Jinelle Ramlackhansingh¹
Fern Brunger¹
 1 Memorial University 

Clinical skills are part of the formal undergraduate medical education curriculum. Medical students are assessed through OSCEs to determine whether their preparedness for clinical work. Medical students need to demonstrate competence, including professionalism in clinical skills. 

This critical ethnography examines professional identity development in pre-clinical medical students. Monthly focus groups were conducted with students, supplemented by faculty and administrative staff interviews. Participant observation of classes and governance meetings contextualized the data. The theoretical frameworks of Bourdieu and Foucault were used in analysis. 

The esearch revealed that some students are in collusion, sharing OSCE cases amongst themselves. A student frankly stated, “the people that went in the morning [OSCE] were telling people what was on the exam in the afternoon”. The practice was kept hidden from faculty and administrators; as student representatives at medical school governance meetings did not disclose the practice, even though they disagreed with it. For those who did not participate collusion, the concern was that it would result in their own lesser demonstration of success, when others were cheating, giving the impression of clinical skills excellence. 

Student practice of unethically sharing OSCE cases puts the medical school's academic integrity into question. However, beyond that obvious concern, my research illustrated that non-cheating students were concerned about their grades rather than the unprofessional behaviour of colleagues. The issue was not addressed at governance meetings, reflecting a culture of silence and tacit acceptance of this unprofessional behaviour. 

Medical schools should be wary of placing too much importance on clinical competence at the expense of an emphasis on the value of professionalism. Medical schools should consider 

rotating OSCE cases, so students are not disadvantaged. The emphasis should focus on being competent for patient care rather than being competent only to pass the exam. 

References (maximum three) 

The Royal College of Physicians and Surgeons of Canada. (n.d.c). Professional. 

http://www.royalcollege.ca/rcsite/canmeds/framework/canmeds-role-professional-e 

The Royal College of Physicians and Surgeons of Canada. (2019). The maintenance of certification program. http://www.royalcollege.ca/rcsite/cpd/cpd-educators-e 

American Medical Association & Council on Ethical Judicial Affairs. (2016). Modernizing the AMA Code of medical ethics. https://www.ama-assn.org/about-us/code-medical-ethics