School of Medicine and Health, Durham University, Queens Campus, Thornaby, Stockton-on-Tees, UK

Abstract

Background

Professionalism in medical students is not only difficult to define but difficult to teach and measure. As negative behaviour in medical students is associated with post-graduate disciplinary action it would be useful to have a model whereby unprofessional behaviour at the undergraduate level can easily be identified to permit appropriate intervention. We have previously developed a scalar measure of conscientiousness, the Conscientiousness Index (CI), which positively correlates to estimates of professional behaviour in undergraduate medical students. By comparing CI points awarded in year 1 and year 2 of study we were able to use the CI model to determine whether teaching and clinical exposure had any effect on students’ conscientiousness.

Methods

CI points were collected by administrative staff from 3 successive cohorts of students in years 1 and 2 of study. Points were awarded to students for activities such as submission of immunisation status and criminal record checks, submission of summative assignments by a specified date and attendance at compulsory teaching sessions. CI points were then converted to a percentage of maximal possible scores (CI %) to permit direct comparison between years 1 and 2 of study.

Results

CI % scores were generally high with each year of study for each cohort showing negatively skewed normal distributions with peaks > 89%. There was a high degree of correlation of CI % scores between year 1 and year 2 of study for each cohort alone and when cohort data was combined. When the change in CI % from year 1 to year 2 for all students was compared there was no significant difference in conscientiousness observed.

Conclusions

We have provided evidence that use of a CI model in undergraduate medical students provides a reliable measure of conscientiousness that is easy to implement. Importantly this study shows that measurement of conscientiousness by the CI model in medical students does not change between years 1 and 2 study suggesting that it is a stable characteristic and not modified by teaching and clinical exposure.

Background

In the UK, there are published guidelines on professionalism, such as

A key question is whether professionalism is a fixed characteristic or whether it can be promoted over time. The implications of these two possibilities are profound as it will explore whether the teaching of professionalism has any effect on the professional behaviour exhibited in medical students and doctors.

Negative behaviour in undergraduate medical students has been associated with postgraduate disciplinary action

We have previously explored the relationship between an objective measure of the stable personality trait of conscientiousness and the construct of professionalism in undergraduate medical students

Interestingly, lack of conscientious behaviour has previously been shown to be associated with unprofessional behaviour in clinical practice

Points awarded to students that form the CI reflect the expectation that conscientious students would be dutiful, self-disciplined, highly organised and thorough in their approach to tasks. Constructing a student CI score therefore involves administrative staff collecting Yes/No decisions based on, for example, whether a student has attended a compulsory teaching session or submitted an assignment on time

We have previously reported a slight increase in CI% in a small number of students between years 1 and 2 of study

Methods

Ethical approval for the study was granted by the ethics committee of the School of Medicine and Health, University of Durham. Conscientiousness Index points were gathered from Phase I (Years 1 and 2) undergraduate medicine students at a UK medical school. Data were collected from 3 consecutive cohorts of students beginning their studies in the academic years 2006–7, 2007–8 and 2008–9.

Conscientiousness Index

Details of the Conscientiousness Index are previously described

Data analysis

The number of events in which Conscientiousness Index points could be awarded differed from cohort to cohort and from year 1 to year 2 within the same cohort of students. This was due to the number of compulsory sessions varying from one cohort to the next and also between years 1 and year 2 of study. Additionally, some events only occur at one particular time, for example, collection of immunisation status occurs in year 1 only. Points awarded were therefore expressed as a percentage of maximal possible points obtainable in a particular academic year to produce a Conscientiousness Index percentage score (CI %) thus permitting statistical comparison between years 1 and 2 of study. The change (delta) in CI % score from year 1 to year 2 was achieved by subtracting a student’s year 1 CI % from their year 2 CI % score. A positive delta value thus reflects an increase in Conscientiousness Index performance and a negative delta a decrease in performance. It was not possible to calculate the delta CI % for those students who did not progress from year 1 to year 2 or had deferred to year 2 from a previous year with no CI points recorded. In such cases the CI % scores have been retained in Figure

Distribution of CI points awarded to medical students in year 1 (A) and year 2 (B) of study.

