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Although several examples of frameworks dealing with "students'" unprofessional behaviour are available, guidance on how to deal locally or regionally with dysfunctional "residents" is limited (Hickson et al. in "Acad Med" 82(11):1040-1048, 2007b; Leape and Fromson in "Ann Intern Med" 144(2):107-115, 2006). Any "rules" are mostly unwritten, and often emerge by trial and error within the specialty training programme (Stern and Papadakis in "N Engl J Med" 355(17):1794-1799, 2006). It is nevertheless of utmost importance that objectives, rules and guidelines comparable to those existing in undergraduate training (Project Team Consilium Abeundi van Luijk in "Professional behaviour: teaching, assessing and coaching students. Final report and appendices." Mosae Libris, 2005; van Mook et al. in "Neth J Crit Care" 16(4):162-173, 2010a) are developed for postgraduate training. And that implicit rules are made explicit. This article outlines a framework based on the lessons learned from contemporary postgraduate medical training programmes.

To explore and describe medical students, postgraduate medical trainees, and medical specialists' perceptions of creativity, the importance they attach to creativity in contemporary healthcare, and, by extension, how they feel creativity can be taught in medical education. The authors conducted seven semi-structured focus groups with medical students (n = 10), postgraduate medical trainees (n = 11) and medical specialists (n = 13). Participants had a trifurcated perception of creativity, which they described as a form of art that involves thinking and action processes. Facing complex patients in a rapidly changing healthcare landscape, doctors needed such a multifaceted perspective to be able to adapt and react to new and often complex situations that require creativity. Furthermore, participants identified conditions that were perceived to stimulate and inhibit creativity in healthcare and suggested several techniques to learn creativity. Participants perceived creativity as a form of art that involves thinking and action processes. Creativity is important to tackle the challenges of current and future workplaces, because it stimulates the search for original solutions which are needed in a rapidly changing healthcare landscape. Participants proposed different methods and techniques to promote creativity learning. However, we need further research to design and implement creativity in medical curricula. [ABSTRACT FROM AUTHOR]

Standardized narratives or profiles can facilitate identification of poor professional behaviour of medical students. If unprofessional behaviour is identified, educators can help the student to improve their professional performance. In an earlier study, based on opinions of frontline teachers from one institution, the authors identified three profiles of medical students' unprofessional behaviour: (1) Poor reliability, (2) Poor reliability and poor insight, and (3) Poor reliability, poor insight and poor adaptability. The distinguishing variable was Capacity for self-reflection and adaptability. The current study used Nominal Group Technique and thematic analysis to refine these findings by synthesizing experts' opinions from different medical schools, aiming to develop a model of unprofessional behaviour profiles in medical students. Thirty-one experienced faculty, purposively sampled for knowledge and experience in teaching and evaluation of professionalism, participated in five meetings at five medical schools in the Netherlands. In each group, participants generated ideas, discussed them, and independently ranked these ideas by allocating points to them. Experts suggested ten different ideas, from which the top 3 received 60% of all ranking points: (1) Reflectiveness and adaptability are two distinct distinguishing variables (25%), (2) The term reliability is too narrow to describe unprofessional behaviour (22%), and (3) Profiles are dynamic over time (12%). Incorporating these ideas yielded a model consisting of four profiles of medical students' unprofessional behaviour (accidental behaviour, struggling behaviour, gaming-the-system behaviour and disavowing behaviour) and two distinguishing variables (reflectiveness and adaptability). The findings could advance educators' insight into students' unprofessional behaviour, and provide information for future research on professionalism remediation. [ABSTRACT FROM AUTHOR]

Objectives: This study explores the optimal focus for negotiation skills development training by investigating how often medical residents negotiate in practice, and how they perceive the effectiveness of their negotiation capabilities. Methods: An exploratory study was performed using a questionnaire regarding the medical residents' working environment, negotiation frequency, knowledge and skills using a 5- point Likert scale, multiple choice questions and open questions. Exploratory factor analysis with principal component analysis, varimax rotation, reliability analysis, and content analysis were used to reduce the number of variables. Descriptive and interferential statistics and multiple regression analysis were used to analyze the data. Results: We analyzed the responses of 60 medical residents. The findings showed that the perceived development of their negotiation knowledge (M=3.06, SD=0.83) was less than their negotiation skills (M=3.69, SD=0.47). Their attitude during negotiations, especially females, differed substantially in the interactions with nurses than with their supervisors. Medical residents with more working experience, better negotiation skills or who worked in hierarchical environments negotiated more frequently with their supervisors. Medical residents with better collaboration skills and negotiation knowledge demonstrated better negotiation skills. Conclusions: This study underlines medical residents' need for negotiation training. In addition to the basic negotiation knowledge and skills, training programs in negotiation should focus on the medical residents' awareness of their attitudes during negotiations, combining the assertiveness shown in interactions with supervisors with the empathy and emotional engagement present in interactions with nurses. Furthermore, attention should be paid to the influence of the environmental hierarchy on negotiation skill development. [ABSTRACT FROM AUTHOR]

