의과대학 재학중 프로페셔널하지 못한 행동과 CPI의 관계(Acad Med, 2007)

의과대학 재학중 프로페셔널하지 못한 행동과 CPI의 관계(Acad Med, 2007)

The Relationship between Measures of Unprofessional Behavior during Medical School and Indices on the California Psychological Inventory

Carol S. Hodgson, Arianne Teherani, Harrion G. Gough, Pamela Bradley, and Maxine A. Papadakis

미국 내과위원회의 전문성에 관한 헌장은 "프로페셔널리즘은 의학과 사회 계약의 기본입니다."이라고 기술하고 있다. 

• 선행 연구는 의대에서의 비전문가적 행동이 국가 의료위원회의 추후 징계 조치와 관련이 있음을 보여주었습니다. 

• 징계 조치를 예측하는 다른 연구에서도 무책임, 자기 개선의 부족, 빈약한 이니셔티브 / 동기 부여가 유사한 결과를 가져온다는 것이 발견되었습니다. 

• 또 다른 연구에서는 무책임한 사례 (필수 과목 평가를 완료하지 못하고 예방 접종 요구 사항을 준수하지 못하는 사례)에서는 임상실습 시기의 직업 윤리에 대한 비전문적 행동을 예측했습니다. 

이 연구들는 후기 문제의 예측 인자로서 비전문가 행동의 중요성을 나타냅니다.

The American Board of Internal Medicine’s charter on professionalism states that “professionalism is the basis of medicine’s contract with society.”1 

• earlier study showed that unprofessional behavior during medical school was associated with later disciplinary action by a state medical board.2 

• Similar results were found in a smaller study in which irresponsibility, lack of self-improvement, and poor initiative/motivation were predictive of later disciplinary action.3 

• In another study, examples of irresponsibility (failing to complete required course evaluations and failing to report compliance with immunization requirements) predicted unprofessional behavior during clerkships.4 

These studies indicate the importance of unprofessional behavior as a predictor of later problems.

캘리포니아 심리 인벤토리 (CPI)는 1948 년 Gough가 "미래 행동을 예측하고 이전 행동을 이해하기위한"성격을 측정하는 도구로 처음 개발되었습니다. CPI의 목적은 긍정적 인 심리적 특성과 적응 행동 측면에서 개인의 일관된 초상화를 제공하는 것입니다. 언어 적으로 보면 일상적으로 표현할 수있는 보편적 인 설명 인 "민속 개념folk concepts"에 호소한다. 434 문항의 CPI는 민속 개념의 척도를 가지고있다. 이 척도의 낮은 점수는 다음을 나타냅니다.

• 책임 : 자기 방종, 무질서, 신뢰할 수없고 무책임하며 자기 개선이 부족합니다.

• 사회화 : 규칙 준수, 부적합, 반항적, 비 관습 적, 냉소적.

• 자기 통제 : 강한 감정과 감정, 통제 불능과 충동에 대한 문제;

• 공동체 성 : 자기를 다른 사람들과 다른 것으로 보며, 관습에 어긋나고, 종종 변하기 쉽고 변덕스럽고 게으르다.

• 웰빙 : 건강 및 / 또는 개인적인 문제에 대해 우려하고, 불공평하게 또는 부주의하게, 비관적이거나, 신경질적이고, 불안해하는 것에 대해 불평하는 경향이 있습니다.

The California Psychological Inventory (CPI) was first developed by Gough11 (p1) in 1948 as a tool to measure personality “for predicting future behavior and understanding prior actions.” The purpose of the CPI is to give a coherent portrait of individuals, in terms of positive psychological qualities and adaptive behavior. In its language, it appeals to everyday universals of description—that is, “folk concepts.” The 434-itemCPI has 20 folk concept scales. Low scores on these scales indicate the following: 

• responsibility: self-indulgent, undisciplined, not reliable, irresponsible, lacks self-improvement; 

• socialization: resists rules, nonconforming, rebellious, unconventional, cynical; 

• self-control: strong feelings and emotions, problems with undercontrol and impulsivity; 

• communality: sees self as different from others, unconventional, often changeable and moody, lazy; and 

• well-being: concerned about health and/or personal problems, tends to complain about being treated unfairly or inconsiderately, pessimistic, nervous, anxious.11

3 개의 벡터는 고차원 구조를 측정합니다. 각 벡터는 연속체에서 측정됩니다. 벡터 2는 norm questioning에서 norm favoring에 이르기까지 다양하며 사회화와 공동성에서 유연성을 뺀 세 가지 척도의 조합입니다. 벡터 2 (규칙 존중)에서 점수가 낮은 사람들은 규칙 점검적, 비순응정, 자기 관대, 미덥지않은, 반항적이라고 기술 할 수 있습니다.