**Distribution of CI points awarded to medical students in year 1 (A) and year 2 (B) of study.**

**2006-7 cohort**

**2007-8 cohort**

**2008-9 cohort**

**Combined cohorts**

**
n
**

**Points range****(max)**

**Mean %**

**S.D**

**
n
**

**Points range****(max)**

**Mean %**

**S.D**

**
n
**

**Points range****(max)**

**Mean %**

**S.D.**

**
n
**

**Points range****(max)**

**Mean %**

**S.D.**

**Year 1**

110

87-134(140)

**89.8**

5.39

93

100-135(136)

**91.4**

4.8

102

91-124(128)

**86.2**

5.1

305

87-135(140)

**89.1**

5.54

**Year 2**

112

73-104(112)

**91.8**

5.59

91

76-94(95)

**91.2**

3.4

98

66-91(97)

**84.4**

5.9

301

66-104(112)

**89.2**

6.13

Scatter plot showing correlation between CI % scores in years 1 and 2 of study for the combined cohorts.

**Scatter plot showing correlation between CI % scores in years 1 and 2 of study for the combined cohorts.**

Change (delta %) in CI % scores from year 1 to year 2 of study for the combined cohorts.

**Change (delta %) in CI % scores from year 1 to year 2 of study for the combined cohorts.**

**2006-7 cohort**

**2007-8 cohort**

**2008-9 cohort**

**Combined cohorts**

*** Denotes a significant correlation with

**
R
**

0.494 ***

0.637***

0.530***

0.54***

**2006-7 cohort**

**2007-8 cohort**

**2008-9 cohort**

**Combined cohorts**

**
n
**

**Mean delta**

**S.D.**

**
n
**

**Mean delta**

**S.D.**

**
n
**

**Mean delta**

**S.D.**

**
n
**

**Mean delta**

**S.D.**

**Change (delta) in CI% score**

107

**+1.84**

5.22

91

**−0.4**

3.5

98

**−1.56**

5.4

296

**−0.11**

5.1

Pearson’s correlation test was used to assess correlation between CI % scores for years 1 and 2 of study for each successive cohort. A one-sample Student’s

Results

Conscientiousness Index points

Conscientiousness index (CI) points were awarded in years 1 and 2 of study over 3 consecutive cohorts of undergraduate medical students beginning their studies in the academic years 2006–7, 2007–8 and 2008–9. The range of points obtained varied between year 1 and year 2 of study and between cohorts of students (Table

Distribution of Conscientiousness Index % scores

Simple visual comparison of CI % scores for each of the 3 cohorts and for each year of study shows similar negatively skewed (towards the right) leptokurtic distributions with peaks at 93%, 95% and 89% for year 1 and 96–7%, 94% and 91% for year 2. Combining the CI % for each year of study showed similar distributions of scores with peaks at 93% and 94% for years 1 and 2 (Figure

Correlation between Conscientiousness Index % scores between years 1 and 2 of study

Figure

Change (delta) in Conscientiousness Index % scores from year 1 to year 2

Figure

Discussion

We have previously shown that the CI model correlates with teaching staff and peer estimates of professionalism in undergraduate students in a UK medical school

The trait of conscientiousness is listed as one of the ‘Big Five’ domains of personality

CI % scores were generally high, with mean values of ~90% for both years 1 and 2 for the combined data from all three cohorts (Figures

It may be argued that an increase in mean CI % scores would be expected to occur in year 2, as previously reported

In the 2007–8 and 2008–9 cohorts virtually all students who performed in the top half of the class for CI in year 1 show a decrease in CI % score for year 2 (data not shown) with the opposite trend seen in the 2006–7 cohort. This effect may be due to regression to the mean

Although we have reported no change in CI score and hence conscientious behaviour between year 1 and year 2 of studies it has been reported that in adulthood, up to the age of ~40 years, conscientiousness, aspects of extroversion (social dominance and emotional stability), open mindedness and agreeableness all improve

Conclusions

This study shows that use of a CI model in undergraduate medical students provides a reliable measure of conscientiousness which may provide an indicator of unprofessional behaviour in students and importantly may identify at an early stage in their training those individuals who are more likely to exhibit unprofessional behaviour in future practice. This would allow early intervention and support for such individuals. Importantly our data shows that conscientiousness, as measured by the CI, in medical students did not change between years 1 and 2 of study suggesting that it is a stable characteristic and not modified by teaching and clinical exposure.

Competing interests

The author(s) declare that they have no competing interests.

Authors' contributions

JM conceived and designed study. AA and JS collected data. AC evaluated and analysed data and wrote first draft of paper. JM and AC contributed to final version of paper. All authors read and approved the final manuscript.

Acknowledgements

None

Pre-publication history

The pre-publication history for this paper can be accessed here: