Addressing professionalism in both formative and summative simulated patient care activities - Experiences with a discretionary deduction approach

Background and purpose: Encouraging and assessing professionalism among pharmacy students can be challenging. While non-punitive approaches are preferred as part of professional socialization, our program found this insufficient to ensure professional behaviour, especially during ungraded simulation lab activities.

Educational activity and setting: In Winter 2015, we included a discretionary grade deduction within the assessments applied to a professional practice lab course in order to provide both intrinsic and extrinsic motivation to follow lab policies on professionalism.

Findings: A professionalism code was developed and discussed with students, and was also used as a template to guide professional behaviour throughout the course. Students not exhibiting these behaviours in lab could be subject to up to a five percent deduction from their final course grade at the instructor's discretion.

Discussion: Instructors considering this strategy are encouraged to introduce it in the first year of the program to ensure consistent expectations throughout the duration of students' training, and to not determine the magnitude of deductions applied until the end of the semester to ensure consistency and consideration of ongoing behaviour. Documentation of actions leading to deductions should be kept to support the decision.

Summary: A deduction-only approach to address unprofessional behaviours in addition to discussion offers additional motivation to students to exhibit professionalism across both graded and ungraded educational activities with minimal additional workload for instructors. The strategy has since been adopted across all lab courses in our program and has also been recommended in lecture-based courses.