How to conceptualize professionalism: a qualitative study

Professional Identity Formation in Medical Education: Some Virtue-Based Insights

Issue: In 2010, the Carnegie Foundation published a call to reorient medical education in terms of the formation of identities rather than mere competencies, and the medical education literature on professional identity formation (PIF) has since grown rapidly. As medical learners navigate a hectic clinical learning environment fraught with challenges to professionalism and ethics, they must simultaneously orient their skills, behaviors, and evolving sense of professional identity. The medical education literature on PIF describes the psychosocial dimensions of that identity formation well. However, in its conceptual formulations, the literature risks underappreciating the pedagogical significance of the moral basis of identity formation-that is, the developing moral agencies and aspirations of learners to be good physicians. Evidence: Our conceptual analysis and argument build on a critical review of the medical education literature on PIF and draw on relevant insights from virtue ethics to deepen the conceptualization of PIF in moral, and not just psychosocial, terms. We show that a narrowly psychosocial view risks perpetuating institutional perceptions that can conceive professionalism norms primarily as standards of discipline or social control. By drawing on the conceptual resources of virtue ethics, we highlight not just the psychosocial development of medical learners but also their self-reflective, critical development as particular moral agents aspiring to embody the excellences of a good physician and, ultimately, to exhibit those traits and behaviors in the practice of medicine. Implications: We consider the pedagogical relevance of this insight. We show that drawing on virtue theory can more adequately orient medical pedagogy to socialize learners into the medical community in ways that nurture their personal growth as moral agents-in terms of their particular, restless aspirations to be a good physician and to flourish as such.

Should we add patients in concordance of judgment learning tool panels? - An analysis between patients and primary care physicians

INTRODUCTION

The Concordance of Judgment Learning Tool (CJLT) has been developed for distance asynchronous learning of professionalism in health sciences education. The learning of professionalism is induced by a student's comparison of their own responses with those of the panel members. Whilst CJLT programs typically include same profession experts in their panels, we believe that they could also include patients. Accordingly, we conducted a study aimed at comparing CJLT response patterns between two groups of primary care physicians (PCPs) and patients.

METHODS

We conducted a mixed prospective study of responses to a CJLT program based on a group of PCPs and a group of patients: an analysis of the response patterns of the two groups and a qualitative analysis of justifications.

RESULTS

A total of 110 participants were included in the study: 70 patients and 40 PCPs. We found a significant difference in response patterns between the PCP and patient groups for nine of the fifteen questions (60%). The qualitative analysis of justifications between groups allowed us to comprehend patients' views on the professionalism of PCPs.

CONCLUSIONS

Including patients in CJLT panels can enrich the feedback offered to students in these online training programs.

Student experiences of professionalism and role models in an oral and maxillofacial surgery internship: A qualitative study

INTRODUCTION

Dental students have a clear concept of professionalism and the importance of role models. Our aim was to determine how dental students experience their first oral and maxillofacial surgery internship in terms of their concept of professionalism and their perception of role models.

METHODS

From June to August 2020, semi-structured telephone interviews were conducted with 22 dental students in their eighth and ninth semesters at the Medical Faculty of the University of Ulm. The interviews were transcribed and evaluated by qualitative content analysis according to Mayring.

RESULTS

The students' concept of dental professionalism was shaped by the elements of a good approach to patients, professional competence, and manual skills. This perception was not changed by the internship. Having a role model was seen as an important learning strategy, and role models were perceived in both positive and negative ways. Role models were perceived as positive if they corresponded to the student's concept of professionalism and as negative if they did not correspond to this concept, especially with regard to social interaction or the approach to patients. Students' reactions to discrepancies between their own moral values and the role models' behaviour were characterised by passivity and withdrawal. With regard to potential future careers, positive internship experiences supported student goals, whereas negative experiences raised doubts about them.

CONCLUSION

Supervising dentists may still underestimate the considerable impact of internships, and their awareness of this impact needs to be increased. Students' reactions to conflicts between reality and their own values do not appear to be constructive. One approach to solving this problem may be to include discussions of professional development in curricula.

Adaptation of the professionalism mini-evaluation exercise instrument into Turkish: a validity and reliability study

BACKGROUND

There is an ongoing search for standardized scales appropriate for each culture to evaluate professionalism, which is one of the basic competencies of a physician. The Professionalism Mini-evaluation Exercise (P-MEX) instrument was originally developed in Canada to meet this need. In this study, it was aimed to adapt the P-MEX to Turkish and to evaluate the validity and reliability of the Turkish version.

METHODS

A total of 58 residents at Bakirkoy Dr. Sadi Konuk Training and Research Hospital were assessed with the Turkish version of P-MEX by 24 raters consisting of faculty members, attending physicians, peer residents, and nurses during patient room visits, outpatient clinic and group practices. For construct validity, the confirmatory factor analysis was performed. For reliability, Cronbach's alpha scores were calculated. Generalizibility and decision studies were undertaken to predict the reliability of the validated tool under different conditions. After the administration of P-MEX was completed, the participants were asked to provide feedback on the acceptability, feasibility, and educational impact of the instrument.

RESULTS

A total of 696 forms were obtained from the administration of P-MEX. The content validity of P-MEX was found to be appropriate by the faculty members. In the confirmatory factor analysis of the original structure of the 24-item Turkish scale, the goodness-of-fit parameters were calculated as follows: CFI = 0.675, TLI = 0.604, and RMSEA = 0.089. In the second stage, the factors on which the items loaded were changed without removing any item, and the model was modified. For the modified model, the CFI, TLI, and RMSEA values were calculated as 0.857, 0.834, and 0.057, respectively. The decision study on the results obtained from the use of P-MEX in a Turkish population revealed the necessity to perform this evaluation 18 times to correctly evaluate professionalism with this instrument. Cronbach's alpha score was 0.844. All the faculty members provided positive feedback on the acceptability, feasibility, and educational impact of the adapted P-MEX.

CONCLUSION

The findings of this study showed that the Turkish version of P-MEX had sufficient validity and reliability in assessing professionalism among residents. Similarly, the acceptability and feasibility of the instrument were found to be high, and it had a positive impact on education.

TRIAL REGISTRATION

2020/249, Bakirkoy Dr. Sadi Konuk Training and Research Hospital.

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.

Understanding of professionalism among medical students in the first year of the COVID-19 pandemic - a qualitative monocentric study

Objective

The existing literature indicates that medical students' understanding of professionalism is influenced by internal and external factors. Therefore, this study aimed to evaluate whether the early phase of the pandemic affected the understanding of professionalism among medical students at the University of Ulm.

Methods

In May and June 2020, semi-structured telephone interviews were conducted with 21 students (in the 8^th and 9^th semester) at the Medical Faculty of the University of Ulm. The interviews were transcribed and analyzed by a qualitative content analysis according to Mayring.

