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Ryan A, Moran CN, Byrne D, Hickey A, Boland F, Harkin DW, Guraya SS, Bensaaud A, Doyle F. Do professionalism, leadership, and resilience combine for professional identity formation? Evidence from confirmatory factor analysis. Front Med (Lausanne) 2024; 11:1385489. [PMID: 38938377 PMCID: PMC11208471 DOI: 10.3389/fmed.2024.1385489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/27/2024] [Indexed: 06/29/2024] Open
Abstract
Introduction Professional identity formation (PIF) is an ongoing, self-reflective process involving habits of thinking, feeling and acting like a physician and is an integral component of medical education. While qualitative work has suggested that PIF is informed by professionalism, resilience, and leadership, there is a dearth of quantitative work in this area. Multiple methods build rigor and the present study aimed to quantitatively assess the relative psychometric contributions of professionalism, resilience, and leadership constructs to informing PIF, using a latent factor analysis approach. Methods We analyzed data from the PILLAR study, which is an online cross-sectional assessment of a pre-clinical cohort of medical students in the RCSI University of Medicine and Health Sciences, Dublin, using established and validated quantitative measures in each area of interest: PIF, professionalism, leadership and resilience. A total of 76 items, combining four validated scales, along with a selection of demographic questions, were used. The hypothesis that PIF is informed by, and correlates with, professionalism, resilience and leadership was examined by conducting a confirmatory factor analysis of a proposed three-factor higher-order model. Model estimation used Maximum Likelihood Method (MLM) with geomin rotation. The hypothesized (measurement) model was examined against an alternative (saturated) model, as well as a three-factor model. Results Latent variable analysis from 1,311 students demonstrated that a three-factor higher-order model best fit the data; suggesting PIF is informed by professionalism, resilience, and leadership, and that these constructs are statistically distinct and account for differential aspects of PIF. This higher-order model of PIF outperformed both the saturated model and the three-factor model. The analysis of which component may be the most or least influential was inconclusive, and the overall model was not influenced by year of training. Discussion Building upon existing conceptual contentions, our study is the first to quantitatively support the contribution of professionalism, resilience, and leadership to the development of professional identity, and to delineate the inter-relationships between PIF and these constructs. This information can be used by medical educators when designing curricula and educational strategies intended to enhance PIF. Future work should seek to assess the influence of these constructs longitudinally.
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Affiliation(s)
- Aine Ryan
- Centre for Professionalism in Medicine and Health Sciences at Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Catherine N. Moran
- Department of Health Psychology, School of Population Health, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - David Byrne
- Department of Health Psychology, School of Population Health, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Anne Hickey
- Department of Health Psychology, School of Population Health, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Fiona Boland
- Data Science Centre, School of Population Health, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Denis W. Harkin
- Centre for Professionalism in Medicine and Health Sciences at Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Shaista S. Guraya
- Institute of Learning, Mohammad Bin Rashid University, Dubai, United Arab Emirates
| | - Abdelsalam Bensaaud
- Centre for Professionalism in Medicine and Health Sciences at Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Frank Doyle
- Department of Health Psychology, School of Population Health, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
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Wong LY, Sendjaya S, Wilson S, Rixon A. Evidence behind the exhortation? A rapid review of servant leadership's influence and claims in healthcare over the last decade. BMJ LEADER 2024; 8:88-92. [PMID: 37491151 DOI: 10.1136/leader-2023-000796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/16/2023] [Indexed: 07/27/2023]
Abstract
Servant leadership is an other-oriented approach to leadership with multiple positive outcomes. However, its influence in the context of medicine, particularly on healthcare leaders, is less clear. We conducted a rapid review to examine the impact of servant leadership in healthcare over the last decade. We included a total of 28 articles, 26 of which described beneficial organisational, relational and personal outcomes of servant leadership. However, most of these were either conceptual or opinion-based articles. Moreover, most quantitative studies were cross-sectional, precluding causal inferences. Our review demonstrates that the purported positive association between servant leadership and healthcare outcomes lacks a strong evidence base. We conclude by calling for more rigorous empirical research to examine the effects and potential challenges of implementing servant leadership in healthcare contexts.
