Assessing medical professionalism: A systematic review of instruments and their measurement properties

"Opportunities and responsibilities": how do pharmacists assess their professionalism?

INTRODUCTION

Professionalism is fundamental to the existence of professions. In pharmacy, interest in this theme improved with events that examined the resocialization of pharmacists in care. With this, evaluating professionalism can help the operationalization of the theme and, consequently, the development of strategies for pharmacy consolidation before its challenges. Therefore, this study aimed to evaluate the professionalism of Brazilian pharmacists.

METHODS

To meet the objective, a cross-sectional study was conducted between March 2022 and August 2023. Data were collected using the Brazilian version of the "Modification of Hall's Professionalism Scale for Use with Pharmacists". The scale has 39 items grouped into the domains: autonomy, vocation, professional council, self-regulation, continuing education, and altruism. Data were analyzed using descriptive statistics and an ANOVA analysis of variance with post-hoc Hochberg or Games-Howell tests with Bootstrapping was conducted to verify differences between groups.

RESULTS

600 pharmacists participated in this study. The majority (69%) was female and carried out their professional activities in community pharmacies (50%). Professionalism scores ranged between 14 and 29 points, with an average of 22.8 points. Pharmacists working in outpatient clinics had higher scores in most factors, namely, altruism, continuing education, professional council, vocation, and autonomy. This indicates that the inclination of pharmacists to occupy areas focused on care can be significant to assess professionalism.

CONCLUSIONS

The data obtained indicate that pharmacists working in outpatient clinics had higher professionalism scores compared to others. This corroborates the worldwide trend experienced by pharmacy in recent decades, which is the execution of increasingly patient-centered practice models.

Learning professionalism using creativity and diversity concepts

CLINICAL RELEVANCE

Professionalism is a multidimensional sociocultural construct that is abstract, evolving and context-dependent in nature. This has made the teaching and assessment of professionalism in healthcare complex and challenging. A lack of professionalism can increase patient risk and litigation.

BACKGROUND

This article examines group creativity and diversity across healthcare and non-healthcare disciplines and how they can assist students in constructing their own understandings and knowledge of professionalism. It is proposed that linking professionalism to creativity will improve understanding on how to help students studying healthcare learn about professionalism better.

METHODS

A total of 30 students from different tertiary levels and across disciplines participated in the study. They explored either a gallery or museum and examined an artefact relating to professionalism. Learning experiences were evaluated via survey results and thematic analyses of their reflective essays and semi-structured interviews.

RESULTS

Participants reported increased understanding of professionalism and appreciation of perspectives and skills of others. The creative aspect of the task was fun and engaging, and group diversity enabled different opinions and perspectives to be heard and shared. This is analogous to a professional working environment. Themes generated from the essays were: (a) intrinsic motivation, (b) diversity, (c) learnings of professionalism, and (d) challenge encountered.

CONCLUSION

The results of this research make a meaningful contribution to existing literature by empirically demonstrating that students from different disciplines could better construct their own understandings of professionalism when their learning activities were performed in an authentically creative and diverse setting. This educational concept is underpinned by diverse types of creativities that are not mutually exclusive. It is hoped that this first piece of evidence will stimulate more studies on utilising group creativity and diversity in healthcare education.

Assessing professional behaviors: a self-administered scale for medical students during clerkships

BACKGROUND

Medical professionalism is a core competency for medical students during clerkships for further professional development. Given that the behavior-based framework could provide clear insight and is easy to assess, the study aimed to create a self-administered scale to measure the professional behaviors of medical students during their clerkships.

METHODS

A comprehensive literature review on medical professional behaviors in English or Chinese and Delphi interviews were used to develop the initial version of the Self-Administered Scale for Professional Behavior of Medical Students During Clerkships. The reliability and validity analysis based on a survey of medical students from China, Cronbach's α calculations, and Confirmatory Factor Analysis (CFA) specifically were conducted to finalize the scale. The associations of professional behaviors with gender, medical programs, and clerkship duration were examined using Wilcoxon rank-sum tests.

RESULTS

We included 121 studies and extracted 57 medical professionalism assessment tools, initially forming a pool of 48 items. To refine these items, eighteen experts participated in two rounds of Delphi interviews, ultimately narrowing down the item pool to 24 items. A total of 492 participants effectively completed the questionnaire. One item was removed due to its correlated item-total correlation (CITC) value, resulting in a final scale containing 23 items with six domains: Respect, Altruism, Communication and Collaboration, Integrity, Duty, and Excellence. The overall Cronbach's alpha value was 0.98, ranging from 0.88 to 0.95 for each domain. The fit indices (χ2/df = 4.07, CFI = 0.96, TLI = 0.95, RMSEA = 0.08, and SRMR = 0.02) signified a good fit for the six-domain model. Medical students' professional behavior was significantly associated with gender (p = 0.03) and clerkship duration (p = 0.001).

CONCLUSION

The scale was demonstrated to be reliable and valid in assessing the professional behaviors of Chinese medical students during clerkships.

Understanding medical professionalism using express team-based learning; a qualitative case-based study

Medical Professionalism (MP) defined as values, behaviours and attitudes that promote professional relationships, public trust and patient safety is a vital competency in health profession education. MP has a distinctive uniqueness due to cultural, contextual, conceptual, and generational variations. There is no standard instructional strategy to probe the understanding of MP in a cohesive, structured, interactive manner. This study aimed to investigate undergraduate medical students' understanding of MP using express team-based learning (e-TBL) at both campuses of Royal College of Surgeons Ireland (RCSI). Using the key principles of a sociocultural theoretical lens in adult learning theory, we designed e-TBL as a context-learning-based educational strategy. We conducted three e-TBL sessions on cross-cultural communication and health disparities, a reflective report on clinical encounters, and professionalism in practice. We collected, collated, and analyzed the student experiences qualitatively using data gathered from team-based case discussions during e-TBL sessions. A dedicated working group developed very short-answer questions for the individual readiness assurance test (IRAT) and MP-based case scenarios for team discussions. In this adapted 4-step e-TBL session, pre-class material was administered, IRAT was undertaken, and team-based discussions were facilitated, followed by facilitator feedback. A qualitative inductive thematic analysis was performed, which generated subthemes and themes illustrated in excerpts. Our thematic analysis of data from 172 students (101 from Bahrain and 71 from Dublin) yielded four unique themes: incoming professional attitudes, transformative experiences, sociological understanding of professionalism, and new professional identity formation. This qualitative study provides a deeper understanding of medical students' perceptions of medical professionalism. The generated themes resonated with divergent and evolving elements of MP in an era of socioeconomic and cultural diversity, transformative experiences, and professional identity formation. The core elements of these themes can be integrated into the teaching of MP to prepare fit-to-practice future doctors.

A scoping review of the self-reported compassion measurement tools

BACKGROUND

Compassion is closely linked to psychological well-being, and several assessment tools have been developed and studied to assess the level of compassion in different populations and for more precise measurement. There is currently a scarcity of comprehensive knowledge about compassion-related assessment tools, and our research provides an overview of these tools.

AIMS

To identify scales used to measure compassion from different flows, and to assess their measurement properties and quality.

METHODS

Focusing on compassion assessment tools, the authors conducted a thorough search of 10 Chinese and English databases from their establishment until August 14, 2022. Data extracted included the author, year, country, objectives, target population, as well as the primary evaluation content. Using the COSMIN checklist, the methodological quality and measurement properties of the included studies were appraised. This scoping review was registered with the Open Science Framework and followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist.

RESULTS

There were 15,965 papers searched, and 36 compassion-related measurement tools were identified in this study. None of the 36 studies provided possessed all nine psychometric properties, as outlined by the COSMIN criteria. On the basis of a systematic evaluation of quality, measurement qualities were ranked. The results for internal consistency and content validity were relatively favorable, whereas the results for structural validity were variable and the results for the remaining attributes were either uncertain or negative. A Venn diagram was used to illustrate the overlapping groups of compassion measurement tools based on the three-way flow of compassion. An overview of the reference instrument and theoretical basis for the included studies was provided, and half of them did not contain any theoretical or scale-based evidence.

