Learning health professionalism at Makerere University: an exploratory study amongst undergraduate students

The Effect of Teaching Professionalism by Using Real Lifetime Scenarios in Undergraduate Medical Students: An Educational Trial

Introduction

The objective of this research is to evaluate the effect of teaching professionalism by real lifetime scenario to undergraduate MBBS medical students.

Methods

This comparative quasi-experimental trial was conducted in OBS/GYN department from May 2019 to Jan 2020. The final year MBBS students of Shalamar Medical and Dental College, Lahore, who attended the clinical rotation of Gynae OBS were enrolled in the study using consecutive sampling. Each batch consists of 15 students. The first two batches were taken as active control, whereas the third batch was taken as an interventional group. The certified faculty in medical education assessed professionalism by using P-MEX at the start and end of the rotation in the gynae ward. P-MEX data are presented as mean and standard deviation. The comparison between the two groups was done using independent sample t-test, and pre- and post-comparison within group was done by paired sample t-test. P-value less than 0.05 was considered as significant.

Results

Among the 45 students, 28(62.22%) were male and 17(37.78%) were female. Age and gender were statistically similar in both groups. The average total score, at the start of the rotation of the intervention group was 1.95±0.294, whereas the active control group was 2.23±0.31. At the end of the rotation, the average total score of the intervention group was 3.22±0.48 and active control was 2.56±0.53. Pre- and post P-MEX score was statistically significant with P<0.001.

Conclusion

This research showed that the teaching of professionalism using real lifetime scenarios led to statistically significant improvement of professionalism in the form of P-MEX mean score among final MBBS students.

The hidden curriculum across medical disciplines: an examination of scope, impact, and context

Background

While research suggests that manifestations of the hidden curriculum (HC) phenomenon have the potential to reinforce or undermine the values of an institution, very few studies have comprehensively measured its scope, impact, and the varied clinical teaching and learning contexts within which they occur. We explored the HC and examined the validity of newly developed constructs and determined the influence of context on the HC.

Methods

We surveyed medical students (n =182), residents (n =148), and faculty (n = 140) from all disciplines at our institution between 2019 and 2020. Based on prior research and expertise, we measured participants' experience with the HC including perceptions of respect and disrespect for different medical disciplines, settings in which the HC is experienced, impact of the HC, personal actions, efficacy, and their institutional perceptions. We examined the factor structure, reliability, and validity of the HC constructs using exploratory factor analysis Cronbach's alpha, regression analysis and Pearson's correlations.

Results

Expert judges (physician faculty and medical learners) confirmed the content validity of the items used and the analysis revealed new HC constructs reflecting negative expressions, positive impacts and expressions, negative impacts, personal actions, and positive institutional perceptions of the HC. Evidence for criterion validity was found for the negative impacts and the personal actions constructs and were significantly associated with the stage of respondents' career and gender. Support for convergent validity was obtained for HC constructs that were significantly correlated with certain contexts within which the HC occurs.

Conclusion

More unique dimensions and contexts of the HC exist than have been previously documented. The findings demonstrate that specific clinical contexts can be targeted to improve negative expressions and impacts of the HC.

"Should I Say Something?": A Simulation Curriculum on Addressing Lapses in Professionalism to Improve Patient Safety

Introduction

Medical students may witness lapses in professionalism but lack tools to effectively address such episodes. Current professionalism curricula lack opportunities to practice communication skills in addressing professionalism lapses.

Methods

We designed a simulation curriculum to introduce professionalism expectations, provide communication tools using elements of the Agency for Healthcare Research and Quality TeamSTEPPS program, and address observed professionalism lapses involving patient safety in hierarchical patient care teams. Students were surveyed on knowledge, skills, and attitude regarding professionalism before, immediately after, and 6 months after participation.

Results

Of 253 students, 70 (28%) completed baseline and immediate postsurveys, and 39 (15%) completed all surveys. In immediate postsurveys, knowledge of communication tools (82% to 94%, p = .003) and empowerment to address residents (19% to 44%, p = .001) and attendings (15% to 39%, p < .001) increased. At 6 months, 96% of students reported witnessing a professionalism lapse.

Discussion

The curriculum was successful in reported gains in knowledge of communication tools and empowerment to address professionalism lapses, but few students reported using the techniques to address witnessed lapses in real life.

Exploring the interest of medical students in global health in South Korea: Does taking a global health course matter?

BACKGROUND

Prioritizing global health is important for positive health outcomes. Doctors play a pivotal role in addressing health issues that they need to recognize the importance of global health practice. However, medical education in global health is still in its early stages in many countries, including South Korea.

METHODS

This study is a quantitative cross-sectional study. Medical students were recruited from all 40 Korean medical schools and data collection was conducted in 2021. Stratified proportional quota sampling was employed as the sampling method. The study examined medical students' interest in global health as the dependent variable. Independent variables included whether individuals had taken global health courses as part of their medical curriculum, while covariates included student background and institutional factors. Logistic regression was used to determine if taking a global health class was associated with global health interests.

