Categorization of unprofessional behaviours identified during administration of and remediation after a comprehensive clinical performance examination using a validated professionalism framework

Background: Unprofessional 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. Aims: To categorize the professionalism problems that occur during the CPX and subsequent remediation of students who perform poorly. Methods: We 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. Results: Eighteen 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. Conclusions: Unprofessional 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.