CONCLUSION

In this study, 36 compassion-related measuring instruments were identified, and the methodological quality and measurement properties of the included studies were acceptable. The included measurements were consistent with flows of compassion. A further focus of further research should be on developing theories in the compassion domain and developing instruments for measuring compassion that are multidimensional, multi-populations, and culturally relevant.

Cross-cultural adaptation and psychometric evaluation of the "Modification of Hall's professionalism scale for use with pharmacists"

BACKGROUND

Professionalism is the demonstration of behaviors that guide the actions of health professionals. In Pharmacy, its implementation is possible through assessment instruments for pharmacists, such as the "Modification of Hall's Professionalism Scale for Use with Pharmacists".

OBJECTIVE

To translate the "Modification of Hall's Professionalism Scale for Use with Pharmacists" into a Brazilian Portuguese version and evaluate its psychometric properties for pharmacists.

METHOD

The methodological process of this study took place in three stages: translation and cross-cultural adaptation of the instrument original version into a Brazilian Portuguese version; validation of the scale content through consensus among geographically distinct experts and, finally; examination of the scale psychometric measurement properties through a convenience sample of 600 Brazilian pharmacists. At this stage, construct validity was verified using Exploratory Factor Analysis (EFA) and reliability was examined by calculating the composite reliability.

RESULTS

The adapted instrument to a Brazilian Portuguese version demonstrated content validity with coefficients considered acceptable, above 0.8. The EFA demonstrated a structure supported by six factors and 39 items. The H index suggested high stability for all factors as well as composite reliability.

CONCLUSION

The Brazilian Portuguese version of the instrument presented appropriate content validity coefficients and psychometric properties. This measure may be useful for future studies on professionalism regarding teaching strategies and assessment of this construct among pharmacists.

Development and validation of a new self-assessment tool to measure professionalism among medical students

Introduction

Professionalism is a key quality that medical students should possess, but it is difficult to define and assess. Current assess-ment tools have room for improvement. This study aimed to design and validate a self-assessment tool to assess professionalism among medical students.

Method

A questionnaire was created based on 10 tenets of professionalism from the Charter on Medical Professionalism jointly published by the American Board of Internal Medicine Foundation, American College of Physicians Foundation and European Federation of Internal Medicine, along with input from Singapore guides. The self-administered questionnaire was administered to Year 2 to 5 students from Yong Loo Lin School of Medicine, National University of Singapore in a voluntary, anonymised manner in the academic year of 2019/2020. Construct validity and internal reliability were evaluated using Principal Component Analysis (PCA) and Cronbach's alpha, respectively.

Results

There was a total of 541 respondents. After removing incomplete responses, 504 responses were included. Following PCA, a 17-item questionnaire titled "Medical Professionalism: A Self-assessment Tool" (MPAST) with a 5-component solution was obtained. The 5 components were commit-ment to: (1) patient's best interest, (2) honesty and integrity, (3) professional competency, (4) patient safety and care, and (5) educational responsibilities. Their Cronbach's alpha value ranged from 0.540 to 0.714, with an overall Cronbach's alpha value of 0.777.

Conclusion

MPAST is valid, reliable, practical, and is the first validated self-assessment tool to assess professional attributes and behaviours among medical students, to our knowledge.

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.

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

Purpose

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

Settings and Design

Multi-center survey study.

Methods

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

Results

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

Conclusions

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

Designing a Tool to Assess Professionalism among Dental Students

Objectives: Professionalism is essential to a strong and trusted patient-doctor relationship, which is believed to potentially enhance patient compliance and treatment outcomes. The purpose of our study was to develop and conduct a psychometric analysis of an assessment tool to evaluate the professional behavior of dental students. Materials and Methods: The study was performed in the School of Dentistry, Tehran University of Medical Sciences. After providing a pool of various criteria to assess professionalism, an expert panel prepared the primary version of the tool. The tool was set in a questionnaire frame to explore the significance level and evaluation feasibility of each criterion. The questionnaire was completed by tutors of the "Medical Ethics" course (n=6). After necessary revisions, face and content validity were evaluated by giving the checklist to eight experienced dental educators to determine the relevance, clarity, and simplicity of the questions. In the second stage, the final checklist (37 items) was given to dental educators to evaluate twenty students. To assess the reliability of this checklist, at least two professors evaluated each student, and weighted-κ was calculated. Minor revisions were made based on the received feedback. Results: According to our data, the total validity of the tool (S-CVI) was 100%. For all items except one, the weighted-κ coefficient was ≥ 0.5, indicating sufficient reliability for these items. Conclusion: Despite the limitations of the present study, the designed tool to evaluate professionalism among dental students in different clinical departments seems to be both valid and reliable.

Physicians' professionalism from the patients' perspective: a qualitative study at a single-family practice in Saudi Arabia

INTRODUCTION

Professionalism is a crucial component of medical practice. It is a culturally sensitive notion that generally consists of behaviors, values, communication, and relationships. This study is a qualitative study exploring physician professionalism from the patients' perspective.

METHODS

Focus group discussions with patients attending a family medicine center attached to a tertiary care hospital were carried out using the four gates model of Arabian medical professionalism that is appropriate to Arab culture. Discussions with patients were recorded and transcribed. Data were thematically analyzed using NVivo software.

RESULTS

Three main themes emerged from the data. (1) In dealing with patients, participants expected respect but understood delays in seeing physicians due to their busy schedules. In communication, participants expected to be informed about their health conditions and to have their questions answered. (2) In dealing with tasks, participants expected proper examination and transparency of diagnosis, but some expected the physician to know everything and did not appreciate them seeking outside opinions. They expected to see the same physician at every visit. (3) In physician characteristics preferences, participants preferred friendly smiling physicians. Some cared about the outer appearance of the physician whereas others did not.

DISCUSSION/CONCLUSIONS

The findings of the study explained only two themes of the four gates model namely dealing with patients and dealing with tasks. Cultural competence and how to benefit from patients' perceptions to be an ideal physician should be incorporated into the process of physicians' training.

Exploring the Critical Driving Forces and Strategy Adoption Paths of Professional Competency Development for Various Emergency Physicians Based on the Hybrid MCDM Approach

The implementation of competency-based medical education (CBME) focuses on learners' competency outcomes and performance during their training. Competencies should meet the local demands of the healthcare system and achieve the desired patient-centered outcomes. Continuous professional education for all physicians also emphasizes competency-based training to provide high-quality patient care. In the CBME assessment, trainees are evaluated on applying their knowledge and skills to unpredictable clinical situations. A priority of the training program is essential in building competency development. However, no research has focused on exploring strategies for physician competency development. In this study, we investigate the professional competency state, determine the driving force, and provide emergency physicians' competency development strategies. We use the Decision Making Trial and Evaluation Laboratory (DEMATEL) method to identify the professional competency state and investigate the relationship among the aspects and criteria. Furthermore, the study uses the PCA (principal component analysis) method to reduce the number of components and then identify the weights of the aspects and components using the ANP (analytic network process) approach. Therefore, we can establish the prioritization of competency development of emergency physicians (EPs) with the VIKOR (Vlse kriterijumska Optimizacija I Kompromisno Resenje) approach. Our research demonstrates the priority of competency development of EPs is PL (professional literacy), CS (care services), PK (personal knowledge), and PS (professional skills). The dominant aspect is PL, and the aspect being dominated is PS. The PL affects CS, PK, and PS. Then, the CS affects PK and PS. Ultimately, the PK affects the PS. In conclusion, the strategies to improve the professional competency development of EPs should begin with the improvement from the aspect of PL. After PL, the following aspects that should be improved are CS, PK, and PS. Therefore, this study can help establish competency development strategies for different stakeholders and redefine emergency physicians' competency to reach the desired CBME outcomes by improving advantages and disadvantages.

