Paul McGurgan¹
1 University of Western Australia, Medical School 

Background:
We examined whether medical students’ opinions on the acceptability of a behaviour were influenced by previously encountering a similar professionally challenging situation, assessed the magnitude of effect of ‘experience’ compared to other demographic factors which influence medical students’ opinions, and evaluated whether opinions regarding some situations/behaviours were more susceptible to ‘experience’ bias? 

Summary of work:
Confidential, on-line survey for medical students distributed to Australian and New Zealand (AUS/NZ) medical schools. Students submitted de-identified demographic information, provided opinions on the acceptability of a wide range of student behaviours in professionally challenging situations, and whether they had encountered similar situations. 

Results:
3171 students participated from all 21 Aus/NZ medical schools (16% of registered students). Medical students reported encountering many of the professionally challenging situations, with varying opinions on what was acceptable behaviour. The most significant factor influencing acceptability towards a behaviour was whether the student reported encountering a similar situation. The professional dilemmas most significantly influenced by previous experience typically related to behaviours that students could witness in clinical environments, and often involved breaches of trust. 

Discussion/Conclusions:
Our results demonstrate the relationship between experience and medical students’ opinions on professional behaviour- the ‘Schweitzer effect’. When students encounter poor examples of professional behaviour, especially concerning trust breaches, it significantly influences their perception of the behaviour. These results highlight the importance of placing students in healthcare settings with positive professional role modelling/work cultures. 

• Medical students report encountering a wide range of professionally challenging situations, and have varying opinions on acceptable professional behaviours.
 • The most significant factor influencing acceptability towards a behaviour was whether the student reported encountering a similar professional dilemma.
 • Students appear susceptible to normalising unprofessional behaviours
 • Placing students in toxic work culture environments with poor role models may enable healthcare systems to perpetuate unprofessional behaviours. 

References (maximum three) 

1. Medical students’ opinions on professional behaviours: The Professionalism of Medical Students’ (PoMS) study. McGurgan, P., Calvert, K. L., Narula, K., Celenza, A., Nathan, E. A. & Jorm, C., 3 Mar 2020, In: Medical Teacher. 42, 3, p. 340-350. 

2. Why Is Patient Safety a Challenge? Insights From the Professionalism Opinions of Medical Students' Research. McGurgan, P. M., Calvert, K. L., Nathan, E. A., Narula, K., Celenza, A. & Jorm, C., Oct 2022, In: Journal of Patient Safety. 18, 7, p. e1124-e1134. 

3. Opinions towards Medical Students’ Self-Care and Substance Use Dilemmas—A Future Concern despite a Positive Generational Effect? McGurgan, P., Calvert, K., Nathan, E., Celenza, A. & Jorm, C., Oct 2022, In: International Journal of Environmental Research and Public Health. 19, 13289. 

NAMRATA CHHABRA¹
Elize Archer²
1 American University of Antigua College of Medicine
2 Stellenbosch University

Empathy stands as a cornerstone in medical professionalism, significantly impacting patient outcomes and physician-patient rapport. While numerous academic entities stress its importance, evidence suggests potential empathy attrition during advanced medical training. 

Summary of Work

This study employed a rigorous descriptive phenomenological methodology to probe the nuances of empathy development amongst undergraduate medical students, particularly discerning experiential facets that bolster or inhibit empathic tendencies. 

Contrary to prevailing literature suggesting empathy erosion, our data unearthed an upward trajectory in students' empathic orientations during their medical education course. Students delineated empathy into a quadripartite construct, comprising cognitive, affective, behavioral, and moral facets. Empathic interaction with patients was perceived not as a unidirectional but a bidirectional relational dynamism. Causal factors enhancing empathy were multifarious: authentic patient interactions, the salutary influence of positive educational exemplars, and individual maturation in emotional sagacity, self-assuredness, and behavioral modulation. However, systemic challenges, such as curriculum rigidity towards biomedical domains, academic inundation, and the dearth of structured empathy-focused pedagogy, surfaced as formidable barriers. 

These elucidations underscore the intricate interplay between intrinsic personal growth trajectories and extrinsic academic and environmental catalysts in sculpting students' empathic landscapes. The delineated barriers signify exigent domains that medical education frameworks need to recalibrate, accentuating an equilibrium between biomedical prowess and empathic competence. 

Empathy, far from being a static inherent trait, emerges as a dynamic construct, continuously molded by a confluence of academic, experiential, and individual determinants. Medical academia must judiciously address these influencing vectors to foster a more empathic future physician cadre. 