Results

The results showed shifts in students' perception of the importance of certain aspects of medical professionalism. Not only competency in the disciplines hygiene, virology, and microbiology came to the fore, but also personal qualities such as "radiating a sense of calm", empathy, and altruism; communicative competency; and the capacity for reflection. The students also perceived changes in the expectations placed on them. More emphasis was placed on their roles as scientific or medical advisors and as helpers in the health care system, a change that was sometimes emotionally stressful. With respect to the study objective, both limiting and supporting factors were named. For example, the clarification of the relevance of the medical professional was motivating.

Conclusion

The study showed that students' understanding of professionalism depends on context, as was suggested by earlier studies in experts. The perception of changed role expectations may thereby also play a role. One consequence of the findings may be to address such dynamics in suitable curricular events and discuss them with students to prevent them proceeding in an uncontrolled manner.

Factors in the Provision of High Quality Midwifery Care: A Qualitative Content Analysis

Introduction: In recent years, health care has faced many changes. Thereupon, it would be beneficial to investigate the quality of midwifery care and its related factors. Many factors contribute to the provision of quality care, and recognizing factors to ensure the quality of midwifery care. This qualitative study was conducted to explain the factors that affect the provision and quality of midwifery care. Methods: This qualitative study with content analysis approach was conducted between June 2017 and February 2018 on 15 midwives working in private and public maternity hospitals in the city of Qom. The participants were selected by purposeful sampling. Semi-structured and in-depth interviews were performed with open ended questions to find out how midwives describe high quality midwifery care. Data were analyzed by conventional content analysis method through MAXQDA-11 software. Results: The findings of this study revealed two main themes, including individual factors (personal efficiency, staffs' psychological status, value-centeredness, cultural-educational issues, and professional attachment), and professional-organizational factors (professional characteristics, patient characteristics, personal-professional welfare, professional empowerment system, value-centered culture of organization, and organizational monitoring and evaluation). Conclusion: The results of this study showed that individual and professional factors are associated with the quality of midwifery care. Midwives who participated in this study believed that providing high quality midwifery care requires a broad range of prerequisites. Since high quality midwifery care decreases maternal and infant mortality and morbidity, it is imperative for policymakers to pay attention to all the factors that contribute to the quality of midwifery care.

Professionalism and dental education: in search of a shared understanding

Professionalism has profound historical origins; however, the current health care environment in the UK dental sphere is changing, which presents new professional dilemmas that require continued learning and debate. Professionalism is a key aspect of the education of dental students and the lifelong learning and development of dental practitioners. However, 'being' professional can be challenging because while it is recognised as a social good, there is much debate on what professionalism means and how best it can be learned and assessed. Since 2017, the UK Council for the Dental Teachers of Professionalism, consisting of educators from UK dental schools and dental therapy hygiene institutions, has been exploring and debating the role and place of professionalism, as well as sharing challenges and good practice within UK dental education. This paper includes a narrative overview of current thinking in the academic literature on professionalism to consider the use of a shared understanding of professionalism to facilitate conversations between various stakeholders.

Conceptualising professionalism in dietetics: an Australasian qualitative study

BACKGROUND

Professionalism is a vital aspect of healthcare and multidisciplinary teamwork. While there is substantive professionalism literature in medicine and an expanding healthcare professions literature, there is a significant gap in understanding professionalism in dietetics. There are very few research papers in the dietetics literature on this issue compared with other health professions. Given the multidisciplinary nature of healthcare, it is important to understand what professionalism means within each profession to develop shared understandings across healthcare teams.

OBJECTIVE

The study aim was to explore how dietetics professionalism is conceptualised by dietetic practitioners/preceptors, faculty and new graduates.

DESIGN

A constructionist exploratory qualitative interview study was conducted.

PARTICIPANTS/SETTING

One hundred participants (dietetic graduates, faculty and practitioners/preceptors), associated with 17 universities across Australia and New Zealand and from diverse geographical and work settings, participated in 27 group and 24 individual interviews from March 2018 to June 2019.

ANALYSIS PERFORMED

Thematic framework analysis was used to examine participants' understandings of professionalism.

RESULTS

Twenty-three dimensions of dietetics professionalism were identified, with the most common being communication and including four novel dimensions of professionalism (generational, emotion management, cultural capability and advocacy) not previously described in other professions. Professionalism as emotion management and generational adds new insights to the professionalism literature, expanding understandings of this vital aspect of healthcare. While high levels of consistency in professionalism understandings existed across the three stakeholder groups, some interesting differences were found. The profession of dietetics shares similarities with other professions in the ways professionalism is conceptualised.

CONCLUSIONS

Using these dimensions of professionalism as a framework for teaching and learning about professionalism will help in clarifying expectations and expand shared understandings about professionalism for dietitians, other health professions and across multidisciplinary teams.

Teaching professionalism in cadaver dissection: medical students' perspective

This study was designed to facilitate freshman medical students’ adaptation to the dissection room and familiarize them with the related ethical codes. Single-group post-test design research was conducted at Tehran University of Medical Sciences in 2018 - 2019. The program began with a brief explanation of the necessity of the subject, and after a documentary film was shown, the principles of professional and ethical behaviors in the dissection room were discussed by a panel of experts. In the end, a valid and reliable evaluation questionnaire (Cronbach's alpha coefficient = 0.89) was distributed among the students. A total of 129 questionnaires were completed and returned. Overall, 94.4% of the students believed that the program provided an excellent opportunity to reflect on professional behaviors during practical anatomy sessions. In addition, 92.8% of the students believed that they would use the ethical points mentioned in the program in the future. Content analysis of the open questions produced three main categories: "motivating learning", "application of theory in practice" and "changing the attitude toward responsibility". The results indicate that adequate preparation for cadaver dissection sessions and learning about professional behavior codes in the first exposure can help medical students to better understand the principles of professional behaviors.

Self-compassion in medical students: a pilot study of its association with professionalism pressure

BACKGROUND

To be a "good doctor" and have "good medical practices" are apparent goals for both medical students and medical faculties. However, the associated implicit and explicit standards could be a source of distress in the form of pressure to achieve professionalism. Self-compassion has been identified as a transtherapeutic factor that plays a crucial role in developing and maintaining mental health. It seems to be an essential meta-skill to learn, especially for medical students who often perceive imperfection as failure. In this pilot study, we investigated the qualities that medical students attribute to the "good doctor" concept, how they perceive themselves compared to this concept, and whether any possible discrepancy between these two perspectives could be associated with self-compassion.

METHODS

Altogether, 301 medical students participated in the study (mean age 22.3 ± 2.1; 71.8 % female). The discrepancy between concepts was measured by a semantic differential consisting of a list of 36 adjectives and antonyms that students repeatedly mentioned in courses in their responses to the question "What should a doctor be like?" Self-compassion was measured by the Self-Compassion Scale.

