Professional-Patient Boundaries: a National Survey of Primary Care Physicians' Attitudes and Practices

BACKGROUND

The essence of humanism in medicine and health care is relationships-caring relationships between clinicians and patients. While raising concerns regarding professional-patient boundaries has positively contributed to our understanding and prevention of potentially harmful boundary violations, there is controversy about which types of relationships, caring acts, and practices are acceptable versus cross boundary lines.

OBJECTIVE

To examine primary care physicians' practices and attitudes regarding acts that have been questioned as potentially "inappropriate" or "unethical" crossing of professional-patient boundaries.

DESIGN

Surveys conducted via in-person polling or electronic and mailed paper submissions from April 2016 to July 2017. We calculated descriptive statistics and examined associations with practices and attitudes using logistic regression.

PARTICIPANTS

Random sample of all US primary care physicians who treat adult patients; convenience sample of attendees at medicine grand rounds presentations.

MAIN MEASURES

Outcomes were self-reported practices and attitudes related to giving patients rides home, paying for patients' medication, helping patients find jobs, employing patients, going to dinner with patients, and providing care to personal friends.

KEY RESULTS

Among 1563 total respondents, 34% had given a ride home, 34% had paid for medications, 15% helped patients find a job, 7% had employed a patient, 10% had dinner with patients, and 59% provided care to personal friends. A majority disapproved of dinner with a patient (75%) but approved of or were neutral on all other scenarios (61-90%).

CONCLUSIONS

The medical profession is quite divided on questions related to drawing lines about appropriate boundaries. Contrary to official and widespread proscriptions against such practices (with exception of dinner dates), many have actually engaged in such practices and the majority found them acceptable.

Which Factors Influence the Use of Patient-Reported Outcome Measures in Dutch Physiotherapy Practice? A Cross-Sectional Study

Purpose: Patient-reported outcome measures (PROMs) have the potential to enhance the quality of health care but, as a result of suboptimal implementation, it is unclear whether they fulfil this role in physiotherapy practice. This cross-sectional study aimed to identify the factors influencing PROM use in Dutch private physiotherapy practices. Method: A total of 444 physiotherapists completed a self-assessment questionnaire and uploaded the data from their electronic health record (EHR) systems to the national registry of outcome data. Univariate and multivariate ordinal logistic and linear regression analysis were used to identify the factors associated with self-reported PROM use and PROM use registered in the EHR systems, which were derived from the self-assessment questionnaire and from the data in the national registry, respectively. Five categories with nine independent variables were selected as potential factors for regression analysis. The similarity between self-reported and registered PROM use was verified. Results: On the basis of self-report and EHR report, we found that 21.6% and 29.8% of participants, respectively, used PROMs with more than 80% of their patients, and we identified the factors associated with PROM use. Conclusions: The factors associated with PROM use are EHR systems that support PROM use and more knowledge about PROM use. These findings can guide future strategies to enhance the use of PROMs in physiotherapy practice.

A modified tool for "reflective practice" in medical education: Adaptation of the REFLECT rubric in Persian

CONTEXT

Reflection is a learnable process that enhances long-life learning, clinical decision-making, and can foster empathy and professionalism. One of the methods for teaching reflection is "reflective writing" that is conducted in "reflective practice." Some tools have been developed to assess "reflective capacity," and The Reflection Evaluation for Learners' Enhanced Competencies Tool (REFLECT) is one of them.

AIMS

This study aimed to adapt the REFLECT rubric in Persian.

SETTINGS AND DESIGN

This quantitative study was conducted in a medical school with the participation of medical interns through census sampling, and in three stages, including translation, pilot study, and main study.

SUBJECTS AND METHODS

Persian translation was obtained by the "forward/backward translation" method. We made some changes in the tool and used it in the pilot and main study to confirm validity and reliability.

STATISTICAL ANALYSIS USED

Cronbach's alpha coefficient, Pearson correlation, and Cohen's kappa were applied for statistical analysis. Data analysis was performed using SPSS23.

