Financial conflicts of interest between pharmaceutical companies and executive board members of internal medicine subspecialty societies in Japan between 2016 and 2020

RATIONALE

Pharmaceutical companies make payments to physicians such as compensations for lecturing or consulting. Of particular, financial relationships between pharmaceutical companies and leaders of professional medical societies are concern in medical community. However, little was known about them in Japan.

AIMS AND OBJECTIVES

This study aimed to evaluate the magnitude and prevalence of personal payments to executive board members (EBMs) of 15 medical associations representing different subspecialties within the Japanese Society of Internal Medicine.

METHOD

All EBMs of 15 medical associations representing internal medicine subspecialties were collected from each association webpage. Payments to the EBMs were extracted from the pharmaceutical companies belonging to the Japan Pharmaceutical Manufacturers Association between 2016 and 2020. We performed descriptive analysis on the payment data.

RESULTS

Of the 353 different EBMs identified, 350 (99.2%) received one or more personal payments from the pharmaceutical companies over the 5 years. 99.2% (350) and 97.2% (343) of all EBMs received personal payments 3 years before and in the year of their board membership. A total of $70,796,014 were made to the EBMs over the 5 years. The median 5-year combined personal payments per EBM was $150,849 (interquartile range [IQR]: $73,412-$282,456). EBMs who were chairman or vice chairman of executive board received significantly larger median personal payments than those who were not ($225,685 vs. $143,885, p = 0.01 in the U test). Among the 15 societies, there were 12 (80.0%) societies with all (100%) EBMs receiving personal payments from the pharmaceutical companies. Although every society has their own conflicts of interest policy, none publicly discloses the financial relationships between pharmaceutical companies and their EBMs due to their privacy.

CONCLUSION

This study demonstrated that nearly all EBMs of 15 medical associations representing internal medicine subspecialties had substantial financial relationships with the pharmaceutical companies in Japan over the past 5 years.

MPLA case: How do you lead as a lead physicist?

This work of fiction is part of a case study series developed by the Medical Physics Leadership Academy (MPLA). It is intended to facilitate the discussion of the managerial and leadership challenges faced by a clinical medical physicist. In this case, a physicist David used to work in a clinic where he thrived and felt like a leader, despite not having the title. After a job change, he is now officially the "Lead Physicist" at a hospital newly affiliated with a large academic healthcare system. He believes he will be equally successful. Yet he struggles to bring about changes and get buy-in from coworkers. In the end, he feels like giving up and considers changing his job. This case is in the scenario of Problem Diagnosis.i The intended use of this case, through group discussion or self-study, is to encourage readers to perform a comprehensive analysis that identifies the root cause of the problem. This case study falls under the scope of and is supported by the MPLA, a committee in the American Association of Physicists in Medicine (AAPM).

The National Academy of School Nursing Fellows (FNASN)

The National Association of School Nurses honors school nurses who have made extraordinary, unique, and enduring contributions to school nursing and the National Association of School Nurses with recognition in the National Academy of School Nursing Fellows (FNASN). The following article outlines the value of FNASNs, how they contribute, and how a school nurse can apply for Fellowship. The time is now for mid-career school nurses to prepare for the opportunity that an NASN Fellow represents!

Online prelicensure nursing students' experiences of academic incivility during COVID-19: A qualitative inquiry

AIM

The aim of this study was to describe online prelicensure nursing students' experiences of incivility during COVID-19.

DESIGN

Qualitative descriptive. Five optional open-ended questions were presented to nursing students to share their experiences with incivility during the pandemic.

METHODS

Data were collected from September to October 2020 as a part of a larger multimethod study on stress, resilience and incivility with nursing students and faculty (n = 710) from a large public undergraduate nursing programme in the southwestern United States. Out of the initial 675 students who completed the survey, 260 individuals responded to three or more of the open-ended questions which were reviewed and coded using reflexive thematic analysis.