Use of situational judgment tests for assessing non-cognitive attributes of final year dental students

OBJECTIVE

Situational judgment tests (SJT) have been previously used in the admission process of medical and dental undergraduate programs, but their utilization as an assessment tool is fairly new. The objective of this study was to explore essential non-cognitive attributes of dental graduates. We also aimed to assess the attributes of final year dental students utilizing SJT and later collected participants' reactions on the test.

METHODS

A mixed-method exploratory sequential study was conducted. One-on-one and group discussions were done with subject matter experts (SMEs) to explore the essential attributes of fresh dental graduates. Based on the thematic analysis, 10 SJT items per domain were constructed by one group of SMEs and expert validated by a different group of SMEs and vice versa. The final dental-SJT was piloted online on final year dental students and their perceptions were collected using a five-point Likert scale questionnaire. Descriptive statistics and Cronbach's alpha were calculated for the test.

RESULTS

The consultation with SMEs generated three main themes, namely, Conventional skills, Tribal skills, and Occupational skills. The 70-item dental-SJT piloted on 150 final year dental students revealed data were normally distributed. The internal reliability of test was good (0.738). Students scored highest in "management skills" (>70%) and lowest in "professional ethics" (56%) and "diverse experiences" (58%). The overall student perception about the test was good.

CONCLUSION

SJT is an effective tool to assess non-cognitive attributes of dental students. It has an overall positive perception about perceived predictive validity, perceived fairness, face and content validity.

Professionalism among academic educational leaders: A concept analysis

INTRODUCTION

The concept of professional ethics of academic educational leaders is an abstract concept for which several highly context-dependent definitions have been provided in the literature. The analysis of this concept is critical to reaching a shared understanding, developing behavioral standards, and designing evaluation measures at universities of medical sciences.

METHODS

To explain the concept of professionalism among academic educational leaders, Walker and Avant's eight-stage concept analysis method was adopted. After an extensive review of resources, 37 articles were included and the antecedents, attributes, and consequences of the concept were extracted.

RESULTS

An examination of the resources and concept analysis revealed that professionalism in academic educational leaders has three main attributes of care ethics, justice-oriented ethics, and ethics of criticism, and its formation depends on personal characteristics, professional capabilities, and having a systemic view.

CONCLUSIONS

The identification of components and professional characteristics of professionalism among academic educational leaders provides a shared understanding of professionalism and is a basic step towards designing measures to evaluate this concept.

Translating and validating a Japanese version of the instrument for patient assessment of medical professionalism (J-IPAMP): a cross-sectional survey

BACKGROUND

Although there are many tools to assess medical professionalism, they rarely address patients' perspectives. The instrument for patient assessment of medical professionalism (IPAMP) comprises 11 items and has been established and validated as a valuable tool for assessing trainees' professionalism from the patient's perspective. However, there is no instrument to assess professionalism from the patient's perspective in Japan. The purpose of the present study was to develop a Japanese version of the IPAMP (J-IPAMP) and test its validity and reliability.

METHODS

We conducted a cross-sectional survey to examine the reliability and validity of the J-IPAMP in two hospitals (one each in an urban and rural area) in Japan. Receptionists or surveyors distributed the anonymous questionnaire to 276 inpatients; all participants were aged above 20 years and assigned to medical trainees. We evaluated its structural and criterion-related validity, as well as internal consistency reliability.

RESULTS

Data of 235 (85.1%) patients were analyzed. Using the split-half validation technique, we performed an exploratory factor analysis (EFA) along with a confirmatory factor analysis (CFA). The EFA showed a one-factor solution. Then, to compare the model fitness between two models (the two-factor model from the original English version vs. unidimensional model suggested by the EFA), the CFA was performed. The CFA showed that almost all of the fit indices met their respective criteria and were approximately the same for the two models. Thus, we adopted a single-factor model. The Pearson correlation coefficients between the total J-IPAMP scores and the global ratings were 0.738, indicating adequate criterion-related validity. The Cronbach's alpha of the 11 items of the instrument was 0.96 (95% confidence interval: 0.96-0.97) and the omega value was 0.96, demonstrating acceptable internal consistency reliability.

CONCLUSIONS

We developed the Japanese version of the IPAMP. Its validity and reliability were verified through analysis. This instrument can be utilized for professionalism education in the postgraduate training setting.

The relationship between medical student engagement in the provision of the school's education programme and learning outcomes

INTRODUCTION

Student engagement in the provision of the school's education programme (educational student engagement) plays an important role in quality assurance in medical education. However, little is known whether this specific type of student engagement has effects on the learning outcomes for the involved medical students.

METHODS

This study was based on a national-wide survey in China among medical students with 123,055 responses. The questionnaire was designed using international and Chinese national standards. T-test, analysis of variance, multivariate regression, and regression with interaction terms were used.

RESULTS

Educational student engagement was positively associated with medical students' learning outcomes in Clinical Practice, Science and Scholarship, Health and Society, and Professionalism. Besides, the influence was heterogeneous among participants at different learning phases. Learning outcomes in Clinical Practice were strongly associated with educational student engagement efficiently at the Clinical Medical Education and the Clerkship Rotation phases, and learning outcomes in Science and Scholarship were best correlated with the Clerkship Rotation phase.

CONCLUSION

Educational student engagement is positively associated with the learning outcomes, with the greatest effect on learning outcomes in Clinical Practice and the least effect in Professionalism. Besides, it has a greater impact on medical students at senior learning phases.

Psychometric evaluation of a nursing competence assessment tool among nursing students: a development and validation study

BACKGROUND

Nursing competence refers to the core abilities that are required for fulfilling one's role as a nurse. A specific instrument comprehensively measuring competence among nursing students has not yet been developed. The purpose of the study was to develop and validate a nursing competence instrument for nursing students in bachelor training.

METHODS

A descriptive and explorative study design was used. Data were collected from students at one medical college in Taiwan in 2020 and 2021. A total of 241 nursing students participated in this study. We developed the initial instrument through systematic review, expert evaluations, and pilot versions. Its validity was then tested using confirmatory factor analysis (CFA) and criterion-related validity, while its reliability was tested using Cronbach's alpha and test-retest analysis.

RESULTS

The final fit indexes of CFA were as follows: chi-square = 860.1 (p < 0.01), normed chi-square = 2.24, SRMR = 0.04, RMSEA = 0.07, CFI = 0.94, and TLI = 0.94. Cronbach's alpha values for the subscales observed ranged from 0.91 to 0.98. The test-retest reliability coefficient for the Nurse Competence Scale was 0.515 (n = 30, p < 0.01).

CONCLUSIONS

The instrument exhibited acceptable psychometric properties, thereby proving itself a valuable tool for evaluating nursing students' competence at bachelor training. Further assessments of its reliability, validity, and generality from mentors' and scholars' views in different contexts and cultures are recommended.

Is it possible to introduce an interview to the Korean Medical Licensing Examination to assess professional attributes?: a survey-based observational study

PURPOSE

This study aimed to gather opinions from medical educators on the possibility of introducing an interview to the Korean Medical Licensing Examination (KMLE) to assess professional attributes. Specifically following topics were dealt with: the appropriate timing and tool to assess unprofessional conduct; the possiblity of prevention of unprofessional conduct by introducing an interview to the KMLE; and the possibility of implementation of an interview to the KMLE.

METHODS

A cross-sectional study approach based on a survey questionnaire was adopted. We analyzed 104 pieces of news about doctors’ unprofessional conduct to determine the deficient professional attributes. We derived 24 items of unprofessional conduct and developed the questionnaire and surveyed 250 members of the Korean Society of Medical Education 2 times. Descriptive statistics, cross-tabulation analysis, and Fisher’s exact test were applied to the responses. The answers to the open-ended questions were analyzed using conventional content analysis.