RESULTS

We inserted a numerical value of 1-4 at the reflection levels, and also removed Axis 2 and an optional writing component. In the pilot study, face and content validity was confirmed involving 10 interns and five medical education specialists. Then, 67 interns participated in the main study, and we measured the reliability of the tool by internal consistency through Cronbach's alpha (0.83) and test-retest through correlation coefficient (0.89). The size of the agreement was measured to determine the inter-rater reliability by Cohen's kappa (0.84).

CONCLUSIONS

The modified REFLECT version is a valid and reliable tool that can help us to assess reflective capacity. The use of this tool is recommended for reflective practice in medicine.

Final year dental students' perception and practice of professionalism and ethical attitude in ten Sudanese dental schools: A cross-sectional survey

Introduction:

Professionalism and ethics are essential components of all dental schools. Therefore, this study aimed to assess the level of professionalism among Sudanese undergraduate dental students.

Materials and Methods:

This descriptive cross-sectional study was conducted among 307 students in the final year undergraduate Dental Surgery Bachelor program with 155 public and 152 private university students. We collected data through a self-administrated, semistructured questionnaire.

Results:

Although most of the students enrolled in dental schools due to their performance at higher school (P value 0.00), this has no significant effect on their attendance and academic performance afterward (P value 0.25). The perception of the students toward ethics teaching was generally positive in both public (77.34%) and private schools (78.77%). Ethics was represented in the curriculum of both private (51.7%) and public (48.3%) dental schools as perceived by their students. 95.43% and 94.00% of public and private students, respectively, would always or sometimes work in teams, and 98.02% and 94.04% of public and private students, respectively, would always or sometimes respect patients' preference (P value 0.01). A total of 95.33% of the dental students would consult or refer patients with unexpected situations. Only 26% of all students would treat infectious diseases themselves.

Conclusion:

About three-quarters of Sudanese dental students showed a satisfactory level of perception toward the importance of teaching dental ethics and professionalism. It was reflected in an excellent attitude for teamwork and respecting patients' choices. The demand for teaching professionalism course in every dental school will increase gradually, and family physicians with interest in medical education may play a pivotal role in teaching professionalism to dental students.

Patient perception of physician empathy in stroke telemedicine

INTRODUCTION

We assessed patients' perceptions of physician empathy during telemedicine consultations as compared to in-person consultations during clinical encounters for acute stroke.

METHODS

This prospective cohort study was undertaken at a comprehensive stroke centre hub in collaboration with a distant community hospital spoke site. Eligible participants presented to hub or spoke emergency departments with suspected acute stroke within three hours of symptom onset. Participants were evaluated at the hub site in person or at the remote site via telemedicine by the same group of neurologists. Following acute care decisions, single-visit data including participant-reported assessments of physician empathy were collected within 24 h. The primary outcome was the Consultation and Relational Empathy score. The secondary outcome for the telemedicine cohort was the Telemedicine Patient Satisfaction Measure score.

RESULTS

Between 31 May 2013-13 March 2019, 70 patients completed the study. Fifty patients were seen by telemedicine and 20 patients were seen in person. Median Consultation and Relational Empathy scores (with a possible score of 10-50) were 49 (range 27-50) for telemedicine and 45 (range 26-50) for in-person consultations (Wilcoxon rank sum p = 0.18). Each item of the Consultation and Relational Empathy questionnaire was rated very good or excellent by at least 87% of participants in the telemedicine group. The median Telemedicine Patient Satisfaction Measure score was 54 (range 12-60), with each item rated agree or strongly agree by at least 84% of participants.

DISCUSSION

We found no difference between telemedicine and in-person visits in patient perception of physician empathy in acute stroke care. Therefore, we conclude that empathy can be conveyed by facial expression, voice and attentiveness in a telemedicine encounter and, in the setting of acute stroke care, does not require physical touch or proximity.

