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AlFaris E, Irfan F, Abouammoh N, Zakaria N, Ahmed AM, Kasule O, Aldosari DM, AlSahli NA, Alshibani MG, Ponnamperuma G. Physicians' professionalism from the patients' perspective: a qualitative study at a single-family practice in Saudi Arabia. BMC Med Ethics 2023; 24:39. [PMID: 37287002 DOI: 10.1186/s12910-023-00918-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 05/23/2023] [Indexed: 06/09/2023] Open
Abstract
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.
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Affiliation(s)
- Eiad AlFaris
- Department of Family and Community Medicine, College of Medicine, King Saud University Chair for Medical Education Research and Development, King Saud University, Riyadh, Saudi Arabia.
| | - Farhana Irfan
- Department of Family and Community Medicine, College of Medicine, King Saud University Chair for Medical Education Research and Development, King Saud University, Riyadh, Saudi Arabia
| | - Noura Abouammoh
- Department of Family and Community Medicine, College of Medicine, King Saud University Chair for Medical Education Research and Development, King Saud University, Riyadh, Saudi Arabia
| | - Nasriah Zakaria
- Ehealth Unit, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
- College of applied science, Al maarefa university Riyadh Saudi Arabia, Riyadh, Saudi Arabia
| | - Abdullah Ma Ahmed
- Department of Family and Community Medicine, College of Medicine, King Saud University Chair for Medical Education Research and Development, King Saud University, Riyadh, Saudi Arabia
| | - Omar Kasule
- Academic and Training Affairs, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Dina M Aldosari
- King Khalid Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Nora A AlSahli
- King Khalid Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Ghatar Alshibani
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Gominda Ponnamperuma
- Department of Medical Education, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Klitzman R. Needs to address clinicians’ moral distress in treating unvaccinated COVID-19 patients. BMC Med Ethics 2022; 23:110. [PMCID: PMC9662110 DOI: 10.1186/s12910-022-00859-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 11/05/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
Moral dilemmas have arisen concerning whether physicians and other providers should treat patients who have declined COVID vaccination and are now sick with this disease. Several ethicists have argued that clinicians have obligations to treat such patients, yet providing care to these patients has distressed clinicians, who have at times declined to do so. Critical questions thus emerge regarding how best to proceed.
Main body
Providers face moral tensions: whether to place the benefits to an unvaccinated patient over their duties to protect themselves and their families, staff and other patients, and goals of working collaboratively with patients. Clinicians’ duties to treat such patients arguably outweigh claims otherwise, but these obligations are creating moral conflict and distress for providers. Moral distress has been associated with burnout, post-traumatic stress disorder, and interpersonal and work difficulties. Given ongoing vaccine refusals, these problems are unlikely to disappear in the foreseeable future. Society has obligations to address this moral distress due to principles of reciprocity, and implicit social contracts, as part of which physicians risk their lives in caring for patients for the good of society as a whole. Responses are thus urgently needed at several levels: by hospitals, medical schools, professional societies, governments, media, providers and patients. Medical training on professionalism should address these stresses, probing why doctors have duties to treat these patients, but also how moral conflicts can ensue, and how best to address these tensions. Governments and institutions should thus alter relevant policies and devote more resources to addressing clinicians’ psychological strains. Institutions should also improve organizational culture. Public health organizations and the media described clinicians, earlier in the pandemic, as heroes, committed to treating COVID patients. This narrative should now be changed to highlight the strains that unvaccinated patients cause—endangering hospital staff and others.
Conclusions
Unvaccinated COVID patients should receive care, but multi-level strategies, involving enhanced policies, education and practice are vital to alleviate ensuing moral distress, and thus aid these clinicians and their patients. Ethical arguments that providers must treat these patients have not considered these obligations’ effects on clinicians, but should do so.
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Delk P, Bowling I, Schroeder C, Wilson TE, Wesson M, Wetherill L. An investigation of preceptors' perceptions of behavioral elements of “professionalism” among genetic counseling students. J Genet Couns 2022; 32:325-341. [PMID: 36184900 DOI: 10.1002/jgc4.1640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 11/05/2022]
Abstract
Professionalism in health care is a loosely defined but increasingly studied concept. In genetic counseling, "professional development" expectations for entry-level genetic counselors are described in the "Practice-Based Competencies for Genetic Counselors," but the teaching and evaluation of "professionalism" among genetic counseling students is relatively unexplored. This study investigated program leaders' and clinical supervisors' perceptions of professionalism demonstrated by genetic counseling graduate students to learn about their associated strengths and lapses. Members of program leadership and clinical supervisors at Accreditation Council for Genetic Counseling (ACGC) accredited genetic counseling graduate programs in the United States and Canada were surveyed regarding their observations of genetic counseling students for the years 2017-2019 regarding four domains of professional behavior: integrity, accountability/conscientiousness, teamwork, and patient care, with the Merriam-Webster definition of each behavior provided for each domain. Participants also provided open-text descriptions. Descriptive results showed that the 263 participants found all facets of these professional behaviors to be essential. Patient care had the highest importance and was the domain with the most strengths observed among genetic counseling students. Lapses in professional behavior were identified for self-awareness, time management, and thoroughness. Free responses noted that suggestions or strategies for education about professional behavior from ACGC may improve the professional behavior of genetic counseling students and in turn, genetic counselors. Participants voiced the importance of consideration of diverse professional and cultural backgrounds in setting the expectations for professional behavior among genetic counseling students and genetic counselors so that "professionalism" in genetic counseling is not defined through a White lens. Further investigation into challenges that genetic counseling students face regarding professional behavior during their graduate training and strategies for education about these behaviors will aid in the growth and improvement of the training of genetic counselors. Given the sensitive nature of this topic, portions of this discussion may be triggering for some readers.
