Does gender impact professionalism lapses at medical school?

Problem

Medical School concern forms as a means of professionalism lapse identification is an internationally recognised approach by institutions and medical regulators. Written records of undergraduate professionalism lapses have shown associations with further medical school and postgraduate professionalism lapses. Furthermore the literature suggests males are more likely to have professionalism lapses than females. Despite the widespread research of medical professionalism there are few contemporary analyses of actual professionalism lapses at medical school. This innovative explorative study examines professionalism concerns throughout the entirety of a cohort’s medical school journey.

Approach

This retrospective observational study was designed with a positivist, quantitative approach. The University of Nottingham (UoN) has a longstanding professionalism concern form submission process for medical students.

247 UoN medical students’ pseudo-anonymised electronic professionalism records were reviewed for concern forms over the course of their 5 year medical degree (2012 entry cohort). These were matched with gender data to allow for analysis. Records were reviewed against the General Medical Council’s Good Medical Practice (GMP) document as the professionalism standard and was used to identify forms as lapses. The GMPs 4 domains were used to broadly categorise lapses whilst maintaining anonymity of students.

Findings

37 forms with lapses were identified for 24 students (9.72% of cohort). 14 were for males and 10 for females, this difference was not statistically significant (p=0.05). 9 students (3.64% of cohort) received multiple professionalism lapse form submissions; 7 male and 2 female, this result was statistically significant (p=0.014). Males had most lapses for ‘Knowledge, skills and performance’ and females for ‘Communication, partnership and teamwork’. Analysis of differences in form submission revealed no significant differences between gender and domain categorisation of lapses.

Consequences

In keeping with the literature, this study demonstrated the majority of students had no professionalism lapses identified and domain mapping was consistent with previous studies. In contrast, the authors found no significant gender differences in professionalism lapse data. However, males were significantly more likely to have multiple lapse forms. Study lapses highlight the need for undergraduate professionalism curricula to emphasise:

1) Appropriate communication with colleagues and wider staff.

2) The professional obligation of medical students to attend teaching/ placements.

Identification of students with professionalism lapses is only as strong as the reporting mechanisms in the institution and variance may not be due to differences in student behaviour but in the recognition and recording. There is currently no set gold standard in how lapses should be identified and recorded. The authors advocate and term a ‘3 R’s approach’ of recognition, recording and remediation, which is based on professional identity formation principles.

Future research is needed to explore the effectiveness in differing professionalism reporting mechanisms and of the effect of remediation too future professionalism.