Towards a Definition of Distinction in Professionalism.

Phenomenon: Professionalism can be characterized by a particular set of attributes that clinicians demonstrate in practice. Although much has been described on those attributes that define acceptable professionalism, the characteristics that define distinction in professionalism have not yet been well defined. Approach: In this exploratory project, qualitative methods were used to triangulate three sources of data collected from three campuses of one medical school: student assessment summaries, teacher interviews, and an institutional policy. Findings: One hundred-thirty student assessment summaries, eight teacher interviews, and one institutional policy were analyzed. Three characteristics emerged that define distinction in professionalism: improvement of oneself, helping others learn, and teamwork. These characteristics are in addition to students demonstrating a clear minimum standard in all other aspects of professionalism. Insights: Findings from this project offer a first step toward a definition of distinction in professionalism for assessing student performance. The characteristics can be demonstrated by students to varying degrees of proficiency and are potentially achievable by all students. Finally, the characteristics would be required in addition to demonstrating a clear minimum standard of performance in all other aspects of professionalism and cannot be inferred by the absence of negative or unprofessional behaviors. Recognizing that conceptions of professionalism have contextual and cultural influences, the characteristics of distinction identified by this project expand the language available for teachers and learners to discuss professionalism. Teachers may use these characteristics to help inform their teaching, learning, and feedback practices. Students will gain clarity about the expectations regarding their professional behavior.

Decision-making bias in assessment: the effect of aggregating objective information and anecdote.

INTRODUCTION: Assessment decisions increasingly rely on synthesis of information from a variety of sources. It is known that aggregation of information to make decisions is open to a number of biases. The aim of this research was to investigate bias, accuracy and confidence of assessment decision making. METHODS: The participants were consultation skills assessors. A model for incremental information was developed with participants being shown results from purposefully selected, but authentic, data from the University's final summative 10-station Objective Structured Clinical Examination (OSCE). After each piece of information, participants gave a pass-fail decision and their confidence in that choice. Following the information from 10 OSCE stations the participants were given a discordant fictional anecdote and again participants gave a pass-fail decision and their confidence. RESULTS: When there is overwhelming evidence to support a pass or fail, participants were not as confident as the data would support. Participants were less confident to make a fail decision than a pass. Despite considerable evidence from multiple results some participants altered decisions based on isolated contradictory information from an anecdote. DISCUSSION: These findings are significant in understanding decision-making. Given equivalent levels of evidence, decision makers are less confident to fail than pass and less robust information can undermine more robust information.

Joining the dots: conditional pass and programmatic assessment enhances recognition of problems with professionalism and factors hampering student progress.

BACKGROUND: Programmatic assessment that looks across a whole year may contribute to better decisions compared with those made from isolated assessments alone. The aim of this study is to describe and evaluate a programmatic system to handle student assessment results that is aligned not only with learning and remediation, but also with defensibility. The key components are standards based assessments, use of "Conditional Pass", and regular progress meetings. METHODS: The new assessment system is described. The evaluation is based on years 4-6 of a 6-year medical course. The types of concerns staff had about students were clustered into themes alongside any interventions and outcomes for the students concerned. The likelihoods of passing the year according to type of problem were compared before and after phasing in of the new assessment system. RESULTS: The new system was phased in over four years. In the fourth year of implementation 701 students had 3539 assessment results, of which 4.1% were Conditional Pass. More in-depth analysis for 1516 results available from 447 students revealed the odds ratio (95% confidence intervals) for failure was highest for students with problems identified in more than one part of the course (18.8 (7.7-46.2) p < 0.0001) or with problems with professionalism (17.2 (9.1-33.3) p < 0.0001). The odds ratio for failure was lowest for problems with assignments (0.7 (0.1-5.2) NS). Compared with the previous system, more students failed the year under the new system on the basis of performance during the year (20 or 4.5% compared with four or 1.1% under the previous system (p < 0.01)). CONCLUSIONS: The new system detects more students in difficulty and has resulted in less "failure to fail". The requirement to state conditions required to pass has contributed to a paper trail that should improve defensibility. Most importantly it has helped detect and act on some of the more difficult areas to assess such as professionalism.

Programmatic research in medical education: a national collaboration.

AIM: We aimed to identify areas that are a high priority for medical education research in New Zealand and that would benefit from a coordinated collaborative approach as an initial step in developing a coordinated research strategy. METHODS: A modified Delphi technique was used to reach consensus, among medical education researchers in New Zealand, on the optimal areas of activity. RESULTS: The programme of research fits under an overarching theme of "Growing a professional workforce". Seven key areas of activity have been identified: engaging in community and clinical learning environments; improving recruitment and retention; improving phases of transition; assessing professional behaviours; promoting quality feedback; engaging clinical teachers and educational and clinical leadership. CONCLUSION This programme of medical education research projects is in the national interest, assists in theory building, helps develop research groups with similar interests, helps avoid duplications, ensures efficient use of funding opportunities, and makes effective use of existing expertise.

How the trainee intern year can ease the transition from undergraduate education to postgraduate practice.

The trainee intern (TI) year is unique to New Zealand medical education. The TI year occupies a complete calendar year in which the medical student is immersed in clinical care as part of healthcare teams. The TI year is an example of a 'capstone' course; integrating theory into practice, fine tuning workplace skills, and easing the transition from undergraduate medical student to practising clinician. We discuss the TI year within the context of 'transition shock'. Transition shock, related to movement between contexts or levels of responsibility, is not unique to medicine or the healthcare professions. This shock is multifactorial but there are many ways that the structure and activities of the TI year may ease this transition. The TI year is valuable in terms of its potential to improve preparedness, both real and perceived, but further research and ongoing evaluation is still required.

Setting up new learning environments in regional and rural areas.

The shortage of doctors in New Zealand, especially in regional and rural areas, together with the recognition that medical students need to learn in a variety of contexts has led to new learning environments being developed. This paper describes some of the key factors that have led to the successful implementation of year-long regional and rural clinical placements for medical students in New Zealand.