RESULTS

In the survey, 49 members (19.6%) responded. Out of 49, 24 (49.5%) responded in the 2nd survey. To assess unprofessional conduct, there was no dominant timing among basic medical education (BME), KMLE, and continuing professional development (CPD). There was no overwhelming assessment tool among written examination, objective structured clinical examination, practice observation, and interview. Response rates of “impossible” (49.0%) and “possible” (42.9%) suggested an interview of the KMLE prevented unprofessional conduct. In terms of implementation, “impossible” (50.0%) was selected more often than “possible” (33.3%).

CONCLUSION

Professional attributes should be assessed by various tools over the period from BME to CPD. Hence, it may be impossible to introduce an interview to assess professional attributes to the KMLE, and a system is needed such as self-regulation by the professional body rather than licensing examination.

Conducting Systematic Reviews of the Quality and Psychometric Properties of Health-Related Measurement Instruments: Finding the Right Tool for the Job

Many health-related measurement instruments have been developed to measure psychological constructs and whilst several instruments are usually available for a particular study, finding the right tool for the job is important. Systematic reviews of measurement properties of instruments have long been identified as a valuable strategy to ensure that we select the right tool to assess mental health. There are many important steps and procedures to guide these types of systematic reviews to find the "best fit" and this paper summarizes some of these key processes and steps. The selection of instrument(s) to use should be made considering the most recent comprehensive review of the quality of the outcome measurement instrument based on unbiased assessment of its psychometric properties, responsiveness, and generalizability of results. Researchers planning to conduct a systematic review of health-related measurement instruments should design the review beforehand using standardized frameworks. Conducting systematic reviews of the quality and psychometric properties of health-related measurement instruments is important to ensure we choose the best tool for the research question and target population.

Evaluating Teaching Effectiveness of Medical Humanities in an Integrated Clerkship Program by a Novel Prospective Propensity Score Matching Framework

Background: This study aims to rigorously compare the effectiveness of the educational programs of a new integrated clinical clerkship in medicine (3 months) and surgery (3 months) at a cancer center with the conventional subspecialty-based rotations at a tertiary teaching hospital, by this prospective, pre-post comparative method. Methods: Between 2013–2016, we compared 69 students who had selected the integrated clerkship that emphasized clinical competency and medical humanities training with 138 matched peers who had completed conventional clerkships during the same period. Outcome measures for medical humanities included empathy, patient-centeredness, and other values and skills related to holistic health care professionalism by introducing prospective propensity score matching (PSM). Results: At baseline, no significant between-group differences existed. At the completion of the core clerkships, students receiving the integrative clerkship had significantly higher scores on the Patient–Practitioner Orientation Scale (PPOS) and the Professionalism Climate in Clinical Teaching Environment (PCI), and similar Jefferson Scale of Physician Empathy Student Version (JSPE) scores, as compared with the comparison group. We also found that the students in this program did not perform worse than those in the traditional internship group in the comprehensive and formative OSCE medical clinical skills test. Conclusions: Our study develops an empirical basis for rigorous evaluation to design medical education to improve the medical humanities values and skills of interns. Features of the new integrated clerkship program that we developed include substantial participation by the students in patient-centered in-hospital culture, as well as reflection, discussion, and feedback on actual clinical cases.

Medical students' perception of professionalism climate in clinical settings

Medical professionalism has a crucial role in educating medical students. The role of professionalism in the clinical environment is therefore an important factor in medical education. This study attempts to evaluate the opinions of medical students in the teaching hospitals of Tehran University of Medical Sciences (TUMS) about the professionalism environment in this university.

A sample of 165 students filled out the Persian translation of UMKC-SOM (Climate of Professionalism Survey) questionnaire. This instrument evaluates students’ perspectives on the degree of adherence to professionalism by faculty, residents and other students.

The results of the study revealed that the total score of professionalism climate was 53.9 for faculty, 42.09 for residents, and 50.76 for students and the difference between these three groups was statistically significant (p-value < 0.01). Results of further analysis through post-hoc tests for multiple comparisons among the groups revealed that the students found their fellow students and faculty more professional than residents. The study also showed that the medical ethics course had no impact on perceptions observations (p-values > 0.05).

The study results also revealed that the students found their fellow students and faculty more professional than residents. This finding demonstrates the importance of teaching professionalism to residents since they serve as role models for students.

Further multicenter studies are needed to improve the professionalism climate in the medical teaching environment.

Redefining the concept of professionalism in nursing: an integrative review

Objective

In today's world with sweeping changes, nurses are responsible for providing high-quality and cost-benefit care, which would almost be impossible unless they achieve their high professional status. To date, no precise and comprehensive definition of professionalism in nursing has been evidently proposed. In fact, many of the previously proposed definitions are either complicated or ambiguous. Moreover, there is no consensus in the literature on an exhaustive definition for “a professional nurse.” The present study aimed to illustrate the concept of professionalism in nursing and identify its defining characteristics.

Methods

In this study, concept analysis was conducted using Whittemore et al.'s method for the integrated review. A comprehensive search of electronic, scientific databases including Eric, PubMed, Scopus, Web of Science, EBSCO, PsychoINFO, Embass, MagIran, IranDoc, SID, and IRANMEDEX was carried out using the keywords such as professionalism, professional behavior, nursing professionalism (NP), professional attribute, and nursing.

Results

In the present study, a comprehensive search of 11 electronic databases retrieved 5738 articles. Then, 2837 duplicate articles were removed by endnote (version 8). Based on a preliminary examination of the titles and abstracts as well as the inclusion and exclusion criteria, 1517 articles were excluded. In addition, 137 articles were removed for scientific reasons. Finally, 52 articles in English and Persian were selected. Content analysis of the articles revealed four major themes, namely, individual prerequisite, professional prerequisite, appropriate structure, and socio-individual factors.

Conclusions

Professionalism in nursing is a major, multidimensional concept according to the literature that included individual prerequisites, professional prerequisites, appropriate structures, and socio-individual factors. In fact, professionalism in nursing comprises a wide range of personal characteristics, self-regulation, professional values, striving to acquire and enhance professional expertise, professional interactions, social, professional, and legal responsibility, and creation of a sense of belonging, and professional development.

Unprofessional behaviour of GP residents and its remediation: a qualitative study among supervisors and faculty

BACKGROUND

Lapses in professionalism have profound negative effects on patients, health professionals, and society. The connection between unprofessional behaviour during training and later practice requires timely identification and remediation. However, appropriate language to describe unprofessional behaviour and its remediation during residency is lacking. Therefore, this exploratory study aims to investigate which behaviours of GP residents are considered unprofessional according to supervisors and faculty, and how remediation is applied.

METHODS

We conducted eight semi-structured focus group interviews with 55 broadly selected supervisors from four Dutch GP training institutes. In addition, we conducted individual semi-structured interviews with eight designated professionalism faculty members. Interview recordings were transcribed verbatim. Data were coded in two consecutive steps: preliminary inductive coding was followed by secondary deductive coding using the descriptors from the recently developed 'Four I's' model for describing unprofessional behaviours as sensitising concepts.

RESULTS

Despite the differences in participants' professional positions, we identified a shared conceptualisation in pinpointing and assessing unprofessional behaviour. Both groups described multiple unprofessional behaviours, which could be successfully mapped to the descriptors and categories of the Four I's model. Behaviours in the categories 'Involvement' and 'Interaction' were assessed as mild and received informal, pedagogical feedback. Behaviours in the categories 'Introspection' and 'Integrity', were seen as very alarming and received strict remediation. We identified two new groups of behaviours; 'Nervous exhaustion complaints' and 'Nine-to-five mentality', needing to be added to the Four I's model. The diagnostic phase of unprofessional behaviour usually started with the supervisor getting a 'sense of alarm', which was described as either a 'gut feeling', 'a loss of enthusiasm for teaching' or 'fuss surrounding the resident'. This sense of alarm triggered the remediation phase. However, the diagnostic and remediation phases did not appear consecutive or distinct, but rather intertwined.

