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In Reply to Weissman

Cruess, Richard L. MD; Cruess, Sylvia R. MD; Boudreau, J. Donald MD; Snell, Linda MD, MHPE; Steinert, Yvonne PhD

doi: 10.1097/ACM.0000000000000727
Letters to the Editor
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Professor of surgery and core faculty member, Center for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada; richard.cruess@mcgill.ca.

Professor of medicine and core faculty member, Center for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada.

Associate professor of medicine and core faculty member, Center for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada.

Professor of medicine and core faculty member, Center for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada.

Professor of family medicine and director, Center for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada.

Disclosures: None reported.

We are pleased to reply to Dr. Weissman, who highlights an important issue of interest—the widely accepted fact that learners are frequently exposed to unprofessional behavior on the part of their clinical teachers. He suggests solving this problem by establishing an ombudsman for students. The ombudsman would be mandated to “explore with the student any clinical experiences that the student believes are not within the boundaries of appropriate professional behavior.”

We do not disagree with Dr. Weissman’s highlighting the potential impact of negative role modeling on identity formation. His proposed solution is one of many that could prove beneficial. However, to put the issue in perspective, our article points out that, although clinical experiences and role models are of paramount importance in professional identity formation (PIF), there are other factors that contribute to the learning environment. Thus, if an ombudsman is to be responsible for assisting students to develop their professional identities, the mandate must be broadened to include the many personal and institutional factors that affect PIF.1

The appointment of an ombudsman is only one possible solution. Some institutions assign responsibility for creating a safe learning environment to medical school faculty. Others, such as ours, rely heavily on mentorship programs to provide a safe space for learners. McGill University assigns each student a mentor (called an Osler Fellow) at the beginning of medical school, and each mentor, along with a more senior student, follows six students throughout their four-year course of study.2

Finally, Dr. Weissman asserts that students must see that unprofessional behavior “will be appropriately disciplined.” If the emphasis is to be on discipline, a system of assessing faculty professionalism that is valid and reliable must be present. As the intent is to assist students to develop their professional identities, structured student input into this system is essential. Such tools are available.3

Supporting PIF is an important objective that requires an integrated educational program as well as broad-based faculty support. An ombudsman could well be a valuable part of this effort but, alone, would not be sufficient.

Richard L. Cruess, MD

Professor of surgery and core faculty member, Center for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada; richard.cruess@mcgill.ca.

Sylvia R. Cruess, MD

Professor of medicine and core faculty member, Center for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada.

J. Donald Boudreau, MD

Associate professor of medicine and core faculty member, Center for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada.

Linda Snell, MD, MHPE

Professor of medicine and core faculty member, Center for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada.

Yvonne Steinert, PhD

Professor of family medicine and director, Center for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada.

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References

1. Cruess RL, Cruess SR, Boudreau JD, Snell L, Steinert Y. A schematic representation of professional identity formation and socialization: A guide for medical educators. Acad Med. 2015;90:718–725
2. Boudreau JD, Macdonald ME, Steinert Y. Affirming professional identities through an apprenticeship: Insights from a four-year longitudinal case study. Acad Med. 2014;89:1038–1045
3. Young ME, Cruess SR, Cruess RL, Steinert Y. The professionalism assessment of clinical teachers (PACT). Adv Health Sci Educ. 2014;19:99–113
© 2015 by the Association of American Medical Colleges