Let's talk about work: pilot study of an education program on discussing work participation with cancer patients for general practitioners in training.

BACKGROUND: Cancer patients report that they lack support from healthcare providers when it comes to returning to or maintaining employment. In the education of general practitioners (GPs) in the Netherlands, there is little attention given to discussing work participation with patients. The aim of this pilot study was to evaluate a newly developed education program for GPs in training that focuses on discussing work participation with cancer patients. METHODS: Two groups of in total twenty-one GPs in training participated in the education program. GPs were educated about the importance of discussing work participation with patients, work-related problems cancer patients can experience, and advice they can give to support cancer patients regarding work issues. In this pilot study using a mixed-method design, participants evaluated the program in two self-developed questionnaires and in a focus group discussion. RESULTS: Seventeen participating GPs (81%) indicated that the education program was suitable for implementation in the education curriculum. Eleven participants (52%) reported that they had never discussed work participation with cancer patients before. Directly after the education program, eighteen participants (86%) reported that they planned to discuss work participation more often with their patients. Four months after the program, 67% indicated they had applied their new knowledge and skills in practice by discussing work participation and by referring cancer patients to occupational health professionals or online resources. According to the GPs in training, integrating the topic of work participation into other education for GPs in training and focusing on a broader group of patients could improve the impact of the education program. CONCLUSIONS: According to the results of this pilot study, the newly developed education program increased the awareness of GPs in training on the importance of discussing work participation with cancer patients. Future studies should focus on whether cancer patients experience more support from their GPs for maintaining and returning to employment after their GP has participated in the training program.

Enhancing surgical internship experiences: The potential of a supporting digital curriculum.

Background: Centralization of care jeopardizes interns' learning experiences and necessitates educational changes. Here we present the development and evaluation of a structured digital curriculum, offered in addition to the clinical internship, to address these challenges. Methods: The structured digital curriculum was implemented in a the VUmc/Amsterdam UMC surgical internship program in the Netherlands. The curriculum used a modular format built around a skill or clinical condition. Each module included background information, digital elements like e-learnings and interactive vlogs, and self-assessments. From April 1st to June 30th, 2022, we conducted a mixed-methods evaluation comparing interns' experiences between the conventional and digital curriculum through surveys and interviews. Results: Thirty-nine interns (28.1 %) completed the survey, 17 (24.2 %) from the traditional curriculum and 22 (31.9 %) from the structured blended curriculum. Results from the interviews triangulated and complemented survey results. Interns appreciated both curricula (course marks 7.4 ± 2.0 vs. 8.1 ± 1.1, P = 0.207). The intervention cohort specifically appreciated the structured and comprehensive presentation of available study materials, which resulted in a sense of empowerment. Conclusions: Integrating a structured digital curriculum to support clinical internships provides interns with comprehensive, readily accessible knowledge, refines their understanding of clinical topics, and results in feelings of empowerment. The combination of clinical and digital education ensures adequate exposure to subjects vital for future doctors, even if clinical exposure is limited. Thus, using a structured digital curriculum prepares the intern and helps the internship program to adequately navigate future medical challenges. Key message: Centralization of care jeopardizes interns' learning experiences and necessitates educational changes. A structured digital curriculum can empower interns in this scenario by providing readily accessible knowledge which refines their understanding of clinical topics.

'Role Model Moments' and 'Troll Model Moments' in Surgical Residency: How Do They Influence Professional Identity Formation?

Introduction: Role models are powerful contributors to residents' professional identity formation (PIF) by exhibiting the values and attributes of the community. While substantial knowledge on different attributes of role models exists, little is known about their influence on residents' PIF. The aim of this study was to explore surgical residents' experiences with role models and to understand how these contribute to residents' PIF. Methods: Adopting a social constructivist paradigm, the authors used a grounded theory approach to develop an explanatory model for residents' experiences with role models regarding PIF. Fourteen surgical residents participated in individual interviews. The authors iteratively performed data collection and analysis, and applied constant comparison to identify relevant themes. Results: Role model behavior is highly situation dependent. Therefore, residents learn through specific 'role model moments'. These moments arise when residents (1) feel positive about a moment, e.g. "inspiration", (2) have a sense of involvement, and (3) identify with their role model. Negative role model moments ('troll model moments') are dominated by negative emotions and residents reject the modeled behavior. Residents learn through observation, reflection and adapting modeled behavior. As a result, residents negotiate their values, strengthen attributes, and learn to make choices on the individual path of becoming a surgeon. Discussion: The authors suggest a nuance in the discussion on role modelling: from 'learning from role models' to 'learning from role model moments'. It is expected that residents' PIF will benefit from this approach since contextual factors and individual needs are emphasized. Residents need to develop antennae for both role model moments and troll model moments and acquire the skills to learn from them. Role model moments and troll model moments are strong catalysts of PIF as residents follow in the footsteps of their role models, yet learn to go their own way.

