶段，专家扮演关心教师的角色，从学生的角度探索失误。在第二阶段，他们作为支持性教练，提供关于专业价值观、提高技能、增强反思性和提供支持的反馈。在第三阶段，如果学生没有表现出反思和改进，特别是如果（未来）患者护理受到潜在影响，参与者则扮演职业守门员的角色。
创建了一个符合“实践共同体”框架的处理专业素养缺失的解释模型。第 1 阶段和第 2 阶段旨在使学生留在医学共同体中，第 3 阶段旨在引导学生离开。这些发现为早期的描述性、基于意见的模型提供了实证支持，可能为处理表现出专业素养缺失的学生的医学教育工作者提供实证基础。