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Affiliation(s)
- Lee Yung Wong
- School of Business, Law and Entrepreneurship, Swinburne University of Technology, Hawthorn, Victoria, Australia
- Emergency Department, Austin Health, Heidelberg, Victoria, Australia
| | - Sen Sendjaya
- Department of Management and Marketing, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Samuel Wilson
- Department of Management and Marketing, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Andrew Rixon
- Department of Business Strategy and Innovation, Griffith University, Nathan, Queensland, Australia
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Cornett M, Palermo C, Ash S. Professional identity research in the health professions-a scoping review. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:589-642. [PMID: 36350489 PMCID: PMC10169899 DOI: 10.1007/s10459-022-10171-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/27/2022] [Indexed: 05/11/2023]
Abstract
Professional identity impacts the workforce at personal, interpersonal and profession levels however there is a lack of reviews of professional identity research across practising health professionals. To summarise professional identity research in the health professions literature and explore how professional identity is described a scoping review was conducted by searching Medline, Psycinfo, Embase, Scopus, CINAHL, and Business Source Complete using "professional identity" and related terms for 32 health professions. Empirical studies of professional identity in post-registration health professionals were examined with health profession, career stage, background to research, theoretical underpinnings and constructs of professional identity being extracted, charted and analysed using content analysis where relevant. From 9941 studies, 160 studies across 17 health professions were identified, with nursing and medicine most common. Twenty studies focussed on professional identity in the five years post-entry to the workforce and 56 studies did not state career stage. The most common background for the research was the impact of political, social and healthcare reforms and advances. Thirty five percent of studies (n = 57) stated the use of a theory or framework of identity, the most common being classified as social theories. Individual constructs of professional identity across the research were categorised into five themes-The Lived Experience of Professional Identity; The World Around Me; Belonging; Me; and Learning and Qualifications. Descriptions of professional identity are broad, varied, rich and multi-layered however the literature is under theorised with current theories potentially inadequate to capture its complexity and make meaningful contributions to the allied health professions.
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Affiliation(s)
- Marian Cornett
- Monash Centre for Scholarship in Health Education, Monash University, Faculty of Medicine, Nursing and Health Sciences, Melbourne, Australia.
| | - Claire Palermo
- Monash Centre for Scholarship in Health Education, Monash University, Faculty of Medicine, Nursing and Health Sciences, Melbourne, Australia
| | - Susan Ash
- Monash Centre for Scholarship in Health Education, Monash University, Faculty of Medicine, Nursing and Health Sciences, Melbourne, Australia
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Girvin B, Sims L, Haughey S. Empowering future pharmacists - Embedding prescribing in the United Kingdom pharmacy undergraduate degree. CURRENTS IN PHARMACY TEACHING & LEARNING 2023; 15:334-339. [PMID: 37105795 DOI: 10.1016/j.cptl.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 02/14/2023] [Accepted: 04/17/2023] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Pharmacy education within the United Kingdom (UK) is on the cusp of a major change with the integration of pharmacist independent prescribing into the undergraduate Master of Pharmacy (MPharm) degree and foundation year. This presents an opportunity for schools of pharmacy to completely review and redesign the MPharm degree in order to embed prescribing. This commentary details what needs to change within the MPharm degree and how these changes can be enacted. COMMENTARY The learning outcomes for the new degree place greater emphasis on diagnostic and consultation skills, risk management, professional judgement, and leadership. Course content needs to be sequenced so that complexity builds throughout the programme and clinical skills are taught and practised within the context of prescribing. There will be more emphasis on higher-order cognitive skills, such as collaborative clinical decision-making, considering potential risks and benefits. Teaching will need to align with learning on placements and time needs built into the curriculum for preparation and debrief sessions following placements and simulation scenarios. The increased responsibility that comes with prescribing rights will require review of how professional identity is formed and professionalism skills are taught and assessed. IMPLICATIONS Pharmacists' expertise in medicines means that they are well-placed to be prescribers, which will help meet health service demands. Long-term funding will be required for placements in community, general practice, and hospital settings, including the provision of training and support to pharmacists mentoring students on placements. In spite of the challenges of curriculum redesign, this opportunity is wholeheartedly welcomed.