Context: As unprofessional behaviour in physicians can compromise patient safety, all physicians should be willing and able to respond to lapses in professionalism. Although students endorse an obligation to respond to lapses, they experience difficulties in doing so. If medical educators knew how students respond and why they choose certain responses, they could support students in responding appropriately. Objectives: The aim of this study was to describe medical students' responses to professionalism lapses in peers and faculty staff, and to understand students' motivation for responding or not responding. Methods: We conducted an explorative, qualitative study using template analysis, in which three researchers independently coded transcripts of semi‐structured, face‐to‐face interviews. We purposefully sampled 18 student representatives convening at a medical education conference. Preliminary open coding of a data subset yielded an initial template, which was applied to further data and modified as necessary. All transcripts were coded using the final template. Finally, three sensitising concepts from the Expectancy–Value–Cost model were used to map participants' responses. Results: Students mentioned having observed lapses in professionalism in both faculty staff and peers. Students' responses to these lapses were avoiding, addressing, reporting or initiating policy change. Generally, students were not motivated to respond if they did not know how to respond, if they believed responding was futile and if they feared retaliation. Students were motivated to respond if they were personally affected, if they perceived the individual as approachable and if they thought that the whole group of students could benefit from their actions. Expectancy of success, value and costs each appeared to be influenced by (inter)personal and system factors. Conclusions: The Expectancy–Value–Cost model effectively explains students' motivation for responding to lapses. The (inter)personal and system factors influencing students' motivation to respond are modifiable and can be used by medical educators to enhance students' motivation to respond to lapses in professionalism observed in medical school. [ABSTRACT FROM AUTHOR]

Context We addressed the assessment of professional behaviour in tutorial groups by investigating students' perceptions of the frequency and impact of critical incidents that impede this assessment and 5 factors underlying these critical incidents. Methods A questionnaire asking students to rate the frequency and impact of 40 critical incidents relating to effective assessment of professional behaviour on a 5-point Likert scale was developed and sent to all undergraduate medical students in Years 2–4 of a 6-year undergraduate curriculum. Results The response rate was 70% ( n = 393). Important factors underlying critical incidents are: lack of effective interaction; lack of thoroughness; tutors' failure to confront students with unprofessional behaviour; lack of effort to find solutions, and lack of student motivation. Confirmatory factor analysis showed a good model fit. Because the relationship between frequency of occurrence and degree of impediment varies, the best information about the true impact of critical incidents and the underlying factors is provided by the product of frequency and degree of impediment. Frequency of occurrence remains stable and degree of impediment increases in Years 2–4. Conclusions The results of this study can be used to design and improve faculty development programmes aimed at improving assessment of professional behaviour. Training programmes should motivate tutors by providing background information as to why and how sound assessment of professional behaviour is to be performed and encourage tutors to confront students with and discuss all aspects of professional behaviour, as well as provide appropriate feedback. [ABSTRACT FROM AUTHOR]