CONCLUSIONS

The processes of identification and remediation of unprofessional behaviour in residents appeared to be intertwined. Identification of behaviours related to lack of introspection or integrity were perceived as the most important to remediate. The results of this research provide supervisors and faculty with an appropriate language to describe unprofessional behaviours among residents, which can facilitate timely identification and remediation.

Undergraduate nursing students' self-reported professional behaviour at the University of Namibia

Background

Development of professional behaviour in nursing students is an important part of a nurse’s overall competence. Self-evaluation is one way of measuring professional behaviour amongst nursing students. However, studies on self-reported professional behaviour of nursing students are limited in Namibia.

Aim

This study aimed to investigate nursing students’ self-reported professional behaviour at the University of Namibia.

Setting

The setting was a university campus offering a Bachelor of Nursing Science degree in Namibia.

Methods

A quantitative descriptive contextual design was used with 100 nursing students. Data were analysed descriptively using a non-parametric Kruskal–Wallis and ANOVA tests of variance and statistical significance.

Results

High mean scores were found in the areas of utilising evidence-based solutions (4.78 ± 0.58), promoting clinical teaching (4.46 ± 0.94), willingness to implement quality improvement initiatives (4.34 ± 0.518), and protecting health, safety and patient’s rights (4.28 ± 0.55). The lowest mean scores were recorded in projecting professional image (2.22 ± 1.27), rendering evidence-based care (4.08 ± 0.44). The study found statistical significance difference between self-reported professional competency (p = 0.01) and quality care improvements (p = 0.02).

Conclusion

In this study, nursing students’ self-reported professional behaviour was rated high (mean scores > 4.0 out of 5). Despite this high rating, it cannot be concluded that the students were professionally competent. We recommend that professional behaviour be measured from both students’ and nurse educators’ or patients’ perspectives.

Contribution

The findings from this study provide supplementary evidence on self-reported professional behaviour with implications on nursing education and practice.

An insightful evaluation of professionalism among dentistry students

Purpose

The objective of this study was to explore the ambience of professionalism related to academic integrity among undergraduate dental students.

Methodology

“Dundee Polyprofessionalism Inventory I: Academic Integrity” was used to collect responses from first-year to fifth-year dental students of the College of Dentistry, King Saud University (Response rate = 78%). The participants’ responses (for 34 professionalism lapses) were recorded by using the Dundee Polyprofessionalism Inventory. Statistical analysis included descriptive statistics, Chi-square, and T-tests (P < 0.05).

Results

The “Ignore” sanction was not opted for any of the 34 professionalism behaviors, and there was unanimous agreement between the participants in considering all 34 behavior statements to be “wrong”. Male and female participants were found to opt for a similar sanction as the median for 16 statements (47%), whereas, for 18 statements (53%), their responses differed with a range of levels 0.5 to 1.5. Preclinical- and clinical-year student responses also showed similarities in their 11 statements (32.3%), and they did differ for 20 statements (58.8%). Interestingly, clinical year respondents were overall on the stricter side of recommending sanctions.

Conclusions

For the majority of the dental students tested, there was a good understanding of the significance of some lapses of professionalism associated with academic integrity. Some of the disclosures in this study were substantially appreciable because none of the students selected “ignore” sanction for any of the survey statements. We found that using the Dundee Polyprofessionalism Inventory for learning and understanding academic professionalism among dental students is useful.

Perception of Medical Professionalism among Medical Residents in Spain

BACKGROUND

Medical professionalism, defined as commitment to the primacy of patient welfare, is the basis for doctor-patient-society relationships, but previous research with medical students has shown that professionalism and social commitment to medicine may be waning. To determine if this trend also appears in recently qualified practicing doctors, we surveyed 90 newly graduated doctors currently working as medical residents in two university hospitals in Murcia, Spain. A previously validated questionnaire that studies the perception of six categories (responsibility, altruism, service, excellence, honesty and integrity, and respect) defining medical professionalism was used.

RESULTS

A good perception of professionalism was found among medical residents, with more than 70% positive responses in all these six categories. There is an increasing trend in the number of negative responses as the residency goes on. Altruism was the category with the greatest percentage of negative answers (22.3%) and Respect was the category with the lowest percentage (12.9%).

CONCLUSIONS

The results show a good professionalism perception in medical residents, but also a slight decline in positive answers that began during medical school. A significant trend was found when including both students and residents. Although there were some differences between students and residents, these were not statistically significant. Educational interventions are needed both at the level of medical school and postgraduate medical residency.

Perception of Saudi Undergraduate Students Towards Professionalism in Medicine

Objectives

Professionalism has garnered immense attention in medical education due to increased societal accountability and focus on excellence in healthcare. However, less attention has been given to identifying attitudes about professionalism in medical students who are the future advocates of the healthcare system. This study aimed to assess perceptions of Saudi undergraduate medical students towards professionalism.

Methods

A cross-sectional survey was carried out among second and sixth year students of the College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia, in September 2018. A self-administered professionalism questionnaire was anonymously completed. Students were asked to provide their level of agreement with 18 survey items using a 5-point Likert scale.

Results

Overall, 288 students participated in the study (males: 49.3% and females: 50.7%), with a response rate of 90%. The median professionalism score was high (71.0; range: 64–76) regardless of age, gender or level of education. Similar high scores were noted in the following subscales: Excellence, 20.0 (range: 18–21); Respect for Others, 17.0 (14–18); Altruism, 12.0 (10–13); Duty, 8.0 (7–9); Accountability, 7.0 (6–8) and Honour and Integrity, 8.0 (7–10). No gender differences were observed in the majority of subscales. However, males demonstrated higher scores in the Duty subscale (males: 9.0 versus females: 8.0; P = 0.026).

Conclusion

Medical students demonstrated high professionalism scores. Future studies are needed to assess the impact of the course curriculum on their level of professionalism over time.

Challenges and satisfaction in Cardiothoracic Surgery Residency Programmes: insights from a Europe-wide survey

OBJECTIVES

The increasing complexity of surgical patients and working time constraints represent challenges for training. In this study, the European Association for Cardio-Thoracic Surgery Residents' Committee aimed to evaluate satisfaction with current training programmes across Europe.

METHODS

We conducted an online survey between October 2018 and April 2019, completed by a total of 219 participants from 24 countries.

RESULTS

The average respondent was in the fourth or fifth year of training, mostly on a cardiac surgery pathway. Most trainees follow a 5-6-year programme, with a compulsory final certification exam, but no regular skills evaluation. Only a minority are expected to take the examination by the European Board of Cardiothoracic Surgery. Participants work on average 61.0 ± 13.1 h per week, including 27.1 ± 20.2 on-call. In total, only 19.7% confirmed the implementation of the European Working Time Directive, with 42.0% being unaware that European regulations existed. Having designated time for research was reported by 13.0%, despite 47.0% having a postgraduate degree. On average, respondents rated their satisfaction 7.9 out of 10, although 56.2% of participants were not satisfied with their training opportunities. We found an association between trainee satisfaction and regular skills evaluation, first operator experience and protected research time.

CONCLUSIONS

On average, residents are satisfied with their training, despite significant disparities in the quality and structure of cardiothoracic surgery training across Europe. Areas for potential improvement include increasing structured feedback, research time integration and better working hours compliance. The development of European guidelines on training standards may support this.