Three vectors measure higher order constructs. Each vector is measured on a continuum. Vector 2 ranges from norm questioning to norm favoring and is a combination of three scales: socialization and communality minus flexibility. Those scoring low on Vector 2 (rule respecting) can be described as rule testing, nonconforming, self-indulgent, unreliable, and rebellious.11

사회 적응, 자기 통제, 공동체 정신, 웰빙, 규칙 준수와 관련하여 CPI 척도로 의과 대학 동안 전문직 종사자의 행동을 증명하지 않은 사람들과는 프로페셔널이 아닌 행동을하는 의사가 다른가?

do medical school matriculates who demonstrated unprofessional behavior differ from those who did not demonstrate unprofessional behavior during medical school on CPI scale scores for responsibility, socialization, self-control, communality, well-being, and rule respecting?

Method

The medical students in this study were from the University of California, San Francisco (UCSF). Information on these graduates is part of existing databases from retrospective case–control studies which examined the association of unprofessional behavior in medical school with later disciplinary action by a state medical board.2,3 The methodology used to select these graduates is previously described.2,3 

• Data from the UCSF cases and controls were extracted from the graduates’ academic records including their admission, course grades, evaluation narratives, scores from licensing exams, administrative correspondence, and the deans’ letters of recommendation. 

• Data from the academic files were entered into a database and coded by investigators blinded to the case or control status of each subject. At least two investigators determined whether the excerpts described unprofessional behavior (no/ yes). The definition of unprofessional behavior was based on previously established criteria.5,18 

Types of unprofessional behavior were developed by analyzing the excerpts of negative comments in the medical student records and these were used to determine the appropriate CPI scales for this study.2,3

총 650명

Psychology faculty at the University of California, Berkeley administered the CPI to UCSF medical students from 1951 to 1970; all medical students matriculating to UCSF during this period were recruited to participate. Data were originally collected on 650 medical students. 

474 포멧을 434 포멧으로 

CPI item data were in the CPI Form 472 format and were scored using the Form434 scales.

Of the graduates for whom professionalism had been previously evaluated on the basis of their academic records (n  264),3 only 26 also had CPI data available. Therefore, the final data set consisted of 26 subjects, seven of whom demonstrated unprofessional behavior during medical school (cases) and 19 who did not (controls). A priori to conducting this study, to enhance power, unprofessional behavior in medical school replaced disciplinary action by a state medical board as the outcome variable.

Results

All but one graduate were male; year of matriculation for the sample ranged from 1960 to 1965. The means and standard deviations for each of the CPI scales are given in Table 1 as are the means for the original 1996 sample of 551 male medical students11 completing the CPI. The CPI scale means of the reference sample (n   551) compared with the overall means in this sample (n  26) were not significantly different. Therefore, this smaller sample of 26 graduates is representative of the original larger sample of male medical students.

The graduates’ level of professionalism was significantly correlated to the CPI scales of responsibility (r  0.53), communality (r  0.50), well-being (r  0.46), and rule respecting (r  0.65).

Discussion

이 연구는 의대에 입학시의 CPI 점수가 의대의 프로페셔널리즘 측정과 관련이 있음을 나타냅니다.

This study indicates that the scores of the CPI, which was taken at matriculation to medical school, are related to a measure of professionalismduring medical school.

이러한 지수가 피험자의 심리적 특성trait보다는 피검자의 상태state를 측정하는 경우, 단기적으로 전문가의 행동을 예측하기 위해 이러한 방법을 기대하는 것은 무리 일 수 있습니다. CPI 척도는 시간이 지남에 따라 안정적이지만 (25 년 시험 - 재검사 데이터 참조), 평생 동안 안정적인지는 확인되지 않았다 .11

If these indices measure the state of the examinee rather than his or her psychological trait, it would be unreasonable to expect these measures to predict professional behavior beyond the short term. Although the CPI scales are stable over time (see above 25-year test– retest data), they have not been shown to be stable through one’s lifetime.11

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Acad Med. 2007 Oct;82(10 Suppl):S4-7.

The relationship between measures of unprofessional behavior during medical school and indices on the California Psychological Inventory.

Hodgson CS1, Teherani A, Gough HG, Bradley P, Papadakis MA.

Author information

1

University of Colorado at Denver and Health Sciences, Denver, CO 80262, USA. carol.hodgson@uchsc.edu

Abstract

BACKGROUND:

Research studies on physicians disciplined by state medical boards showed specific types of unprofessional behavior were predictive of later disciplinary action. Similarly, law enforcement officers who received disciplinary action scored lower on certain scales of the California Psychological Inventory (CPI).

METHOD:

This study used a case-control descriptive design and independent t tests to examine differences in scores on six psychologicalindices (CPI scales) by level of unprofessional behavior during medical school.

RESULTS:

Physicians who demonstrated unprofessional behavior during medical school versus those who did not scored significantly lower on four CPI scales. Results are consistent with findings in which general unprofessional behavior during medical school can be further characterized to domains of irresponsibility, lack of self-improvement, and poor initiative.

CONCLUSIONS:

The psychological indices of the CPI scales differed by level of unprofessional behavior, which leads one to wonder whether the use of personality measures should be considered during the admissions process to medical school.

PMID:

 

17895687

 

DOI:

 

10.1097/ACM.0b013e318140047f

[Indexed for MEDLINE]