Digital Training Resources in the Dutch Surgical Residency Curricula and the Perspectives of Residents: A Thematic Analysis of Resident Interviews.

BACKGROUND: Digital training resources show great promise in augmenting traditional surgical education - especially in times of social distancing and limited surgical caseload. Embedding digital resources in surgical curricula is however not current, nor common practice in Dutch hospitals. While the digital world has become part of a resident's everyday life, surprisingly little is known about surgical residents' experiences and expectations towards use of digital resources for their own surgical education. This study aims to identify digital resources currently used in Dutch surgical curricula and to describe surgical residents' perspectives towards digital education. METHODS: A series of semi-structured interviews with Dutch surgical residents were conducted until data sufficiency occurred. The interviews consisted of two parts: 1) current surgical training and implemented digital resources, and 2) future surgical training and the role of digital resources therein. All interviews were digitally recorded, transcribed verbatim, and thematically analyzed. RESULTS: Sixteen surgical residents were interviewed - two out of each of the eight educational regions for surgery in the Netherlands. Five digital resource categories were identified and four general educational themes (requirements, advantages, disadvantages, and general education themes), overarching 13 sub-themes. In general, residents were enthusiastic with regard to using digital resources, especially when the perceived advantages supported their autonomy. CONCLUSIONS: Dutch surgical residents indicate that digital resources may support their educational experiences, but state that ideally they must be combined with much appreciated on-the-job training, and be offered to them tailored to their individual needs. No resources are considered to be a "magic bullet" in itself. The specific needs of residents and educators need to be addressed clearly in order to successfully adopt and implement digital resources on a larger scale.

Medical student engagement in small-group active learning: A stimulated recall study.

BACKGROUND: Active learning relies on students' engagement with teachers, study materials and/or each other. Although medical education has adopted active learning as a core component of medical training, teachers have difficulties recognising when and why their students engage or disengage and how to teach in ways that optimise engagement. With a better understanding of the dynamics of student engagement in small-group active learning settings, teachers could be facilitated in effectively engaging their students. METHODS: We conducted a video-stimulated recall study to explore medical students' engagement during small-group learning activities. We recorded one teaching session of two different groups and selected critical moments of apparent (dis)engagement. These moments served as prompts for the 15 individual semi-structured interviews we held. Interview data were analysed using Template Analysis style of thematic analysis. To guide the analysis, we used a framework that describes student engagement as a dynamic and multidimensional concept, consisting of behavioural, cognitive and emotional components. RESULTS: The analysis uncovered three main findings: (1) In-class student engagement followed a spiral-like pattern. Once students were engaged or disengaged on one dimension, other dimensions were likely to follow suit. (2) Students' willingness to engage in class was decided before class, depending on their perception of a number of personal, social and educational antecedents of engagement. (3) Distinguishing engagement from disengagement appeared to be difficult for teachers, because the intention behind student behaviour was not always identifiable. DISCUSSION: This study adds to the literature by illuminating the dynamic process of student engagement and explaining the difficulty of recognising and influencing this process in practice. Based on the importance of discerning the intentions behind student behaviour, we advise teachers to use their observations of student (dis)engagement to initiate interaction with students with open and inviting prompts. This can help teachers to (re-)engage students in their classrooms.

What stressors and energizers do PhD students in medicine identify for their work: A qualitative inquiry.

INTRODUCTION: Rising mental health issues is a global problem among PhD students. This study aimed to identify stressors and energizers in PhD work. METHODS: PhD students at a university medical center were asked to describe the top three stressors and energizers in their PhD work through a survey. The narrative answers were subjected to content analysis. RESULTS: Three hundred and eighty-six PhD students participated. We identified five overarching themes: Research is challenging, Resources can be limited, Recognizing the value of work, Experience of autonomy, and Relationships are key to success. We found positive (energizers) as well as negative (stressors) comments for each theme. DISCUSSION: Supportive supervision with open communication has been identified in the literature as the most important contributor to PhD student well-being, while work-life imbalance has been identified as the most important reason for psychological distress. With our study, we add energizers and stressors that fit into a theoretical framework (Self-determination theory). This helps to understand the problem better and provide specific recommendations. CONCLUSIONS: Optimal challenges, resources and supervision, autonomy and good relationships at work are perceived as energizers. Challenges in research beyond capability, limitations in resources, not being valued, autonomy restriction and poor relationships at work are perceived as stressors in PhD work.