RESULTS

The study included 2450 participants and almost 32% of medical students (n = 781) were interested in global health. Taking global health classes in school was associated with a higher likelihood of developing an interest in global health (OR: 1.29, 95% CI: 1.00-1.67). The likelihood of being interested in global health decreased across the academic year (OR: 0.70, 95% CI: 0.53-0.94). Individuals in graduate entry programs were associated with an interest in global health (OR: 1.32, 95% CI: 1.01-1.72).

CONCLUSION

This study provides the first comprehensive nationwide assessment of medical students' perspectives on global health education in South Korea. The findings underscore the importance of early and sustained exposure to global health topics in medical education in fostering interest in global health. These results can serve as valuable evidence for medical educators seeking to integrate global health education into their curricula.

Positive consequences of the hidden curriculum in undergraduate nursing education: An integrative review

Background:

Hidden Curriculum (HC) plays an essential role in nursing education and professionalism. However, its positive consequences have been overlooked. Thus, this study aimed to explore and discuss the positive consequences of HC in nursing undergraduate education.

Materials and Methods:

A comprehensive literature search was conducted to investigate articles published between January 2010 and December 2020. Furthermore, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used to select articles, and Consolidated criteria for Reporting Qualitative research (COREQ) and Strengthening the Reporting of Observational studies in Epidemiology (STROBE) tools were employed to appraise qualitative and quantitative studies, respectively. The applied search strategy resulted in a final list of 16 articles out of a total of 132 articles. Next, the data were integrated and categorized using the Whittemore and Knafl methodology.

Results:

Three categories were identified: Individual Consequences; involving increased self-confidence, self-esteem, assertiveness, adaptation, autonomy, and lifelong learning. Social Consequences; involving enhanced socialization, cultural consciousness, and social interactions. Professional Consequences; involving professional socialization, professional identity, professional ethics, link theory and practice, and professional dignity.

Conclusions:

Altogether, we concluded that the emergence of HC and its positive and remarkable consequences in nursing knowledge helps the personal, social, and professional development in nursing.

Assessment of Medical Professionalism among Students and Faculty Members of Shalamar Medical and Dental College, Lahore

INTRODUCTION

Medical professionalism is an essential part of training and professional development of medical students. Unprofessional behavior in medical school may lead to professional misconduct in the future careers. The Learner's Attitude of Medical Professionalism Scale (LAMPS) is a self-assessment questionnaire. It has been used in this study to assess and compare self-reported attitudes about different domains of medical professionalism among First and Final Year students and Faculty of Shalamar Medical and Dental College (SMDC). LAMPS has been used to identify the gaps in the attitudes of medical students and professionals, which can be addressed through a training program of professionalism.

METHODS

This is a cross-sectional survey conducted in SMDC from June to Dec 2018. First Year and Final Year Students and Faculty were recruited by non-probability convenience sampling. The sample size was calculated by the Cochran's Formula, keeping the level of significance at 5% and margin of error at 3%. The reliability of LAMPS using Cronbach's alpha is 0.7. It has been validated by 32 experts followed by pilot testing. The domains of professionalism were scored according to Likert Scale. The data were analyzed using SPSS 24. T-test was used for comparison of the means.

RESULTS

There were a total of 204 study participants; 88 students from First Year, 78 from Final Year and 38 Faculty Members. Honor/Integrity was the most valued trait and Excellence/Autonomy was the lowest scored domain of medical professionalism. There was a significant difference among attitudes of the First and Final Year students in the domains of Excellence/Autonomy and Altruism. Excellence/Autonomy and Honor/Integrity showed a significant difference between the Final Year students and Faculty.

CONCLUSIONS

Medical students and faculty have significantly different views of certain attributes of professionalism. Honor/Integrity was the most valued trait and Excellence/Autonomy was the lowest valued trait of medical professionalism.

Transfusion medicine and blood banking education and training for blood establishment laboratory staff: A review of selected countries in Africa

BACKGROUND

Avoidable human error is a significant cause of transfusion adverse events. Adequately trained, laboratory staff in blood establishments and blood banks, collectively blood facilities, are key in ensuring high-quality transfusion medicine (TM) services. Gaps in TM education and training of laboratory staff exist in most African countries. We assessed the status of the training and education of laboratory staff working in blood facilities in Africa.

STUDY DESIGN AND METHODS

A cross-sectional study using a self-administered pilot-tested questionnaire was performed. The questionnaire comprised 26 questions targeting six themes. Blood facilities from 16 countries were invited to participate. Individually completed questionnaires were grouped by country and descriptive analysis performed.

RESULTS

Ten blood establishments and two blood banks from eight African countries confirmed the availability of a host of training programs for laboratory staff; the majority of which were syllabus or curriculum-guided and focused on both theoretical and practical laboratory skills development. Training was usually preplanned, dependent on student and trainer availability and delivered through lecture-based classroom training as well as formal and informal on the job training. There were minimal online didactic and self-directed learning. Teaching of humanistic values appeared to be lacking.