Background: STARS (Students and Trainees Advocating for Resource Stewardship) is a medical student leadership program that promotes integration of resource stewardship (RS) into medical education in at least seven countries. Little is known about how participation affects student leaders.To understand how partaking in STARS impacted participants’ knowledge, skills, and influenced career plans, and aspirations.We conducted qualitative semi-structured interviews with STARS participants (n = 27) from seven countries.STARS was designed to facilitate grassroots efforts that embed RS principles into medical education. STARS programs globally share common features: participation from several medical schools, centralized organizing hubs and leadership summits, and support from faculty mentors. Students take lessons learnt from centralized programming to implement changes that advance RS initiatives at their schools.Students finished STARS with better RS knowledge, enhanced change management skills (leadership, advocacy, collaboration), and a commitment to incorporate RS into future practice. Nearly all respondents hoped to pursue leadership activities in medicine, but most were unclear if they would focus efforts to advance RS.STARS participants gained knowledge as it relates to RS, change management skills, and catalyzed a commitment to incorporate high-value care into future practice. Medical education initiatives should be leveraged as a key strategic approach to build RS capacity.Aim: STARS (Students and Trainees Advocating for Resource Stewardship) is a medical student leadership program that promotes integration of resource stewardship (RS) into medical education in at least seven countries. Little is known about how participation affects student leaders.To understand how partaking in STARS impacted participants’ knowledge, skills, and influenced career plans, and aspirations.We conducted qualitative semi-structured interviews with STARS participants (n = 27) from seven countries.STARS was designed to facilitate grassroots efforts that embed RS principles into medical education. STARS programs globally share common features: participation from several medical schools, centralized organizing hubs and leadership summits, and support from faculty mentors. Students take lessons learnt from centralized programming to implement changes that advance RS initiatives at their schools.Students finished STARS with better RS knowledge, enhanced change management skills (leadership, advocacy, collaboration), and a commitment to incorporate RS into future practice. Nearly all respondents hoped to pursue leadership activities in medicine, but most were unclear if they would focus efforts to advance RS.STARS participants gained knowledge as it relates to RS, change management skills, and catalyzed a commitment to incorporate high-value care into future practice. Medical education initiatives should be leveraged as a key strategic approach to build RS capacity.Setting and Participants: STARS (Students and Trainees Advocating for Resource Stewardship) is a medical student leadership program that promotes integration of resource stewardship (RS) into medical education in at least seven countries. Little is known about how participation affects student leaders.To understand how partaking in STARS impacted participants’ knowledge, skills, and influenced career plans, and aspirations.We conducted qualitative semi-structured interviews with STARS participants (n = 27) from seven countries.STARS was designed to facilitate grassroots efforts that embed RS principles into medical education. STARS programs globally share common features: participation from several medical schools, centralized organizing hubs and leadership summits, and support from faculty mentors. Students take lessons learnt from centralized programming to implement changes that advance RS initiatives at their schools.Students finished STARS with better RS knowledge, enhanced change management skills (leadership, advocacy, collaboration), and a commitment to incorporate RS into future practice. Nearly all respondents hoped to pursue leadership activities in medicine, but most were unclear if they would focus efforts to advance RS.STARS participants gained knowledge as it relates to RS, change management skills, and catalyzed a commitment to incorporate high-value care into future practice. Medical education initiatives should be leveraged as a key strategic approach to build RS capacity.Program Description: STARS (Students and Trainees Advocating for Resource Stewardship) is a medical student leadership program that promotes integration of resource stewardship (RS) into medical education in at least seven countries. Little is known about how participation affects student leaders.To understand how partaking in STARS impacted participants’ knowledge, skills, and influenced career plans, and aspirations.We conducted qualitative semi-structured interviews with STARS participants (n = 27) from seven countries.STARS was designed to facilitate grassroots efforts that embed RS principles into medical education. STARS programs globally share common features: participation from several medical schools, centralized organizing hubs and leadership summits, and support from faculty mentors. Students take lessons learnt from centralized programming to implement changes that advance RS initiatives at their schools.Students finished STARS with better RS knowledge, enhanced change management skills (leadership, advocacy, collaboration), and a commitment to incorporate RS into future practice. Nearly all respondents hoped to pursue leadership activities in medicine, but most were unclear if they would focus efforts to advance RS.STARS participants gained knowledge as it relates to RS, change management skills, and catalyzed a commitment to incorporate high-value care into future practice. Medical education initiatives should be leveraged as a key strategic approach to build RS capacity.Program Evaluation: STARS (Students and Trainees Advocating for Resource Stewardship) is a medical student leadership program that promotes integration of resource stewardship (RS) into medical education in at least seven countries. Little is known about how participation affects student leaders.To understand how partaking in STARS impacted participants’ knowledge, skills, and influenced career plans, and aspirations.We conducted qualitative semi-structured interviews with STARS participants (n = 27) from seven countries.STARS was designed to facilitate grassroots efforts that embed RS principles into medical education. STARS programs globally share common features: participation from several medical schools, centralized organizing hubs and leadership summits, and support from faculty mentors. Students take lessons learnt from centralized programming to implement changes that advance RS initiatives at their schools.Students finished STARS with better RS knowledge, enhanced change management skills (leadership, advocacy, collaboration), and a commitment to incorporate RS into future practice. Nearly all respondents hoped to pursue leadership activities in medicine, but most were unclear if they would focus efforts to advance RS.STARS participants gained knowledge as it relates to RS, change management skills, and catalyzed a commitment to incorporate high-value care into future practice. Medical education initiatives should be leveraged as a key strategic approach to build RS capacity.Discussion: STARS (Students and Trainees Advocating for Resource Stewardship) is a medical student leadership program that promotes integration of resource stewardship (RS) into medical education in at least seven countries. Little is known about how participation affects student leaders.To understand how partaking in STARS impacted participants’ knowledge, skills, and influenced career plans, and aspirations.We conducted qualitative semi-structured interviews with STARS participants (n = 27) from seven countries.STARS was designed to facilitate grassroots efforts that embed RS principles into medical education. STARS programs globally share common features: participation from several medical schools, centralized organizing hubs and leadership summits, and support from faculty mentors. Students take lessons learnt from centralized programming to implement changes that advance RS initiatives at their schools.Students finished STARS with better RS knowledge, enhanced change management skills (leadership, advocacy, collaboration), and a commitment to incorporate RS into future practice. Nearly all respondents hoped to pursue leadership activities in medicine, but most were unclear if they would focus efforts to advance RS.STARS participants gained knowledge as it relates to RS, change management skills, and catalyzed a commitment to incorporate high-value care into future practice. Medical education initiatives should be leveraged as a key strategic approach to build RS capacity. [ABSTRACT FROM AUTHOR]