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Affiliation(s)
- Briegeen Girvin
- School of Pharmacy, Queen's University Belfast, United Kingdom.
| | - Laura Sims
- University of Exeter Medical School, United Kingdom.
| | - Sharon Haughey
- School of Pharmacy, Queen's University Belfast, United Kingdom.
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McKimm J, Ramani S, Forrest K, Bishop J, Findyartini A, Mills C, Hassanien M, Al-Hayani A, Jones P, Nadarajah VD, Radu G. Adaptive leadership during challenging times: Effective strategies for health professions educators: AMEE Guide No. 148. MEDICAL TEACHER 2023; 45:128-138. [PMID: 35543323 DOI: 10.1080/0142159x.2022.2057288] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Leadership and management are becoming increasingly recognised as vital for high-performing organisations and teams in health professions education. It is often difficult for those embarking on leadership activities (as well as more experienced leaders) to find their way through the volume of literature and generic information on the topic. This guide aims to provide a framework for developing educators' understanding of leadership, management, and followership in the context of health professions education. It explains many relevant approaches to leadership and suggests various strategies through which educators can develop their practice to become more effective.
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Affiliation(s)
- Judy McKimm
- Swansea University Medical School, Wales, UK
- Department of Internal Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Subha Ramani
- Harvard Medical School, Boston, USA
- Massachusetts General Hospital Institute for Health Professions Education, Boston, USE
- Honorary Professor of Medical Education, University of Manchester, Manchester, UK
| | - Kirsty Forrest
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Jo Bishop
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Ardi Findyartini
- Head of Medical Education Unit and Head of Cluster, Centre for Medical Education, Indonesia Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Chloe Mills
- Department of Applied Linguistics, Swansea University, Swansea, UK
| | - Mohammed Hassanien
- Department of Clinical Biochemistry & Medicasl Education, College of Pharmacy Practice, King Abdulaziz University, Jeddah, Saudi Arabia
- College of Medicine, Tanta University, Tanta, Egypt
| | - Abdulmonem Al-Hayani
- Anatomy, Department of Anatomy, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Paul Jones
- Faculty of Medicine & Health Sciences, Swansea University, Swansea, UK
| | - Vishna Devi Nadarajah
- Institutional Development at the International Medical University, Kuala Lumpur, Malaysia
| | - Greg Radu
- Departement of Psychiatry, Memorial University, St. Clare's Hospital, St. John's, Canada
- Department of Health and Community Services, Government of Newfoundland and Labrador, St John's, Canada
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Inayat H, Torti J, Hemmett J, Lingard L, Chau B, Inayat A, Elzinga JL, Sultan N. An Approach to Leadership Development and Patient Safety and Quality Improvement Education in the Context of Professional Identity Formation in Pre-Clinical Medical Students. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231170522. [PMID: 37187919 PMCID: PMC10176555 DOI: 10.1177/23821205231170522] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/31/2023] [Indexed: 05/17/2023]
Abstract
Objectives Leadership and patient safety and quality improvement (PSQI) are recognized as essential parts of a physician's role and identity, which are important for residency training. Providing adequate opportunities for undergraduate medical students to learn skills related to these areas, and their importance, is challenging. Methods The Western University Professional Identity Course (WUPIC) was introduced to develop leadership and PSQI skills in second-year medical students while also aiming to instill these topics into their identities. The experiential learning portion was a series of student-led and physician-mentored PSQI projects in clinical settings that synthesized leadership and PSQI principles. Course evaluation was done through pre/post-student surveys and physician mentor semi-structured interviews. Results A total of 108 of 188 medical students (57.4%), and 11 mentors (20.7%), participated in the course evaluation. Student surveys and mentor interviews illustrated improved student ability to work in teams, self-lead, and engage in systems-level thinking through the course. Students improved their PSQI knowledge and comfort levels while also appreciating its importance. Conclusion The findings from our study suggest that undergraduate medical students can be provided with an enriching leadership and PSQI experience through the implementation of faculty-mentored but student-led groups at the core of the curricular intervention. As students enter their clinical years, their first-hand PSQI experience will serve them well in increasing their capacity and confidence to take on leadership roles.