CONCLUSION

We confirmed the availability of diverse training programs across a variety of African countries. Incorporation of virtual learning platforms, rather than complete reliance on didactic, in-person training programs may improve the education reach of the existing programs. Digitalization driven by the coronavirus disease 2019 pandemic may provide an opportunity to narrow the knowledge gap in low- and middle-income countries (LMICs).

Perceptions of medical students towards the practice of professionalism at the Arabian Gulf University

BACKGROUND

To enhance the development of a curriculum in professionalism for medical students, the aim of this research was to evaluate medical students' responses regarding professionalism teaching and behaviors in their clinical experience at the Arabian Gulf University (AGU).

METHODS

A retrospective cross-sectional, questionnaire-based study involving Year 5 medical students at the AGU. We used a "climate of professionalism" survey that consisted of two parts. The first part asked students to rate their perceptions of the frequency of professionalism practices of their peers (medical students), residents, and faculty. The response choices included: "mostly", "sometimes", and "rarely". The second part asked the students to assess their perceptions of the professionalism teaching and behaviors of the faculty. The response choices included: "mostly", "sometimes", and "rarely". We calculated an overall score for the responses in both parts of the questionnaire by assigning 3, 2, and 1 points to the response choices, respectively. We also calculated subscale scores reflecting different professionalism constructs. We used descriptive statistics and a one-way Analysis of Variance (ANOVA) followed by multiple testing comparisons with Bonferroni correction to examine pairwise comparisons. A p < 0.05 was considered statistically significant.

RESULTS

The mean total scores of participants' ratings of professional behaviors of medical students, residents, and faculty for each academic year were approximately 60% of the total maximum score. The mean total scores of participants' rating of faculty's teaching and modeling behaviors concerning professionalism were approximately 58% of the maximum score. Compared with similar studies performed in the Arab Region, ratings regarding professional teaching and modeling of professionalism were lower.

CONCLUSION

We recommend the further evaluation of professionalism teaching and behaviors at the AGU and further discussions regarding curriculum reform.

Attitudes toward professionalism in medical students and its associations with personal characteristics and values: a national multicentre study from Slovenia raising the question of the need to rethink professionalism

Background: Professionalism is becoming one of the main competencies that all medical students should develop during their education. The attitudes of medical students to professionalism in the study process can change, depending on the curriculum and methods of teaching. Factors associated with attitudes to professionalism can be divided into the characteristics of the physician and the context, eg, education about professionalism and the health system; however other student characteristics are also important. This study focused on the factors associated with attitudes toward professionalism and took into account student demographic characteristics, personality and their personal values. Methods: A convenience sampling method was employed in the academic year 2015-2016 in the fourth and final year medical students at the two Medical Faculties in Slovenia. The instrument consisted of questionnaires examining the Big Five personality traits questionairre (BFQ), the scale of personal values and demographic and family background data. The outcome measure was the validated professionalism attitude scale (PAS). Results: A total of 323 students participated, of which 101 (31.3%) were men and 222 (68.7%) were women. The samples of the two faculties did not differ in any demographic characteristics and were analyzed together. Of the personal values, partner/love, profession/work and sport activity were significantly associated with the total score of the PAS (β=0.22, p=0.033; β=0.24, p=0.003; β=0.17, p=0.040, respectively). After the adjustments for the BFQ dimensions, only profession/work kept significance (β=0.19, p=0.016). Women scored significantly higher on attitudes toward professionalism (total PAS score: M_w=93.4±5.1, M_m=89.1±9.8, p=0.001), and this significance remained in multivariate modeling (β=-0.20, p=0.001). Of the hereditary traits, only acceptability was associated with attitudes toward professionalism (β=0.25, p<0.001). Conclusions: It seems that personal characteristics and values are important in students` concept of their future professional behavior. Further research will show whether these patterns are prerequisites for enrollment in the study process.

Host clinical preceptors' perceptions of professionalism among learners completing global health electives

OBJECTIVES

This study aims to gain an understanding of the perceptions of host clinical preceptors in Malawi and Lesotho of the professionalism exhibited by short-term learners from the United States and Canada during short-term global health electives.

METHODS

Focus group discussions were conducted with 11 host clinical preceptors at two outpatient pediatric HIV clinics in sub-Saharan Africa (Malawi and Lesotho). These clinics host approximately 50 short-term global health learners from the United States and Canada each year. Focus group moderators used open-ended discussion guides to explore host clinical preceptors' perceptions of the professionalism of short-term global health learners. Thematic analysis with an inductive approach was used to identify salient themes from these focus group discussions.

RESULTS

Eleven of the 18 possible respondents participated in two focus group discussions. Adaptability, eagerness to learn, active listening, gratitude, initiative, and punctuality was cited as professional behaviors among short-term global health learners. Cited unprofessional behaviors included disregard of local clinicians' expertise and unresponsiveness to feedback. Host clinical preceptors described difficulty providing feedback to short-term global health learners and discrepancies between what may be considered professional in their home setting versus in the study settings. Respondents requested pre-departure orientation for learners and their own orientation before hosting learners.