Assessment of US Paramedic Professionalism: A Psychometric Appraisal

INTRODUCTION

Professionalism is an essential behavior for paramedic students to demonstrate. In the United States, paramedic accreditation standards require educators to evaluate and document summative affective evaluation on each paramedic student before graduation. The 2009 Emergency Medical Services Education Standards identified the affective behaviors as one of the three learning domains and published a grading tool to help educators recognize professional behaviors. However, little attention was given to the validity or reliability of this tool. Therefore, the aim of this study was to evaluate the psychometric properties of the 5-point Paramedic Affective Domain Tool.

METHODS

This was a retrospective study with educators that completed evaluations on paramedic students from May 2013 to January 2017. A total of 707 cases met inclusion criteria and 131 unique evaluators from 27 different paramedic programs. A Rasch Partial Credit Model was used to analyze the data.

RESULTS

Almost 97% of the paramedic students received passing scores and 28.1% (n=199) received perfect scores. Only 3.5% (n=25) failed the evaluation. Scores ranged from 11 to 55 (M = 46, SD = 9.02) and α = 0.97. Evidence suggests that the tool is not valid and the clustering of scores suggests minimal information can be gleaned from the results.

CONCLUSION

Serious consideration should be made in the continued use of this tool and future research should focus on developing a new tool that is both valid and reliable.

Evolution of Ethical Principles in the Practice of Pharmaceutical Medicine From a UK Perspective

Pharmaceutical medicine has evolved to be a distinct medical scientific discipline over time. Pharmaceutical medicine has distinctive features related to complex innovative medicines development activities in an often commercially focused competitive environment. This sometimes uneasy mix of professionalism and commercialisation demands of its medical and scientific researchers alike, a focus on strict adherence to ethical standards, guidelines, practices and behaviors in the interest of delivering new, effective, high-quality lifesaving and life-enhancing medicines quickly and reliably to patients in need. To support the speciality, codes of ethical standards and practices have been developed, with several being recently updated. These various codes are outlined in this paper along with relevant historical perspectives and interrelationship with concepts of professionalism. Reflecting the longer history of pharmaceutical medicine as a speciality in the UK and experience of the authors, there is a focus on the UK for the historical perspectives.

Utilizing Psychodynamic Principles to Teach Professionalism to Medical Students Through an Innovative Curriculum

Professionalism is a fundamental expectation of practicing medicine and a core competency in medical education, yet the methods of how to teach and evaluate it are still experimental. Professionalism involves self-reflection, a psychodynamic understanding of the patient's and the doctor's predicament, and conflict resolution, so psychiatrists are uniquely qualified to teach it. This article describes an innovative course that utilizes psychodynamic principles to teach professionalism to medical students. The authors present a novel 2-year curriculum for teaching professionalism to first- and second-year medical students utilizing psychodynamic principles to help develop awareness of others' feelings and motivations, self-reflection, compassion, empathy, and skills in ethical conflict resolution by means of written and oral narrative exercises. Outcomes are evaluated by the student ratings about the course and the faculty, and by using the test for emotional intelligence (EI), administered as a baseline and then at the end of each year. Each subsequent year the students demonstrated a statistically significant increase in EI scores, student evaluations of the course ranked among the highest in the medical school, clerkship supervisors and residency training directors noted the high degree of professionalism of the students, and the number of student applicants to psychiatry residency were consistently higher than the national average. In addition, this course was awarded the 2018 Alpha Omega Alpha Honor Medical Society's Edward B. Harris Medical Professionalism Award for the best professionalism course of U.S. medical schools. Psychodynamic principles are fundamental for teaching medical professionalism at a medical-student level. Professionalism also serves as a way to introduce students to psychiatry early in the curriculum, and psychiatrists and other mental health professionals are uniquely qualified to teach medical professionalism.

Perceptions of Visible Body Art Among Radiographers

PURPOSE

To determine the perceptions among radiographers of visible tattoos and nontraditional body piercings (piercings other than traditional pierced earlobes) in the clinical setting.

