“They liked it if you said you cried”: how medical students perceive the teaching of professionalism

Hudson H Birden and Tim Usherwood
Med J Aust 2013; 199 (6): 406-409. || doi: 10.5694/mja12.11827


Objective: To discover what Australian medical students think about the way professionalism is taught in their medical curriculum.

Design, participants and setting: Qualitative study including five focus groups between 2 June 2010 and 30 September 2010, comprised of medical students from both undergraduate and postgraduate entry programs who were in the last 1–2 years of the medical program and had undertaken rural longitudinal integrated clinical placements.

Results: The five focus groups ran for a total of 5.5 hours. Participants (16 women and 24 men; mean age, 26 years [range 23–32 years]) expressed a low regard for the ways in which professionalism had been taught and assessed in their learning programs. They “gamed the system”, giving assessors the results on reflective writing assignments that they believed would gain them a pass. They considered experiential learning — observing good professional practice — to be the best way (some view it as the only way) to learn professionalism and consolidate what they learned, and formed their individual mental model of professionalism through group reflection with their peers in medical school.

Conclusions: While students will always be critical of their curriculum, the universal negative views we captured indicate that current teaching would benefit from review. We suggest a less didactic approach in early years, with more evaluation and feedback from students to assure relevance; an emphasis on true reflection, as opposed to guided reflections linked to overformalised requirements; and more attention devoted to role-modelling and mentoring in the clinical years of training.

  • Hudson H Birden1,2
  • Tim Usherwood3

  • 1 University Centre for Rural Health, North Coast, Lismore, NSW.
  • 2 Centre for Values, Ethics, and the Law in Medicine, Sydney School of Public Health, University of Sydney, Sydney, NSW.
  • 3 Westmead Clinical School, University of Sydney, Sydney, NSW.


We thank the students who participated in this research for their time and thoughtfulness, and the University of Sydney Postgraduate Award Program and the Australian Rural Health Research Collaboration for financial support.

Competing interests:

Tim Usherwood is a clinical teacher at one of the universities whose students participated in this study.

  • 1. Gordon J. Fostering students’ personal and professional development in medicine: a new framework for PPD. Med Educ 2003; 37: 341-349.
  • 2. Finn G, Garner J, Sawdon M. ‘You’re judged all the time!’ Students’ views on professionalism: a multicentre study. Med Educ 2010; 44: 814-825.
  • 3. Reis DC. Who am I and why am I here? Professionalism research through the eyes of a medical student. Acad Med 2008; 83 (10 Suppl): S111-S112.
  • 4. Cohen MJ, Kay A, Youakim JM, Balaicuis JM. Identity transformation in medical students. Am J Psychoanal 2009; 69: 43-52.
  • 5. Apker J, Eggly S. Communicating professional identity in medical socialization: considering the ideological discourse of morning report. Qual Health Res 2004; 14: 411-429.
  • 6. Borges NJ, Manuel RS, Elam CL, Jones BJ. Comparing millennial and generation X medical students at one medical school. Acad Med 2006; 81: 571-576.
  • 7. Skiles J. Teaching professionalism: a medical student’s opinion. Clin Teach 2005; 2: 66-71. doi: 10.1111/j.1743-498X.2005.00063.x.
  • 8. Fehser J. Teaching professionalism: a student’s perspective. Mt Sinai J Med 2002; 69: 412-414.
  • 9. Brainard AH, Brislen HC. Viewpoint: learning professionalism: a view from the trenches. Acad Med 2007; 82: 1010-1014.
  • 10. Reddy ST, Farnan JM, Yoon JD, et al. Third-year medical students’ participation in and perceptions of unprofessional behaviors. Acad Med 2007; 82 (10 Suppl): S35-S39.
  • 11. Leo T, Eagen K. Professionalism education: the medical student response. Perspect Biol Med 2008; 51: 508-516.
  • 12. Monrouxe LV, Rees CE, Hu W. Differences in medical students’ explicit discourses of professionalism: acting, representing, becoming. Med Educ 2011; 45: 585-602.
  • 13. Byszewski A, Hendelman W, McGuinty C, Moineau G. Wanted: role models–medical students’ perceptions of professionalism. BMC Med Educ 2012; 12: 115.
  • 14. Wear D, Zarconi J. Can compassion be taught? Let’s ask our students. J Gen Intern Med 2008; 23: 948-953.
  • 15. Levenson R, Atkinson S, Shepherd S. The 21st century doctor: understanding the doctors of tomorrow. London: The King’s Fund, 2010. (accessed May 2013).
  • 16. Hays R, Gay S. Reflection or ‘pre-reflection’: what are we actually measuring in reflective practice? Med Educ 2011; 45: 116-118.
  • 17. Thompson BM, Teal CR, Rogers JC, et al. Ideals, activities, dissonance, and processing: a conceptual model to guide educators’ efforts to stimulate student reflection. Acad Med 2010; 85: 902-908.
  • 18. Mann K, Gordon J, MacLeod A. Reflection and reflective practice in health professions education: a systematic review. Adv Health Sci Educ Theory Pract 2009; 14: 595-621.
  • 19. Howe A, Barrett A, Leinster S. How medical students demonstrate their professionalism when reflecting on experience. Med Educ 2009; 43: 942-951.
  • 20. Gordon JJ, Evans HM. Learning medicine from the humanities. In: Swanwick T, editor. Understanding medical education: evidence, theory and practice. Oxford: Wiley-Blackwell, 2010: Ch. 6.
  • 21. Roberts LW, Green Hammond KA, Geppert CM, Warner TD. The positive role of professionalism and ethics training in medical education: a comparison of medical student and resident perspectives. Acad Psychiatry 2004; 28: 170-182.
  • 22. Michalec B. Clinical experiences during preclinical training: the function of modeled behavior and the evidence of professionalism principles. Int J Med Educ 2012; 3: 37-45. doi: 10.5116/ijme.4f42. 5c99.


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