RESULTS

Thirteen themes were organized into four analytical categories: (1) experiencing incivility, (2) causes and consequences of incivility, (3) the pandemic and academic incivility and (4) promoting civility in the academic setting.

CONCLUSIONS

Prelicensure nursing students perceived unrealistic expectations, a lack of awareness and miscommunication hindered academic performance, as well as, created feelings of stress, discouragement and inadequacy.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Fostering academic civility during virtual educational experiences may require training in proper coping strategies when challenged with incivility.

IMPACT

As the body of research emerges concerning the effects of COVID-19 and undergraduate nursing education, understanding prelicensure students' experiences of academic incivility could prove to be beneficial to designing strategies co-created with students to promote positive educational outcomes. Understanding students' viewpoints of uncivil experiences revealed prioritizing civility awareness is essential in creating healthy academic environments, improving clinical performance and providing safe patient care.

REPORTING METHOD

The COREQ (COnsolidated criteria for REporting Qualitative research) checklist was used.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Letters of Recommendation: Make Your Nominee Stand Out

Every nurse will be asked to write a letter of recommendation during their career. It is a privilege to be invited to write a letter of recommendation. A well-written letter of recommendation can make or break a stellar individual's chances of receiving the recognition they deserve or getting the job they want. Some find the prospect of writing a letter of recommendation intimidating, however, writing one does not have to be daunting. In this article, we will share a formula you can use to write a succinct, data-driven, and effective letter of support.

Informing online professional dietetics practice: The development and pilot testing of the Social Media Evaluation Checklist

AIM

To develop and pilot a tool to evaluate Australian dietitians' and student dietitians' ethical and professional practice using social media.

METHODS

A Social Media Evaluation Checklist was developed based on checklist development literature with a four-staged process. Stage one included a literature review and input from an expert panel to ensure content validity. Stages two and three were to ensure face validity by categorising the checklist and pilot testing the tool. Instagram profiles and posts were audited by two authors using the checklist in the final stage to analyse ethical and professional use. An account purposely created for this study was used, and the first 25 dietitian and first 25 student dietitian profiles identified using the key words 'dietitian', 'student dietitian' and 'dietitian student' and the hashtag '#australiandietitian' were reviewed.

RESULTS

A total of 50 Instagram profiles and 250 posts were audited based on seven categories; (1) financial disclosure, (2) cultural awareness, (3) evidence-based information, (4) transparency, (5) privacy/confidentiality, (6) professionalism and (7) justifiability. Areas for improvement included advertising transparency which was met in only 12% of dietitian posts, and the provision of evidence-based information, which was met in 56% of dietitian posts and 72% of student dietitian posts.

CONCLUSIONS

This study provides insight into the ethical and professional use of social media by Australian dietitians and dietetics students. With the evolving nature of social media, guidance is required. This will ensure dietitians remain, now and in the future, the credible source of nutrition information for the public.

Pragmatic Systemic Solutions to the Wicked and Persistent Problem of the Unprofessional Disruptive Physician in the Health System

We have always had and will always have "disruptive" or "dysfunctional" doctors behaving unprofessionally within healthcare institutions. Disruptive physician behaviour (also called "unprofessional behaviour") was described almost 150 years ago, but remains a persistent, wicked problem in healthcare, largely fuelled by systemic inaction. In this Commentary, we aim to explore the following aspects from a systemic lens: (i) the gaps in understanding systemic resistance and difficulty in addressing this issue; and (ii) pragmatic approaches to its management in the healthcare system. In doing so, we hope to shift the systemic effect from nihilism and despair, to one of hopeful realism about disruptive or unprofessional behaviour. We suggest that solutions lie in cultural change to ensure systemic awareness, responsiveness and early intervention, and an understanding of what systemic failure looks like in this context. Staff education, policies and procedures that outline a consistent reporting and review process including triaging the problem, its source, its effects, and the attempted solutions, are also crucial. Finally, assessment and intervention from appropriately mental-health-trained personnel are required, recognising that this is a complex mental health problem. We are not doing anyone any favours by ignoring, acting as bystanders, or otherwise turning a blind eye to disruptive or unprofessional behaviour; otherwise, we share culpability.

