Assessing how well three evaluation methods detect deficiencies in medicalstudents' professionalism in two settings of an internal medicine clerkship

Purpose. To compare the performances of three evaluation methods in detecti ng deficiencies of professionalism among third year medical students during their ambulatory care and inpatient ward rotations of a core internal medi cine clerkship. Method. From 1994 to 1997, 18 students at The Uniformed Services University of the Health Sciences failed to satisfactorily complete their core 12-wee k third-year internal medicine clerkship due to deficiencies in professiona lism. Three evaluation methods had been used to assess all students' profes sionalism during the two rotations of their clerkship: standard checklists, written comments, and comments from formal evaluation sessions. Using qual itative methods and the information obtained by the three evaluation method s, the authors abstracted the record of each student concerning his or her clerkship behavior in terms of the six domains of professionalism used on t he standard checklist. A detection index, which is the percentage of all in structors' less than-acceptable ratings of a student across the six profess ionalism domains, was calculated for each evaluation method for each of the two clerkship settings. Results. For each evaluation method, deficiencies in professionalism were t wice as likely to be identified during the ward rotation as during the ambu latory care rotation (p <.002 for all). Formal evaluation session comments had the highest detection index in both clinical settings. Although the num bers of written and formal evaluation session comments per evaluator and pe r cited professionalism domain were similar, nearly a fourth df the instruc tors made identifying comments at the evaluation sessions only. Conclusion. In the clerkship studied, deficiencies in professionalism of su ch magnitude as to require remediation were more likely to be identified in the inpatient than in the ambulatory care setting. Of the three evaluation methods studied, the face to-face, formal evaluation sessions significantl y improved the detection of unprofessional behavior in both clerkship setti ngs. Further efforts at such an interactive evaluation process with ambulat ory care clerkship instructors may be essential for improving the identific ation of unprofessional behavior in that setting.