CONCLUSIONS

Both host clinical preceptors and short-term global health learners should be aware that behaviors that may be considered best practice in one clinical setting may be perceived as unprofessional in another. Future studies to develop a common definition of professionalism during short-term global health electives are merited.

The Hidden Curricula of Medical Education: A Scoping Review

PURPOSE

To analyze the plural definitions and applications of the term "hidden curriculum" within the medical education literature and to propose a conceptual framework for conducting future research on the topic.

METHOD

The authors conducted a literature search of nine online databases, seeking articles published on the hidden, informal, or implicit curriculum in medical education prior to March 2017. Two reviewers independently screened articles with set inclusion criteria and performed kappa coefficient tests to evaluate interreviewer reliability. They extracted, coded, and analyzed key data, using grounded theory methodology.

RESULTS

The authors uncovered 3,747 articles relating to the hidden curriculum in medical education. Of these, they selected 197 articles for full review. Use of the term "hidden curriculum" has expanded substantially since 2012. U.S. and Canadian medical schools are the focus of two-thirds of the empirical hidden curriculum studies; data from African and South American schools are nearly absent. Few quantitative techniques to measure the hidden curriculum exist. The "hidden curriculum" is understood as a mostly negative concept. Its definition varies widely, but can be understood via four conceptual boundaries: (1) institutional-organizational, (2) interpersonal-social, (3) contextual-cultural, and/or (4) motivational-psychological.

CONCLUSIONS

Future medical education researchers should make clear the conceptual boundary or boundaries they are applying to the term "hidden curriculum," move away from general musings on its effects, and focus on specific methods for improving the powerful hidden curriculum.

A preliminary survey of professionalism teaching practices in anatomy education among Indian Medical Colleges

Professionalism and ethics have gained widespread recognition as competencies to be fulfilled, taught, and assessed within medical education. The role of the anatomy course in developed nations has evolved over time and now encompasses multiple domains, including knowledge, skills, and the inculcation of professionalism and ethics. The Medical Council of India recently recommended the integration of professionalism teaching in undergraduate medical curricula. The authors investigated whether the initial orientation lectures and instructions given by faculty at the outset of undergraduate medical anatomy courses throughout India served a "hidden curriculum" regarding professionalism practices, and whether these orientation messages could serve as an early exposure to medical professionalism and ethics for medical students. An online survey was carried out among 102 anatomy faculty members across India requesting details about specific professionalism protocols and instructions regarding behavior in the dissection hall that are routinely given to preclinical students, as well as the importance that they placed on professional behavior. It was found that most faculty members regularly instruct students regarding expected behavior during the anatomy course, including dissection practices. These instructions stress attributes of professionalism like humanism, accountability, and honesty. However, there needs to be a more concentrated effort by educators to prohibit such unprofessional practices like dissection hall photography, and better information is required regarding biomedical waste disposal. Despite the absence of clear guidelines for professionalism teaching in medical education in India, the existing framework of anatomy education provides an opportunity to introduce the concept of professionalism to the first-year medical student. This opportunity may provide an early foundation for designing a professionalism-integrated curriculum. Anat Sci Educ 10: 433-443. © 2017 American Association of Anatomists.

Physicians' Practice of Dispensing Medicines: A Qualitative Study

OBJECTIVES

The physical act of giving medication to patients to administer away from a health care setting, dispensing, is normally performed by pharmacists. Dispensing of medication by physicians is a neglected patient safety issue, and having observed considerable variation in practice, the lead author sought to explore this issue further. A literature review yielded zero articles pertaining to this, so an exploratory study was commenced. The qualitative arm, relating to junior physicians' experience of, and training in, dispensing, is reported here.

METHODS

Focus groups were conducted to explore the beliefs, ideas, and experiences of physicians-in-training pertaining to dispensing of medication. These were recorded and transcribed. The transcriptions were thematically analyzed using the grounded theory.

RESULTS

The emergency department was the most common site of dispensing. No formal training in dispensing had been received. Informal training was variable in content and utility. The physicians felt that dispensing was part of their role.

CONCLUSIONS

Despite being expected to dispense, and the patient safety issues involved in giving drugs to patients to use at home, physicians do not feel that they have been trained to undertake this task. These findings from 1 hospital raise questions about the wider quality and safety of this practice.

Applying conscientiousness index: a tool to explore medical students' professionalism in Indonesia

OBJECTIVES

This study was aimed to describe lecturers' perspective concerning the suitable Conscientiousness Index (CI) components and implementations, as well as to compare the CI scores in year 1-4 student batches.

