New way of gauging professional behavior in medical students

A score given to medical students, called the Conscientiousness Index, can detect behaviours which may need investigation at an early stage, allowing targeted support to be given to ultimately make for better doctors, according to the Durham University study.

The Conscientiousness Index (CI) is believed to be the first ever index to measure diligence among undergraduate medical students, and the researchers say it could contribute to improving doctors' performance after qualification.

Evidence from US studies has shown that negative behaviour by medical students is linked to the likelihood of subsequent negative behaviour in later careers, say the scientists. The research team believes the early identification of problems could be vital in addressing issues and giving support to ultimately produce better doctors.

The Conscientiousness Index measures the diligence of students in their day-to-day behaviour on the course by gaining and losing points. For example, students can receive points for submitting compulsory information such as CRB checks within deadline, but are deducted points for failing to attend compulsory teaching sessions without good reason.

The study, published in the current issue of the peer-reviewed journal Academic Medicine, found that those students who were extremely conscientious according to the index were also independently perceived by staff as being highly professional. Those students that did not score highly received mixed responses from staff demonstrating that students are never consistently worrying but mostly conscientious with some lapses. The researchers say it is these lapses that could be identified and addressed with the right support.

Lead author Professor John McLachlan from Durham University's School of Medicine and Health said: "A doctor's behaviour is as important as his or her knowledge. In fact, most complaints to the General Medical Council are about doctors' behaviours, not their lack of knowledge.

"In medical training, it is vital that we train people to be rounded, knowledgeable and professional. However, measuring professionalism is problematic because it is difficult to define and often relies on qualitative judgements.

"Using the index, we found that the vast majority of students are highly conscientious making a very small percentage stand out when they lapse. This makes it easier for staff to identify those students and take early steps to help them."

In the study, just over 200 students were assessed using the Conscientiousness Index which had no impact on their academic grading. They were awarded or deducted points in various categories such as attendance, submission of data, feedback and assignments, and other areas of positive and negative behaviour such as professionally responding to a medical emergency or reading but failing to respond to repeated emails from staff.

The vast majority of the students in the pilot were assessed as being extremely conscientious with only a very small proportion showing some inconsistencies in assessments of their professionalism.

In addition to a score given to the students, a group of nine experienced staff members were asked to express an expert judgement on the professionalism of the students. These staff were not aware of the students' scores on the Conscientiousness Index. The staff were asked if they were happy with the professionalism shown by the student, had concerns about a student's professionalism, or did not know the student well enough to comment.

The scientists say the pilot has already attracted attention from other universities in the UK, and could also be implemented at post-qualifying level amongst junior doctors.

Professor McLachlan said: "Our findings suggest that in encouraging desirable professional behaviour, targeting students' conscientiousness might be a good place to start. This index is an easy, objective and uncontroversial method for exploring students' professionalism.

"The Index is a bit like a screening test, much as they do for breast cancer. Over 90 per cent of women who are referred further for a biopsy prove not to have cancer but it is still considered worthwhile to screen them. In the same way, about 98 per cent of students who display unprofessional behaviour as students do not get into disciplinary trouble later but it may well still be worth screening to help them early on."

General Medical Council guidance identifies six key principles in its Good Medical Practice (source: General Medical Council)

• Make the care of the patient the doctors' first concern.
  
• Protect and promote the health of patients and the public.
  
• Ensure a good standard of practice and care, which includes keeping knowledge and skills up to date, working within personal limitations, and working cooperatively.
  
• Treat patients as individuals and respect their dignity, which includes treating them considerately but also with confidentiality.
  
• Work in partnership with patients, listen to their concerns, give them information appropriately, respect their decisions, and support their self-care.
  
• Practice medicine with honesty, openness, and integrity. This category includes non-discrimination, meriting trust, and acting without delay if the doctor or a colleague is putting patients at risk.