Unprofessional behaviour of GP residents and its remediation: a qualitative study among supervisors and faculty.

BACKGROUND: Lapses in professionalism have profound negative effects on patients, health professionals, and society. The connection between unprofessional behaviour during training and later practice requires timely identification and remediation. However, appropriate language to describe unprofessional behaviour and its remediation during residency is lacking. Therefore, this exploratory study aims to investigate which behaviours of GP residents are considered unprofessional according to supervisors and faculty, and how remediation is applied. METHODS: We conducted eight semi-structured focus group interviews with 55 broadly selected supervisors from four Dutch GP training institutes. In addition, we conducted individual semi-structured interviews with eight designated professionalism faculty members. Interview recordings were transcribed verbatim. Data were coded in two consecutive steps: preliminary inductive coding was followed by secondary deductive coding using the descriptors from the recently developed 'Four I's' model for describing unprofessional behaviours as sensitising concepts. RESULTS: Despite the differences in participants' professional positions, we identified a shared conceptualisation in pinpointing and assessing unprofessional behaviour. Both groups described multiple unprofessional behaviours, which could be successfully mapped to the descriptors and categories of the Four I's model. Behaviours in the categories 'Involvement' and 'Interaction' were assessed as mild and received informal, pedagogical feedback. Behaviours in the categories 'Introspection' and 'Integrity', were seen as very alarming and received strict remediation. We identified two new groups of behaviours; 'Nervous exhaustion complaints' and 'Nine-to-five mentality', needing to be added to the Four I's model. The diagnostic phase of unprofessional behaviour usually started with the supervisor getting a 'sense of alarm', which was described as either a 'gut feeling', 'a loss of enthusiasm for teaching' or 'fuss surrounding the resident'. This sense of alarm triggered the remediation phase. However, the diagnostic and remediation phases did not appear consecutive or distinct, but rather intertwined. CONCLUSIONS: The processes of identification and remediation of unprofessional behaviour in residents appeared to be intertwined. Identification of behaviours related to lack of introspection or integrity were perceived as the most important to remediate. The results of this research provide supervisors and faculty with an appropriate language to describe unprofessional behaviours among residents, which can facilitate timely identification and remediation.

Validation of the professional identity questionnaire among medical students.

BACKGROUND: Professionalism represents a cornerstone of the medical profession, prompting medical educators to actively develop instruments to measure professional identity formation among medical students. A quantitative approach to this problem has been lacking. Hence in this study, we investigate the validity and reliability of using Brown et al.'s [1986] Professional Identity Questionnaire (PIQ) to measure professional identity among medical students. METHODS: We used the American Psychological Association's account of validity and reliability to examine the PIQ in terms of its internal structure, its relation to a validated motivation scale, its content, and its internal consistency. To this end, we performed two factor analyses, a Pearson's correlation test, an expert evaluation and measured Cronbach's alpha, respectively.. RESULTS: Factor analysis revealed two latent factors underlying the items of the PIQ. We found a negative to positive spectrum of Pearson's correlations corresponding to increasingly internal qualities of motivation. Experts unanimously rated four out of ten of the PIQ's items as relevant, reliability analysis yielded a Cronbach's alpha value of 0.82. CONCLUSION: Despite poor ratings by experts in the field, these results illustrate the PIQ as a valid and reliable quantitative measure of medical students' professional identity; its two factors reflecting the measure of attached and detached attitudes towards the medical profession. Educators may use the instrument as a tool for monitoring PIF among their students, as well as for designing and evaluating their medical curriculum. Future research might build on the current findings by investigating other dimensions of the PIQ's validity, including response process validity, predictive validity and consequential validity.

Burnout and engagement among PhD students in medicine: the BEeP study.