Natural Language Processing of Learners' Evaluations of Attendings to Identify Professionalism Lapses

Unprofessional faculty behaviors negatively impact the well-being of trainees yet are infrequently reported through established reporting systems. Manual review of narrative faculty evaluations provides an additional avenue for identifying unprofessional behavior but is time- and resource-intensive, and therefore of limited value for identifying and remediating faculty with professionalism concerns. Natural language processing (NLP) techniques may provide a mechanism for streamlining manual review processes to identify faculty professionalism lapses. In this retrospective cohort study of 15,432 narrative evaluations of medical faculty by medical trainees, we identified professionalism lapses using automated analysis of the text of faculty evaluations. We used multiple NLP approaches to develop and validate several classification models, which were evaluated primarily based on the positive predictive value (PPV) and secondarily by their calibration. A NLP-model using sentiment analysis (quantifying subjectivity of the text) in combination with key words (using the ensemble technique) had the best performance overall with a PPV of 49% (CI 38%-59%). These findings highlight how NLP can be used to screen narrative evaluations of faculty to identify unprofessional faculty behaviors. Incorporation of NLP into faculty review workflows enables a more focused manual review of comments, providing a supplemental mechanism to identify faculty professionalism lapses.

Nurse educators' professional practice attributes and its determinants

BACKGROUND

Professional practice attributes of nurses help to promote nursing as a profession and advance nursing education. Nursing professionals need to demonstrate a high level of professional commitment to their practices and must be professionally competent to perform their roles.

MATERIAL AND METHODS

Descriptive survey was conducted at the nursing educational institutes affiliated with the Indian Nursing Council and situated in the selected Northern Indian states. The sample included 343 nurse educators who were selected using simple random sampling. The self-reported method was adopted to collect data where three questionnaires including socio-demographic information, organizational characteristics of current place of work, and professional practice attributes assessment criteria were used. Descriptive and inferential statistics were used for data analysis.

RESULTS

Overall, the study's participants scored poorly on professional practice attributes (Mean, SD: 1.98, 2.03), which were linked to their personal (age and gender), professional (educational background, professional qualification, current designation), and organizational (duration of organization's establishment, courses provided, college management) characteristics.

CONCLUSION

The findings highlighted the need for nurse educators to be more competent and dedicated in their respective fields. The study also suggests that in order to raise the standard of nursing education, nursing regulatory bodies like nursing councils, universities, and governments must take the necessary steps to foster the professional development of nurse educators.

Chinese medical students reflections on medical professionalism: A qualitative thematic analysis

There is no common medical professionalism framework in China, mandating work to conceptualize professionalism from various perspectives. Studies on students viewpoints about medical professionalism are limited. Therefore, this study aimed to investigate how Chinese medical students perceive professionalism to provide a reference for future medical education reform and policy development. Fifty-four written reflections on medical professionalism were collected from first-year students of China 4 + 4 medical education program enrolled in 2020 to 2021 academic years. Essays were subjected to thematic analysis using NVivo 12. Three main themes emerged: inter-personal, intra-personal, and public professionalism. Students emphasized the importance of physician-patient relationships, proficiency of medical knowledge, and enthusiasm for promoting health-related issues. By contrast, teamwork and confidentiality were not considered essential aspects of professionalism. The medical professionalism framework articulated by students in China was roughly the same as in other countries. Where there were differences, these may have been due to the unique sociocultural environment. Future medical professionalism education should be adjusted according to students understanding of professionalism.

Healthcare lobbying and campaign finance activities of vision-related professional societies, 2015 to 2022

Purpose

To compare the lobbying expenditures and political action committee (PAC) campaign finance activities of the American Academy of Ophthalmology (AAO), American Society of Cataract and Refractive Surgery (ASCRS), and American Optometric Association (AOA) from 2015 to 2022.