RESULTS

The obtained results offer an insight into students' conceptualization of a "good doctor" and the hierarchy of given characteristics. Statistical analysis revealed significant associations between the discrepancy between the "ideal" doctor concept vs. actual self-perception and Self-Compassion Scale scores. The more students are compassionate to themselves, the lower the discrepancy.

CONCLUSIONS

The current pilot study supports the hypothesis that student self-compassion could play some role in the degree of discrepancy between the ideal "good doctor" image and student self-concept. This result could support the importance of educational interventions developing self-compassion for medical students. The proposed discrepancy measurement could also be a tool for measuring the effect of well-being programs aimed at self-compassion in medical students.

Teaching Professionalism to Medical Students Using Dissection-Based Anatomy Education: a Practical Guide

Professionalism is a core competency for all healthcare professionals and is a subject of great interest within the academic community due to its vital importance in delivering the highest quality patient care. Despite this, professionalism remains difficult to define, teach and assess. The potential use of anatomy education in teaching professionalism has been increasingly highlighted within the literature, but still remains an underutilised tool in medical education. Therefore, this practical guide offers evidence-based practical points for successfully incorporating professionalism within a dissection-based anatomy course delivered to undergraduate medical students.

Use of the Behavior Assessment Tool in 18 Pilot Residency Programs

Background

The purpose of this study was to determine the feasibility and evaluate the effectiveness of the American Board of Orthopaedic Surgery Behavior Tool (ABOSBT) for measuring professionalism.

Methods

Through collaboration between the American Board of Orthopaedic Surgery and American Orthopaedic Association's Council of Residency Directors, 18 residency programs piloted the use of the ABOSBT. Residents requested assessments from faculty at the end of their clinical rotations, and a 360° request was performed near the end of the academic year. Program Directors (PDs) rated individual resident professionalism (based on historical observation) at the outset of the study, for comparison to the ABOSBT results.

Results

Nine thousand eight hundred ninety-two evaluations were completed using the ABOSBT for 449 different residents by 1,012 evaluators. 97.6% of all evaluations were scored level 4 or 5 (high levels of professional behavior) across all of the 5 domains. In total, 2.4% of all evaluations scored level 3 or below reflecting poorer performance. Of 431 residents, the ABOSBT identified 26 of 32 residents who were low performers (2 or more < level 3 scores in a domain) and who also scored "below expectations" by the PD at the start of the pilot project (81% sensitivity and 57% specificity), including 13 of these residents scoring poorly in all 5 domains. Evaluators found the ABOSBT was easy to use (96%) and that it was an effective tool to assess resident professional behavior (81%).

Conclusions

The ABOSBT was able to identify 2.4% low score evaluations (<level 3) for all residents. The tool was concordant with the PD for 81% of the residents considered low performers or "outliers" for professional behavior. The 5-domain construct makes it an effective actionable tool that can be used to help develop performance improvement plans for residents.

Level of Evidence

Level II.

Great expectations: views and perceptions of professionalism amongst mental health services staff, patients and carers

BACKGROUND

Numerous studies have explored the concept of 'professionalism' in medicine, yet little attention has been paid to the concept in a mental health services context.

AIMS

This study sought to determine how the lived experience of patients, carers and healthcare professionals in mental health services align with medically defined, generic, professionalism standards.

METHOD

Interviews and focus groups were conducted with patients, carers, nurses, occupational therapists, psychiatrists and psychologists. A framework analysis approach was used to analyse the data, based on the 'Improving Selection to the Foundation Programmes' Professional Attributes Framework.

RESULTS

Fifty-six individuals participated. Data aligned to all nine attributes of the Professional Attributes Framework, however the expectations within each attribute varied from that originally cited. A tenth attribute was devised during the process of analysis; Working with Carers. This attribute acknowledges the need to liaise with, and support carers in mental health services. Situational examples included both online and offline behaviours and the topic of 'black humour' emerged.

CONCLUSIONS

Compared to a conventional medical definition of professionalism, additional themes and differing emphases were observed for mental health and learning disability services. These findings should be used to inform the teaching and evaluation of professionalism, especially for staff pursuing mental health service careers.

A professionalism program in medical education and training - From broad values to specific applications: YLL School of Medicine, Singapore

The process for introducing and developing a program for teaching medical professionalism at the National University of Singapore, School of Medicine is outlined. Professionalism was recognised as embracing 'honesty and integrity,' 'responsibility and participation,' 'respect and sensitivity,' and 'compassion and empathy.' Those broad values are expressed as specific attitudes and behaviours that are taught and assessed throughout the course. Honesty and integrity, for example, are demonstrated by 'presenting original, authentic assignments' (in medical education); and 'accepting personal mistakes and honestly acknowledging them' (in clinical training and practice). Values and items of behaviour were drawn from the literature, and reviewed and refined to address needs identified within the Medical School. A broad spectrum of pre-clinical and clinical teachers contributed to this development. The program was reassessed to determine the extent to which it has been implemented and has evolved following its adoption. The results are confirming in that: the majority of recommendations have been implemented; the program has developed further; and is supported by ancillary student enrichment activities. Medical professionalism has been given prominence through all phases of the course. Nevertheless, challenges remain and particularly in the extent to which medical professionalism is taught and assessed in various clinical postings.

Professional decision-making in medicine: Development of a new measure and preliminary evidence of validity

Introduction

This study developed a new Professional Decision-Making in Medicine Measure that assesses the use of effective decision-making strategies: seek help, manage emotions, recognize consequences and rules, and test assumptions and motives. The aim was to develop a content valid measure and obtain initial evidence for construct validity so that the measure could be used in future research or educational assessment.

Methods

Clinical scenario-based items were developed based on a review of the literature and interviews with physicians. For each item, respondents are tasked with selecting two responses (out of six plausible options) that they would choose in that situation. Three of the six options reflect a decision-making strategy; these responses are scored as correct. Data were collected from a sample of 318 fourth-year medical students in the United States. They completed a 16-item version of the measure (Form A) and measures of social desirability, moral disengagement, and professionalism attitudes. Professionalism ratings from clerkships were also obtained. A sub-group (n = 63) completed a second 16-item measure (Form B) to pilot test the instrument, as two test forms are useful for pre-posttest designs.

Results

Scores on the new measure indicated that, on average, participants answered 75% of items correctly. Evidence for construct validity included the lack of correlation between scores on the measure and socially desirable responding, negative correlation with moral disengagement, and modest to low correlations with professionalism attitudes. A positive correlation was observed with a clerkship rating focused on professionalism in peer interactions.

Conclusions

These findings demonstrate modest proficiency in the use of decision-making strategies among fourth-year medical students. Additional research using the Professional Decision-Making Measure should explore scores among physicians in various career stages, and the causes and correlates of scores. Educators could utilize the measure to assess courses that teach decision-making strategies.

Assessment of medical professionalism: preliminary results of a qualitative study

BACKGROUND

The importance of medical professionalism has been well documented in the literature. Cultural background affects the constituents of professionalism. However, few studies have explored the domains of medical professionalism in an Asian context. We aim to describe the views and experiences of both patients and faculty on medical professionalism in an urban Asian city state.

