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X-Ray Vision - Finding Opportunities to Teach Professionalism in the Preclinical Years

Background: Although professionalism constitutes one of eight domains of competence outlined by the AAMC, it remains difficult to teach to medical students (Al-Eraky, 2015). While previous literature emphasizes the value of reflective writing in developing clinical students’ professional identities (Kenny,2003), there has been minimal incorporation into the pre-clinical years.  


Methods: 88 second-year medical students listened to patient stories about reproductive illnesses and completed reflective essays. De-identified essays were coded by three reviewers using directed content analysis to indicate whether students explored the domains of competency (Table 1) in their essays. Reviewers identified additional sub themes, and consensus was achieved after each round of coding. IRB exemption was obtained.  Table1: Professionalism Domains, ACGME 5.1 Demonstrate compassion, integrity and respect for others 5.2 Demonstrate responsiveness to patient needs that supersedes self-interest 5.3 Demonstrate respect for patient privacy and autonomy 5.4 Demonstrate accountability to patient, society, and the profession 5.5 Demonstrate sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities and sexual orientation. 5.6 Demonstrate a commitment to ethical principles pertaining to provision or withholding of care, confidentiality, informed consent, and business practices, including compliance with relevant laws, policies and regulatory bodies  


Results: 96.6% of students addressed at least 1 domain of professionalism, with some addressing up to four. The most common domain identified was Domain 5.1: demonstrates compassion, integrity and respect for others (86.2% of the essays, p < 0.001). Agreement between reviewers ranged from 75-98.9%. Subthemes included 1) complexity of the medical system; 2) psychosocial impact of disease; 3) tiers of medical care; 4) the role of patients as their own advocates; 5) importance of the patient “story”; and 6) importance of communication.


Discussions: This approach may provide an avenue for pre-clinical students to demonstrate their understanding of  professionalism. Feedback to students surrounding professionalism themes could be an avenue to open the dialog about the professional competencies expected of them.


Keywords: Curriculum Development/Evaluation, Instructional Materials/Methods, Professionalism

Topics: CREOG & APGO Annual Meeting, 2017, Student, Clerkship Director, Professionalism, UME,

General Information

Student,Clerkship Director,
Clinical Focus

Author Information

Megan Orlando, MD; Emily Frosch, MD; Isabel Green, MD

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