Medical professionalism research characteristics and hotspots: a 10-year bibliometric analysis of publications from 2010 to 2019

An abundance of publications on medical professionalism have been published in recent years. Our study aimed to analyze the external characteristics of publications on professionalism using bibliometrics, to describe its current developments and trends, and to explore professionalism research hotspots using co-word analysis. We retrieved literature on professionalism published from 2010 to 2019 from the Web of Science database. Histcite and CiteSpace were used to analyze external characteristics of publications, including publication trends and distributions of publications by country/region, institution, author, and journal. Co-word analysis was conducted to analyze research hotspots, using the Bibliographic Item Co-Occurrence Matrix Builder and Graphical Clustering Toolkit. We constructed a strategic diagram to show the state of each research hotspot and the relationship between the various hotspots in this field. Results showed publications on professionalism increased in number year by year as a whole. The USA, including its institutions and authors, maintained the top position worldwide in terms of numbers of publications and citations. Among scholarly journals, Academic Medicine has published more articles and has had higher citations per paper than any other journal. Six research hotspots on professionalism were identified, visualized, and expounded. Of these, the theme of "measurement and evaluation of clinical competence" received the most attention in the field of professionalism. The reporting of quantifiable knowledge on the characteristics and research hotspots of publications could help inform gaps in the field of medical professionalism and provide evidence and guidance for future work for researchers, physicians, and educators.

Postgraduate ethics training programs: a systematic scoping review

BACKGROUND

Molding competent clinicians capable of applying ethics principles in their practice is a challenging task, compounded by wide variations in the teaching and assessment of ethics in the postgraduate setting. Despite these differences, ethics training programs should recognise that the transition from medical students to healthcare professionals entails a longitudinal process where ethics knowledge, skills and identity continue to build and deepen over time with clinical exposure. A systematic scoping review is proposed to analyse current postgraduate medical ethics training and assessment programs in peer-reviewed literature to guide the development of a local physician training curriculum.

METHODS

With a constructivist perspective and relativist lens, this systematic scoping review on postgraduate medical ethics training and assessment will adopt the Systematic Evidence Based Approach (SEBA) to create a transparent and reproducible review.

RESULTS

The first search involving the teaching of ethics yielded 7669 abstracts with 573 full text articles evaluated and 66 articles included. The second search involving the assessment of ethics identified 9919 abstracts with 333 full text articles reviewed and 29 articles included. The themes identified from the two searches were the goals and objectives, content, pedagogy, enabling and limiting factors of teaching ethics and assessment modalities used. Despite inherent disparities in ethics training programs, they provide a platform for learners to apply knowledge, translating it to skill and eventually becoming part of the identity of the learner. Illustrating the longitudinal nature of ethics training, the spiral curriculum seamlessly integrates and fortifies prevailing ethical knowledge acquired in medical school with the layering of new specialty, clinical and research specific content in professional practice. Various assessment methods are employed with special mention of portfolios as a longitudinal assessment modality that showcase the impact of ethics training on the development of professional identity formation (PIF).

CONCLUSIONS

Our systematic scoping review has elicited key learning points in the teaching and assessment of ethics in the postgraduate setting. However, more research needs to be done on establishing Entrustable Professional Activities (EPA)s in ethics, with further exploration of the use of portfolios and key factors influencing its design, implementation and assessment of PIF and micro-credentialling in ethics practice.

In Search of Medical Professionalism Research: Preliminary Results from a Review of Widely Read Medical Journals

INTRODUCTION

Professionalism is a core concept in medicine. The extent to which knowledge about professionalism is anchored in empirical research is unknown. Understanding the current state of research is necessary to identify significant gaps and create a road map for future professionalism efforts. The authors conducted an exploratory literature review to characterize professionalism research published in widely read medical journals, identify knowledge gaps, and describe the sources of funding for the identified studies.

METHODS

The authors focused on Medline's Abridged Index Medicus and 4 core Medline education-oriented journal and developed a search filter using text words found in the article title or abstract addressing professionalism. Articles were further filtered to include those indicating a research focus.

RESULTS

The search strategy resulted in 461 professionalism research articles for analysis. Articles were divided into themes of education (n = 212, 45.9%), performance (n = 83, 18%), measurement development (n = 13, 2.8%), remediation (n = 53, 11.5%), and well-being (n = 100, 21.6%). There were 36 studies from 1980 to 2002 (Era 1: before publication of Accreditation Council for Graduate Medical Education competencies) and 425 from 2003 to 17 (Era 2: after Accreditation Council for Graduate Medical Education publication of competencies). Professionalism education was the most common topic area, and most studies were from single institutions with results based on convenience samples. Most studies received no funding or were funded by the authors' own institution.

DISCUSSION

Little empirical research is available on professionalism in widely read medical journals. There has been limited external research funding available to study this topic.

CONCLUSION

More investment in high quality professionalism research is justified and should be encouraged.

Assessment of Professionalism During the Emergency Medicine Clerkship Using the National Clinical Assessment Tool for Medical Students in Emergency Medicine

OBJECTIVES

In 2016, a national consensus conference created the National Clinical Assessment Tool for Medical Students in Emergency Medicine (NCAT-EM), a standardized end-of-shift assessment tool. We report the first large-scale analysis of professionalism concerns collected from May 2017 through December 2018 by a multisite consortium using the NCAT-EM. Our primary objective was to characterize the nature and frequency of professionalism concerns. Our secondary objective was to identify characteristics associated with giving or receiving a professionalism flag.

METHODS

The consortium database includes assessments for all students on EM clerkships at participating sites. This report presents descriptive statistics about the frequency of different flags, the distribution of flags among different student categories, assessor and student characteristics, and distribution of global assessment scores on assessments citing concerns. We used Fisher's exact test to look for associations between the frequency of professionalism flags and the sex of the students and assessors and across student categories. We used logistic regression to look for relationships between professionalism concerns and global assessment scores as well as intent to apply in EM.

RESULTS

We screened 6,768 assessments of 784 students by 719 assessors from 13 sites. After excluding assessments without flags and assessments with apparent data entry errors, we analyzed 57 (0.8%) assessments containing 79 flags. The most frequent flags were punctuality (25/79, 31.6%) and initiative (20/79, 25.3%). Few students received flags (42/784, 5.4%). Few assessors flagged concerns (41/719, 5.7%). We detected no correlation between the frequency of flags and whether a student was applying in EM or between the sex of students and assessors. Global scores of lower one-third appeared more often in assessments with a flag (30/57, 52.6% vs. 233/6,711, 3.5%).

CONCLUSIONS

Only 5.4% of students received flags. Punctuality and initiative accounted for a majority of citations. Professionalism flags correlated strongly with lower global assessment scores.

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.

Assessment of dental residents' professionalism through Professionalism Mini-Evaluation Exercise (P-MEX)

PURPOSE/OBJECTIVES

The aim of the study was to assess the professional behavior of dental residents through Professionalism Mini-Evaluation Exercise (P-MEX).

METHODS

This was a descriptive-analytical study. Content validity of P-MEX form was investigated for use in the context of dentistry. A total of 24-item version of P-MEX consisted of doctor-patient relationship skills (n = 7), reflective skills (n = 5), time management (n = 3), and interprofessional relationship skills (n = 9) was used in the present study. Residents in different dental specialties (n = 56) were evaluated by trained raters (448 times). Data were analyzed by descriptive (mean, SD) and analytical tests (Pearson, ANOVA, and post hoc test (Bonferroni)).

RESULTS

Validity of P-MEX was approved in the field of dentistry. The mean score of professional behavior in residents were reported 2.79 ± 0.24, with minimum and maximum scores of 2.17 and 3.62, respectively. The residents' professional behavior in the domain of reflective skills and doctor-patient relationship skills were lower than the other domains.

CONCLUSION(S)

The results showed that the scores of professional behavior among dental residents were classified in the below expectation level and their scores have followed a downward trend from the second year. Therefore, planning for training and continuous assessment of professional behavior among residents in the faculty of dentistry should be considered.