Methods

Financial data were collected from the Federal Election Commission and OpenSecrets database. Analysis was performed to characterize and compare financial activity among the organizations. P < 0.05 was considered significant and all analyses were two-sided.

Results

From 2015 to 2022, the AAO, ASCRS, and AOA spent $6,745,000, $5,354,406, and $13,335,000 on lobbying, respectively. The AOA's annual lobbying expenditure (median, $1,725,000) was significantly greater than AAO's ($842,500, P = 0.03) and ASCRS's ($694,289, P < 0.001). In PAC donations, OPHTHPAC, affiliated with AAO, received $3,221,737 from 2079 donors (median, $900); eyePAC, affiliated with ASCRS, received $506,255 from 349 donors ($500); and AOA-PAC received $6,642,588 from 3641 donors ($825). Compared to eyePAC, median donations to OPHTHPAC (P = 0.01) and AOA-PAC (P = 0.04) were significantly higher. In campaign spending, OPHTHPAC contributed $2,728,500 to 326 campaigns (median, $5000), eyePAC contributed $293,500 to 58 campaigns ($3000), and AOA-PAC contributed $5,128,673 to 617 campaigns ($5500). eyePAC's median campaign contribution was significantly lower than the AOA's (P < 0.001) and AAO's (P = 0.007). Every PAC directed most of its contributions toward Republican campaigns; eyePAC donated the highest proportion (64.9%).

Conclusions

AOA was more assertive in shaping policy by increasing lobbying expenditures, fundraising, and donating to a greater number of election campaigns.

Studying the Association Between Knowledge of Professionalism and Demographic Characteristics in King Saud University Medical Students

Objectives To study the association between the level of knowledge regarding professionalism and demographic characteristics among medical students from years three to five at King Saud University, Riyadh, Saudi Arabia. Methods Data for this quantitative observational cross-sectional study were collected using stratified random sampling. The participants included male and female students from years three to five studying at the College of Medicine, King Saud University. Data were collected using a self-administered questionnaire and analyzed using the Student's t-test and a one-way ANOVA test. Results The study comprised 112 female (52%) and 103 male (48%) students who completed 215 questionnaires. The mean percentage values of correct answers by females and males were 59.99% and 59.31%, respectively. Statistical analysis revealed no significant difference between the mean percentage of correct answers given by males and females (p=0.684). The mean percentage of correct answers among the 3rd, 4th, and 5th-year medical students was 59.27%, 56.56%, and 62.72%, respectively. Statistical analysis revealed significant differences between the academic year groups (p<0.05), and the grade point average (GPA) groups showed significant differences (p<0.05). Conclusion A highly significant association was found between knowledge of professionalism and both academic level and performance among medical students. This suggests that professional perception evolves parallel to acquiring basic science and clinical knowledge.

[On the question of the content of the concept of «professionalism» in relation to workers in the field of medicine and healthcare]

The article presents an overview of foreign publications reflecting approaches to the definition of the essence of the concept of «professionalism» in relation to representatives of the field of health and medicine. The main personal and professional qualities of the doctor, which are associated with the concept of «professionalism» in patients, are noted. It is noted that the formation of professional behavior is influenced not only by the personal qualities of a medical worker, but also by the working environment of the medical organization in which he carries out professional activities. It is concluded that the formation of the professionalism of a medical worker should be carried out with the participation of both the employee himself and the public health system and the system of medical professional education.

