on mini-CEX and CbD, but thesescores in turn were only weaklypredictive of ‘in difficulty’ status.

Mitchell and colleagues concludedthat WPBA is not a valid methodof screening for trainees in diffi-culty. One of the limitations ofthis study is the reliability of thereference standard: identificationof the trainee in difficulty byeducational supervisors. Becauseof its subjective nature, it is likelythat the true proportion of train-ees in difficulty is underestimated(although the number is stilllikely to be small). In particular,those with health-related diffi-culties may fall under the radar.

Fox and colleagues found that afear of stigma and of academicfailure is a significant barrier todisclosure and finding support forFP trainees with health problems.1

The WPBAs themselves are notwithout difficulty. Their validity isinfluenced by the observer–trai-nee relationship, and a traineealready aware of their ‘in diffi-culty’ status may selectivelychoose cases and observers inorder to maximise their WPBAscores.

Mitchell and colleagues offer aword of caution. Despite real-lifeexamples of WPBAs being pilotedin summative assessment, there is

insufficient evidence that theycan be relied upon as certifyingcompetence. Instead, WPBAsshould continue to be used bothin formative assessment and inunison with other assessments togive a holistic measure of profes-sional competence.

REFERENCE

1. Fox FE, Doran NJ, Rodham KJ, Taylor

GJ, Harris MF, O’Connor M. Junior

doctors’ experiences of personal

illness: a qualitative study. Med Educ

2011;45:1251–1261.

doi: 10.1111/j.1743-498X.2012.00588.x

Supporting the traineedoctor with personalillness: is there a cure?Alice Stewart, Department of Neonatology, Monash Medical Centre, Melbourne, Victoria,Australia

Fox FE, Doran NJ, Rodham KJ, Taylor GJ,

Harris MF, O’Connor M. Junior doctors’

experiences of personal illness: a

qualitative study. Med Educ

2011;45:1251–1261.

A research group at the Universityof Bath has investigated theexperience of personal illnessamongst trainee doctors. Theprevalence and burden of illnessin this population is poorlyunderstood. Although workingconditions and training demandsare known to have a negativeimpact on health, there is littleunderstanding of the experiencesand support needs of traineedoctors who are unwell. In re-sponse, Fox and colleaguesexamined this issue in foundation

programme (FP) trainees in adeanery in south-west England.

This qualitative study was spon-sored by the Severn Deanery, butto ensure anonymity, data col-lection and analysis were inde-pendently performed byUniversity of Bath researchers. Anemail was sent to all FP traineesin the deanery, inviting them toparticipate if they had ‘experi-enced significant illness’ duringtheir medical training. Ten doc-tors responded and eight con-sented to participate. Theyreported a range of health condi-tions: medical, mental, malig-nancy and surgical. A semi-structured interview with open-

ended questions was conductedwith each participant by the leadresearcher. The audiotaped inter-views were transcribed, anony-mised and coded. The followingmaster themes were identified:illness experience; crossing theline; medical culture; stigma;disclosure; and support.

The illness experience challengedthe trainees’ perceptions of theirsocietal role and assumed invul-nerability to illness. The roletransition from ‘well’ doctor to‘unwell’ patient was conceptua-lised as crossing the line. Someparticipants reported increasedempathy for their patients as aresult of their own illness

The illnessexperience

challenged thetrainees’

perceptions oftheir societal

role

266 � Blackwell Publishing Ltd 2012. THE CLINICAL TEACHER 2012; 9: 265–268

experience, but others reported adepletion of their emotionalreserve. On a professional level,trainees were impacted by amedical culture of competencyand competitiveness: they feltpressure to return to work, evenwhen unwell, out of a sense ofduty to colleagues and patients,and out of fear of academicfailure. The phenomenon of stig-ma appeared to be subjectiverather than overt, in some casesinformed by colleagues’ attitudes

towards patients with similarconditions. The perceived stigmawas greatest in trainees withchronic or mental healthconditions. Although traineesrecognised that disclosure wasrequired to gain necessary pro-fessional support, barriers to thisincluded medical culture, stigmaand individual coping styles.

All of these themes related to howtrainees both sought and experi-enced support. Those who were

proactive in disclosing their illnessand seeking assistance were morelikely to receive effective andpractical support, compared withthose who were more passive. Animportant finding of the study wasthat trainees reported a reluctanceto seek pastoral support frommedical or educational supervisorsbecause of perceived repercussionsin training progression.

Although it studied only onedeanery, with self-selectingparticipants, this study providesimportant insights for anyonewho supervises trainee doctors.The implications of this researchinclude the need for improvedtrainee and supervisor awarenessabout the importance of illnessdisclosure and support (as well asthe potential barriers to this), theprovision of pastoral supportseparate from educational super-vision, and a clear organisationalpathway for initiating and moni-toring support that is both effec-tive and practical.

doi: 10.1111/j.1743-498X.2012.00589.x

The status quoofmodernmedical professionalismAndre Dubois and Vinod Patil, Department of Medicine, Queen Mary University of London,UK

Chandratilake M, McAleer S, Gibson J.

Cultural similarities and differences in

medical professionalism: a multi-region

study. Med Educ 2012;46:257–266.

DOI: 10.1111 ⁄ j.1365-2923.

2011.04153.x

Chandratilake and colleagues fromthe University of Dundee exam-ined the essentialness of profes-sional attributes held by medicalpractitioners from differentnational backgrounds.

This study used a questionnaireto ask medical practitioners torate how essential certain attri-butes were to professionalism,using a unipolar scale (a scale of1–5, with 1 being not essentialand 5 being very essential). Thecontent of the questionnaireswas drawn up from attributespublished by medical governingbodies in the UK and USA, withadditions from recent literature

on the subject. A total of fifty-seven were found. These werethen reviewed by an interna-tionally represented group, at ateaching session on how to teachprofessionalism. Forty-six differ-ent attributes were identified,and a further nine non-evidence-based items were added to testthe validity of the evidence-based ones.

It is importantto understandthe attributesthatprofessionalsfrom amulticulturalbackgroundshould expectof one another

� Blackwell Publishing Ltd 2012. THE CLINICAL TEACHER 2012; 9: 265–268 267