The medical education community has devoted a great deal of attention to the development of professionalism in trainees within the context of clinical training—particularly regarding trainees’ handling of ethical dilemmas related to clinical care. The community, however, knows comparatively less about the development of professional behavior in medical students during the preclerkship years. In medical schools with flexible testing, students take quizzes or examinations in an unproctored setting at a time of their choosing—as long as it falls within a specified window of time. Unproctored, flexible testing offers students early opportunities to develop appropriate professional behavior. In this Perspective, the authors outline different flexible testing models from three institutions—University of Virginia School of Medicine, University of Michigan Medical School, and Icahn School of Medicine at Mount Sinai—all of which offer various levels of testing flexibility in relation to time and location. The authors’ experiences with these models suggest that preclinical medical students’ early development of professional behavior requires scaffolding by faculty and staff. Scaffolding involves setting clear, specific expectations for students (often through the form of an honor code), as well as active engagement and discussion with learners about the expectations and procedures for self-regulation in the academic environment.
P.T. Ross is director, Advancing Scholarship, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0001-7751-784X.
M.G. Keeley is assistant dean for student affairs and professor of pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia; ORCID: https://orcid.org/0000-0001-8602-2638.
R.S. Mangrulkar is associate dean for medical student education and associate professor of internal medicine and learning health sciences, University of Michigan Medical School, Ann Arbor, Michigan.
R. Karani is senior associate dean for undergraduate medical education and curricular affairs; director, Institute for Medical Education; and professor of medical education, medicine, and geriatrics and palliative medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
P. Gliatto is senior associate dean for undergraduate medical education and student affairs and associate professor of medical education, medicine, and geriatric and palliative medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
S.A. Santen is senior associate dean for assessment, evaluation and scholarship, professor, Department of Emergency Medicine, Virginia Commonwealth School of Medicine, Richmond, Virginia, and former assistant dean for educational research and quality improvement, associate chair for education, and professor, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-8327-8002.
An AM Rounds blog post on this article is available at academicmedicineblog.org.
Funding/Support: The University of Michigan Medical School (where Dr. Ross, Dr. Santen, and Dr. Mangrulkar have worked or currently work) received funding from an American Medical Association, Accelerating Change in Medical Education grant.
Other disclosures: None reported.
Ethical approval: Reported as not applicable.
Previous presentations: The three flexible testing models were discussed during an Emerging Solutions session at the Association of American Medical Colleges Medical Education Meeting, November 2016, Seattle, Washington.
Correspondence should be addressed to Paula T. Ross, Office of Medical Student Education, University of Michigan Medical School, 5100-C3 Taubman Health Sciences Library, Ann Arbor, MI 48109; telephone: (734) 763-8837; e-mail: email@example.com.