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Affiliation(s)
- Hamza Inayat
- Schulich School of Medicine &
Dentistry at Western University in London, Ontario, Canada
| | - Jacqueline Torti
- Department of Medicine, and Scientist,
Centre for Education Research and Innovation, Schulich School of Medicine and
Dentistry, Western University, London, Canada
| | - Juliya Hemmett
- Division of Nephrology, Department of
Medicine, Cummings School of Medicine, Calgary, Canada
| | - Lorelei Lingard
- Department of Medicine, and Scientist,
Centre for Education Research and Innovation, Schulich School of Medicine and
Dentistry, Western University, London, Canada
| | - Brandon Chau
- Department of Emergency Medicine,
University of British Columbia, Kelowna, Canada
| | - Ali Inayat
- Medical Student at the St. George's
University, Grenada, West Indies, and Northumbria University, Newcastle,
England
| | - Jason L. Elzinga
- Physician for the Department of
Emergency Medicine at the University of Calgary, Calgary, Canada
| | - Nabil Sultan
- Nephrologist and Associate Professor in
the Department of Nephrology, Schulich School of Medicine &
Dentistry, Western University, London, Canada
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Ryan A, Hickey A, Harkin D, Boland F, Collins ME, Doyle F. Professional Identity Formation, Professionalism, Leadership and Resilience (PILLAR) in Medical Students: Methodology and Early Results. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231198921. [PMID: 37692556 PMCID: PMC10483968 DOI: 10.1177/23821205231198921] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/13/2023] [Indexed: 09/12/2023]
Abstract
Objectives The fundamental role of medical education is the transformation of students to doctors, through a process of education and professional identity formation (PIF), which can be informed by several educational, behavioural and emotional factors. PIF has been deemed to be of equal importance to the acquisition of clinical knowledge and skills and includes constructs such as professionalism, leadership and resilience. We aimed to assess professional identity formation, professionalism, leadership and resilience (PILLAR) in the junior years of medical school in the 2020/2021 academic year and illustrate the potential role of quantitative assessment to demonstrate progression in these areas. In this research, we provide the methods and baseline results for the PILLAR study. Methods We implemented a compulsory assessment in pre-clinical years of graduate entry and direct entry medicine at the Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland. Validated scales were used to assess students' PILLAR. Descriptive and univariable statistical techniques were used to compare student scores between respective years. Results A total of 1311 students (92% response rate) provided their consent for research. For the psychometric scales, there were no evident trends among the years on these assessment measures. Results indicated significant differences in all measures, however, these did not correspond to ascending years of seniority. Conclusion The PILLAR methodology provides important information on the challenges of quantitatively assessing medical students in the four key areas of PIF, professionalism, leadership, and resilience. Our cross-sectional results point to cohort effects, without the expected progression per year in the cross-sectional data, or suggest that the chosen quantitative measures may be problematic for these constructs in pre-clinical students. Therefore, while we believe that PILLAR has potential as a progress test for these constructs, this will only truly be elucidated by repeated measures of each cohort over time.
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Affiliation(s)
- Aine Ryan
- Centre for Professionalism in Medicine and Health Sciences, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Anne Hickey
- Department of Health Psychology, School of Population Health, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Denis Harkin
- Centre for Professionalism in Medicine and Health Sciences, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Fiona Boland
- Data Science Centre, School of Population Health, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Mary E. Collins
- Royal College of Surgeons in Ireland Graduate School of Healthcare Management, Dublin, Ireland
| | - Frank Doyle
- Department of Health Psychology, School of Population Health, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
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