Role Models in the OR: Medical Student Observations of Exemplary Behavior

Medical students are taught, “don’t criticize colleagues in front of the patient,” “don’t be dismissive of the patient’s fears.” Educators assume that otherwise the students might perceive such unprofessional behavior as acceptable and model their own behavior on it. So it is not surprising that most medical education research on professionalism has focused on the lapses, on what not to do.

But a lot of good behavior takes place, too. In a study published in the September 2011 issue (online August 17, 2011) of Medical Education, Columbia University Medical Center researchers Saundra E. Curry, MD; Clarissa I. Cortland, BA; and Mark J. Graham, PhD, identified positive behaviors that medical students observe in the intense, patient-focused environment of the operating room (OR).

For two consecutive years, the researchers asked third-year medical students on the one-week anesthesia rotation to record two OR interactions they observed, one an instance of exemplary behavior (“good”) and the other of a professional lapse (“bad”). The researchers then took terms from a standardized taxonomy of bad behaviors (e.g., yelling, objectifying the patient) and transformed them into their positive version (e.g., discussing problems calmly, treating the patient with sensitivity). They then matched student observations of good behavior to the good terms. They found that the good behaviors fell into six main themes. Three had to do with interactions with patients (calm, communication, comforting), two with one another (teamwork, respect), and one with the medical students (teaching).

The students were not shy about voicing their observations, both positive and negative. Rather than use such abstract terms as “altruism” and “accountability,” they described behavior as a series of actions. Many of the observed behaviors were very specific, such as when an attending anesthesiologist had a patient hold her own facemask. The anesthesiologist later told the student that since the patient was having so many things done to her, the least they could do was give her some sense of dignity and control by having her help out as much as she could.

The fact that the students frequently mentioned explicit teaching―specifically addressing the student to teach a point―suggested that explicit teaching might not happen as often as the students would like. The researchers suggest that students be made more aware that role-modeling, rather than overt, didactic teaching, is common in medical education. Conversely, teachers of medical students―in this case, in the OR―need to be aware that their everyday behavior provides numerous “teaching moments” for impressionable students.

When students witness bad behavior, it may serve as a reminder of what not to do. At the same time, however, they may take away the message that appropriate professional behavior is unimportant. Further along in their training, as junior team members, they may be more likely to mimic the behavior of more senior members, perpetuating inappropriate professional behavior.

Although medical students have always witnessed exemplary behavior by senior medical practitioners, recording and discussing their observations reinforces the idea that such behaviors are worth emulating. And developing a taxonomy of positive behaviors lays the groundwork for further research into how medical students acquire their understanding of optimal professional behavior.