"They liked it if you said you cried": how medical students perceive the teaching of professionalism

Objective: To discover what Australian medical students think about the way professionalism is taught in their medical curriculum. Design, participants and setting: Qualitative study including five focus groups between 2 June 2010 and 30 September 2010, comprised of medical students from both undergraduate and postgraduate entry programs who were in the last 1-2 years of the medical program and had undertaken rural longitudinal integrated clinical placements. Results: The five focus groups ran for a total of 5.5 hours. Participants (16 women and 24 men; mean age, 26 years [range 23-32 years]) expressed a low regard for the ways in which professionalism had been taught and assessed in their learning programs. They "gamed the system", giving assessors the results on reflective writing assignments that they believed would gain them a pass. They considered experiential learning - observing good professional practice - to be the best way (some view it as the only way) to learn professionalism and consolidate what they learned, and formed their individual mental model of professionalism through group reflection with their peers in medical school. Conclusions: While students will always be critical of their curriculum, the universal negative views we captured indicate that current teaching would benefit from review. We suggest a less didactic approach in early years, with more evaluation and feedback from students to assure relevance; an emphasis on true reflection, as opposed to guided reflections linked to overformalised requirements; and more attention devoted to role-modelling and mentoring in the clinical years of training.