Professionalism must be understood

University of Otago acting vice-chancellor Prof Helen Nicholson has been heartened the inquiry into the 2019 overseas holiday scam, involving some sixth-year medical students, found no grounds to believe any staff encouraged any unethical or unprofessional behaviour.

Rather, staff were consistent in reporting their shock, disbelief and sense of betrayal at the situation whereby some of the trainee interns (TIs), instead of completing the clinical work required for their 11- or 12-week overseas electives, were holidaying instead.

Measures imposed on those discovered to have been doing this included not being allowed to graduate at the end of 2019 with their peers, paying back grant funding of more than $6500, writing a self-reflective essay, agreeing to community service or research and automatic referral to the Fitness to Practise Committee.

There has been some difference of opinion about whether these students were treated too harshly, given the inquiry panel’s finding it is likely insufficient attendance occurred in other years. (The university has repaid the Tertiary Education Commission $156,178, a proportion of the TI grant it received and disbursed to students earlier than 2019.)

There will be no witch hunt to find and seek reimbursement from anyone who may have transgressed. Instead, the university is concentrating on improving what was a rather loose high-trust system to ensure this cannot happen again.

Prof Nicholson’s media release on the inquiry findings draws attention to the fact neither the university nor the Medical Council have any concerns around the clinical competence of the students involved in 2019, who are now in practice. We are not sure what concerns had been raised about that.

Curiously, however, the university, busy slapping itself on the back about the finding on the lack of involvement of staff, makes no mention in its press release of the inquiry panel’s concern about the "evident disconnect" between the teaching of professional and ethical practice throughout the medical school programme and the "reality that TIs in the final year of that programme could act unprofessionally, seemingly without recognition that they were doing so".

The inquiry panel said staff it interviewed could not shed light on why this might have been the case.

It was clear students, for whatever reasons, considered it acceptable to behave unprofessionally in the Trainee Intern elective, the inquiry found.

"Independent of their responsibility for making these poor choices, and for which they rightly bear consequences, this represents a failure of the programme to identify and correct significant deficits in understanding what constitutes professional behaviour in large numbers of students. It is not simply this being a case of these students being ‘bad apples’. There is a much wider responsibility the Otago Medical School must address to both identify and correct shortcomings in the medical programme that facilitated this behaviour, including the teaching of professionalism and ethics and the connection between these and their behaviour during the elective module."

The inquiry recommended a multidisciplinary working group be established to review the professional and ethical education teaching throughout the Advanced Learning in Medicine section of the medical degree (years four to six) to find ways of ensuring, as far as feasible, that students appreciate its practical implications for all aspects of clinical practice.

If the relationship between medical practitioners and their patients is to work as it should, ethical and professional behaviour is vital. Patients need to feel confident that all medical graduates have a clear understanding of what that involves. We trust the university will take on board the inquiry’s concerns about this aspect of training and move quickly to address any gaps in what is being taught and how well it is being understood by students.

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