INTRODUCTION: Using a self-determination theory framework, we investigated burnout and engagement among PhD students in medicine, and their association with motivation, work-life balance and satisfaction or frustration of their basic psychological needs. METHOD: This cross-sectional study was conducted among PhD students at a university medical centre (n = 990) using an electronic survey on background characteristics and validated burnout, engagement, motivation and basic psychological needs questionnaires. Cluster analysis was performed on the burnout subscale scores to find subgroups within the sample which had similar profiles on burnout. Structural equation modelling was conducted on a hypothesized model of frustration of basic psychological needs and burnout. RESULTS: The response rate was 47% (n = 464). We found three clusters/subgroups which were composed of PhD students with similar burnout profiles within the cluster and different profiles between the clusters. Cluster 1 (n = 199, 47%) had low scores on burnout. Clusters 2 (n = 168, 40%) and 3 (n = 55, 13%) had moderate and high burnout scores, respectively, and were associated with low engagement scores. Cluster 3, with the highest burnout scores, was associated with the lowest motivational, engagement, needs satisfaction and work-life balance scores. We found a good fit for the "basic psychological needs frustration associated with burnout" model. DISCUSSION: The most important variables for burnout among PhD students in medicine were lack of sleep and frustration of the basic psychological needs of autonomy, competence and relatedness. These add to the factors found in the literature.

'One size does not fit all': The value of person-centred analysis in health professions education research.

Health professions education (HPE) research is dominated by variable-centred analysis, which enables the exploration of relationships between different independent and dependent variables in a study. Although the results of such analysis are interesting, an effort to conduct a more person-centred analysis in HPE research can help us in generating a more nuanced interpretation of the data on the variables involved in teaching and learning. The added value of using person-centred analysis, next to variable-centred analysis, lies in what it can bring to the applications of the research findings in educational practice. Research findings of person-centred analysis can facilitate the development of more personalized learning or remediation pathways and customization of teaching and supervision efforts. Making the research findings more recognizable in practice can make it easier for teachers and supervisors to understand and deal with students. The aim of this article is to compare and contrast different methods that can be used for person-centred analysis and show the incremental value of such analysis in HPE research. We describe three methods for conducting person-centred analysis: cluster, latent class and Q­sort analyses, along with their advantages and disadvantage with three concrete examples for each method from HPE research studies.

How to identify, address and report students' unprofessional behaviour in medical school.

This AMEE guide provides a research overview of the identification of, and responding to unprofessional behaviour in medical students. It is directed towards medical educators in preclinical and clinical undergraduate medical education. It aims to describe, clarify and categorize different types of unprofessional behaviours, highlighting students' unprofessional behaviour profiles and what they mean for further guidance. This facilitates identification, addressing, reporting and remediation of different types of unprofessional behaviour in different types of students in undergraduate medical education. Professionalism, professional behaviour and professional identity formation are three different viewpoints in medical education and research. Teaching and assessing professionalism, promoting professional identity formation, is the positive approach. An inevitable consequence is that teachers sometimes are confronted with unprofessional behaviour. When this happens, a complementary approach is needed. How to effectively respond to unprofessional behaviour deserves our attention, owing to the amount of time, effort and resources spent by teachers in managing unprofessional behaviour of medical students. Clinical and medical educators find it hard to address unprofessional behaviour and turn toward refraining from handling it, thus leading to the 'failure to fail' phenomenon. Finding the ways to describe and categorize observed unprofessional behaviour of students encourages teachers to take the appropriate actions.

A Road Map for Attending to Medical Students' Professionalism Lapses.

PURPOSE: To develop a road map for educators attending to medical students' professionalism lapses, aiming to offer an empirical base for approaching students who display such lapses. METHOD: Between October 2016 and January 2018, 23 in-depth interviews with 19 expert faculty responsible for remediation from 13 U.S. medical schools were conducted about the way they handle students' professionalism lapses. Three researchers independently completed three rounds of coding. Data collection, coding, and analysis were performed in a constant comparative process. A constructivist grounded theory approach was used to develop an explanatory model for attending to students' professionalism lapses. RESULTS: Based on participants' descriptions, the authors developed a three-phase approach for attending to professionalism lapses. In phase 1, experts enacted the role of concerned teacher, exploring the lapse from the student's perspective. In phase 2, they functioned as supportive coach, providing feedback on professionalism values, improving skills, creating reflectiveness, and offering support. In phase 3, if the student did not demonstrate reflectiveness and improvement, and especially if (future) patient care was potentially compromised, participants assumed an opposite role: gatekeeper of the profession. CONCLUSIONS: An explanatory model for attending to professionalism lapses that fits in the overarching "communities of practice" framework was created. Whereas phase 1 and 2 aim at keeping students in the medical community, phase 3 aims at guiding students out. These findings provide empirical support to earlier descriptive, opinion-based models and may offer medical educators an empirical base for attending to students who display professionalism lapses.

Developing a two-dimensional model of unprofessional behaviour profiles in medical students.

