Secondary Logo

A Roadmap for Attending to Medical Students’ Professionalism Lapses

Mak-van der Vossen, Marianne C., MD; Croix, Anne de la, MA, MEd, PhD; Teherani, Arianne, Ms Ed, PhD; Mook, Walther N.K.A. van, MD, PhD; Croiset, Gerda, MD, PhD; Kusurkar, Rashmi A., MD, PhD

doi: 10.1097/ACM.0000000000002537
Research Report: PDF Only

Purpose: To develop a roadmap for educators attending to medical students’ professionalism lapses, aiming to offer an empirical base for approaching students who display such lapses.

Method: Between October 2016 and January 2018, 23 in-depth interviews with 19 expert faculty responsible for remediation from 13 U.S. medical schools were conducted about the way they handle students’ professionalism lapses. Three researchers independently completed three rounds of coding. Data collection, coding, and analysis were performed in a constant comparative process. A constructivist grounded theory approach was used to develop an explanatory model for attending to students’ professionalism lapses.

Results: Based on participants’ descriptions, the authors developed a 3-phase approach for attending to professionalism lapses. In phase 1 experts enacted the role of concerned teacher, exploring the lapse from the student’s perspective. In phase 2, they functioned as a supportive coach, providing feedback on professionalism values, improving skills, creating reflectiveness, and offering support. In phase 3, if the student did not demonstrate reflectiveness and improvement, and especially if (future) patient care was potentially compromised, participants assumed an opposite role, gatekeeper of the profession.

Conclusions: An explanatory model for attending to professionalism lapses that fits in the overarching “communities of practice” framework was created. Whereas phase 1 and 2 aim at keeping students in the medical community, phase 3 aims at guiding students out. These findings provide empirical support to earlier descriptive, opinion-based models, and may offer medical educators an empirical base for attending to students who display professionalism lapses.

M.C. Mak-van der Vossen is a general physician, coordinator of professional behavior, and PhD student, Department of Research in Education, VUmc School of Medical Sciences, Amsterdam, The Netherlands; ORCID:

A. de la Croix is assistant professor, LEARN! Academy, Vrije Universiteit, and researcher, Department of Research in Education, VUmc School of Medical Sciences, Amsterdam, The Netherlands.

A. Teherani is professor of medicine and education researcher, Center for Faculty Educators, School of Medicine, University of California San Francisco, San Francisco, California.

W.N.K.A. van Mook is an internist/intensivist, Department of Intensive Care Medicine, postgraduate dean, Maastricht University Medical Center, and professor of medical education, Maastricht University, Maastricht, The Netherlands.

G. Croiset, is professor of education and training, Health and Life Sciences, and dean of education and training, University Medical Center Groningen, Groningen, The Netherlands.

R.A. Kusurkar is associate professor of medical education and head, Department of Research in Education, VUmc School of Medical Sciences, Amsterdam, The Netherlands; ORCID:

Supplemental digital content for this article is available at

Acknowledgements: The authors wish to thank the participants for generously contributing their time and expertise.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: This study was qualified as exempt from ethical approval by the University of California, San Francisco Institutional Review Board.

Correspondence should be addressed to Marianne Mak-van der Vossen, VUmc School of Medical Sciences, Department of Research in Education, PO box 7057, 1007 MB Amsterdam, The Netherlands; telephone: +31204448239; e-mail:; Twitter: @mariannemak.

© 2019 by the Association of American Medical Colleges