Elements and Determinants of Professional Identity During the Pandemic: A Hermeneutic Qualitative Study

Phenomenon: The construct of professionalism in undergraduate medical education is a core outcome that is included in the wider concept of professional identity formation. The former is grounded in the more general concept of identity, intended as an internalized set of role expectations. Some have proposed frameworks based on psychological or sociological approaches, but empirical research is still scarce and often limited to the exploration of the role of specific learning activities. The pandemic imposed adaptations that produced an artificial setting for a social experiment, suitable to observe how the deprivation of the social component of a student's life, such as in presence teaching and practical training, unveiled the elements and determinants of the developing identity of medical students. Approach: This research was the extension of a previous phenomenological study about medical students' lived experience of distance learning during the lockdown phase in Italy. We adopted a hermeneutic approach to furtherly deepen the analysis of the phenomenon at stake, in dialogue with the relevant literature. Eight 6th year medical students underwent an in-depth interview, themes were inductively generated and used to identify elements and determinants of the developing identities. Findings: Four themes developed, synthetized in the overarching theme "From crawling to standing on your feet and walking toward an uncertain future". The themes were: "social places and practices that make me feel like a student and a medical student", "toward self-regulation", "an emotional journey", "threats to the identity". The elements of the perceived identity as a medical student were autonomy and learning self-regulation, professional knowledge, competence, and sense of belonging to a community. The determinant factors which influenced the identity as a medical student were living environment, learning spaces and architectures, the social networks, the attendance of the healthcare facilities, the relationship with teachers, the social acknowledgement as a medical student, and as a doctor. Insights: It was possible to identify the generation of both constitutive elements of identity and determinants influencing identity development and this distinction is an added value of the research. According Gilles Deleuze's concept of "empty square" (the sudden lack of an object one used to have at hand: sociality in this case), this research highlighted the ambivalent nature of identity. Individualization and socialization are the "uneven sides" of that same paradoxical object which is identity.

An ophthalmology professionalism survey tool: outcomes from a multi-center study in Central India

Purpose

To describe a professionalism survey tool and its use to assess knowledge of medical professionalism in ophthalmology training programs in Central India.

Settings and Design

Multi-center survey study.

Methods

A validated 33-question, scenario-based survey addressing professionalism attributes was administered at five centers in central India. The attributes tested included "personal characteristics," "physician-patient relationships," "workplace practice and relationships," and "socially responsible behaviors." A mean attribute score (%) was calculated and compared to "gold standard" responses by a group of expert senior ophthalmologists (100% agreement for responses).

Results

A total of 225 participants completed the survey; 124 residents, 47 fellows, and 54 consultants (98.4% response rate). The total mean attribute score was 80.7 ± 9.1 (min 16.67, max 100). There was variation in the mean attribute score by professionalism attribute (P < 0.001), and a trend toward higher mean attribute scores for consultants compared to trainees across all attribute groups. The scores for "personal characteristics" (93 ± 9.7) and "physician-patient relationship" (82 ± 15.8) were the highest, whereas scores for "socially responsible behaviors" (73.9 ± 18.6) and "workplace practices" were low (72 ± 13).

Conclusions

There is a generally high level of professionalism knowledge among ophthalmologists in central India. The results suggest that experience does impact knowledge of professionalism. Potential for improvement in professionalism exists in around "workplace practices", and around "socially responsible behaviors". These findings may serve as a valuable discussion starter and teaching tool to enhance professionalism in ophthalmology training programs.

[Medical charity: participation of non-profit organizations in the field of medical scientific research]

The article examines the practice of medical charity as a virtuous activity in the field of medical care. The main attention is paid to non-profit organizations that, in accordance with the legislation, have the status of non-governmental organizations or non-governmental organizations. An overview of the main activities of NGOs with an emphasis on participation in the organization and financing of medical research is presented.