Take-Home Messages/Implications for Further Research or Practice 

For robust empathy cultivation in medical aspirants, institutional imperatives should encompass the following: 

References (maximum three) 

Conor Gilligan¹
Karen D'Souza², Lynette Clearihan³, Charlotte Denniston⁴, Vicki Jones⁵, Zsuzsoka Kecskes⁶, Margaret Schnitzler⁷ and Tim Wilkinson⁸
1 EACH
2 School of Medicine Deakin University
3 Monash University
4 University of Melbourne
5 University of Auckland
6 University of Wollongong
7 University of Sydney
8 University of Otago

Background
Professionalism is a high stakes competency in healthcare – its presence linked to a safety culture and its absence linked to poor patient outcomes. We sought to understand how medical schools in Australia and New Zealand are defining, teaching and assessing professionalism, with particular interest in the type and effectiveness of remediation strategies being used.


Summary of work

A mixed methods survey of all Medical Schools in Australia and New Zealand regarding their approaches to students learning about professionalism was undertaken in 2021 to identify good practice and develop guidance for future practice. 

Results
22 of 23 medical schools responded. Although 86% had a definition of professionalism, these often comprised a number of components – from values to behaviours, attributes, codes of conduct to statements or demonstration of these. 

All assessed professionalism however only 63% defined the expected attributes of a future doctor and linked these with assessment. 

Most medical schools used a variety of assessment modalities - observed clinical encounters (n=21/23) and incident reporting (n=21/23) were the most common. There were variable approaches to remediating professionalism lapses and lack of certainty about effectiveness of these approaches.


Discussion and Conclusions 

Lack of a clear definition and expected behavioural attributes of professionalism undermines the effectiveness of systematic programs of assessment. Measuring and remediating issues in professionalism can be addressed in varying ways, either as a judgement (hurdle or summative assessment) or as a diagnosis (set of observed behaviours), with the option of using formal policies and procedures, however their effectiveness is not well studied. 

Take-home messages / implications for further research or practice 
Assessment of professionalism requires a 'whole of system' approach through being explicit about what attributes or components of professionalism are expected, taught, role-modelled and assessed. Remediation of professional behavioural lapses is an area requiring further cross- institutional study. 

Lauren O'Mullane¹
Naomi Staples¹ and Deborah O'Mara²
1 University of Sydney Medical School
2 University of Sydney Medical School/ AMEE/ ANZAHPE 

Background:
The Sydney Medical Program (SMP) utilises a Situation Judgement Test (SJT) as part of professionalism assessment. Its use as a formative assessment as part of a programmatic assessment portfolio assists first year students understand their response to situationsthatariseinclinicalandeducationalsettings. CandidateperceptionsofmedicalSJTs are primarily focussed on its role in screening processes (Sharma, 2015; Takacs and Tracy, 2022), with little research exploring perceptions within a medical education context (Sahota et al., 2023). 

Summary:
Our study aimed to determine medical student outcomes and perceptions of SJT when used as an education tool. First year medical students from 2020-2023 (n=1140) undertookanonlineSJTcomprisingscenariosandappropriatenessratingresponseoptions. On completion of the SJT, linked voluntary feedback was obtained as open-ended comments (>90% response rate). Student SJT response scores and feedback underwent quantitative and thematic analysis, respectively. 

Results:
Student SJT outcomes and feedback will be presented over time. Student response scores were significantly different (p<0.05) when compared to an expert panel but were stable over time. Student sentiment towards the SJT was positive, mixed, and negative. Students recognised the benefit of being exposed to scenarios and gauging their responses. They also found the question format challenging, some believed the questions lacked nuance and some found the rating response options limiting. 

Discussion:
Lack of student professional experience may contribute to their perceptions of the SJT. 

Conclusions:
The stability of the SJT scores over time demonstrates the reliability of our SJT assessment. Student feedback provides evidence for the content validity of our SJT. 

Take home message:
Influence of experience will be explored in future research examining SJT performance and feedback in final year students. Improvements to SJT design and how it is used as an educational tool need to be considered. 

References (maximum three) 

Sahota G.S., Fisher V., Patel B., Juj K. and Taggar J.S. 2023. The educational value of situational judgement tests (SJTs) when used during undergraduate medical training: A systematic review and narrative synthesis. Med Teach. pp 1-8. doi: 10.1080/0142159X.2023.2168183 

Sharma M. 2015. Medical students' perceptions of the situational judgement test: a mixed methods study. Br J Hosp Med. 76:234-8. doi: 10.12968/hmed.2015.76.4.234. 

Takacs E.B. and Tracy C.R. 2022. Evaluating the Whole Applicant: Use of Situational Judgment Testing and Personality Testing to Address Disparities in Resident Selection. Curr Urol Rep. 23:308-318. doi: 10.1007/s11934-022-01115-8