Reasoning when it counts: students' rationales for action on a professionalism exam

Acad Med. 2007 Oct;82(10 Suppl):S40-3. doi: 10.1097/ACM.0b013e31813ffda4.


Background: Previous research explored students' reasoning in the face of professional dilemmas, using interviews in response to videotaped scenarios. This study determined the effects of a change in context (to a written exam) and format (video versus text scenarios) on students' response patterns.

Method: Fifty-three students were randomized to videotaped or text-based scenarios in the context of a mock written exam. Responses were coded by two raters.

Results: Interrater reliability was high (kappa = 0.872). There were no differences in response patterns between the video and text groups. When compared with the interview setting, students' exam responses showed a shift towards more "acceptable" rationales for action; however, they still considered implications for themselves.

Conclusions: This shift in responses indicates that students took the exam seriously. Their continued reference to implications for themselves might therefore reflect a sense that their status as students makes these considerations legitimate; alternatively, students' interpretation of altruism may be different than what the profession avows.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Clinical Competence / standards*
  • Education, Medical, Undergraduate / methods*
  • Educational Measurement / methods*
  • Humans
  • Motivation*
  • Problem Solving*
  • Students, Medical / psychology*
  • Surveys and Questionnaires
  • Video Recording