METHODS

Data for this qualitative study were collected through focus group discussions (FGDs) with patients and in-depth interviews (IDIs) with faculty members. The IDIs and FGDs were audio-recorded and transcribed verbatim. Thematic analysis was conducted by two independent coders using a priori framework derived from Professionalism Mini Evaluation Exercise (P-MEX). Sociodemographic data of faculty members and patients were obtained through brief questionnaires.

RESULTS

A total of 31 patients (58.1% male, all had visited healthcare facilities within the past year) and 26 faculty members (42.3% male, 38.5% from medical disciplines, median years as faculty is 11) participated in this study. The results supported the four domains of medical professionalism - Doctor-patient relationship skills, Reflective skills, Time management and Inter-professional relationship skills. Two new sub-domains which emerged from data were (1) communicated effectively with patient and (2) demonstrated collegiality.

CONCLUSIONS

The domains of professionalism in Singapore were similar to previous studies. This study allows a better understanding of medical professionalism to enhance the assessment and ultimately, the teaching of medical professionalism in an urban multi-ethnic Asian city.

Top-cited articles in medical professionalism: a bibliometric analysis versus altmetric scores

INTRODUCTION

Citation counts of articles have been used to measure scientific outcomes and assess suitability for grant applications. However, citation counts are not without limitations. With the rise of social media, altmetric scores may provide an alternative assessment tool.

OBJECTIVES

The aims of the study were to assess the characteristics of highly cited articles in medical professionalism and their altmetric scores.

METHODS

The Web of Science was searched for top-cited articles in medical professionalism, and the characteristics of each article were identified. The altmetric database was searched to identify report for each identified article. A model to assess the relationship between the number of citations and each of the key characteristics as well as altmetric scores was developed.

RESULTS

No correlations were found between the number of citations and number of years since publication (p=0.192), number of institutes (p=0.081), number of authors (p=0.270), females in authorship (p=0.150) or number of grants (p=0.384). The altmetric scores varied from 0 to 155, total=806, median=5.0, (IQR=20). Twitter (54%) and Mendeley (62%) were the most popular altmetric resources. No correlation was found between the number of citations and the altmetric scores (p=0.661). However, a correlation was found for articles published in 2007 and after (n=17, p=0.023). To further assess these variables, a model was developed using multivariate analysis; did not show significant differences across subgroups. The topics covered were learning and teaching professionalism, curriculum issues, professional and unprofessional behaviour.

CONCLUSIONS

Altmetric scores of articles were significantly correlated with citations counts for articles published in 2007 and after. Highly cited articles were produced mainly by the USA, Canada and the UK. The study reflects the emerging role of social media in research dissemination. Future studies should investigate the specific features of highly cited articles and factors reinforcing distribution of research data among scholars and non-scholars.

How consultants determine diagnostic competence in histopathology trainees

Aims

This is a qualitative study exploring how consultant histopathologists determine diagnostic competence in their trainees.

Methods

Semi-structured interviews were conducted with consultants and trainees and analysed using the Framework Method.

Results

Five major themes emerged from the data: process, person, stage of training, trust and time. Within these major themes, there were multiple subthemes which reflect the complex, longitudinal nature of the judgement, as well as the knowledge, skills and attitudes which are most relevant to diagnostic competence. A conceptual framework is proposed to illustrate the judgement ecology, which is supported by anonymised quotes from interview participants.

Conclusions

Our study is the first to explore in depth how consultant histopathologists determine diagnostic competence in their trainees. This is particularly important as histopathology is a unique medical specialty for which there is little evidence to support the current assessment strategies during training. The resulting conceptual model and findings from this study may help to form an evidence base to inform future assessment tools in histopathology.

A Best Evidence Medical Education (BEME) systematic review of: What works best for health professions students using mobile (hand-held) devices for educational support on clinical placements? BEME Guide No. 52

BACKGROUND

Ingrained assumptions about clinical placements (clerkships) for health professions students pursuing primary basic qualifications might undermine best educational use of mobile devices.

QUESTION

What works best for health professions students using mobile (hand-held) devices for educational support on clinical placements?

METHODS

A Best Evidence Medical Education (BEME) effectiveness-review of "justification" complemented by "clarification" and "description" research searched: MEDLINE, Educational Resource Information Center, Web of Science, Cumulative Index to Nursing and Allied Health Literature, PsycInfo, Cochrane Central, Scopus (1988-2016). Reviewer-pairs screened titles/abstracts. One pair coded, extracted, and synthesized evidence, working within the pragmatism paradigm.

SUMMARY OF RESULTS

From screening 2279 abstracts, 49 articles met inclusion-criteria, counting four systematic reviews for context. The 45 articles of at least Kirkpatrick K2 primary research mostly contributed K3 (39/45, 86.7%), mixed methods (21/45, 46.7%), and S3-strength (just over one-half) evidence. Mobile devices particularly supported student: assessment; communication; clinical decision-making; logbook/notetaking; and accessing information (in about two-thirds). Informal and hidden curricula included: concerns about: disapproval; confidentiality and privacy; security;-distraction by social connectivity and busy clinical settings; and mixed messages about policy.

DISCUSSION AND CONCLUSION

This idiosyncratic evidence-base of modest robustness suggested that mobile devices provide potentially powerful educational support on clinical placement, particularly with student transitions, metalearning, and care contribution. Explicit policy must tackle informal and hidden curricula though, addressing concerns about transgressions.

Balancing altruism and self-interest: GP and patient implications

This paper explores how general practitioners (GPs) address potentially opposing motivations stemming from being altruistic and self-interested, and the implications for patients and GPs. The author finds that GPs address dual goals of patient care and profit generation. This can be challenging, while professional values (altruism) encourage a patient focus, business realities (self-interest) mandate other priorities. Viewing clinicians as altruistic in isolation of business needs is unrealistic, as is the notion that profit is the dominant motivation. A blending of interests occurs, pursuing reasonable self-interest, patients’ best interests are ultimately met. GPs need a profit focus to sustain/improve the practice, benefitting patients through continued availability and capacity for enhancement. Therefore, it is argued that GPs behave in a manner that is ‘part altruistic, part self-interested’ and mutually beneficial. These insights should be considered in designing incentive systems for GPs, raising compelling questions about contemporary understanding of the nature of professionals.