METHODS

An institutional review board-approved survey was delivered electronically to radiography clinical preceptors working at hospitals affiliated with a radiography program in the South Central part of the United States. Discussion board forum posts about the survey were created in the American Society of Radiologic Technologists Communities, targeting radiographers throughout the United States. Responses were collected for 4 weeks and compared quantitatively using linear regression, logistic regression, and chi-square analysis. Qualitative results were examined for themes, and proportions among themes were reported.

RESULTS

A total of 943 valid responses were received from radiographers working in the United States. Acceptance of body art was lower among individuals without tattoos compared with those who have tattoos (P < .001). Individuals without piercings had a lower acceptance of piercings compared with those who have piercings (P < .001). Acceptance was lower for those who have tattoos but cover them at work compared with those who have visible tattoos at work (P < .001). Acceptance was not statistically significant among those who have piercings who cover them compared with those who have visible nontraditional piercings at work (P = .073). Respondents believed it was more acceptable for members of the public to display a tattoo than for radiographers to display a tattoo at work (P < .001). However, acceptability was higher (P < .001) when the radiographer's tattoo was medically related.

DISCUSSION

Research links visible body art with negative perceptions of professionalism and skill set ability in other professions, but no studies have addressed radiography. This study reflects findings similar to those professions. A negative perception exists among radiographers regarding the display of body art while working, even among those who have body art. However, the subject of a tattoo might matter more than the location of a tattoo in terms of acceptability. These results have implications for the credibility and appropriateness of radiographers who display body art in the clinical setting because it might adversely affect the perceptions of co-workers and the perceptions of patient care provided during imaging services, and might affect hospital policy management.

CONCLUSION

Among radiographers working in the United States, a negative perception exists regarding visible body art such as tattoos and nontraditional piercings in the health care setting. Implications include negative perceptions of radiographers displaying body art while working. Future research might influence policy implementation as hospitals work to continually improve satisfaction scores and perceptions of care received.

Exploring the Impact of Participating as Pharmacy Camp Counselors on Student Pharmacists' Professional Identity

Objective. To explore how participation as a pharmacy camp counselor impacted pharmacy students' professional identity and views on professionalism. Methods. A pharmacy camp was developed to introduce rising high school juniors and seniors to the pharmacy profession. First- and second-year student pharmacists were invited to serve as counselors and, afterward, to participate in a focus group to share their experiences. Researchers used the focus group data to explore the impact of the camp experience on the student pharmacists. A direct interpretation approach was used to examine data as it allowed the research team to assess this single instance and draw meaning from focus group findings. Categories/themes were constructed through the interpretations of patterns and relationships discovered within the deconstructed results. Results. Ten student pharmacists participated in the focus group. The students provided their perspectives on the camp experience, including their role as camp counselors, the campers attending the camp, and the differences observed between student pharmacists and non-pharmacy camp counselors. Student pharmacists' comments gravitated toward the topic of professionalism. Student pharmacist counselors recognized positive and negative models of professionalism and made personal judgments concerning these concepts. Conclusion. Inclusion of student pharmacists in leadership roles such as this proved to be an effective means for further developing professional attributes. The focus group feedback provided novel insights into the professional mindset of student pharmacists. After serving as camp counselors, student pharmacists described their new perspectives on the importance of professionalism in their individual journeys, among their peers, and as future student pharmacists.

Assessing Professionalism in Medicine - A Scoping Review of Assessment Tools from 1990 to 2018

BACKGROUND

Medical professionalism enhances doctor-patient relationships and advances patient-centric care. However, despite its pivotal role, the concept of medical professionalism remains diversely understood, taught and thus poorly assessed with Singapore lacking a linguistically sensitive, context specific and culturally appropriate assessment tool. A scoping review of assessments of professionalism in medicine was thus carried out to better guide its understanding.

METHODS

Arksey and O'Malley's (2005) approach to scoping reviews was used to identify appropriate publications featured in four databases published between 1 January 1990 and 31 December 2018. Seven members of the research team employed thematic analysis to evaluate the selected articles.

