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Before the white coat: perceptions of professional lapses in the pre-clerkship

Authors

  • Shiphra Ginsburg,

    1. Department of Medicine, University of Toronto, Toronto, Ontario, Canada
    2. Centre for Research in Education, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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  • Natasha Kachan,

    1. Centre for Research in Education, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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  • Lorelei Lingard

    1. Centre for Research in Education, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
    2. Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
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Shiphra Ginsburg MD, MEd, FRCPC, Assistant Professor of Medicine, Mount Sinai Hospital, 600 University Ave, Room 433, Toronto, Ontario M5G 1X5, Canada. Tel: 00 1 416 586 8671; Fax: 00 1 416 586 8864; E-mail: shiphra.ginsburg@utoronto.ca

Abstract

Background  It has been shown that the professional development of clinical clerks is influenced by their experiences of unprofessional behaviour, but the perceptions of pre-clerkship students have received relatively little attention. Our purpose was to develop a greater contextual understanding of the situations in which pre-clerkship students encounter professional challenges, and to investigate what pre-clerkship students consider to be professional lapses in these situations.

Methods  We conducted 4 focus groups (n = 22 students); transcripts were analysed by 3 researchers using grounded theory.

Results  Pre-clerkship students reported lapses in the areas of communicative violation, role resistance, objectification, accountability and harm, validating our previous clerkship-based framework. However, they also reported numerous lapses committed by fellow students and many instances of lack of accountability to students, which were not reported by clerks. Many of their reports involved non-health care professionals.

Conclusions  The willingness of pre-clerkship students to report on fellow students was associated with a tendency to blame their colleagues, at the expense of a more reflective analysis, and their views on professionalism appeared to be generic rather than medicine-specific. We should reinforce students' appreciation of these generic values and add on medicine-specific values as the students progress, in order to better cultivate professionalism without entitlement.

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