Key results
Medical educators responded evenly to the BME, the KMLE, and GME/CPD at appropriate assessment timing to assess preventing the unprofessional conduct of doctors. Medical educators did not overwhelmingly select an appropriate assessment tool during the written examination, practice observation, an interview, and OSCE. Medical educators responded with “impossible” and “possible” at a similar rate to prevent unprofessional conduct by introducing an interview to the KMLE. However, half of the medical educators answered “impossible” for implementing an interview in the KMLE, and “possible” was even lower.
Interpretation
There was no overwhelming timing to assess doctors’ unprofessional conduct, which may imply that the professional conduct should be continuously assessed during the BME, in the KMLE, and GME/CPD period, not a specific period. This is because professional attributes are not acquired at a specific time but require continuous development. Therefore, the public’s argument that assessing professional attributes in a single test, such as licensing examination, can screen unprofessional doctors does not seem valid.
There was no dominant assessment tool among the 4 assessment tools, which may imply that various tools should be used instead of one specific tool to assess professional attributes. The appropriate tools are different depending on the professional attributes to be evaluated, and using multiple tools, not just one, is important for accurate measurement. This result can be interpreted as not valid for the public argument that an interview is the best tool for assessing professional attributes. Rather than blaming the unprofessional conduct of individual doctors, it seems more appropriate to create a system that continuously educates and assesses professional performance. Therefore, instead of enabling practice throughout a lifetime with a single test such as licensing examination, professional bodies should continuously assess colleagues to ensure they are not engaged in unprofessional conduct.
The response rates of “impossible” and “possible” to prevent unprofessional conduct by introducing an interview in the KMLE were similar. The position of “impossible” focused on whether professional attributes were measurable in the licensing examination and whether an interview could successfully discriminate as an assessment tool. However, the “possible” position seemed to focus on the educational effect that professional attributes are taught as examination content. There was a difference in that “impossible” was selected from a psychometric perspective and “possible” from an educational perspective. It is interesting to note that both the positions of “impossible” and “possible” posit that professional attributes should be important education content in the BME. However, it is known that a downside is that assessment drives learning. There is a risk that medical students focus on the skills they need to achieve high scores. The BME is a very important period in which medical students can develop their professional identity. However, education and assessment in GME/CPD are also emphasized as doctors need to be professional in practice.
Regarding the implementation of an interview to assess professional attributes in the KMLE, “impossible” was selected more than “possible.” The position of “impossible” seemed to consider practical aspects such as questions (or scenario) development, rater recruitment, and rater training for quality control of an interview. The position of “possible” considered policy perspectives such as the willingness of licensing examination administration. However, it seems impossible to develop questions and recruit and train raters to implement interviews with more than 3,000 examinees, only with the willingness of the examination institution.
In Korea, some unprofessional conduct of doctors is subject to criminal punishment. A change is needed to a system that allows doctors to self-regulate as a professional group rather than legal punishment. Therefore, a system should be developed in which professional bodies regulate doctors autonomously.
Comparison with previous studies
Previous studies argued that professional attributes are not acquired all at once, so should be taught and assessed longitudinally even after graduating from medical school, and self-regulation should be implemented as a lifelong practice [
4,
5].
In meta-analysis studies on professionalism measures, it is necessary to use an appropriate assessment tool for the purpose and target of the assessment [
6,
7]. Various tools such as self-assessment, direct observation, peer assessment, patients’ opinions, and role model evaluation have been developed and used to measure professional attributes [
6].
Professional attributes include affective domains such as attitudes, values, and goals [
4]. According to previous studies, the assessment of the affective domain is less reliable than the cognitive domain [
3], and thus should be continuously assessed with various tools [
4].
In foreign countries such as the Unties States, Canada, United Kingdom, and Australia, professional bodies manage medical licensure, and licenses are renewed according to workplace-based assessment results every 1 to 5 years [
11]. The public or colleagues may report members’ unprofessional conduct to professional bodies, and these warn or discipline members according to the results of their own investigation [
12,
13].
Conclusion
More participants said that the introduction of interviews in licensing examinations cannot prevent the unprofessional conduct of doctors, and has no cost-effectiveness. Professional attributes should be continuously taught and assessed over the period from BME to CPD rather than a single test such as licensing examination. However, unprofessional attributes cannot be prevented by education and assessment. Therefore, a system is needed for recertification of medical licenses and self-regulation by the professional body.