Defining professionalism for mental health services: a rapid systematic review

Background: Efforts have been made to define professionalism across the professions, yet little attention has been paid to the concept in mental health services, where patients' needs differ to that in other healthcare specialties. Aims: To derive a definition of professionalism for mental health services using the existing literature. Method: A rapid, systematic review was conducted to identify empirical and non-empirical records that described professionalism in a mental health service context from 2006 to 2017. Studies were synthesised narratively using thematic analysis. Results: Seventy records were included in the review. Professionalism was described on two levels; at a societal level, a dynamic social contract between professions and society, and; at an individual level, having intrapersonal, interpersonal, and working professionalism. Utilising emerging themes, an operationalised definition of professionalism, suitable for a mental health service context was derived. Conclusions: Within mental health services, emphasis is placed on the interpersonal aspects of practice such as communication skills, maintaining boundaries and humanity. Themes relating to the vulnerability of patients and the challenge of supporting autonomy and choice whilst maintaining safety and acting in a client's best interest are also evident. 'Practical wisdom' and a flexible approach to working are needed to manage these challenging situations.

Perceptions of occupational therapy students and clinical tutors on the attributes of a good role model

BACKGROUND

Occupational therapy students learn in different environments, where role modelling takes place. Nevertheless, little is known about student and tutors perceptions on model´s characteristics.

OBJECTIVES

The aims of this study were to investigate the perceptions of occupational therapy students on the most important attributes of role models and to confront their views with those of clinical tutors.

METHODS

A sample of 61 students completed a structured, standardized online questionnaire. Ten clinical tutors regarded by students as good models underwent a semi-structured individual interview. Data were analyzed quantitatively and qualitatively (thematic content analysis).

RESULTS

The most important attributes of a good role model according to student perception were: good relationship with patients, integrity and ethical behaviour, respectful relationships with colleagues, patient management skills, commitment to personal and professional growth and enthusiasm for the profession. Clinical tutors believed that they were nominated as good role models because they demonstrated empathy towards patients, good relationships with students and enthusiasm for their profession.

CONCLUSIONS AND SIGNIFICANCE

Perceptions of occupational therapy students and clinical tutors about role models characteristics were similar. Identification of attributes of good role models may inform teacher training and faculty development in occupational therapy.

Dental professionalism and influencing factors: patients' perception

BACKGROUND

Professionalism was recognized as a fundamental competency of medical/dental practice at the beginning of the twenty-first century. Organizations and experts published several definitions of professionalism, but research on patients' perception of professionalism has been limited. To address this gap in literature, this study explored dental patients' perception of dental professionalism, and then compared their perception with that of dental professionals.

METHODS

Of the 800 questionnaires that were distributed to dental patients in public and private clinics and hospitals, 504 were returned and were used in the analysis. A factor analysis was used to generate themes and sub-themes. Independent sample t-tests were performed to compare two independent groups and the ANOVA tests to compare means in more than two independent groups.

RESULTS

A factor analysis revealed four factors: excellence and communication skills; humanism, commitment, and service mindedness; competence in practice; and dentists' duties and management skills. Adherence to sterilization and infection control rules and procedures; personal hygiene and clean professional attire; good communication skills; diagnostic and clinical judgment and provision of the most efficient dental treatment; and ethical decisions and ethical care were ranked as the first five most important elements of dental professionalism from patients' perspective. Several demographic factors showed significant differences in perception.

CONCLUSION

Patients' and dentists' perception of dental professionalism and professional behavior vary in certain aspects. These differences must be addressed to ensure excellence of dental service. Dental professionals must also be aware of the personal factors that affect a patient's perception of professionalism.

Teaching professionalism: some features in Canadian physiotherapy programs

The role of "professionalism" is core to many health professions including Physical Therapy (PT), and the development of competence in professionalism is a key requirement of entry-to-practice PT programs. However, the actual curriculum, teaching methodologies, and evaluation methods currently used to develop professional competence during PT training programs in Canada are unclear. This study explored current teaching practices, evaluation and curricular content related to professionalism in Canadian entry-to-practice PT programs. Results showed that teaching practices related to professionalism were not necessarily congruent with methods promulgated by educational theory and relied heavily on lecture, while more appropriate strategies such as simulation and role play were under-utilized. The numbers of different teaching methods utilized for specific aspects of professionalism were variable. Emphasis on different curricular areas related to professionalism also varied: communication was given the most emphasis while change management was under-represented. It is posited that teaching methods related to professionalism could be improved and curricular content and emphasis should also be reconsidered.

Doctors' values, resilience and professionalism

In 2001, Richard Smith, then editor of the BMJ, asked why doctors were so unhappy. He provoked a huge international response. The suggested reasons included: changes in the social structures of work; the demographic shift and difficulties in the recruitment and retention of staff; the replacement of trust with accountability; changes in relationships with people and bodies that are responsible for policy and practice; and negative media reporting.

Dental hygienists' perceptions of professionalism are multidimensional and context-dependent: a qualitative study in Japan

BACKGROUND

Due to the declining birth rate and aging of Japanese society, the roles and responsibilities of dental hygienists are continuously expanding. Medical professionalism needs to be pursued continuously throughout one's career in order to improve dental care and treatment. Although conceptualising professionalism is essential to the education of health professionals, professionalism in the field of dental hygiene has not been defined or adequately examined in Japan. The purposes of this study are to investigate dental hygienists' perceptions of the constituent elements of professionalism and the factors affecting their perceptions.

METHODS

Semi-structured interviews were conducted with 18 dental hygienists in Japan. Drawing on the conceptualisation of professionalism in medicine described by Van de Camp et al., the transcribed data were thematically analysed.

RESULTS

The dental hygienists in this study perceived 70 constituent elements that were categorised into eight core competencies related to professionalism. These competencies were further classified into three main themes: intrapersonal, interpersonal, and public professionalism. There were three sociohistorical factors that affected their perceptions of the constituent elements, namely academic background (university or technical school), the contexts of any previously provided dental care (university hospital or dental clinic), and their social interactions with their colleagues during their engagement in dental practice (dental team or interprofessional team). Moreover, according to their sociohistorical backgrounds, the dental hygienists saw themselves variously as scholars (university graduates), facilitators (university hospital), skillful artisans (dental clinic), or collaborators (interprofessional team).

CONCLUSIONS

Dental hygienists' perceptions of professionalism are multidimensional and context-dependent, so culture- and professional-specific elements need to be included in educational curricula and continuing professional development programmes. In particular, the conceptualisation of professionalism in the field of dental hygiene as described in this study can be a springboard for enhancing undergraduate education and clinical training.

Preclinical medical students' understandings of academic and medical professionalism: visual analysis of mind maps

INTRODUCTION

Several studies have begun to explore medical students' understandings of professionalism generally and medical professionalism specifically. Despite espoused relationships between academic (AP) and medical professionalism (MP), previous research has not yet investigated students' conceptualisations of AP and MP and the relationships between the two.

OBJECTIVES

The current study, based on innovative visual analysis of mind maps, therefore aims to contribute to the developing literature on how professionalism is understood.

METHODS

We performed a multilayered analysis of 98 mind maps from 262 first-year medical students, including analysing textual and graphical elements of AP, MP and the relationships between AP and MP.

