Early detection and evaluation of professionalism deficiencies in medical students: One school's approach

Since 1995, the University of California, San Francisco, School of Medicine has monitored students' professional behaviors in their third and fourth y ears. The authors recognized that several students with professionalism def iciencies during their clerkships had manifested problematic behaviors earl ier in medical school. They also observed behaviors of concern-such as inap propriate behavior in small groups-in some first- and second-year students who could have been helped by early remediation. The authors describe the m odifications to the evaluation system to bring professionalism issues to a student's attention in a new, earlier, and heightened way. In this new system for first- and second-year students, the course director of a student who has professionalism deficiencies submits a Physicianship Evaluation Form to the associate dean for student affairs, who then meets w ith the student to identify the problematic issues, to counsel, and to reme diate. The student's behavior is monitored throughout the academic years. I f the student receives two or more forms during the first two years and a s ubsequent form in the third or fourth year, this indicates a persistent pat tern of inappropriate behavior. Then the physicianship problem is described in the dean's letter of recommendation for residency and the student is pl aced on academic probation. The student may be eligible for academic dismis sal from school even if he or she has passing grades in all courses. The authors describe their experience with this system, discuss lessons lea rned, and review future plans to expand the system to deal with residents' mistreatment of students.