• Arianne Teherani, Patricia S O'Sullivan, Mark Lovett, and Karen E Hauer.
• University of California, San Francisco, CA 94143-3202, USA. arianne.teherani@ucsf.edu
• Med Teach. 2009 Nov 1; 31 (11): 1007-12.

BackgroundUnprofessional behaviours by medical students predict future disciplinary outcomes. Comprehensive clinical performance examinations (CPXs) that are commonly employed to evaluate learners may provide an opportunity to identify unprofessional behaviours.AimsTo categorize the professionalism problems that occur during the CPX and subsequent remediation of students who perform poorly.MethodsWe interviewed 33 individuals responsible for remediation after the CPX at 33 medical schools. We applied a validated framework for characterizing unprofessional behaviours to the professionalism problems described. We searched transcripts for 119 descriptors representing eight categories of unprofessional behaviour from this framework.ResultsEighteen interviewees identified professionalism as a problem during the examination and subsequent remediation. Unprofessional behaviours reported to occur in order of most to least mentioned, where a diminished capacity for self-improvement, impaired relationships with patients, irresponsibility, poor initiative and unprofessional behaviour associated with anxiety.ConclusionsUnprofessional behaviours are exhibited during the CPX and subsequent remediation. The frequently occurring behaviours of irresponsibility and diminished capacity for self-improvement are predictive of future professionalism problems and co-occur with behaviours that preclude meaningful patient relationships. A framework for identifying unprofessional behaviours may be useful in the formal assessment of professionalism during the CPX.

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