RESULTS

3799 abstracts were identified, 138 full-text articles reviewed and 74 studies included. The two themes identified were the context-specific nature of assessments and competency-based stages in medical professionalism.

CONCLUSIONS

Prevailing assessments of professionalism in medicine must contend with differences in setting, context and levels of professional development as these explicate variances found in existing assessment criteria and approaches. However, acknowledging the significance of context-specific competency-based stages in medical professionalism will allow the forwarding of guiding principles to aid the design of a culturally-sensitive and practical approach to assessing professionalism.

Perspectives of Pharmacy Graduates Toward an Undergraduate Ethics Course and Its Potential Impact on Their Professional Practice

PURPOSE

The aim of this study was to gauge the opinions and attitudes of pharmacy graduates toward an undergraduate ethics course they received and to explore if the ethics course was relevant to their practice.

SAMPLE AND METHODS

This online questionnaire-based study involved pharmacy college graduates (alumni) who, at the time of the study, were practicing in different practice settings and who had all graduated from the same college of pharmacy in Qatar. An online questionnaire comprising 27 items related to attitudes, perceptions, and impact of the undergraduate ethics course on professional practice was distributed through email to all eligible alumni. Both descriptive and inferential statistics were performed for data analyses, with a p-value <0.05 considered statistically significant.

RESULTS

Of 119 invited graduates, 62 (52.1%) responded to the survey. About 73% of the respondents were satisfied with the ethics course received and 77.5% agreed that the course helped them in applying ethical principles in practice. Over 57% of the respondents discussed ethical issues in practice and 84.2% of these reported that the discussions were influenced by having had the ethics course. Barriers to applying ethical principles and discussing ethical issues in practice included lack of time (41%) and lack of reliable resources (23.1%). Participants' years of experience did not influence their attitudes toward the ethics course and its impact on professional practice (p>0.05 for both). However, practicing in a hospital setting or completing postgraduate education had a significant influence on the perception of the impact of the course on professional practice (p=0.036 and p=0.035, respectively).

CONCLUSION

A large proportion of pharmacy graduates value the ethics course received during their undergraduate program in pharmacy. The course appeared to have a positive influence on graduates' professional practice. Future studies should investigate specific areas that need to be reinforced in the curriculum and reliable reference resources should be developed and/or identified.

The Hidden Curriculum: A Good Thing?

Introduction The hidden curriculum is defined as a set of influences that function at the level of the organizational structure and culture to impact learning. Literature supports the significant impact of the hidden curriculum on all levels of learners in medical education. Our project aims to capture the messages being delivered to healthcare providers at our local facility. Methods Multiple one-time educational sessions on the hidden curriculum were provided over a five-year period to healthcare professionals. Participants were asked to share personal examples of their lived experiences with the hidden curriculum. A thematic analysis of the responses was completed and coded by two independent reviewers.  Results Participants consisted of medical students, residents, faculty physicians, and allied health professionals. Their experience of the hidden curriculum emerged in six main themes: Vulnerability, Hierarchy, Privilege, Navigation & Negotiation, Positivity, and Dehumanizing. Conclusion A minority of responses demonstrated the positive impact that the hidden curriculum can have on professional development. This project highlights the importance of formally addressing the hidden curriculum to capitalize on its impact on medical trainees. The results have inspired a project focusing on residents as the population of interest in their unique role as learners and preceptors.

Active Care In Practice: Long-Term Experiences From An Education Programme

Purpose

To explore whether the Active Care education programme has influenced the participants in practice over time and if so how.

Method and material

A hermeneutic explorative approach. Semi-structured focus group interviews and individual interviews with participants from the education programme from 2014 to 2015. Participants came from different areas in care and had different professional backgrounds. Systematic text condensation analysis based on Malterud.

Results

The Active Care programme has given the participants new knowledge that motivated, inspired and gave them power to change their practice. The new knowledge seems to give resonance in their basic values and strengthens their understanding of the importance of the users’ basic needs and right to be empowered.