RESULTS

The most common textual attributes of AP were learning, lifestyle and personality, while attributes of MP were knowledge, ethics and patient-doctor relations. Images of books, academic caps and teachers were used most often to represent AP, while images of the stethoscope, doctor and red cross were used to symbolise MP. While AP-MP relations were sometimes indicated through co-occurring text, visual connections and higher-order visual metaphors, many students struggled to articulate the relationships between AP and MP.

CONCLUSIONS

While the mind maps' textual attributes shared similarities with those found in previous research, suggesting the universality of some professionalism attributes, our study provides new insights into students' conceptualisations of AP, MP and AP-MP relationships. We encourage medical educators to help students develop their understandings of AP, MP and AP-MP relationships, plus consider the feasibility and value of mind maps as a source of visual data for medical education research.

A concept analysis of professional commitment in nursing

BACKGROUND

The concept of professional commitment is being widely studied at present. However, although it is considered an indicator for the most human part of nursing care, there is no clear definition for it, and different descriptors are being used indiscriminately to reference it.

OBJECTIVE

The aim of this study is to clarify the concept of professional commitment in nursing through the Rodgers' evolutionary concept analysis process.

DESIGN

Systematic search using English and Spanish descriptors and concept analysis. Studies published between 2009 and June 2015, front-to-back analysis of the Nursing Ethics journal and manual check of articles cited in studies related to the Nijmegen Professionalism Scale.

RESEARCH DESIGN

The procedure of concept analysis developed by Rodgers was used.

ETHICAL CONSIDERATIONS

Although the topic was not labeled as sensitive and subject to ethical approval, its realization was approved by the Ethical Committee of Clinical Research of Aragon (CEICA) approved the study on 18 March 2015 and also careful procedures have been followed according to ethics expressed in the Declaration of Helsinki.

FINDINGS AND DISCUSSION

A total of 17 published studies. A clear definition of the concept was made, and surrogate terms, concept dimension, differential factors related to the concept, sociocultural variations and consequences for nursing practice were identified.

CONCLUSION

There is a need for continuous advancement in the development of the concept, specific actions to encourage this and the improvement of evaluation methods for its study.

Cadaveric dissection as an educational tool for anatomical sciences in the 21st century

Anatomical education has been undergoing reforms in line with the demands of medical profession. The aim of the present study is to assess the impact of a traditional method like cadaveric dissection in teaching/learning anatomy at present times when medical schools are inclining towards student-centered, integrated, clinical application models. The article undertakes a review of literature and analyzes the observations made therein reflecting on the relevance of cadaveric dissection in anatomical education of 21st century. Despite the advent of modern technology and evolved teaching methods, dissection continues to remain a cornerstone of anatomy curriculum. Medical professionals of all levels believe that dissection enables learning anatomy with relevant clinical correlates. Moreover dissection helps to build discipline independent skills which are essential requirements of modern health care setup. It has been supplemented by other teaching/learning methods due to limited availability of cadavers in some countries. However, in the developing world due to good access to cadavers, dissection based teaching is central to anatomy education till date. Its utility is also reflected in the perception of students who are of the opinion that dissection provides them with a foundation critical to development of clinical skills. Researchers have even suggested that time has come to reinstate dissection as the core method of teaching gross anatomy to ensure safe medical practice. Nevertheless, as dissection alone cannot provide uniform learning experience hence needs to be complemented with other innovative learning methods in the future education model of anatomy. Anat Sci Educ 10: 286-299. © 2016 American Association of Anatomists.

Medical professionalism frameworks across non-Western cultures: A narrative overview

BACKGROUND

Medical professionalism is context-specific, but most literature on professionalism stems from Western countries. This study is about benchmarking of different frameworks on professionalism and interpreting the commonalities and discrepancies of understanding professionalism across different cultures. We need to study the cultural underpinning of medical professionalism to graduate future "global" practitioners who are culturally sensitive enough to recognize differences (and also similarities) of expectations of patients in various contexts.

AIM

This study aims at describing culture specific elements of three identified non-Western frameworks of professionalism, as well as their commonalities and differences.

METHOD

A narrative overview was carried out of studies that address professionalism in non-Western cultures in the period 2002-2014.

RESULTS

Out of 143 articles on medical professionalism, only four studies provided three structured professionalism frameworks in non-Western contexts. Medical professionalism attributes in non-Western cultures were influenced by cultural values. Out of the 24 identified attributes of professionalism, 3 attributes were shared by the three cultures. Twelve attributes were shared by at least two cultures, and the rest of the attributes were unique to each culture.

CONCLUSIONS

The three frameworks provided culture-specific elements in a unique conceptual framework of medical professionalism according to the region they originated from. There is no single framework on professionalism that can be globally acknowledged. A culture-oriented concept of professionalism is necessary to understand what the profession is dedicated to and to incorporate the concept into the medical students' and physicians' professional identity formation.

Early involvement in a multiprofessional course: an integrated approach to the development of personal and interpersonal skills

WHAT IS ALREADY KNOWN IN THIS AREA • Many papers describing multiprofessional educational activities relate to activities occurring late into curricula activity. • Meta-analyses demonstrate multiprofessional learning only becoming effective when students are placed in a working environment. • Scant attention is placed upon the early development of students, recognising the need to 'grow into professionalism' and sharing the development of those skills so relevant to both unprofessional and multiprofessional life. WHAT THIS WORK ADDS • This paper describes an early-exposure activity, related to multiprofessional learning, in which students share the learning of common requirements for professional development, and evaluate their experience in a positive manner. SUGGESTIONS FOR FUTURE RESEARCH • The real benefit to multiprofessional life and real-world activity will only be truly evaluated as their individual courses develop and the newly found skills of reflection are allowed to develop.

Professional behaviours demonstrated by undergraduate dental students using an incident reporting system

Critical incident reporting is widely used across healthcare and other sectors for reporting adverse events or behaviours. More recently it has been used in medical education as a means of assessing student professionalism. The aims of this study were to determine the usage of critical incident forms when reporting behaviours related to professionalism demonstrated by undergraduate dental students, and the types of behaviours exhibited. Three types of form could be awarded for highly professional (green), minor unprofessional (yellow) and serious unprofessional (red) behaviours. All forms completed over a two-year period were analysed recording the year of student, type of card and demographic of the member of staff reporting the incident. All text relating to the nature of the incident was entered into a qualitative data analysis software package and analysed thematically. In total, 583 cards were awarded, 55% green, 34% yellow and 11% red. Seventy-four percent of cards were awarded in a clinical environment, with administrative staff using them the most (29%). The overwhelming professional behaviours demonstrated related to altruism. The most common unprofessional behaviours related to a lack of conscientiousness, although a greater range of common unprofessional behaviours were reported. In conclusion, critical incidents forms were widely used for reporting both professional and unprofessional behaviours particularly in clinical environments by a range of staff. Such forms may be a valuable addition to the professionalism assessment portfolio, capturing behaviours not previously reported using traditional methods.