METHODS

Components were formulated from objective measurements based on interviews with 12 faculty members. The components include: attendance, adherence to rules, evaluative feedback submissions, performance in assignments and clinical skills, assignment submissions, volunteerism, accomplishments, and general misconducts. The scores were collected from year 1-4 pre-clinical medical students (N=144) during the first semester of 2014-2015. Final interviews were conducted with 9 faculty members. Quantitative analysis was performed using Kruskal-Wallis and Mann-Whitney test. Qualitative analysis was performed using content analysis.

RESULTS

Using Kruskal-Wallis test, significant difference was found in the CI scores among all years (p=0.000). Post-hoc analysis using Mann-Whitney test showed significant difference in all years except year 1 and 4 (p=0.388). Of the 9 lecturers interviewed during the second interviews, 7 endorsed the importance of CI, while 2 doubted its applicability.

CONCLUSIONS

Due to the unique characteristics of each block, our system had not been able to conduct a balanced CI evaluation, as compared to the original research. We concluded that the implementation of CI would be highly dependent on the faculty members, with their commitment as the main pre-requisite. We hope to involve academic advisors as CI evaluators and improve our student-centered learning for future assessments. Further study is needed to investigate the longitudinal implementation of CI.

Perception of medical professionalism among the surgical community in the University of Nairobi: a mixed method study

BACKGROUND

Professionalism defines the relationship between colleagues, patients and the society as a whole. Furthermore, being a social construct, professionalism is sophisticated to be regarded simply as a single concept across different cultural contexts. This study sought to explore how professionalism is conceptualized by the clinicians, students and patients in a teaching hospital in Kenya.

METHODS

A sequential mixed methods study was conducted among clinicians, students and patients at Kenyatta National Hospital on the surgical wards from March 1(st)-December 31(st), 2014. The first phase of the study involved focus group discussions (FGDs) of between 10-12 persons and individual in-depth interviews of senior faculty and patients. Grounded theory method was used for collecting perceptions of participants on professionalism. These views were then coded using Atlas 5.2, allowing the development of a questionnaire that provided the survey tool for the second phase of the study. For the questionnaire, response options utilized a 4-point Likert scale with a range from "strongly agree" to "strongly disagree". Factor analysis was used to analyse the responses to the survey. Internal reliability was determined by Cronbach's α.

RESULTS

Sixteen FGDs and 18 in-depth interviews were held with 204 clinicians, students and patients. A further 188 participants completed the questionnaire. Respect was the most frequently mentioned or picked component of professionalism during the interview and survey respectively, with 74.5 % of participants reporting "strongly agree". Factor analysis showed that 3 factors accounted for the majority of the variance in the items analysed; respect in practice, excellence in service and concern for the patient. The Cronbach's α for this analysis was 0.927.

CONCLUSION

The study cohort predominantly conceptualizes professionalism as relating to respect between colleagues and toward patients. Respect, being a cultural norm, should form part of the core curriculum of professionalism in order to be relevant for the Kenyan context.

A situation analysis of inter-professional education and practice for ethics and professionalism training at Makerere University College of Health Sciences

Background

Students at Makerere University College of Health Sciences (MakCHS) are introduced to ethics and professionalism using the inter-professional education (IPE) model. Ethics and professionalism should be running themes throughout succeeding years of study during which students are expected to develop qualities and skills for future inter-professional practice (IPP). We performed a situation analysis of IPE and IPP among students and teaching health professionals at MakCHS to guide development of a relevant training curriculum of ethics and professionalism.

Methods

A cross sectional study with quantitative and qualitative methods which included questionnaires, focus group discussions and key informant interviews.

Results

We interviewed 236 undergraduate students (148, 63 % male) and 32 teaching health professionals (25, 78 % male). Two hundred fifteen (91 %) students indicated they had joint learning activities with students of other professions and 166 (70 %) stated there was benefit in having an IPE model training curriculum. Most students (140, 59 %) strongly agreed that learning with other students will make them more effective members of the health team. Whereas the respondents reported inter professionalism as being well articulated in their course curricula, more than half said IPE is only implemented in the pre-clinical years of study. They noted that IPE and IPP concepts were not well programmed, health professionals engaged in teaching had poor attitudes towards IPE and IPP, there were limited numbers of skilled health care workers to implement IPP and there was poor communication between students and teaching health professionals. Majority of teaching health professionals noted challenges in implementation of IPE such as poor coordination and large student population and major factors influencing ethics and professionalism in healthcare such as limited government support, low pay for the health care workers, disrespect and lack of appreciation of the health workers by the public.

Conclusions

Our findings demonstrate that IPE, IPP, ethics and professionalism are not emphasized in the clinical years of study at MakCHS. We recommend increased sensitization on the concepts of IPE and IPP plus enhanced mentorship for both students and teaching health professionals. Innovative strategies of implementation of IPE and IPP for training in ethics and professionalism must be introduced.

Cross-cultural perspectives on the patient-provider relationship: a qualitative study exploring reflections from Ghanaian medical students following a clinical rotation in the United States

BACKGROUND

In international health experiences, learners are exposed to different culturally-based patient care models. Little is known about student perceptions of patient-provider interactions when they travel from low-to high-resource settings. The purpose of this study was to explore these reflections among a subset of Ghanaian medical students who participated in clinical rotations at the University of Michigan Medical School (UMMS).