Conclusion

Active teaching methods that appeal to participants help to understand and expand carers’ repertoire and increases professionalism across professions and positions. Structural factors need to be addressed to meet the goal of integrated person-centered services.

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Professional and Cultural Development of Medical Students Mentoring Adolescents in a Predominately Native Hawaiian Community

First year medical students (MS1s) increase their skills in medical professionalism and their understanding of adolescent needs and cultural humility through an intermediate and high school health career pathway/mentoring program. Teaching and service-learning activities incorporate health promotion and traditional Native Hawaiian practices and provide experiences that help MS1s to understand concepts important to medical professional development and adolescent mentoring. The content of this article was presented as a workforce development session at the 2018 Pacific Region Indigenous Doctors Conference. Methods: This article describes the program curriculum for MS1 community health electives mentoring rural, underserved, predominantly Native Hawaiian students and examines the training elements and reflections from 40 MS1s participants in the first four years of the Nānākuli Pathways to Health teen mentoring program. Student reflections were themed and analyzed for content discussing the students' professional development and experience in mentoring. Results: Analysis of four separate medical student cohorts enrolled in a teen mentoring community health elective demonstrate that mentoring relationships and program curricula helped them to develop skills in medical professionalism including establishing relationships, self-reflection, self-evaluation, communication, compassion, excellence in teaching, and a deepened understanding of native Hawaiian culture and health disparity.

Feasibility of an ethics and professionalism curriculum for faculty in obstetrics and gynecology: a pilot study

OBJECTIVE

There have been increased efforts to implement medical ethics curricula at the student and resident levels; however, practising physicians are often left unconsidered. Therefore, we sought to pilot an ethics and professionalism curriculum for faculty in obstetrics and gynaecology to remedy gaps in the formal, informal and hidden curriculum in medical education.

METHODS

An ethics curriculum was developed for faculty within the Department of Obstetrics and Gynaecology at a tertiary care, academic hospital. During the one-time, 4-hour, mandatory in-person session, the participants voluntarily completed the Oldenburg Burnout Inventory, Handoff Clinical Evaluation Exercise, University of Missouri-Kansas City School of Medicine and overall course evaluation. Patient satisfaction survey scores in both the hospital and ambulatory settings were compared before and after the curriculum.

RESULTS

Twenty-eight faculty members attended the curriculum. Overall, respondents reported less burnout and performed at the same level or better in terms of patient handoff than the original studies validating the instruments. Faculty rated the professionalism behaviours as well as teaching of professionalism much lower at our institution than the validation study. There was no change in patient satisfaction after the curriculum. However, overall, the course was well received as meeting its objectives, being beneficial and providing new tools to assess professionalism.

CONCLUSION

This pilot study suggests that an ethics curriculum can be developed for practising physicians that is mindful of pragmatic concerns while still meeting its objectives. Further study is needed regarding long term and objective improvements in ethics knowledge, impact on the education of trainees and improvement in the care of patients as a result of a formal curriculum for faculty.

Reforming regulatory relationships: The impact of medical revalidation on doctors, employers, and the General Medical Council in the United Kingdom

In 2012, medical regulation in the United Kingdom was fundamentally changed by the introduction of revalidation - a process by which all licensed doctors are required to regularly demonstrate that they are up to date and fit to practice in their chosen field and are able to provide a good level of care. This paper examines the implications of revalidation on the structure, governance, and performance management of the medical profession, as well as how it has changed the relationships between the regulator, employer organizations, and the profession. We conducted semi-structured interviews with clinical and non-clinical staff from a range of healthcare organizations. Our research suggests that organizations have become intermediaries in the relationship between the General Medical Council and doctors, enacting regulatory processes on its behalf and extending regulatory surveillance and oversight at local level. Doctors' autonomy has been reduced as they have become more accountable to and reliant on the organizations that employ them.