Not all unprofessional behaviors are equal: The creation of a checklist of bad behaviors

INTRODUCTION

Professionalism is a key component of medical education and training. However, there are few tools to aid educators in diagnosing unprofessional behavior at an early stage. The purpose of this study was to employ policy capturing methodology to develop two empirically validated checklists for identifying professionalism issues in early-career physicians.

METHOD

In a series of workshops, a professionalism competency model containing 74 positive and 70 negative professionalism behaviors was developed and validated. Subsequently, 23 subject matter experts indicated their level of concern if each negative behavior occurred 1, 2, 3, 4, or 5 or more times during a six-month period. These ratings were used to create a "brief" and "extended" professionalism checklist for monitoring physician misconduct.

RESULTS

This study confirmed the subjective impression that some unprofessional behaviors are more egregious than others. Fourteen negative behaviors (e.g. displaying obvious signs of substance abuse) were judged to be concerning if they occurred only once, whereas many others (e.g. arriving late for conferences) were judged to be concerning only when they occurred repeatedly.

DISCUSSION

Medical educators can use the professionalism checklists developed in this study to aid in the early identification and subsequent remediation of unprofessional behavior in medical students and residents.

Healing Medicine's Future: Prioritizing Physician Trainee Mental Health

In this article, we discuss current perceptions of the model physician and how these perceptions conflict with stressful realities of training environments and contribute to the staggering rates of burnout and depression faced by medical students and residents. We suggest a multi-tiered interventional approach to address these problems, with innovations for individual trainees, programs, institutions, and the health care system. Finally, we discuss the medical community's ethical obligations to ensure that it is appropriately and thoughtfully investing in the wellness of medicine's next generations of practitioners.

Adaptation, psychometric properties and feasibility of the Professionalism Scale Germany

INTRODUCTION

Pre- and postgraduate education is meant to be competency-based. Over the last two decades various competency frameworks have been published. An important aspect of competency is professionalism, being discussed widely in the literature while a clear-cut definition is still lacking. The purpose of this study was to translate the Nijmegen Professionalism Scale into the German language, to adapt the scale to the German setting and to examine the psychometric properties, test-retest reliability and feasibility of the culturally adapted instrument designed to assess professionalism in general practice, in addition to the validity of the concept of professionalism and to testify the transfer across linguistic, cultural and societal differences.

METHOD

After translating the Nijmegen Professional Scale into German, we conducted its cultural adaptation, the German Professionalism Scale (Pro-D). Its psychometric properties were assessed using Cronbach's α, descriptive statistics, and test-retest reliability. The validation of the construct was analysed by confirmatory factor analysis. Feasibility was confirmed in interviews with GP trainees and their trainers.

RESULTS

A total of 133 trainees completed the Pro-D. The Pro-D showed high internal consistency (Cronbach's α 0.93) and good test-retest reliability (Spearman's rank correlation and Wilcoxon's matched-pairs test) for the different domains. Confirmatory factor analysis was unable to establish construct validity. Change in sensitivity of the instrument was good. Statements of interviews confirmed the feasibility of the new instrument.

CONCLUSIONS

We found good psychometric properties for the Pro-D. This might indicate transferability of the concept across linguistic, cultural and societal differences although the concept of professionalism was not replicated in a confirmatory factor analysis.

Development of a residency program in radiation oncology physics: an inverse planning approach

Over the last two decades, there has been a concerted effort in North America to organize medical physicists' clinical training programs along more structured and formal lines. This effort has been prompted by the Commission on Accreditation of Medical Physics Education Programs (CAMPEP) which has now accredited about 90 residency programs. Initially the accreditation focused on standardized and higher quality clinical physics training; the development of rounded professionals who can function at a high level in a multidisciplinary environment was recognized as a priority of a radiation oncology physics residency only lately. In this report, we identify and discuss the implementation of, and the essential components of, a radiation oncology physics residency designed to produce knowledgeable and effective clinical physicists for today's safety-conscious and collaborative work environment. Our approach is that of inverse planning, by now familiar to all radiation oncology physicists, in which objectives and constraints are identified prior to the design of the program. Our inverse planning objectives not only include those associated with traditional residencies (i.e., clinical physics knowledge and critical clinical skills), but also encompass those other attributes essential for success in a modern radiation therapy clinic. These attributes include formal training in management skills and leadership, teaching and communication skills, and knowledge of error management techniques and patient safety. The constraints in our optimization exercise are associated with the limited duration of a residency and the training resources available. Without compromising the knowledge and skills needed for clinical tasks, we have successfully applied the model to the University of Calgary's two-year residency program. The program requires 3840 hours of overall commitment from the trainee, of which 7%-10% is spent in obtaining formal training in nontechnical "soft skills".

Professionalization in Pharmacy Education as a Matter of Identity

Little research exists on the formation of professional identity in higher education health programs. Such programs may approach the teaching, learning, and assessment of professionalism based upon a suite of attitudes, values, and behaviors considered indicative of a practicing professional. During this transition, professional identity formation can be achieved through student engagement with authentic experiences and interaction with qualified professionals. This paper examines the shift toward identity formation as an essential element of professional education and considers its implications for pharmacy curriculum design.

Challenges to professionalism: Social accountability and global environmental change

This article explores the concept of professionalism as it relates to social change and social accountability, and expands on them in the light of global environmental changes. Professionalism in medicine includes concepts of altruism, service, professional knowledge, self-regulation and autonomy. Current dialogues around social accountability suggest that medical schools should re-orientate their strategy and desired education, research and service outcomes to the health needs of the communities they serve.This article addresses the following questions: • How do we reconcile ideas of medical professionalism with the demands of creating a more equal, just, sustainable and socially inclusive society? • What new challenges do or will we face in relation to environmental degradation, biodiversity loss, ecosystem health and climate change? • How can medical schools best teach social and environmental responsiveness within a framework of professionalism? • How do medical schools ensure that tomorrow's doctors possess the knowledge, skills and attitude to adapt to the challenges they will face in future roles?We offer ideas about why and how medical educators can change, recommendations to strengthen the teaching of professionalism and social accountability and suggestions about the contribution of an emerging concept, that of "environmental accountability".

Learning medical professionalism with the online concordance-of-judgment learning tool (CJLT): A pilot study

CONTEXT

Professionalism development entails learning to make judgments in ambiguous situations. A Concordance of Judgment Learning Tool (CJLT), comprised of 20 vignettes involving professionalism issues, was developed. Students obtained a measure of how concordant their judgments were with a panel of experts and learned from given explanations.

METHOD

Twenty clinical vignettes implying professionalism issues were written including, for each, four possible courses of action. Expert panel, nominated by all clerkship students, was made up of attending physicians that best represented professionalism role models. Experts completed CJLT and gave explanations for their answers. All clerks were invited to answer each vignette, and then received automated expert feedback including explanations.