Nurturing professionalism in medical schools. A systematic scoping review of training curricula between 1990-2019

Introduction: Professionalism is an evolving, socioculturally informed multidimensional construct that influences doctor-patient relationships, patient satisfaction and care outcomes. However, despite its clinical significance there is little consistency in how professionalism is nurtured amongst medical students. To address this gap a systemic scoping review of nurturing professionalism in medical schools, is proposed.Methods: Levac's framework and the PRISMA-P 2015 checklist underpinned a 6-stage systematic review protocol. Concurrent use of Braun and Clarke's approach to thematic analysis and directed content analysis was used to identify the key elements in nurturing professionalism.Results: 13921 abstracts were identified from six databases, 854 full-text articles reviewed, and 162 full-text included articles were included. The 4 themes identified through thematic analysis are consistent with findings of the directed content analysis. These were the definition of professionalism, the approaches, content, barriers and enablers to teaching professionalism.Conclusion: Informed by a viable definition of professionalism and clear milestones nurturing professionalism nurturing professionalism begins with culturally appropriate training in clinical competence, humanistic qualities and reflective capacity. This process requires effective evaluations of professional identity formation, and the impact of the learning environment underlining the need for longitudinal assessments of the training process.

An Insight into Professional Identity Formation: Qualitative Analyses of Two Reflection Interventions During the Dissection Course

The professional behavior of future doctors is increasingly important in medical education. One of the first subjects in the curriculum to address this issue is gross anatomy. The Tuebingen Medical Faculty implemented a learning portfolio and a seminar on medical professionalism during the dissection course. The aims of this research project are to get an overview of how students form a professional identity in the dissection course and to compare the content of both their oral and written reflections on the course. A qualitative analysis was conducted of the oral and written reflections on the dissection laboratory experience. This study was conducted during winter term 2013/2014 with a cohort of 163 participants in the regular dissection course. Written reflection texts (from n = 96 students) and audio recordings from four oral reflection seminar discussions (with n = 11 students) were transcribed and deductively categorized with Mayring's qualitative content analysis method. Both qualitative analyses show that students reflected on many topics relevant to professional development, including empathy, respect, altruism, compassion, teamwork, and self-regulation. Quantitative analysis reveals that students who attended the oral reflection wrote significantly more in their written reflection than students who did not. There is, however, no difference in the reflection categories. Reflection content from students corresponds with categories derived from existing competency frameworks. Both the seminar (oral reflections) and the learning portfolio (written reflections) present excellent opportunities to foster professional development during anatomy education; the key is using them in conjunction with the dissection course.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Validity, reliability and acceptability of Professionalism Mini-Evaluation Exercise (P-MEX) for emergency medicine residency training

Professionalism is a core competency in the medical profession. In this paper, we aimed to confirm the validity, reliability and acceptability of the Professionalism Mini-Evaluation Exercise (P-MEX) instrument for the emergency medicine (EM) residency program. Twenty-two EM attending physicians completed 383 P-MEX forms (the Persian version) for 90 EM residents. Construct validity was assessed via structural equation modeling (SEM). The reliability coefficient was estimated by the generalizability theory, and acceptability was assessed using two researcher-made questionnaires to evaluate the perspectives of residents and assessors. There was a consensus among the participants regarding the content of P-MEX. According to the results of SEM, the first implementation of the original model was associated with a moderate fit and high item loadings. The model modified with correlated error variances for two pairs of items showed an appropriate fit. The reliability of P-MEX was 0.81 for 14 occasions. The perception survey indicated high acceptability for P-MEX from the viewpoint of the residents and increasing satisfaction with P-MEX among the assessors over time.

According to the results of the research, P-MEX is a reliable, valid, and acceptable instrument for assessing professionalism in EM residents.

A Medical Record Peer-Review System to Evaluate Residents' Clinical Competence: Criterion Validity Analysis

In contrast to input evaluation (education delivered at school) and output evaluation (students' capability at graduation), the methods of outcome evaluation (performance after graduation) of medical education have not been sufficiently established. To establish a method to measure the quality of patient care and conduct outcome evaluation, we have been developing a peer review system of medical records. Here, we undertook a pilot study to evaluate the criterion validity of our system by using "evaluation by program directors (supervisors in the hospitals)" as a criterion standard. We selected 13 senior residents from three teaching hospitals. Five reviewers (general internists working in other hospitals) visited the hospitals independently and evaluated five patients' records for each resident based on the previously established sheet comprising 15 items. Independently, program directors of the senior residents evaluated their clinical performance using an evaluation sheet comprising ten items. Pearson's analysis revealed statistically significant correlation coefficients in three pairs of assessments including clinical reasoning (r = 0.5848, P = 0.0358). Bootstrap analysis revealed statistically significant correlation coefficients in additional 5 pairs including history taking (r = 0.509, 95% confidence interval: 0.034-0.847). In contrast, the correlation coefficients were low in some items: r = 0.132 (-0.393-0.639) for physical examination and r = 0.089 (-0.847-0.472) for attitude toward patients. To the best of our knowledge, this is the first study, albeit a pilot one, that investigates the criterion validity of medical record evaluations conducted by comparing the assessments of medical records with those by program directors.

Just a Game: the Dangers of Quantifying Medical Student Professionalism

A medical student on her internal medicine clerkship says her numerical medical professionalism grade was "just a game." Building on this anecdote, we suggest there is good reason to believe that numerical summative assessments of medical student professionalism can, paradoxically, undermine medical student professionalism by sapping internal motivation and converting conversations about core professional values into just another hurdle to residency. We suggest better ways of supporting medical student professional development, including a portfolio comprised of written personal reflection and periodic 360° formative assessment in the context of longitudinal faculty coaching.

Self-Assessment of Preparedness among Critical Care Trainees Transitioning from Fellowship to Practice

This study evaluated the subjective assessment of preparedness needs of critical care trainees and recent graduates between 2013 and 2014. A questionnaire was developed and validated by the subcommittee of the In-Training Section of Society of Critical Care Medicine (SCCM). The survey was deployed twice between December 2013 and January 2014 via email to any trainee or individual graduated from a critical care fellowship within the previous three years. Six percent (180) of all individuals completed the survey, and 67% of respondents had recently interviewed for a job. Northeast was the preferred location for a job (47%), and academia was favored over private practice (80% vs. 15%). Of the respondents that secured an interview, 55% felt prepared for the interview, 67% felt prepared to build an adequate job portfolio, 33% received formal guidance from their mentor/training program. 89% of total respondents agreed it is important to participate in a formal training course in job search, portfolio development, and interviewing process. The preferred sources of training were equally distributed between their home institution, webinars, and SCCM. There is an ongoing need in education regarding the transition period from fellowship to practice.

Assessment of professionalism: From where have we come - to where are we going? An update from the Ottawa Consensus Group on the assessment of professionalism

BACKGROUND

In 2009, an International Working Group (IWG) on the Assessment of Professionalism began collaborating and published recommendations in 2011. Nearly a decade later the IWG reconvened to take stock of the state of practice and research in professionalism and the impact of the 2011 report.

METHOD

A bibliometric study identified all publications on assessment of professionalism since 2011, noting those that cited the original report. Articles were coded to identify the reason for citation and new trends in assessment. Bibliometric data were supplemented by discussion groups held at key international education meetings.

RESULTS

Six-hundred publications on the assessment of professionalism were found in Google Scholar and 164 in Web of Science since 2011, of which 177 (30%) and 84 (50%) respectively cited the original IWG publication. English language publications were most common (83%), but there were articles in 13 other languages by authors from 40 countries. The report was cited commonly to justify attention to professionalism in general (41%), assessment of professionalism (38%) and to explore professionalism in different countries and professions (25%). A thematic analysis showed that of 9 research areas recommended in 2011, 7 of 9 categories were represented with a large increase in research across languages and cultures.