METHODS

In-depth, semi-structured interviews lasting 60-90 min were conducted with 15 individuals who had participated in 3-to 4-week clinical rotations at UMMS between January 2008 and December 2011. Interviews were conducted from March to August 2012 and transcribed verbatim, then independently coded by three investigators. Investigators compared open codes and reached a consensus regarding major themes.

RESULTS

Participating Ghanaian medical students reported that their perspectives of the patient-provider relationship were significantly affected by participation in a UMMS rotation. Major thematic areas included: (1) observations of patient care during the UMMS rotation, including patient comfort and privacy, physician behavior toward patients, and patient behavior; (2) reflections on the role of humanism and respect within patient care; (3) barriers to respectful care; and (4) transformation of student behaviors and attitudes. Students also reported integrating more patient-centered care into their own medical practice upon return to Ghana

DISCUSSION

Participation in a US-based clinical rotation has the potential to introduce medical students from resource-limited settings to a different paradigm of patient-provider interactions, which may impact their future behavior and perspectives regarding patient care in their home countries.

CONCLUSIONS

Students from under-resourced settings can derive tremendous value from participation in clinical electives in more affluent settings, namely through exposure to a different type of medical care.

Turkish students' perceptions of professionalism at the beginning and at the end of medical education: a cross-sectional qualitative study

AIM

Medical students' perceptions of professionalism might reflect the impact of the current educational processes on their professional identity development. This study focuses on Ankara University Faculty of Medicine students' perceptions of 'good doctor' along with the factors effective on the formation of these perceptions.

METHOD

Six focus groups with 59 medical students from Grade-1 and Grade-6 were held. The transcripts of discussions were analyzed thematically.

RESULTS

Results regarding 'being a good physician' mostly mirrored the findings of previous studies framing the medical professionalism concept. The thematic pattern of the discussions on the relation between professional development and medical education suggests that students suffer from a gradual erosion of perception during medical education. That the education cannot either change the person for the better or might downgrade the person instead of improving her/him were shared by participants from both grades. Students consider clinical practice and role models two main variables determining the person's qualification as a professional.

CONCLUSIONS

The formal and hidden programs determine the quality and efficacy of the professional education together. Attempts to restructure medical education must recognize the reciprocal dynamics between these two components and, thus, should carefully work out the practical aspect of the educational processes.

Medical professionalism across cultures: a challenge for medicine and medical education

BACKGROUND

The recognition of medical professionalism as a complex social construct makes context, geographical location and culture important considerations in any discussion of professional behaviour. Medical students, medical educators and practitioners are now much more on the move globally, exposing them to cultural and social attitudes, values and beliefs that may differ from their own traditional perceptions of professionalism.

AIMS AND METHODS

This paper uses the model of the intercultural development continuum and the concept of "cultural fit" to discuss what might transpire when a student, teacher or doctor is faced with a new cultural environment. Using our own experiences as medical educators working abroad and supported by evidence in the literature, we have developed four anecdotal scenarios to highlight some of the challenges that different cultural contexts bring to our current (Western) understanding of professionalism.

RESULTS AND CONCLUSIONS

The scenarios highlight some of the potentially different regional and/or cultural perspectives and nuances of professional behaviours, attitudes or values that many of us either take for granted or find difficult, depending on our training and socio-cultural upbringing. With this paper, we hope to start a long overdue conversation about global professionalism amongst medical educators, identify potential areas for research and highlight a need for medical schools to embrace a "global" approach to how professionalism is embedded in their curricula.

The Perceptions of Professionalism by 1(st) and 5(th) Grade Medical Students

INTRODUCTION

Professionalism is essential for the development of mature physicians but not much education is devoted to that theme.

AIM

We aimed to determine the views of undergraduate medical students on medical professionalism.

METHODS

This was a qualitative study, based on focus groups of the first and fifth-year undergraduate medical students. Transcripts of the focus groups were independently evaluated by two researches. Segments of transcripts, identified as important, were marked as verbatims. A grounded theory method with open coding was applied. A list of codes was developed and reviewed by both researchers until the consensus was reached. Then, the codes were reviewed and put into the categories and dimensions.

RESULTS

Students recognized 10 main medical professionalism dimensions (empathy, respect, responsibility, autonomy, trust, communication, difference between professional and private life, team work, partnership) and two dimensions associated with it (physician's characteristics, external factors). Slight change of the attitudes towards a more self-centred future physicians' figure was observed in the fifth-year medical students.

CONCLUSION

The students have an appropriate picture of the physicians' figure even at the beginning of their medical studies but still needs an education in professionalism. It seems that the fifth-year students perceive physicians as more self-centred when compared to their first-year colleagues.