Standardized narratives or profiles can facilitate identification of poor professional behaviour of medical students. If unprofessional behaviour is identified, educators can help the student to improve their professional performance. In an earlier study, based on opinions of frontline teachers from one institution, the authors identified three profiles of medical students' unprofessional behaviour: (1) Poor reliability, (2) Poor reliability and poor insight, and (3) Poor reliability, poor insight and poor adaptability. The distinguishing variable was Capacity for self-reflection and adaptability. The current study used Nominal Group Technique and thematic analysis to refine these findings by synthesizing experts' opinions from different medical schools, aiming to develop a model of unprofessional behaviour profiles in medical students. Thirty-one experienced faculty, purposively sampled for knowledge and experience in teaching and evaluation of professionalism, participated in five meetings at five medical schools in the Netherlands. In each group, participants generated ideas, discussed them, and independently ranked these ideas by allocating points to them. Experts suggested ten different ideas, from which the top 3 received 60% of all ranking points: (1) Reflectiveness and adaptability are two distinct distinguishing variables (25%), (2) The term reliability is too narrow to describe unprofessional behaviour (22%), and (3) Profiles are dynamic over time (12%). Incorporating these ideas yielded a model consisting of four profiles of medical students' unprofessional behaviour (accidental behaviour, struggling behaviour, gaming-the-system behaviour and disavowing behaviour) and two distinguishing variables (reflectiveness and adaptability). The findings could advance educators' insight into students' unprofessional behaviour, and provide information for future research on professionalism remediation.

Investigating US medical students' motivation to respond to lapses in professionalism.

CONTEXT: As unprofessional behaviour in physicians can compromise patient safety, all physicians should be willing and able to respond to lapses in professionalism. Although students endorse an obligation to respond to lapses, they experience difficulties in doing so. If medical educators knew how students respond and why they choose certain responses, they could support students in responding appropriately. OBJECTIVES: The aim of this study was to describe medical students' responses to professionalism lapses in peers and faculty staff, and to understand students' motivation for responding or not responding. METHODS: We conducted an explorative, qualitative study using template analysis, in which three researchers independently coded transcripts of semi-structured, face-to-face interviews. We purposefully sampled 18 student representatives convening at a medical education conference. Preliminary open coding of a data subset yielded an initial template, which was applied to further data and modified as necessary. All transcripts were coded using the final template. Finally, three sensitising concepts from the Expectancy-Value-Cost model were used to map participants' responses. RESULTS: Students mentioned having observed lapses in professionalism in both faculty staff and peers. Students' responses to these lapses were avoiding, addressing, reporting or initiating policy change. Generally, students were not motivated to respond if they did not know how to respond, if they believed responding was futile and if they feared retaliation. Students were motivated to respond if they were personally affected, if they perceived the individual as approachable and if they thought that the whole group of students could benefit from their actions. Expectancy of success, value and costs each appeared to be influenced by (inter)personal and system factors. CONCLUSIONS: The Expectancy-Value-Cost model effectively explains students' motivation for responding to lapses. The (inter)personal and system factors influencing students' motivation to respond are modifiable and can be used by medical educators to enhance students' motivation to respond to lapses in professionalism observed in medical school.

Descriptors for unprofessional behaviours of medical students: a systematic review and categorisation.

BACKGROUND: Developing professionalism is a core task in medical education. Unfortunately, it has remained difficult for educators to identify medical students' unprofessionalism, because, among other reasons, there are no commonly adopted descriptors that can be used to document students' unprofessional behaviour. This study aimed to generate an overview of descriptors for unprofessional behaviour based on research evidence of real-life unprofessional behaviours of medical students. METHODS: A systematic review was conducted searching PubMed, Ebsco/ERIC, Ebsco/PsycINFO and Embase.com from inception to 2016. Articles were reviewed for admitted or witnessed unprofessional behaviours of undergraduate medical students. RESULTS: The search yielded 11,963 different studies, 46 met all inclusion criteria. We found 205 different descriptions of unprofessional behaviours, which were coded into 30 different descriptors, and subsequently classified in four behavioural themes: failure to engage, dishonest behaviour, disrespectful behaviour, and poor self-awareness. CONCLUSIONS: This overview provides a common language to describe medical students' unprofessional behaviour. The framework of descriptors is proposed as a tool for educators to denominate students' unprofessional behaviours. The found behaviours can have various causes, which should be explored in a discussion with the student about personal, interpersonal and/or institutional circumstances in which the behaviour occurred. Explicitly denominating unprofessional behaviour serves two goals: [i] creating a culture in which unprofessional behaviour is acknowledged, [ii] targeting students who need extra guidance. Both are important to avoid unprofessional behaviour among future doctors.