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Affiliation(s)
- Paula Delk
- Department of Medical and Molecular Genetics Indiana University School of Medicine Indianapolis Indiana USA
| | - Isabella Bowling
- Department of Medical and Molecular Genetics Indiana University School of Medicine Indianapolis Indiana USA
| | - Courtney Schroeder
- Department of Medical and Molecular Genetics Indiana University School of Medicine Indianapolis Indiana USA
| | - Theodore E. Wilson
- Department of Medical and Molecular Genetics Indiana University School of Medicine Indianapolis Indiana USA
| | - Melissa Wesson
- Department of Medical and Molecular Genetics Indiana University School of Medicine Indianapolis Indiana USA
| | - Leah Wetherill
- Department of Medical and Molecular Genetics Indiana University School of Medicine Indianapolis Indiana USA
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Hoobehfekr S, Asghari F, Sayarifard A, Kadivar M, Kashefinejad S. Medical students' perception of professionalism climate in clinical settings. J Med Ethics Hist Med 2022; 14:10. [PMID: 35035798 PMCID: PMC8696550 DOI: 10.18502/jmehm.v14i10.7238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/10/2021] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Saba Hoobehfekr
- Resident of Psychiatry, Department of Psychiatry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariba Asghari
- Associate Professor, Medical Ethic Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Azadeh Sayarifard
- Community Based Participatory Research Center, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Maliheh Kadivar
- Professor, Department of Neonatology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shayan Kashefinejad
- Resident of Psychiatry, Department of Psychiatry, Iran University of Medical Sciences, Tehran, Iran
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Chimonas S, Mamoor M, Kaltenboeck A, Korenstein D. The future of physician advocacy: a survey of U.S. medical students. BMC MEDICAL EDUCATION 2021; 21:399. [PMID: 34303349 PMCID: PMC8310411 DOI: 10.1186/s12909-021-02830-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 07/14/2021] [Indexed: 05/07/2023]
Abstract
BACKGROUND Advocacy is a core component of medical professionalism. It is unclear how educators can best prepare trainees for this professional obligation. We sought to assess medical students' attitudes toward advocacy, including activities and issues of interest, and to determine congruence with professional obligations. METHODS A cross-sectional, web-based survey probed U.S. medical students' attitudes around 7 medical issues (e.g. nutrition/obesity, addiction) and 11 determinants of health (e.g. housing, transportation). Descriptive statistics, Kruskal-Wallis tests, and regression analysis investigated associations with demographic characteristics. RESULTS Of 240 students completing the survey, 53% were female; most were white (62%) or Asian (28%). Most agreed it is very important that physicians encourage medical organizations to advocate for public health (76%) and provide health-related expertise to the community (57%). More participants rated advocacy for medical issues as very important, compared to issues with indirect connections to health (p < 0.001). Generally, liberals and non-whites were likelier than others to value advocacy. CONCLUSIONS Medical students reported strong interest in advocacy, particularly around health issues, consistent with professional standards. Many attitudes were associated with political affiliation and race. To optimize future physician advocacy, educators should provide opportunities for learning and engagement in issues of interest.
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Affiliation(s)
- Susan Chimonas
- Center for Health Policy & Outcomes at Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY, 10017, USA.
| | - Maha Mamoor
- Center for Health Policy & Outcomes at Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY, 10017, USA
| | - Anna Kaltenboeck
- Center for Health Policy & Outcomes at Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY, 10017, USA
| | - Deborah Korenstein
- Center for Health Policy & Outcomes and chief of the General Internal Medicine Service at Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Mianehsaz E, Tabatabaee SMR, Sharif MR, Gilasi HR, Shojaee Far HR, Nejad Tabrizi B. Professionalism among medical residents in a young second-level university in Iran: a cross-sectional study. J Med Ethics Hist Med 2020; 13:1. [PMID: 32337008 PMCID: PMC7168782 DOI: 10.18502/jmehm.v13i1.2463] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 02/05/2020] [Indexed: 11/24/2022] Open
Abstract
Professionalism is a set of behaviors that build trust in physicians’ relationships with patients and the public. The aim of this study was to assess professionalism among residents in Kashan University of Medical Sciences, Kashan, Iran. This cross-sectional study was conducted on 139 residents recruited through the census method. Data were collected using the American Board of Internal Medicine Professionalism Questionnaire. The first part of the questionnaire was on residents’ personal characteristics, and the second part contained fifteen items in the three domains of professionalism, namely excellence, honor/integrity, and altruism/respect. The mean scores of the questionnaire and its domains were calculated and their relationships with residents’ personal characteristics were evaluated. The mean scores (± SD) of professionalism and its excellence, honor/integrity, and altruism/respect domains were 4.93 ± 2.4, 5.92 ± 1.85, 4.94 ± 3.39, and 4.35 ± 3.27, respectively (in a range of 0-10). Professionalism had significant relationships only with residents’ specialty and gender. The level of professionalism in residents was low, which requires the attention of educational authorities. Moreover, the mean score of professionalism among residents in surgical specialties was significantly lower than non-surgical specialties. Various factors can be considered in this regard and it cannot be concluded that the lower score means worse professional behavior.
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Affiliation(s)
- Elaheh Mianehsaz
- Assistant Professor, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Seyed Mohammad Reza Tabatabaee
- Assistant Professor, Department of Emergency Medicine, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohammad Reza Sharif
- Professor, Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Hamid Reza Gilasi
- Associate Professor, Department of Epidemiology and Biostatistics, Faculty of Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Hamid Reza Shojaee Far
- Researcher, Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
| | - Behzad Nejad Tabrizi
- Researcher, Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
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