Developing personal attributes of professionalism during clinical rotations: views of final year bachelor of clinical medical practice students

BACKGROUND

Medical professionalism as a set of behaviours that transcends personal values, beliefs and attitudes to incorporate ethical and moral principles is considered a covenant between society and the practice of medicine. The Bachelor of Clinical Medical Practice (BCMP) a three year professional degree was launched at the University of the Witwatersrand in January 2009 in response to a documented shortage of doctors especially in the rural areas of South Africa. The BCMP programme is unique in its offering as it requires a teaching approach that meets the needs of an integrated curriculum, providing for an accelerated transition from the classroom to the patient's bedside.

METHODS

Following five week attachments in designated District Education Campuses, 25 final year BCMP students were required to reflect individually on the covenant that exists between society and the practice of medicine based on their daily interactions with health care workers and patients for three of the five rotations in a one page document. A retrospective, descriptive case study employed qualitative methods to group emerging themes from 71 portfolios. Ethical clearance was obtained from the Human Research Ethics Committee at the University of the Witwatersrand.

RESULTS

As an outcome of an ethical analysis, the majority of BCMP students reflected on the determinants of accountable and responsible practice (N=54). The commitment to the Oath became significant with a personalised reference to patients 'as my patients'. Students acknowledged professional health care workers (HCWs) who demonstrated commitment to core values of good practice as they recognised the value of constantly reflecting as a skill (n=51). As the students reflected on feeling like 'guinea pigs' (n=25) migrating through periods of uncertainity to become 'teachable learners', they made ethical judgements that demonstrated the development of their moral integrity. A few students felt vulnerable in instances where they were pressured into 'pushing the line'.

CONCLUSIONS

Through their portfolio narratives, BCMP students showed a willingness to shape their evolving journeys of moral growth and personal development. This study has highlighted as an ongoing challenge the need to identify a process by which professionalism is sustained by HCWs to benefit health sciences students.

Baccalaureate nursing students' perspectives on learning about caring in China: a qualitative descriptive study

BACKGROUND

The need to provide humanistic care in the contemporary healthcare system is more imperative now and the importance of cultivating caring in nursing education is urgent. Caring as the primary work of nursing has been discussed extensively, such as the meaning of caring, and teaching and learning strategies to improve nursing students' caring ability. Yet attempts to understand students' perspectives on learning about caring and to know their learning needs are seldom presented. The aim of this qualitative descriptive study was to explore the baccalaureate nursing students' perspectives on learning about caring in China.

METHODS

A qualitative descriptive study using focus group interviews were undertaken in two colleges in Yunnan Province, China from February 2010 to April 2010. Purposeful sampling of 20 baccalaureate nursing students were recruited. Content analysis of the transcribed data was adopted to identify the themes.

RESULTS

Four categories with some sub-categories related to students' perspectives on learning about caring were identified from the data: 1) Learning caring by role model; 2) conducive learning environment as the incentive to the learning about caring; 3) lack of directive substantive way of learning as the hindrance to the learning about caring; 4) lack of cultural competency as the barrier to the learning about caring.

CONCLUSIONS

Both caring and uncaring experiences can promote the learning about caring in a way of reflective practice. The formal, informal and hidden curricula play an important role in the learning about caring. Cultural awareness, sensitivity and humility are important in the process of learning to care in a multicultural area.

Decline of medical student idealism in the first and second year of medical school: a survey of pre-clinical medical students at one institution

BACKGROUND

Idealism declines in medical students over the course of training, with some studies identifying the beginning of the decline in year 3 of US curricula.

PURPOSES

This study tested the hypothesis that a decline in medical student idealism is detectable in the first two years of medical school.

METHODS

We sought to identify differences in survey responses between first-year (MS1) and second-year (MS2) medical students at the beginning (T1) and end (T2) of academic year 2010 on three proxies for idealism, including items asking about: (a) motivations for pursuing a medical career; (b) specialty choice; and (c) attitudes toward primary care. Principle component analysis was used to extract linear composite variables (LCVs) from responses to each group of questions; linear regression was then used to test the effect of on each LCV, controlling for race, ethnicity, rural or urban origins, gender, and marital status.

RESULTS

MS2s placed more emphasis on status/income concerns (β=0.153, p<0.001), and much less emphasis on idealism as a motivator (β=-0.081, p=0.054), in pursuing a medical career; more likely to consider lifestyle and family considerations (β=0.098, p=0.023), and less likely to consider idealistic motivations (β=-0.066, p=NS); and were more likely to endorse both negative/antagonistic (β=0.122, p=0.004) and negative/sympathetic (β=0.126, p=0.004) attitudes toward primary care.

CONCLUSIONS

The results are suggestive that idealism decline begins earlier than noted in other studies, implying a need for curricular interventions in the first two years of medical school.

Professionalism and occupational therapy: An exploration of faculty and students’ perspectives

Background.

Professionalism is a complex, multifaceted concept embedded within the curricula of occupational therapy programs and professional documents; yet there is no clear explanation in the literature.

Purpose.

To explore occupational therapy faculty and students’ perspectives of the meaning of professionalism.

