Student professionalism in clerkships

Professionalism can be challenging to assess during clerkships. Current literature focuses either on aspirational generalities or professionalism lapses. Most tools assessing professionalism employ Likert scales. This study investigated the frequency and detail with which clerkship directors describe professional behaviours in end-of-clerkship narrative assessments.

We analysed de-identified core clerkship final narratives from one New York City medical school collected in academic years 2018-2019 and 2019-2020. We used ATLAS.ti and the six-step thematic approach outlined by Braun & Clarke to perform a qualitative analysis, coding each semantic unit.

We found that 176 out of 753 narratives (23%) mentioned professionalism, but only 29 (16%) of those provided a detailed description including an anecdote or example. Focusing on these most detailed comments, we identified seven core themes: managing time, following through on expectations, eager to engage, work ethic & efficiency, effective communication, going above and beyond and situational awareness. Themes range from simple behaviours to sophisticated behaviours that may not fully develop until residency.

Narratives that use the word "professional" or "professionalism" without examples are unlikely to facilitate learning, meaningful assessment or opportunities for remediation. Our hierarchical framework can be used to teach students how to navigate the current clinical environment and can assist supervisors in providing students with specific, actionable feedback and assessment. Our model explicitly fosters a growth mindset in assessing and developing professionalism.