Distinguishing Three Unprofessional Behavior Profiles of Medical Students Using Latent Class Analysis.

PURPOSE: Because unprofessional behavior of physicians is associated with unprofessional behavior in medical school, identifying unprofessional behavior in medical school is critical. Research has noted the difficulty in assessing professional behavior. Instead of identifying isolated behaviors, it could be more helpful to recognize behavioral patterns to evaluate students' professional behavior. The authors aimed to identify patterns in the unprofessional behaviors of medical students and to construct descriptions based on these patterns. METHOD: Content analysis of research articles yielded a template of unprofessional behaviors for coding student evaluation forms indicating unsatisfactory professional behavior, collected from 2012 to 2014 at the VUmc School of Medical Sciences, Amsterdam, the Netherlands. Latent class analysis was used to identify classes of students with a high chance of displaying comparable unprofessional behaviors. Teachers' feedback of prototype students was summarized to generate profile descriptions. RESULTS: A template of 109 behaviors was used to code 232 evaluation forms of 194 students (3.9% students/year). Latent class analysis identified three hypothetical classes of students: Class 1 (43%) was labeled as "Poor reliability," class 2 (20%) was labeled as "Poor reliability and poor insight," and class 3 (37%) was labeled as "Poor reliability, poor insight, and poor adaptability." CONCLUSIONS: These profiles of unprofessional behavior might help to improve the evaluation of unprofessional behavior in medical school. Further research should provide evidence for confidently accepting or rejecting the profiles as an instrument to identify which students are expected to benefit from remediation trajectories.

What difficulties do faculty members face when conducting workplace-based assessments in undergraduate clerkships?

OBJECTIVE: Workplace-based assessments are based on the principle of providing feedback to medical students on clinical performance in authentic settings. In practice, however, the assessment often overshadows the feedback. The aim of this study was to determine what problems faculty perceived when performing workplace-based assessments and what solutions they suggested to overcome these difficulties. METHODS: Discussion meetings were conducted with education coordinators and faculty (n=55) from 11 peripheral hospitals concerning the difficulties encountered when conducting workplace-based assessments. We analysed the reports from these discussion meetings using an integrated approach guided by our research questions to code the data. Two researchers analysed the data independently and resolved differences of opinion through consensus. RESULTS: The problems perceived by faculty in workplace-based assessments (difficulties) and suggestions for improvement formed the overarching themes. Problems included the short duration of clerkships, students choosing the assessment moments, the use of grades for the mini-Clinical Evaluation Exercise, the difficulty in combining teacher and assessor roles and the difficulty in giving fail judgements. Suggestions for improvement included longer clerkship duration, faculty choosing the assessment moments, using a pass/fail system for the mini-Clinical Evaluation Exercise and forward feeding of performance from earlier clerkships following a fail judgement. CONCLUSIONS: Our study indicates that faculty perceive difficulties when conducting workplace-based assessments. These assessments need periodical review to understand the difficulties faculty experience using them; they also require periodical feedback to ensure their proper and effective use.

Assessing professional behaviour: Overcoming teachers' reluctance to fail students.

BACKGROUND: Developing professional behaviour is an important goal of medical education in which teachers play a significant part. Many teachers can be reluctant to fail students demonstrating unprofessional behaviour. We hypothesize that supporting teachers in teaching and assessing professional behaviour and involving them in remediation will reduce this reluctance. FINDINGS: In 2010, VUmc School of Medical Sciences Amsterdam introduced an educational theme on professional behaviour for the bachelor's and master's programmes in medicine with a special emphasis on supporting teachers in teaching and assessing professional behaviour and involving them in the remediation process. Information was extracted from the student database on the number of unprofessional behaviour judgments awarded over 2008-2010 (before the intervention), and 2010-2013 (after introducing the intervention), which was compared. To find out if teachers' reluctance to fail had decreased, qualitative feedback from the teachers was gathered and analysed. Since the implementation of the educational theme, the number of unprofessional behaviour judgments has risen. The teachers are positive about the implemented system of teaching and assessing professional behaviour, and feel less reluctant to award an unsatisfactory professional behaviour judgment. CONCLUSIONS: Supporting teachers in teaching and assessing professional behaviour and involving them in students' remediation appears to reduce their reluctance to fail students demonstrating unprofessional behaviour.