Methods

This interpretivist qualitative study used convenience sampling to recruit eight second-year occupational therapy master's students and five occupational therapy faculty members to participate in two separate focus groups. Open-coding and constant comparative methods were used to identify themes.

Findings.

Data analysis yielded the following student focus group themes: uncertainty about professional expectations; searching for answers through concrete concepts; and the context-specific nature of professionalism. Faculty focus group themes were professional responsibility; professional awareness; and the context-specific nature of professionalism. Understanding and enacting professionalism may be a developmental process.

Implications.

Further exploration of the meaning of professionalism from a variety of other occupational therapy stakeholders is needed.

Promises and hurdles of undergraduate medical development in Greece

AIM

In this paper we sought to explore undergraduate medical students' views about their professional development during their studies that are considered to be related to medical professionalism.

METHOD

A descriptive cross-sectional study using interpretative analysis of anonymous 10-item questionnaires was conducted at the University of Patras Medical School (UPMS), Greece. The study sample consisted of 134 undergraduate students in their fifth and sixth year of study at UPMS.

RESULTS

Undergraduate students emphasized the great significance of daily clinically-oriented practice in the wards in the group of behaviors consistent with medical professionalism. The integrated curriculum and informal discussions with members of the academic staff in the form of role models were also regarded as valuable approaches strongly enhancing professionalism. Students' personal statements contained attributes regarding premium professional skills, including constancy and perfectionism throughout a lifelong learning process, so as to be able to provide high quality medical care to patients.

CONCLUSION

According to our undergraduate medical students themselves, the last 2 years of their studies are important to understand the essence of professionalism and develop their professional medical attitudes. Clinically-oriented teaching activities together with the informal curriculum of enhanced role modeling promote medical professional behaviors and increase standards of health care provided to patients.

Using movies to teach professionalism to medical students

BACKGROUND

Professionalism topics are usually not covered as a separate lesson within formal curriculum, but in subtler and less officially recognized educational activities, which makes them difficult to teach and assess. Interactive methods (e.g. movies) could be efficient teaching methods but are rarely studied. The aims of this study were: 1) to test the relevance and usefulness of movies in teaching professionalism to fourth year medical students and, 2) to assess the impact of this teaching method on students' attitudes towards some professionalism topics.

METHOD

This was an education study with qualitative data analysis in a group of eleven fourth year medical students from the Medical School of University Maribor who attended an elective four month course on professionalism. There were 8 (66.7%) female students in the group. The mean age of the students was 21.9 ± 0.9 years. The authors used students' written reports and oral presentations as the basis for qualitative analysis using thematic codes.

RESULTS

Students recognised the following dimensions in the movie: communication, empathy, doctors' personal interests and palliative care. It also made them think about their attitudes towards life, death and dying.

CONCLUSIONS

The controlled environment of movies successfully enables students to explore their values, beliefs, and attitudes towards features of professionalism without feeling that their personal integrity had been threatened. Interactive teaching methods could become an indispensible aid in teaching professionalism to new generations.

Mentorship needs at academic institutions in resource-limited settings: a survey at Makerere University College of Health Sciences

BACKGROUND

Mentoring is a core component of medical education and career success. There is increasing global emphasis on mentorship of young scientists in order to train and develop the next leaders in global health. However, mentoring efforts are challenged by the high clinical, research and administrative demands. We evaluated the status and nature of mentoring practices at Makerere University College of Health Sciences (MAKCHS).

METHODS

Pre-tested, self-administered questionnaires were sent by email to all Fogarty alumni at the MAKCHS (mentors) and each of them was requested to complete and email back the questionnaire. In addition to training level and number of mentors, the questionnaires had open-ended questions covering themes such as; status of mentorship, challenges faced by mentors and strategies to improve and sustain mentorship within MAKCHS. Similarly, open-ended questionnaires were sent and received by email from all graduate students (mentees) registered with the Uganda Society for Health Scientists (USHS). Qualitative data from mentors and mentees was analyzed manually according to the pre-determined themes.

RESULTS

Twenty- two out of 100 mentors responded (14 email and 8 hard copy responses). Up to 77% (17/22) of mentors had Master's-level training and only 18% (4/22) had doctorate-level training. About 40% of the mentors had ≥ two mentees while 27% had none. Qualitative results showed that mentors needed support in terms of training in mentoring skills and logistical/financial support to carry out successful mentorship. Junior scientists and students reported that mentorship is not yet institutionalized and it is currently occurring in an adhoc manner. There was lack of awareness of roles of mentors and mentees. The mentors mentioned the limited number of practicing mentors at the college and thus the need for training courses and guidelines for faculty members in regard to mentorship at academic institutions.

CONCLUSIONS

Both mentors and mentees were willing to improve mentorship practices at MAKCHS. There is need for institutional commitment to uphold and sustain the mentorship best practices. We recommend a collaborative approach by the stakeholders in global health promotion to build local capacity in mentoring African health professionals.