Teaching professionalism to first
year medical students using teambased learning
Beth Choby, MD FAAFP
Renate Rosenthal, PhD
Bill Brescia, Ed D
Department of Medical Education
University of Tennessee Health Science Center
Memphis, TN
Timeline for session
Introduction and welcome
Participant discussion
Didactic presentation
TBL scenarios 1-3
Large group discussion
Questions and wrap-up
5 minutes
5 minutes
15 minutes
10 min each
10 min each
5 minutes
• Dr. Beth Choby, MD FAAFP
• Dr. Renate Rosethal, PhD
• Dr. Bill Brescia, EdD
Audience query
• What methods do you currently use for
teaching professionalism in the early medical
school curriculum
• How effective are they?
• Widely used
• Carries so many connotations/nuances that
meaning is blurred
Professionalism- can you define it?
• Criterion-based approach
– Profession provides important public service
– Practice requires considerable skill
– Draws on body of knowledge exclusive to itself
– Requires moral component intrinsic to practice
and has code of ethics
– Requires autonomy of practice
– Needs a strong voice
Graham C, et al. Widening debate about medical professionalism. Med Education 2013:
Van der Camp
• Identified 90 constituent elements of
• Three domains: interpersonal, public and
intrapersonal professionalism
• Altruism, accountability, integrity and respect
only items commonly cited
• Suggests a lack of consensus within medical
community about definition
Van de Camp K, et al. How to conceptualize professionalism: a qualitative study.
Med Teach 2004; 26(8):696-702.
LCME Standard MS-31
• “A medical education program must ensure
that its learning environment promotes the
development of explicit and appropriate
professional attributes in its medical students
(i.e., attitudes, behaviors, and identity)”
Liaison Committee on Medical Education: Functions and structure of a medical school
Standards for Accreditation of Medical Education Programs Leading to the MD degree.
How essential is professionalism
training in the pre-clinical years?
• Unprofessional behavior during medical school associated
with subsequent disciplinary action by medical boards
• Seeing authority figure behaving rudely to a colleague
reduced a subject’s performance on both routine and creative
tasks (Porath and Erez)
• Students who witness rude behavior toward fellow student
similarly perform worse on memory and creative tasks
Kulac E, et al. Medical students’ participation in and perception of unprofessional
Behaviors: comparison of preclinical and clinical phases. Adv Physiol Educ 2013; 37:298-302
Porath CL, et al. does rudeness really matter? The effects of rudeness on task performance
And helpfulness. Acad Manage J 2007; 50: 1181-1197.
How do students see it?
• Attributes cited by medical students when
asked to define professionalism
Byszewski, et al. 2012
• “Students want professionalism to have a
prominent place at their school, but not
necessarily in their didactic curriculum”
• “Students cringe and feel patronized when
professionalism is discussed”
• Disconnect between faculty and students
regarding “professional” behaviors
Cuesta-Briand et al. 2014
• Main emerging themes from students’ views on
professionalism were “adopting professional
persona”, adhering to code of
practice/professional guidelines, and treating
others with respect
• Professional persona enacted by appropriate
dress and detachment when speaking with
patients (elicited student dislike and skepticism)
• Told what to wear as “superficial face” of
Cuesta-Briand B, et al. ‘A world of difference’: a qualitative study of medical students’
Views on professionalism and the ‘good doctor’ BMC Med education 2014;14:77
More student perceptions
• ‘Good doctor’ ≠ ‘Professional doctor’
• Students see as two separate constructs with
different characteristics and only some
• Professionalism “activated on demand to
perform as expected”
• “Professional and ethical chameleons” to
navigate training
Overlap areas
• Respect, communication, team work and
adequate knowledge base seen as core to
• Internally-motivated behavior
• ? Starting scaffold for talking with students
Teaching professionalism in medical
• Principles of Clinical Medicine course
– Longitudinal “doctoring” experience
– New format after curriculum overhaul
• Went from 1 week experience every 6-8 weeks (block system) to
continuous sequential course
– Classes every semester (4 hours credit) in first two years of
medical school (pre-clinical)
• Professionalism previously taught in large lecture
– ? Student buy in
– “Preaching” concerns
– Continued issues with attire and “professionalism” issues
New course= new thinking
• Curriculum design geared toward flipped
classroom and interactive learning
• We have a beautiful new TBL complex, so…
• How can we use it?
• Can you teach professionalism using a TBL
Teaching professionalism by TBL
Recruited faculty presenters
Literature search to identify pre-readings
Development of the IRAT/GRAT assessment
Scenario development
Development of the documentation rubrics
“Life in the morning of a medical
• Please open the designated folder and review the
scenario “life in the morning of a medical
• After discussing with your group, complete the
provided sheet
• Time allotment
– Small group review/discussion
– Large group discussion
10 minutes
10 minutes
“Life in the afternoon of a medical
• Small group review/discussion 10 minutes
• Large group discussion
10 minutes
“Later that evening……”
• Small group review/discussion 10 minutes
• Large group discussion
10 minutes
What the students said
• ? Coverage of male vs. female type
professionalism issues?
• Student discussions three months after the
What the faculty saw
• Attire issues
• Students able to identify issues that previously
might have gone under the radar
Plans for next year
• Incorporation of student comments and
further validation of scenarios
• Pre- and post-TBL knowledge and attitudes
• 6 and 12 month follow-up on experiences and
Questions and networking
• Questions?
• Please take some time to exchange contact
information with people you have met
• Thank for attending and have a wonderful

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