Measuring conscientiousness and professionalism in undergraduate medical students

Background: There is gathering evidence that concern about professionalism expressed by staff with regard to undergraduate medical students represents a statistically significant risk factor for referral for disciplinary action in later clinical practice. But, 'professionalism' as a concept is variously defined, and is generally seen as difficult to measure. This is because such measures are usually highly subjective, and take place on limited numbers of occasions. We are interested in hints from the literature that a significant part of professionalism is what might be thought of as diligence or conscientiousness. Methods: We award students points on every occasion when they might be conscientious in performing simple tasks (such as attending compulsory sessions, providing essential documentation and participating in required administrative procedures). This is aggregated over the year to give a continuous, objective and multi-occasion score that is inexpensive to construct. We then determine the relationship of this score with independent staff and student estimates of professionalism. Results: We observe a positive correlation between conscientiousness and professionalism at both high and low ends of the spectrum. Discussion: This correlation raises a number of further questions. What is the sensitivity and specificity of this measure? How might it best be used with students: as a formative tool to change behaviours or as a summative tool to affect progression? And how will students react to its use? Finally, can it be extended to spheres other than undergraduate education, for instance with postgraduate trainees?