Rethinking sports history to include sportswomen in 1900s France

In the history of French sport, the practice of physical activities by women is essentially considered non-existent before the 1920s, with the exception of a few aristocratic women. Although this idea persists, it has been challenged by recent research on early sportswomen. These studies raise the question of the scope of sports history, and indeed the very definition of sports itself. These are usually defined in the social sciences as physical activities that are organized, codified and institutionalized, structured by clubs and federations. While at the beginning of the 20th century these clubs and federations were most often closed to women, this does not mean that women were not practicing sports. Physical activities were gaining increasing popularity among women even before this time, and not only among the upper class. There is evidence of women swimming, cycling, racewalking, and even wrestling or boxing in the United States, Canada and Britain, as well as in France. These practices necessarily developed outside institutions, with women taking them up as individual pastimes. As demand grew, some sought to profit from this, and sports promoters organized the first competitions. Journalists then reported on these events in the press, sometimes with amusement, sometimes with disapproval. Yet the first women walkers, runners, cyclists and other athletes are only now beginning to appear in historical studies. This paper seeks to contribute to the rehabilitation of these sportswomen, who include working-class boxers and wrestlers, all of whom have long been subject to a double exclusion-institutional and historical. It presents the history of the first competitions of sportswomen-professional or amateur-in France at the turn of the century, a first foundation stone in writing a new and more inclusive history of sport.

Data Analysis of Physician Competence Research Trend: Social Network Analysis and Topic Modeling Approach

BACKGROUND

Studies on competency in medical education often explore the acquisition, performance, and evaluation of particular skills, knowledge, or behaviors that constitute physician competency. As physician competency reflects social demands according to changes in the medical environment, analyzing the research trends of physician competency by period is necessary to derive major research topics for future studies. Therefore, a more macroscopic method is required to analyze the core competencies of physicians in this era.

OBJECTIVE

This study aimed to analyze research trends related to physicians' competency in reflecting social needs according to changes in the medical environment.

METHODS

We used topic modeling to identify potential research topics by analyzing data from studies related to physician competency published between 2011 and 2020. We preprocessed 1354 articles and extracted 272 keywords.

RESULTS

The terms that appeared most frequently in the research related to physician competency since 2010 were knowledge, hospital, family, job, guidelines, management, and communication. The terms that appeared in most studies were education, model, knowledge, and hospital. Topic modeling revealed that the main topics about physician competency included Evidence-based clinical practice, Community-based healthcare, Patient care, Career and self-management, Continuous professional development, and Communication and cooperation. We divided the studies into 4 periods (2011-2013, 2014-2016, 2017-2019, and 2020-2021) and performed a linear regression analysis. The results showed a change in topics by period. The hot topics that have shown increased interest among scholars over time include Community-based healthcare, Career and self-management, and Continuous professional development.

CONCLUSIONS

On the basis of the analysis of research trends, it is predicted that physician professionalism and community-based medicine will continue to be studied in future studies on physician competency.

'I've got no idea': an ethnography of Critical Care Nurses' nuanced and ambiguous professional identities in regional Australia

Historical sociological perspectives posit professional identity to emerge from socialisation and attainment of 'traits' considered unique to and distinguishing of a profession. Such essentialist understandings, however, cannot account for group heterogeneity, nurses' lived experiences, nor the fluidity of professional and personal identity. This article conceptualises professional identity as being both individual and collective, influenced by context, involving subjective meaning-making, and membership to a specific professional group. Drawing on ethnographic data gathered through participant observation and semi-structured interviews with Critical Care Nurses in an Intensive Care Unit in regional Australia, we identify four themes that reveal different aspects of professional identity: conceptualising professional identity; professional identity as a title and legislative requirement; professional identity as qualifications and training; and professional identity as a social performance. The findings demonstrate that Critical Care Nurses hold multifaceted perceptions of professional identity. While they collectively distinguish their nursing training, knowledge, and practice from other nurses, they struggle to articulate what professional identity is, while creating boundaries between different forms of nursing education and qualifications to construct their professional identity. These uncertain and diverse meanings of professional identity contribute to nurse identity ambiguity, while also reflecting the necessity of flexible individual and collective nursing identities.

Evaluation of Moral Reasoning Skills among Dental Students in the Makkah Region, Saudi Arabia

Introduction

One of the main roles of healthcare educators is to prepare students to make the right ethical decisions. This study evaluated the moral reasoning levels of dental students according to Kohlberg's six-stage moral development system.

