Medical professionalism in the formal curriculum: 5th year medical students' experiences

Background: The standards and outcomes outlined in the General Medical Council's publication 'Tomorrow's Doctors' include proposals that medical professionalism be included in undergraduate curricula. Learning the values and attitudes necessary to become a 'doctor as a professional' has traditionally been left largely to the informal and hidden curricula. There remains no consensus or confirmed evidence upon which to base best practice for teaching in this area. In 2010, as part of a revision of the fifth year curriculum the University of Bristol Medical School introduced tutorials which focused on students' achievement of the learning objectives in 'Tomorrow's Doctors Outcomes 3: the doctor as a professional'. This study sought to explore the students' experiences of these tutorials in order to develop the evidence base further. Methods: Sixteen medical students participated in three focus- group interviews exploring their experiences of medical professionalism tutorials. A course evaluation questionnaire to all fifth year students also provided data. Data were analysed using the principles of Interpretative Phenomenological Analysis. Results: Four main themes were identified: students' aversion to 'ticking-boxes', lack of engagement by the students, lack of engagement by the tutors and students' views on how medical professionalism should be taught. Conclusions: A curriculum innovation which placed the achievement of medical professionalism in the formal curriculum was not unanimously embraced by students or faculty. Further consideration of the students' aversion to '`ticking-boxes' is warranted. With continued demand for increased accountability and transparency in medical education, detailed check-lists of specific learning objectives will continue to feature as a means by which medical schools and learners demonstrate attainment. Students' experiences and acceptance of these check-lists deserves attention in order to inform teaching and learning in this area. Learner and faculty 'buy in' are imperative to the success of curriculum change and vital if the students are to attain the intended learning objectives. Effective faculty development and student induction programmes could be employed to facilitate engagement by both parties.