RESULTS

Seventy-nine students sat for the activity. The optimized test included 20 cases and 54 questions (Cronbach's alpha coefficient of 0.64). Student - expert concordance scores ranged from 54 to 77 with a mean at 64.6 (standard deviation 5.1). Satisfaction survey results indicated high satisfaction and relevance of tool despite some pitfalls. Post-test focus group data revealed relevant experiential learning on professionalism issues.

DISCUSSION

Students' scores and perceptions suggest pedagogic relevance of the CJLT in fostering professionalism development in clerkship. CJLT is user-friendly and shows promise as a situation experiential learning activity.

Professional development and exposure to geriatrics: medical student perspectives from narrative journals

Teaching professionalism is an important goal in American medical education. With the aging of the U.S. population, it is critical to understand how medical students develop professional behaviors when caring for older adults. Exposure to geriatrics and older patients can enhance students' professional development with patients of all ages and across different specialties. Medical students learn explicit and implicit messages during their education. In addition to helping to evaluate curricula, reflective journaling encourages individual development and helps in revealing how medical students become professionals. In this study, medical student volunteers described their responses to new geriatrics content in their curriculum, encounters with older patients in clinical settings, and their evolving physician identities. Multidisciplinary team analysis elicited 10 themes regarding: evaluation of geriatrics within the curriculum, recognition of geriatrics principles, and attitudes regarding aging and professional development over time. This article focuses on the impact of geriatrics exposure on students' professional development, revealing ways that students think about professionalism and older patients. Medical educators should consider journaling to help foster and gauge students' professional development.

Medical professionalism: an experimental look at physicians' Facebook profiles

BACKGROUND

Use of social networking services (SNS) is on the rise. While many users sign in for personal purposes, it is not uncommon for professionals to connect over SNSs with clients, students, and patients.

METHODS

The present study used an experimental approach to examine how medical doctors' SNS profiles impacted potential patients' impressions of professionalism. Participants (N=250 students) were randomly assigned to view one of six Facebook profiles. Profiles were populated with 1) solely professional material, 2) personal material that was strictly healthy, or 3) personal material that included unhealthy behavior. Profiles portrayed a male or female physician resulting in a total of six experimental conditions. Medical professionalism was measured with the First Impressions of Medical Professionalism (FIMP) scale, specifically developed for this study.

RESULTS

There was a large and statistically significant main effect for profile type, F(2, 250)=54.77, p<0.001, ηp(2)=0.31. Post hoc tests indicated that personal profiles that contained healthy behavior were rated as most professional followed by profiles with strictly professional content. Personal unhealthy profiles were rated as least professional. Additionally, female profiles consistently received higher professionalism ratings across all three profile types [F(1, 250)=5.04, p=0.026, ηp(2)=0.02].

CONCLUSION

Our results suggest that a physician's SNS profile affects a patient's perception of that physician's medical professionalism. A personal, healthy profile may augment a patient's perception of that physician's character virtues if the profile content upholds the decorum of the medical field.

'A world of difference': a qualitative study of medical students' views on professionalism and the 'good doctor'

BACKGROUND

The importance of professional behaviour has been emphasized in medical school curricula. However, the lack of consensus on what constitutes professionalism poses a challenge to medical educators, who often resort to a negative model of assessment based on the identification of unacceptable behaviour. This paper presents results from a study exploring medical students' views on professionalism, and reports on students' constructs of the 'good' and the 'professional' doctor.

METHODS

Data for this qualitative study were collected through focus groups conducted with medical students from one Western Australian university over a period of four years. Students were recruited through unit coordinators and invited to participate in a focus group. De-identified socio-demographic data were obtained through a brief questionnaire. Focus groups were audio-recorded, transcribed and subjected to inductive thematic analysis.

RESULTS

A total of 49 medical students took part in 13 focus groups. Differences between students' understandings of the 'good' and 'professional' doctor were observed. Being competent, a good communicator and a good teacher were the main characteristics of the 'good' doctor. Professionalism was strongly associated with the adoption of a professional persona; following a code of practice and professional guidelines, and treating others with respect were also associated with the 'professional' doctor.

CONCLUSIONS

Students felt more connected to the notion of the 'good' doctor, and perceived professionalism as an external and imposed construct. When both constructs were seen as acting in opposition, students tended to forgo professionalism in favour of becoming a 'good' doctor.Results suggest that the teaching of professionalism should incorporate more formal reflection on the complexities of medical practice, allowing students and educators to openly explore and articulate any perceived tensions between what is formally taught and what is being observed in clinical practice.

Professionalism education should reflect reality: findings from three health professions

CONTEXT

Despite a growing and influential literature, 'professionalism' remains conceptually unclear. A recent review identified three discourses of professionalism in the literature: the individual; the interpersonal, and the societal-institutional. Although all have credibility and empirical support, there are tensions among them.

OBJECTIVES

This paper considers how these discourses reflect the views of professionalism as they are expressed by students and educator-practitioners in three health care professions, and their implications for education.

METHODS

Twenty focus groups were carried out with 112 participants, comprising trainee and educator paramedics, occupational therapists and podiatrists. The focus group discussions addressed participants' definitions of professionalism, the sources of their perceptions, examples of professional and unprofessional behaviour, and the point at which participants felt one became 'a professional'.

RESULTS

Analysis found views of professionalism were complex, and varied within and between the professional groups. Participants' descriptions of professionalism related to the three discourses. Individual references were to beliefs or fundamental values formed early in life, and to professional identity, with professionalism as an aspect of the self. Interpersonal references indicated the definition of 'professional' behaviour is dependent on contextual factors, with the meta-skill of selecting an appropriate approach being fundamental. Societal-institutional references related to societal expectations, to organisational cultures (including management support), and to local work-group norms. These different views overlapped and combined in different ways, creating a complex picture of professionalism as something highly individual, but constrained or enabled by context. Professionalism is grown, not made.

CONCLUSIONS

The conceptual complexity identified in the findings suggests that the use of 'professionalism' as a descriptor, despite its vernacular accessibility, may be problematic in educational applications in which greater precision is necessary. It may be better to assume that 'professionalism' as a discrete construct does not exist per se, and to focus instead on specific skills, including the ability to identify appropriate behaviour, and the organisational requirements necessary to support those skills.

Defining professionalism in medical education: a systematic review

INTRODUCTION

We undertook a systematic review and narrative synthesis of the literature to identify how professionalism is defined in the medical education literature.

METHODS

Eligible studies included any articles published between 1999 and 2009 inclusive presenting viewpoints, opinions, or empirical research on defining medical professionalism.

RESULTS

We identified 195 papers on the topic of definition of professionalism in medicine. Of these, we rated 26 as high quality and included these in the narrative synthesis.

CONCLUSION

As yet there is no overarching conceptual context of medical professionalism that is universally agreed upon. The continually shifting nature of the organizational and social milieu in which medicine operates creates a dynamic situation where no definition has yet taken hold as definitive.