Materials and Methods

This cross-sectional study was conducted in three dental schools in the Makkah region. Senior-year students completed the self-administered Socio-moral Reflection Objective Measure (SROM), which consists of hypothetical moral dilemmas and options that mirror individual reasoning possibilities. SROM results were matched to Kohlberg's six-stage moral development system and associations with demographic variables and perceptions of educational context variables assessed.

Results

One hundred and eighty-eight senior students (mean age 23 ± 1.1 years) completed the SROM. Only 34.6% (n = 44) students reached stage four (morality of law and duty to the social order), while most students (63.8%; n = 81) were at stage three (morality of mutual interpersonal expectations); 1.6% (n = 2) were at stage two (the instrumental relativist orientation). No subject achieved stage 5. Attainment of moral reasoning was not associated with demographic or perception of educational context variables.

Conclusion

Students demonstrated a relatively low level of moral reasoning. Healthcare educators must review curricula to provide focused training for students to cultivate their moral reasoning skills. Further studies are also needed to confirm and explain this low moral reasoning level in dental students.

Withdrawing extra corporeal membrane oxygenation (ECMO) against a family's wishes: Three permissible scenarios

The ethical permissibility of unilaterally withdrawing life-sustaining technologies has been a perennial topic in transplant and critical care medicine, often focusing on CPR and mechanical ventilation. The permissibility of unilateral withdrawal of extracorporeal membrane oxygenation (ECMO) has been discussed sparingly. When addressed, authors have appealed to professional authority rather than substantive ethical analysis. In this Perspective, we argue that there are at least three (3) scenarios wherein healthcare teams would be justified in unilaterally withdrawing ECMO, despite the objections of the patient's legal representative. The ethical considerations that provide the groundwork for these scenarios are, primarily: equity, integrity, and the moral equivalence between withholding and withdrawing medical technologies. First, we place equity in the context of crisis standards of medicine. After this, we discuss professional integrity as it relates to the innovative usage of medical technologies. Finally, we discuss the ethical consensus known at the "equivalence thesis." Each of these considerations include a scenario and justification for unilateral withdrawal. We also provide three (3) recommendations that aim at preventing these challenges at their outset. Our conclusions and recommendations are not meant to be blunt arguments that ECMO teams wield whenever disagreement about the propriety of continued ECMO support arises. Instead, the onus will be on individual ECMO programs to evaluate these arguments and decide if they represent sensible, correct, and implementable starting points for clinical practice guidelines or policies.

Behaviours that contribute to pharmacist professionalism: a scoping review

OBJECTIVES

Clearly understanding and describing professional behaviours of pharmacists allows the profession, researchers and policy-makers to observe and monitor the professionalism of pharmacists, and design interventions to improve it where needed. The primary objective of this review was to identify which behaviours are discussed to contribute to professionalism in registered pharmacists in peer-reviewed literature. The secondary objective was to review the identified behaviours using a behavioural specification framework to understand how they are expressed.

DESIGN

A scoping literature review was conducted.

DATA SOURCES

An electronic database search of Scopus, Embase, PsycINFO, PsychArticles, Emcare and Medline limited to articles published in English from 1 January 2000 to 21 October 2022 was conducted.

ELIGIBILITY CRITERIA

Eligible articles contributed behaviourally relevant content with reference to registered pharmacists' professionalism.

DATA EXTRACTION AND SYNTHESIS

Extracted behaviourally relevant content was subject to researcher's familiarisation, then deductive coding to one of two overarching definitions of technical or non-technical behaviour. Data were then inductively coded through assignment of a descriptive code to identify categories of professional behaviour within these two overarching types of behaviour.

RESULTS

Seven articles were identified and included in the final analysis. From the extracted behaviourally relevant content, 18 categories of behaviours were identified. All articles identified behaviours in categories titled 'establishes effective relationships' and 'complies with regulations codes and operating procedures'. Identified behaviours were often broadly described and merged with descriptions of influences on them and broader outcomes that they contribute to.

CONCLUSIONS

Behaviours described to contribute to pharmacists' professionalism in the literature are broad and non-specific.