Guidance for Male Mentors to Support the Safety and Success of Female Mentees

Women constitute the majority of students at US schools and colleges of pharmacy but make up only a minority of senior faculty members. In academic pharmacy, male mentors play an essential role in supporting the professional success of female mentees. These male mentors must recognize their role in creating safe and equitable environments for female mentees to learn and collaborate. They should respect the unique experiences and concerns of female mentees, particularly regarding sexual violence and harassment, and conduct themselves in a manner that prioritizes safety. They should also strive to develop the same interpersonal connections with female mentees that they work to develop with male mentees, realizing that maintaining inequitable personal distance from women undermines their professional success. Specific suggestions for balancing the potentially competing concepts of mentee safety and personal connection are offered by the authors, a male faculty mentor and female student mentee pair.

Nazis, Teleology, and the Freedom of Conscience: In Response to Gamble and Pruski's 'Medical Acts and Conscientious Objection: What Can a Physician be Compelled to Do?'

Medical practitioners of all specialisms (e.g. RN, MD) are identified by their professional titles. Their function is determined by their regulators, and subject to voluntary employment contracts. Whilst they are expected to act in their patients' best interests, there are situations in which a physician - having human rights - can object to certain acts. This right of objetction arises from the recognition of the practitioner's own conscience rather than the end or purpose of the procedure being performed. Gamble and Pruski explore an act-centred morality, and therefore define acts as medical (and subject to compulsion) and non-medical (therefore voluntary). This analysis has merit when applied to health-systems as a whole, but fails to take into account the humanity of physicians and the specific interactions with patients in different contexts. As such, it serves as a way of compelling physicians to act against their conscience rather than protecting them.

Why not common morality?

This paper challenges the leading common morality accounts of medical ethics which hold that medical ethics is nothing but the ethics of everyday life applied to today's high-tech medicine. Using illustrative examples, the paper shows that neither the Beauchamp and Childress four-principle account of medical ethics nor the Gert et al 10-rule version is an adequate and appropriate guide for physicians' actions. By demonstrating that medical ethics is distinctly different from the ethics of everyday life and cannot be derived from it, the paper argues that medical professionals need a touchstone other than common morality for guiding their professional decisions. That conclusion implies that a new theory of medical ethics is needed to replace common morality as the standard for understanding how medical professionals should behave and what medical professionalism entails. En route to making this argument, the paper addresses fundamental issues that require clarification: what is a profession? how is a profession different from a role? how is medical ethics related to medical professionalism? The paper concludes with a preliminary sketch for a theory of medical ethics.

Guideline of guidelines: social media in urology

The use of social media is rapidly expanding. This technology revolution is changing the way healthcare providers share information with colleagues, patients, and other stakeholders. As social media use increases in urology, maintaining a professional online identity and interacting appropriately with one's network are vital to engaging positively and protecting patient health information. There are many opportunities for collaboration and exchange of ideas, but pitfalls exist without adherence to proper online etiquette. The purpose of this article is to review professional guidelines on the use of social media in urology, and outline best practice principles that urologists and other healthcare providers can reference when engaging in online networks.

Modeling Doctor of Pharmacy Students' Stress, Satisfaction, and Professionalism Over Time

Objective. To gauge multiple dimensions of pharmacy students' professionalism, stress, and satisfaction with the Doctor of Pharmacy (PharmD) program. Methods. An online survey of first- through fourth-year pharmacy students was conducted from 2015-2018 to gauge the degree of students' professionalism (personal reflection, patient-centric care focus, cultural and interprofessional competencies), program stress (levels, sources, and burnout syndrome), and satisfaction. Multilevel structural equation modeling (SEM) determined the relationship between stress and satisfaction, and the degree to which these impacted levels of professionalism after adjusting for potential correlates (age, sex, financial stress, relationship status, race, and employment status). Results. Seven hundred sixty-four responses to the survey were received across the four calendar years. Of the students in the sample, 51% were female with a mean (SD) age of 26.6 (3.4) years. The overall response rate to the surveys was 86.2%. Professionalism was most strongly indicated by the measures of community-centeredness, patient-centeredness, and perceived benefits of being part of a team-based environment. The SEM model demonstrated an inverse relationship between the two composite latent constructs of stress and satisfaction. When modeled simultaneously, program satisfaction was found to be the more significant predictor of professionalism than stress after adjusting for associations with age, sex, and relationship status. Conclusion. Professionalism of pharmacy students is positively associated with students' satisfaction with the program, but professionalism is not independently significantly predicted by stress. Students who have positive responses to community- and patient-centeredness and who feel they benefit from engaging in a team-based environment are most likely to have greater professionalism.