CONCLUSIONS

Though the assessment of professionalism remains a challenge the research base continues to grow, especially related to professionalism across cultures and languages, and a large percentage of publications cite the IWG recommendations. There remains a gap in research and writing about patients' perspectives.

A Phenomenological Study of Italian Students' Responses to Professional Dilemmas: A Cross-Cultural Comparison

Phenomenon: Medical professionalism is a complex construct, based in social and cultural influences, yet little research has been done to show how culture influences the behaviors and attitudes of medical students. We presented Italian students with the same professional dilemmas used in a previous Canadian and Taiwanese cross-cultural study to look for similarities and differences and detect elements of Italian culture that influenced how students responded to dilemmas. The aim was to provide medical educators with some insights into students' behavioral strategies and feelings when faced with a professional dilemma. Approach: Using Giorgi's method, we performed a phenomenological analysis of 15 interviews of Italian medical students who responded to standardized video scenarios representing professional dilemmas. These videos were used in Canada and Taiwan and were translated into Italian. All students were from the same degree course, at Year 6, and were recruited on a voluntary basis at the beginning of the Internal Medicine course. Interview transcripts were anonymized before analysis. Findings: Scenarios were perceived as realistic and easy to envision in Italy. Four themes emerged: establishing priority among principles, using tactics to escape the dilemma, defending the self, and defending the relationships. When compared with previous studies, we noted that Italian students did not mention the principles of reporting inappropriate behavior, seeking excellence, or following senior trainees' advice. Insights: This is the first cross-cultural study of professionalism that involves a Mediterranean country and the observed differences could be interpreted as expressions of Italian cultural traits: distrust toward authority and a cooperative rather than competitive attitude. These findings have practical implications for educators to design and run curricula of professionalism with culturally appropriate topics. They highlight the need for more cross-cultural research.

A Systematic Scoping Review of Ethical Issues in Mentoring in Surgery

BACKGROUND

Mentoring is crucial to the growth and development of mentors, mentees, and host organisations. Yet, the process of mentoring in surgery is poorly understood and increasingly mired in ethical concerns that compromise the quality of mentorship and prevent mentors, mentees, and host organisations from maximising its full potential. A systematic scoping review was undertaken to map the ethical issues in surgical mentoring to enhance understanding, assessment, and guidance on ethical conduct.

METHODS

Arksey and O'Malley's methodological framework was used to guide a systematic scoping review involving articles published between January 1, 2000 and December 31, 2018 in PubMed, Embase, Scopus, ERIC, ScienceDirect, Mednar, and OpenGrey databases. Braun and Clarke's thematic analysis approach was adopted to compare ethical issues in surgical mentoring across different settings, mentee and mentor populations, and host organisations.

RESULTS

A total of 3849 abstracts were identified, 464 full-text articles were retrieved, and 50 articles were included. The 3 themes concerned ethical lapses at the levels of mentor or mentee, mentoring relationships, and host organisation.

CONCLUSIONS

Mentoring abuse in surgery involves lapses in conduct, understanding of roles and responsibilities, poor alignment of expectations, and a lack of clear standards of practice. It is only with better structuring of mentoring processes and effective support of host organisation tasked with providing timely, longitudinal, and holistic assessment and oversight will surgical mentoring overcome prevailing ethical concerns surrounding it.

Definition of professionalism and tools for assessing professionalism in pharmacy practice: a systemic review

PURPOSE

In contemporary pharmacy, the role of pharmacists has become more multifaceted as they now handle a wider range of tasks and take more responsibility for care provision for patients than 20 years ago. Such an evolution in the pharmacist's responsibilities is accompanied by the need for pharmacists to display high-quality patient-centred care and counselling, and to demonstrate professionalism, which now needs to be taught and assessed are part of pharmacy education and practice. This workaimed at identifying definition of professionalism in pharmacy practice and critically evaluatingpublished instruments for assessing professionalism in pharmacy practice.

METHODS

We searched the medical literature listed in Scopus, Medline, andPsycINFOdatabasesfrom 1 January 2000 to 31 December 2018. All papers meeting our selection criteria, were reviewed and summarised into a clear review of professionalism requirements in pharmacy practice. Details of the instruments measuring professionalism were reviewed in detail.

RESULTS

There is no accepted simple definition of professionalism, although we identified several theoretical and policy frameworks required for professional pharmaceutical practice. We identified 4 instruments (Behavioural Professionalism Assessment Instrument (BPAI), Lerkiatbundit's Instrument, Pharmacy Professionalism Instrument (PPI) and Professionalism Assessment Tool (PAT) that build on these frameworks and measure professional practice in pharmacy students. These were found to be reliable and valid but had only been used and tested in student populations.

CONCLUSION

Given the increasing role of community pharmacisits there is a need for assessment of professionalism in practice. Professionalism is a complex concept that is challenging to measure because it has no standardised definition and existing literature related to the topic is limited. Current instruments available focus on measuring the development of the elements of professionalism among pharmacy students rather than pharmacists.

First Year Medical Student Peer Nominations of Professionalism: A Methodological Detective Story about Making Sense of Non-Sense

This article explores the assessment of professionalism within a cohort of medical students during a sequential 13-week medical school histology and anatomy course. Across seven data points, students were asked to identify a professionalism role model from amongst their peers and to score Likert-structured rationales for their decision. Based on density scores, an initial social network analysis identified six peer-nomination "stars." However, analysis of these stars revealed considerable variability and random-like "noise" in both the nomination and explanation data sets. Subsequent analyses of both data sets explored the possibility of underlying patterns in this noise using tests of reliability, principal components factor analysis, and fixed-effects regression analysis. These explorations revealed the presence of two dimensions (professional vs. supportive) in how students sought to explain their nomination decisions. Although data variability remained quite high, significantly less variability was present in the professional than in the supportive dimension, suggesting that academic helpfulness rationales are both empirically distinct and more mutable than rationales grounded in professionalism-related factors. In addition, data showed that the greater the stability in one's choice of a professionalism role model nomination over the T1-T7 data periods, the more stable one's reasons for that nomination-both for professionalism and supportive dimensions. Results indicate that while peer assessment of professionalism by first-year medical students may not be very reliable, students can differentiate between more personal and professional factors, even at this early stage in their professional development. Formal instruction within the pre-clinical curriculum should recognize and address this distinction. Anat Sci Educ. © 2018 American Association of Anatomists.

A Systematic Review of the Quality and Utility of Observer-Based Instruments for Assessing Medical Professionalism

BACKGROUND

Professionalism, which encompasses behavioral, ethical, and related domains, is a core competency of medical practice. While observer-based instruments to assess medical professionalism are available, information on their psychometric properties and utility is limited.

OBJECTIVE

We systematically reviewed the psychometric properties and utility of existing observer-based instruments for assessing professionalism in medical trainees.

METHODS

After selecting eligible studies, we employed the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria to score study methodological quality. We identified eligible instruments and performed quality assessment of psychometric properties for each selected instrument. We scored the utility of each instrument based on the ability to distinguish performance levels over time, availability of objective scoring criteria, validity evidence in medical students and residents, and instrument length.

RESULTS

Ten instruments from 16 studies met criteria for consideration, with studies having acceptable methodological quality. Psychometric properties were variably assessed. Among 10 instruments, the Education Outcomes Service (EOS) group questionnaire and Professionalism Mini-Evaluation Exercise (P-MEX) possessed the best psychometric properties, with the P-MEX scoring higher on utility than the EOS group questionnaire.

CONCLUSIONS

We identified 2 instruments with best psychometric properties, with 1 also showing acceptable utility for assessing professionalism in trainees. The P-MEX may be an option for program directors to adopt as an observer-based instrument for formative assessment of medical professionalism. Further studies of the 2 instruments to aggregate additional validity evidence is recommended, particularly in the domain of content validity before they are used in specific cultural settings and in summative assessments.