The Human Ecological Perspective and Biopsychosocial Medicine

With regard to philosophical anthropology, a human ecological framework for the human-environment relationship as an "ecology of the person" is outlined, which focuses on the term "relationship" and aims to be scientifically sound. It also provides theoretical orientations for multiprofessional clinical work. For this purpose, a multi-dimensional basic grid for the characterization of the individual human being is proposed. The necessity and meaningfulness of a differentiation and systematization of the terms "environment", and above all "relationship", are demonstrated, and practical examples and links to similar framework models are given.

Professionalism experiences of undergraduate learner nurses during their 4-year training programme at a Higher Education Institution in the Western Cape, South Africa

Background

Professional socialisation of student nurses needs to be integrated into the formal teaching and learning during the nursing programme. Embedded in the training programme are professional values that are used synonymously with nursing professionalism. Professionalism is the conduct, qualities, values, vision, mission and/or goals that characterise a profession, and describes behaviours that are expected within the profession’s members. However, one’s values are shaped by one’s experiences, influence one’s behaviour and interactions with others, and are manifested in many aspects of professional behaviour. New nurses to the profession are expected to display behaviours of professionalism, thus requiring nurse training schools to help students internalise these behaviours. Nurse educators therefore carry a responsibility to shape future nurses’ growth towards professionalism.

Objectives

This article reports on the experiences of undergraduate student nurses regarding nursing professionalism during their 4-year training programme at a Higher Education Institution in the Western Cape, South Africa.

Method

A qualitative, exploratory and descriptive design was applied. Eight focus group discussions were conducted with first- to fourth-year student nurses registered for the undergraduate nursing programme. Data were transcribed verbatim and analysed using open coding. Ethical principles and trustworthiness were maintained throughout the study.

Results

Six main themes indicated that undergraduate student nurses experienced issues with role modelling, language barriers, their own understanding of professional behaviour, reasons for students and practitioners’ unprofessional behaviour, prejudice towards degree students and students’ professional or unprofessional behaviour experienced as contributing to the image of the profession.

Conclusion

Student nurses received mixed messages leading to emotional turbulence. They needed clear guidance from role models to demonstrate how to behave professionally.

Obstacles of professional behavior among medical trainees: A qualitative study from Iran (2018)

INTRODUCTION

Despite all efforts that have been made to promote professional behavior among medical trainees, unfortunately, reports from medical schools around the world confirm the prevalence of nonprofessional behaviors by medical students. Experts in the field of medical ethics and medical education in different countries have suggested several reasons for failing to minimize unprofessional performance among medical students.

MATERIALS AND METHODS

This qualitative study aimed to promote our understanding from the challenges faced by Iranian medical students in providing professional behavior. The study was first conducted in the form of a semi-structured face-to-face interview with medical students and then completed with a focus group discussion (FGD) session. Forty-nine medical students participated in the interviews and 11 students participated in the FGD session. Qualitative conventional content analysis was used for examining the data.

RESULTS

The participants classified the obstacles of professional behavior into the following three main categories: problems related to educational system, problems related to the society, and problems related to students themselves.

CONCLUSION

Regarding the impact of various personal, social, and educational factors on the creation and expansion of unprofessional behaviors among medical students, it is essential to have a comprehensive approach for solving the problem.